Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per y...BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.展开更多
BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)inc...BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.展开更多
Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver sur...Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparosco...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.展开更多
To the Editor:Pancreatic leiomyosarcoma(PLMS)is a rare mesenchymal tumor with an aggressive nature and large size,accounting for 0.1%of malignant pancreatic neoplasms[1].Conventional treatment for resectable large PLM...To the Editor:Pancreatic leiomyosarcoma(PLMS)is a rare mesenchymal tumor with an aggressive nature and large size,accounting for 0.1%of malignant pancreatic neoplasms[1].Conventional treatment for resectable large PLMS involves open surgical resection,with no documented cases of laparoscopic approaches reported in the literature to date.Herein,we present a case of successful laparoscopic resection of a large PLMS.A 64-year-old female was referred to our hospital in April 2019,presenting with a one-week history of abdominal pain and vomiting.Her medical history included hypertension,insulin-dependent diabetes mellitus,and chronic bronchitis.展开更多
BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient sel...BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.展开更多
BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in...BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in the prognostic evaluation of CRC.Laparoscopic radical resection is a common surgical approach for treating CRC.However,research on the link between preoperative imaging and short-term prognosis in this context is limited.We hypothesized that specific preope-rative imaging features can predict the short-term prognosis in patients under-going laparoscopic CRC resection.AIM To investigate the imaging features of CRC and analyze their correlation with the short-term prognosis of laparoscopic radical resection.METHODS This retrospective study conducted at the Affiliated Cancer Hospital of Shandong First Medical University included 122 patients diagnosed with CRC who under-went laparoscopic radical resection between January 2021 and February 2024.All patients underwent magnetic resonance imaging(MRI)and were diagnosed with CRC through pathological examination.MRI data and prognostic indicators were collected 30 days post-surgery.Logistic regression analysis identified imaging fea-tures linked to short-term prognosis,and a receiver operating characteristic(ROC)curve was used to evaluate the predictive value.RESULTS Among 122 patients,22 had irregular,low-intensity tumors with adjacent high signals.In 55,tumors were surrounded by alternating signals in the muscle layer.In 32,tumors extended through the muscular layer and blurred boundaries with perienteric adipose tissue.Tumor signals appeared in the adjacent tissues in 13 patients with blurred gaps.Logistic regression revealed differences in longitudinal tumor length,axial tumor length,volume transfer constant,plasma volume fraction,and apparent diffusion coefficient among patients with varying prognostic results.ROC analysis indicated that the areas under the curve for these parameters were 0.648,0.927,0.821,0.809,and 0.831,respectively.Sensitivity values were 0.643,0.893,0.607,0.714,and 0.714,and specificity 0.702,0.904,0.883,0.968,and 0.894(P<0.05).CONCLUSION The imaging features of CRC correlate with the short-term prognosis following laparoscopic radical resection.These findings provide valuable insights for clinical decision-making.展开更多
This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical seg...This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical segment VIII resection,a challenging procedure due to the complex liver anatomy and difficulty in accessing deep-seated lesions.Peng and colleagues’experience with caudal and cranial approaches in 34 patients underscores the feasibility of these techniques while sparking debates about the optimal approach.Their study’s strengths lie in technique standardization and comprehensive analysis,although its limitations highlight the need for further research.As minimally invasive liver surgery progresses,larger,prospective trials and integration of advanced technologies are essential for establishing best practices.展开更多
BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outc...BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operato...Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.展开更多
Laparoscopic liver resection(LLR)is currently the first-linetreatment for multiple liver diseases.Although clinical data have proven its safety and effectiveness,bleeding and carbon dioxide(CO_(2))embolism are still t...Laparoscopic liver resection(LLR)is currently the first-linetreatment for multiple liver diseases.Although clinical data have proven its safety and effectiveness,bleeding and carbon dioxide(CO_(2))embolism are still the major complications of LLR.The objective of this review was to summarize the pathogenetic mechanism,clinical manifestations,risk factors,prophylactic measures,and treatment strategies for CO_(2) embolism in LLR and propose further research directions regarding these controversial issues.A narrative review of the literature from three databases,including PubMed,Embase,and Web of Science,was conducted without any date or language restrictions.The search terms included CO_(2) embolism,gas embolism,laparoscopy,liver resection,and hepatectomy.The incidence of CO_(2) embolism in LLR(1.2%–4.6%)is approximately 10 times greater than that in overall laparoscopic surgery(0.15%).Transesophageal echocardiogram is currently considered the gold standard for identifying CO_(2) embolism.Risk factors are multifactorial and involve patient characteristics,procedural techniques,and anesthetic management.Presently,in clinical practice,a pneumoperitoneal pressure of 10–15 mmHg is typically used to balance bleeding and CO_(2) embolism during LLR.The majority of observed CO_(2) embolism events are benign,with no significantclinical impact on short-term or long-term outcomes.However,meticulous monitoring,timely recognition,and prompt intervention are crucial during LLR to prevent life-threatening events.Future research should further refinerisk stratification,validate early detection methods,and develop standardized management protocols for CO_(2) embolism in LLR.展开更多
BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the c...BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the continuous development of medical technology,laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.AIM To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer,and the differences in the risk analysis of unplanned reoperation after operation.METHODS As the research subjects,this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022.Among them,50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group.Data pertaining to clinical indexes,gastrointestinal hormones,nutrition indexes,the levels of inflammatory factors,quality of life,Visual Analog Scale score,and the postoperative complications of the two groups of patients before and after treatment were collected,and the therapeutic effects in the two groups were analyzed and compared.RESULTS Compared with the control group,perioperative bleeding,peristalsis recovery time,and hospital stays were significantly shorter in the research group.After surgery,the levels of gastrin(GAS)and motilin(MTL)were decreased in both groups,and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group.The hemoglobin(Hb)levels increased after surgery,and the level of Hb in the research group was significantly higher compared with the control group.After the operation,the expression levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group.One year after the operation,the quality of life of the two groups was greatly improved,with the quality of life in the research group being significantly better.CONCLUSION Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction;moreover,the quality of life of patients was significantly improved,which warrants further promotion.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic ...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.展开更多
BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0...BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients wit...AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.展开更多
BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
文摘BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.
基金Supported by The Key Research and Development Program of Anhui Province of China,No.1804h08020273The Key Research Project of Health Commission of Anhui Province of China,No.AHWJ2022a016.
文摘BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.
文摘Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.
基金Supported by National Natural Science Foundation of China,No.82273442.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.
基金supported by grants from Zhejiang Provincial Natural Science Foundation of China(LZ22H030003)National Natural Science Foundation of China(82270682)。
文摘To the Editor:Pancreatic leiomyosarcoma(PLMS)is a rare mesenchymal tumor with an aggressive nature and large size,accounting for 0.1%of malignant pancreatic neoplasms[1].Conventional treatment for resectable large PLMS involves open surgical resection,with no documented cases of laparoscopic approaches reported in the literature to date.Herein,we present a case of successful laparoscopic resection of a large PLMS.A 64-year-old female was referred to our hospital in April 2019,presenting with a one-week history of abdominal pain and vomiting.Her medical history included hypertension,insulin-dependent diabetes mellitus,and chronic bronchitis.
基金Supported by Beijing Natural Science Foundation,No.L222054 and No.4232058.
文摘BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.
文摘BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in the prognostic evaluation of CRC.Laparoscopic radical resection is a common surgical approach for treating CRC.However,research on the link between preoperative imaging and short-term prognosis in this context is limited.We hypothesized that specific preope-rative imaging features can predict the short-term prognosis in patients under-going laparoscopic CRC resection.AIM To investigate the imaging features of CRC and analyze their correlation with the short-term prognosis of laparoscopic radical resection.METHODS This retrospective study conducted at the Affiliated Cancer Hospital of Shandong First Medical University included 122 patients diagnosed with CRC who under-went laparoscopic radical resection between January 2021 and February 2024.All patients underwent magnetic resonance imaging(MRI)and were diagnosed with CRC through pathological examination.MRI data and prognostic indicators were collected 30 days post-surgery.Logistic regression analysis identified imaging fea-tures linked to short-term prognosis,and a receiver operating characteristic(ROC)curve was used to evaluate the predictive value.RESULTS Among 122 patients,22 had irregular,low-intensity tumors with adjacent high signals.In 55,tumors were surrounded by alternating signals in the muscle layer.In 32,tumors extended through the muscular layer and blurred boundaries with perienteric adipose tissue.Tumor signals appeared in the adjacent tissues in 13 patients with blurred gaps.Logistic regression revealed differences in longitudinal tumor length,axial tumor length,volume transfer constant,plasma volume fraction,and apparent diffusion coefficient among patients with varying prognostic results.ROC analysis indicated that the areas under the curve for these parameters were 0.648,0.927,0.821,0.809,and 0.831,respectively.Sensitivity values were 0.643,0.893,0.607,0.714,and 0.714,and specificity 0.702,0.904,0.883,0.968,and 0.894(P<0.05).CONCLUSION The imaging features of CRC correlate with the short-term prognosis following laparoscopic radical resection.These findings provide valuable insights for clinical decision-making.
基金Supported by National Natural Science Foundation of China,No.82170406 and No.81970238.
文摘This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical segment VIII resection,a challenging procedure due to the complex liver anatomy and difficulty in accessing deep-seated lesions.Peng and colleagues’experience with caudal and cranial approaches in 34 patients underscores the feasibility of these techniques while sparking debates about the optimal approach.Their study’s strengths lie in technique standardization and comprehensive analysis,although its limitations highlight the need for further research.As minimally invasive liver surgery progresses,larger,prospective trials and integration of advanced technologies are essential for establishing best practices.
文摘BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
基金Supported by Liaoning Province People's Livelihood Science and Technology(Health)Plan Joint Project,No.2021JH2/10300127the State Scholarship Funding of CSC,No.201908865001。
文摘Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.
基金supported by grants from the Science and Technology Program of Zhejiang Province(Nos.2024C03201,2025C02133)the Central Government Guides Local Science and Technology Development Fund Projects(No.2024ZY01020).
文摘Laparoscopic liver resection(LLR)is currently the first-linetreatment for multiple liver diseases.Although clinical data have proven its safety and effectiveness,bleeding and carbon dioxide(CO_(2))embolism are still the major complications of LLR.The objective of this review was to summarize the pathogenetic mechanism,clinical manifestations,risk factors,prophylactic measures,and treatment strategies for CO_(2) embolism in LLR and propose further research directions regarding these controversial issues.A narrative review of the literature from three databases,including PubMed,Embase,and Web of Science,was conducted without any date or language restrictions.The search terms included CO_(2) embolism,gas embolism,laparoscopy,liver resection,and hepatectomy.The incidence of CO_(2) embolism in LLR(1.2%–4.6%)is approximately 10 times greater than that in overall laparoscopic surgery(0.15%).Transesophageal echocardiogram is currently considered the gold standard for identifying CO_(2) embolism.Risk factors are multifactorial and involve patient characteristics,procedural techniques,and anesthetic management.Presently,in clinical practice,a pneumoperitoneal pressure of 10–15 mmHg is typically used to balance bleeding and CO_(2) embolism during LLR.The majority of observed CO_(2) embolism events are benign,with no significantclinical impact on short-term or long-term outcomes.However,meticulous monitoring,timely recognition,and prompt intervention are crucial during LLR to prevent life-threatening events.Future research should further refinerisk stratification,validate early detection methods,and develop standardized management protocols for CO_(2) embolism in LLR.
文摘BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the continuous development of medical technology,laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.AIM To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer,and the differences in the risk analysis of unplanned reoperation after operation.METHODS As the research subjects,this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022.Among them,50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group.Data pertaining to clinical indexes,gastrointestinal hormones,nutrition indexes,the levels of inflammatory factors,quality of life,Visual Analog Scale score,and the postoperative complications of the two groups of patients before and after treatment were collected,and the therapeutic effects in the two groups were analyzed and compared.RESULTS Compared with the control group,perioperative bleeding,peristalsis recovery time,and hospital stays were significantly shorter in the research group.After surgery,the levels of gastrin(GAS)and motilin(MTL)were decreased in both groups,and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group.The hemoglobin(Hb)levels increased after surgery,and the level of Hb in the research group was significantly higher compared with the control group.After the operation,the expression levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group.One year after the operation,the quality of life of the two groups was greatly improved,with the quality of life in the research group being significantly better.CONCLUSION Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction;moreover,the quality of life of patients was significantly improved,which warrants further promotion.
基金Supported by National Clinical Key Specialty Major Research Project of Hunan Provincial Health Commission in 2023,No.Z2023165.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.
基金Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine,No.MS2023017 and No.SLJ0311the Jiangsu Provincial Health Commission,No.ZDXK202251.
文摘BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
基金Supported by the Medical Research Project of Jiangsu Health Commission,No.Z2021010.
文摘AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
