Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays ...Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.展开更多
BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemb...BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.展开更多
BACKGROUND Colorectal cancer is a major public health problem,with 1.9 million new cases and 953000 deaths worldwide in 2020.Total mesorectal excision(TME)is the standard of care for the treatment of rectal cancer and...BACKGROUND Colorectal cancer is a major public health problem,with 1.9 million new cases and 953000 deaths worldwide in 2020.Total mesorectal excision(TME)is the standard of care for the treatment of rectal cancer and is crucial to prevent local recurrence,but it is a technically challenging surgery.The use of artificial intelligence(AI)could help improve the performance and safety of TME surgery.AIM To review the literature on the use of AI and machine learning in rectal surgery and potential future developments.METHODS Online scientific databases were searched for articles on the use of AI in rectal cancer surgery between 2020 and 2023.RESULTS The literature search yielded 876 results,and only 13 studies were selected for review.The use of AI in rectal cancer surgery and specifically in TME is a rapidly evolving field.There are a number of different AI algorithms that have been developed for use in TME,including algorithms for instrument detection,anatomical structure identification,and image-guided navigation systems.CONCLUSION AI has the potential to revolutionize TME surgery by providing real-time surgical guidance,preventing complic-ations,and improving training.However,further research is needed to fully understand the benefits and risks of AI in TME surgery.展开更多
Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantati...Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.展开更多
AIM:To explore the feasibility of pertorming minimally invasive surgery(MIS)on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis. METHODS:A total of 105 patients underwent ...AIM:To explore the feasibility of pertorming minimally invasive surgery(MIS)on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis. METHODS:A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995.Besides investigating many clinicopathological features such as tumor size,gross appearance,and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis. RESULTS:The rate of lymph node metastasis in cases where the depth of invasion was<500 μm,500-2 000 μm,or >2 000 μm was 9%(2/23),19%(7136),and 33%(15/46), respectively(P<0.05).In univariate analysis,no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age,sex,tumor location,gross appearance,tumor differentiation,Lauren's classification,and lymphatic invasion.In multivariate analysis, tumor size(>4 cm vs≤2 cm,odds ratio=4.80, P=0.04)and depth of invasion(>2 000 μm vs ≤500 μm, odds ratio=6.81,P=0.02)were significantly correlated with lymph node metastasis.Combining the depth and size in cases where the depth of invasion was less than 500 μm, we found that lymph node metastasis occurred where the tumor size was greater than 4 cm.In cases where the tumor size was less than 2 cm,lymph node metastasis was found only where the depth of tumor invasion was more than 2 000 μm. CONCLUSION:MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 μm in depth.展开更多
Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been prov...Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.展开更多
BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some pat...BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some patients may however present with oligometastasis which can be treated with loco-regional therapy.AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.METHODS A systematic search of the literature was performed in Cochrance Library,MEDLINE and EMBASE databases from September 1950 to January 2019.Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.RESULTS A total of 14 publications were included,of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis.All included articles evaluated the specific outcomes of metastasis,management modality and survival outcomes.The majority of the patients presented with oesophageal squamous cell carcinoma.The median disease free interval(time to recurrence)in patients was 19.6 mo and the overall survival reached 30.8 months.Unfavourable prognostic factors were assessed in eight studies and included time to recurrence<12 mo,large diameter pulmonary lesions(>20 mm),disease free interval(DFI)<12 mo,extra-pulmonary metastasis,primary tumour pathological stage III/IV.CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to locoregional treatment,and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.展开更多
AIM： To determine the prognostic significance of isolated tumor cells （ITCs） and lymph node micrometastases in gastric cancer. METHODS： Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecu...AIM： To determine the prognostic significance of isolated tumor cells （ITCs） and lymph node micrometastases in gastric cancer. METHODS： Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern. RESULTS： Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases （20.7%） and were not significantly associated with patient survival （P = 0.3460）. After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining （pNlmi（i＋））, 34 cases with only micrometastases （pNlmi）, and 142 cases with pN1 with one or more macrometastases （pN1）. Cases with pNlmi and pNlmi（i＋） had a significantly better prognosis than the cases with pN1 （P = 0.0037）. ITCs were found in 38 of these 58 cases, and could be divided into four groups： 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival （median survival： 28 mo, P〈0.0001）.CONCLUSION： Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.展开更多
The androgen receptor(AR)remains a key driver of prostate cancer(PCa)progression,even in the advanced castrate-resistant stage,where testicular androgens are absent.It is therefore of critical importance to understand...The androgen receptor(AR)remains a key driver of prostate cancer(PCa)progression,even in the advanced castrate-resistant stage,where testicular androgens are absent.It is therefore of critical importance to understand the molecular mechanisms governing its activity and regulation during prostate tumourigenesis.MicroRNAs(miRs)are small w22 nt noncoding RNAs that regulate target gene,often through association with 30 untranslated regions(30UTRs)of transcripts.They display dysregulation during cancer progression,can function as oncogenes or tumour suppressors,and are increasingly recognised as targets or regulators of hormonal action.Thus,understanding factors which modulate miRs synthesis is essential.There is increasing evidence for complex and dynamic bi-directional cross-talk between the multi-step miR biogenesis cascade and the AR signalling axis in PCa.This review summarises the wealth of mechanisms by which miRs are regulated by AR,and conversely,how miRs impact AR’s transcriptional activity,including that of AR splice variants.In addition,we assess the implications of the convergence of these pathways on the clinical employment of miRs as PCa biomarkers and therapeutic targets.展开更多
AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in t...BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.展开更多
Point-of-care(POC) tests enable rapid results and are well established in medical practice.Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnost...Point-of-care(POC) tests enable rapid results and are well established in medical practice.Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnostic pathways.This review aims to identify current and newtechnologies for the POC diagnosis of gastrointestinal cancer.A structured search of the Embase and Medline databases was performed.Papers reporting diagnostic tests for gastrointestinal cancer available as a POC device or containing a description of feasibility for POC application were included.Studies recovered were heterogeneous and therefore results are presented as a narrative review.Six diagnostic methods were identified(fecal occult blood, fecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis).Fecal occult blood testing has a reported sensitivity of 66%-85% and specificity greater than 95%.The others are at a range of development and clinical application.POC devices have a proven role in the diagnosis of gastrointestinal cancer.Barriers to their implementation exist and the transition from experimental to clinical medicine is currently slow.New technologies demonstrate potential to provide accurate POC tests and an ability to diagnose gastrointestinal cancer at an early stage with improved clinical outcome and survival.展开更多
BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has...BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has been evaluated by a number of population-based studies,which have identified certain food items as having protective potential,though the findings have been inconsistent.Herein we present a systematic review and meta-analysis on the potential protective role of five common phytochemically rich dietary components(nuts,cruciferous vegetables,citrus fruits,garlic and tomatoes)in reducing CRC risk.AIM To investigate the independent impact of increased intake of specific dietary constituents on CRC risk in the general population.METHODS Medline and Embase were systematically searched,from time of database inception to January 31,2020,for observational studies reporting CRC incidence relative to intake of one or more of nuts,cruciferous vegetables,citrus fruits,garlic and/or tomatoes in the general population.Data were extracted by two independent reviewers and analyzed in accordance with the Meta-analysis of Observational Studies in Epidemiology(MOOSE)and Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)reporting guidelines and according to predefined inclusion/exclusion criteria.Effect sizes of studies were pooled using a random-effects model.RESULTS Forty-six studies were identified.CRC risk was significantly reduced in patients with higher vs lower consumption of cruciferous vegetables[odds ratio(OR)=0.90;95%confidence interval(CI):0.85-0.95;P<0.005],citrus fruits(OR=0.90;95%CI:0.84-0.96;P<0.005),garlic(OR=0.83;95%CI:0.76-0.91;P<0.005)and tomatoes(OR=0.89;95%CI:0.84-0.95;P<0.005).Subgroup analysis showed that this association sustained when looking at case-control studies alone,for all of these four food items,but no significant difference was found in analysis of cohort studies alone.Nut consumption exhibited a similar trend,but overall results were not significant(OR=0.72;95%CI:0.50-1.03;P<0.07;I2=90.70%).Putative anticarcinogenic mechanisms are proposed using gene-set enrichment analysis of gene/protein perturbations caused by active compounds within each food item.CONCLUSION Increased cruciferous vegetable,garlic,citrus fruit and tomato consumption are all inversely associated with CRC risk.These findings highlight the potential for developing precision nutrition strategies for CRC prevention.展开更多
Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these ...Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.展开更多
The FOXO3a and FOXM1 forkhead transcription factors are key players in cancer initiation,progression,and drug resistance.Recent research shows that FOXM1 is a direct transcriptional target of FOXO3a,a vital downstream...The FOXO3a and FOXM1 forkhead transcription factors are key players in cancer initiation,progression,and drug resistance.Recent research shows that FOXM1 is a direct transcriptional target of FOXO3a,a vital downstream effector of the PI3K-AKT-FOXO signaling cascade.In addition,FOXM1 and FOXO3a also antagonize each other's activity by competitively binding to the same target genes,which are involved in chemotherapeutic drug sensitivity and resistance.Understanding the role and regulation of the FOXO-FOXM1 axis will provide insight into chemotherapeutic drug action and resistance in patients,and help to identify novel therapeutic approaches as well as diagnostic and predictive biomarkers.展开更多
Sex determining region Y-box 2(Sox2), a member of the SoxB1 transcription factor family, is an important transcriptional regulator in pluripotent stem cells(PSCs). Together with octamer-binding transcription factor 4 ...Sex determining region Y-box 2(Sox2), a member of the SoxB1 transcription factor family, is an important transcriptional regulator in pluripotent stem cells(PSCs). Together with octamer-binding transcription factor 4 and Nanog, they co-operatively control gene expression in PSCs and maintain their pluripotency. Furthermore, Sox2 plays an essential role in somatic cell reprogram-ming, reversing the epigenetic configuration of differ-entiated cells back to a pluripotent embryonic state. In addition to its role in regulation of pluripotency, Sox2 is also a critical factor for directing the differentiation of PSCs to neural progenitors and for maintaining the properties of neural progenitor stem cells. Here, we review recent findings concerning the involvement of Sox2 in pluripotency, somatic cell reprogramming and neural differentiation as well as the molecular mecha-nisms underlying these roles.展开更多
AIM: To review the currently available literature comparing laparoscopic to open resection of hepatocellular carcinoma (HCC) in patients with known liver cirrhosis.
Hepatocellular carcinoma(HCC)is a common malignancy and now the second commonest global cause of cancer death.HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation.As the option ...Hepatocellular carcinoma(HCC)is a common malignancy and now the second commonest global cause of cancer death.HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation.As the option for curative treatments is limited to early stage cancers,diagnosis in non-symptomatic individuals is crucial.International guidelines advise regular surveillance of high-risk populations but the current tools lack sufficient sensitivity for early stage tumors on the background of a cirrhotic nodular liver.A number of novel biomarkers have now been suggested in the literature,which may reinforce the current surveillance methods.In addition,recent metabonomic and proteomic discoveries have established specific metabolite expressions in HCC,according to Warburg's phenomenon of altered energy metabolism.With clinical validation,a simple and non-invasive test from the serum or urine may be performed to diagnose HCC,particularly benefiting low resource regions where the burden of HCC is highest.展开更多
Hepatic ischemia-reperfusion injury is a major cause of liver transplant failure,and is of increasing significance due to increased use of expanded criteria livers for transplantation.This review summarizes the mechan...Hepatic ischemia-reperfusion injury is a major cause of liver transplant failure,and is of increasing significance due to increased use of expanded criteria livers for transplantation.This review summarizes the mechanisms and protective strategies for hepatic ischemia-reperfusion injury in the context of liver transplantation.Pharmacological therapies,the use of pre-and post-conditioning and machine perfusion are discussed as protective strategies.The use of machine perfusion offers significant potential in the reconditioning of liver grafts and the prevention of hepatic ischemia-reperfusion injury,and is an exciting and active area of research,which needs more study clinically.展开更多
Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy...Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy for early HCC,and is currently recognized as the main ablative tool for HCC tumors<5 cm in size;however,progression and local recurrence remain the main disadvantages of this approach.To solve this clinical problem,recent efforts were concentrated on multimodal treatment,combining different strategies,including the combination of RFA and immunotherapy.This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells,significantly reduces the risk of recurrence and improves survival rates compared to RFA alone.This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies,and discuss the need for further research on this topic.展开更多
文摘Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
文摘BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.
文摘BACKGROUND Colorectal cancer is a major public health problem,with 1.9 million new cases and 953000 deaths worldwide in 2020.Total mesorectal excision(TME)is the standard of care for the treatment of rectal cancer and is crucial to prevent local recurrence,but it is a technically challenging surgery.The use of artificial intelligence(AI)could help improve the performance and safety of TME surgery.AIM To review the literature on the use of AI and machine learning in rectal surgery and potential future developments.METHODS Online scientific databases were searched for articles on the use of AI in rectal cancer surgery between 2020 and 2023.RESULTS The literature search yielded 876 results,and only 13 studies were selected for review.The use of AI in rectal cancer surgery and specifically in TME is a rapidly evolving field.There are a number of different AI algorithms that have been developed for use in TME,including algorithms for instrument detection,anatomical structure identification,and image-guided navigation systems.CONCLUSION AI has the potential to revolutionize TME surgery by providing real-time surgical guidance,preventing complic-ations,and improving training.However,further research is needed to fully understand the benefits and risks of AI in TME surgery.
文摘Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.
文摘AIM:To explore the feasibility of pertorming minimally invasive surgery(MIS)on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis. METHODS:A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995.Besides investigating many clinicopathological features such as tumor size,gross appearance,and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis. RESULTS:The rate of lymph node metastasis in cases where the depth of invasion was<500 μm,500-2 000 μm,or >2 000 μm was 9%(2/23),19%(7136),and 33%(15/46), respectively(P<0.05).In univariate analysis,no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age,sex,tumor location,gross appearance,tumor differentiation,Lauren's classification,and lymphatic invasion.In multivariate analysis, tumor size(>4 cm vs≤2 cm,odds ratio=4.80, P=0.04)and depth of invasion(>2 000 μm vs ≤500 μm, odds ratio=6.81,P=0.02)were significantly correlated with lymph node metastasis.Combining the depth and size in cases where the depth of invasion was less than 500 μm, we found that lymph node metastasis occurred where the tumor size was greater than 4 cm.In cases where the tumor size was less than 2 cm,lymph node metastasis was found only where the depth of tumor invasion was more than 2 000 μm. CONCLUSION:MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 μm in depth.
文摘Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.
文摘BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some patients may however present with oligometastasis which can be treated with loco-regional therapy.AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.METHODS A systematic search of the literature was performed in Cochrance Library,MEDLINE and EMBASE databases from September 1950 to January 2019.Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.RESULTS A total of 14 publications were included,of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis.All included articles evaluated the specific outcomes of metastasis,management modality and survival outcomes.The majority of the patients presented with oesophageal squamous cell carcinoma.The median disease free interval(time to recurrence)in patients was 19.6 mo and the overall survival reached 30.8 months.Unfavourable prognostic factors were assessed in eight studies and included time to recurrence<12 mo,large diameter pulmonary lesions(>20 mm),disease free interval(DFI)<12 mo,extra-pulmonary metastasis,primary tumour pathological stage III/IV.CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to locoregional treatment,and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.
基金Supported by a grant (FG03-11-02) from the 21C Frontier Functional Human Genome Project from the Ministry of Science and Technology of Korea
文摘AIM： To determine the prognostic significance of isolated tumor cells （ITCs） and lymph node micrometastases in gastric cancer. METHODS： Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern. RESULTS： Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases （20.7%） and were not significantly associated with patient survival （P = 0.3460）. After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining （pNlmi（i＋））, 34 cases with only micrometastases （pNlmi）, and 142 cases with pN1 with one or more macrometastases （pN1）. Cases with pNlmi and pNlmi（i＋） had a significantly better prognosis than the cases with pN1 （P = 0.0037）. ITCs were found in 38 of these 58 cases, and could be divided into four groups： 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival （median survival： 28 mo, P〈0.0001）.CONCLUSION： Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.
基金The authors gratefully acknowledge research funding from the Prostate Cancer Foundation,Prostate Cancer UK,The Rosetrees Trust and Imperial College London.
文摘The androgen receptor(AR)remains a key driver of prostate cancer(PCa)progression,even in the advanced castrate-resistant stage,where testicular androgens are absent.It is therefore of critical importance to understand the molecular mechanisms governing its activity and regulation during prostate tumourigenesis.MicroRNAs(miRs)are small w22 nt noncoding RNAs that regulate target gene,often through association with 30 untranslated regions(30UTRs)of transcripts.They display dysregulation during cancer progression,can function as oncogenes or tumour suppressors,and are increasingly recognised as targets or regulators of hormonal action.Thus,understanding factors which modulate miRs synthesis is essential.There is increasing evidence for complex and dynamic bi-directional cross-talk between the multi-step miR biogenesis cascade and the AR signalling axis in PCa.This review summarises the wealth of mechanisms by which miRs are regulated by AR,and conversely,how miRs impact AR’s transcriptional activity,including that of AR splice variants.In addition,we assess the implications of the convergence of these pathways on the clinical employment of miRs as PCa biomarkers and therapeutic targets.
基金Supported by Cancer Research United KingdomWessex Medical Research
文摘AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
文摘BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.
基金Supported by NIHR Diagnostic Evidence Co-operative London at Imperial College Healthcare NHS Trust is funded by the National Institute for Health Research
文摘Point-of-care(POC) tests enable rapid results and are well established in medical practice.Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnostic pathways.This review aims to identify current and newtechnologies for the POC diagnosis of gastrointestinal cancer.A structured search of the Embase and Medline databases was performed.Papers reporting diagnostic tests for gastrointestinal cancer available as a POC device or containing a description of feasibility for POC application were included.Studies recovered were heterogeneous and therefore results are presented as a narrative review.Six diagnostic methods were identified(fecal occult blood, fecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis).Fecal occult blood testing has a reported sensitivity of 66%-85% and specificity greater than 95%.The others are at a range of development and clinical application.POC devices have a proven role in the diagnosis of gastrointestinal cancer.Barriers to their implementation exist and the transition from experimental to clinical medicine is currently slow.New technologies demonstrate potential to provide accurate POC tests and an ability to diagnose gastrointestinal cancer at an early stage with improved clinical outcome and survival.
文摘BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has been evaluated by a number of population-based studies,which have identified certain food items as having protective potential,though the findings have been inconsistent.Herein we present a systematic review and meta-analysis on the potential protective role of five common phytochemically rich dietary components(nuts,cruciferous vegetables,citrus fruits,garlic and tomatoes)in reducing CRC risk.AIM To investigate the independent impact of increased intake of specific dietary constituents on CRC risk in the general population.METHODS Medline and Embase were systematically searched,from time of database inception to January 31,2020,for observational studies reporting CRC incidence relative to intake of one or more of nuts,cruciferous vegetables,citrus fruits,garlic and/or tomatoes in the general population.Data were extracted by two independent reviewers and analyzed in accordance with the Meta-analysis of Observational Studies in Epidemiology(MOOSE)and Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)reporting guidelines and according to predefined inclusion/exclusion criteria.Effect sizes of studies were pooled using a random-effects model.RESULTS Forty-six studies were identified.CRC risk was significantly reduced in patients with higher vs lower consumption of cruciferous vegetables[odds ratio(OR)=0.90;95%confidence interval(CI):0.85-0.95;P<0.005],citrus fruits(OR=0.90;95%CI:0.84-0.96;P<0.005),garlic(OR=0.83;95%CI:0.76-0.91;P<0.005)and tomatoes(OR=0.89;95%CI:0.84-0.95;P<0.005).Subgroup analysis showed that this association sustained when looking at case-control studies alone,for all of these four food items,but no significant difference was found in analysis of cohort studies alone.Nut consumption exhibited a similar trend,but overall results were not significant(OR=0.72;95%CI:0.50-1.03;P<0.07;I2=90.70%).Putative anticarcinogenic mechanisms are proposed using gene-set enrichment analysis of gene/protein perturbations caused by active compounds within each food item.CONCLUSION Increased cruciferous vegetable,garlic,citrus fruit and tomato consumption are all inversely associated with CRC risk.These findings highlight the potential for developing precision nutrition strategies for CRC prevention.
基金supported by grants from the National Natural Science Foundation of China(Grant No.82470544)the Fundamental Research Funds for the Central Universities(Grant No.226-2024-00153).
文摘Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.
文摘The FOXO3a and FOXM1 forkhead transcription factors are key players in cancer initiation,progression,and drug resistance.Recent research shows that FOXM1 is a direct transcriptional target of FOXO3a,a vital downstream effector of the PI3K-AKT-FOXO signaling cascade.In addition,FOXM1 and FOXO3a also antagonize each other's activity by competitively binding to the same target genes,which are involved in chemotherapeutic drug sensitivity and resistance.Understanding the role and regulation of the FOXO-FOXM1 axis will provide insight into chemotherapeutic drug action and resistance in patients,and help to identify novel therapeutic approaches as well as diagnostic and predictive biomarkers.
文摘Sex determining region Y-box 2(Sox2), a member of the SoxB1 transcription factor family, is an important transcriptional regulator in pluripotent stem cells(PSCs). Together with octamer-binding transcription factor 4 and Nanog, they co-operatively control gene expression in PSCs and maintain their pluripotency. Furthermore, Sox2 plays an essential role in somatic cell reprogram-ming, reversing the epigenetic configuration of differ-entiated cells back to a pluripotent embryonic state. In addition to its role in regulation of pluripotency, Sox2 is also a critical factor for directing the differentiation of PSCs to neural progenitors and for maintaining the properties of neural progenitor stem cells. Here, we review recent findings concerning the involvement of Sox2 in pluripotency, somatic cell reprogramming and neural differentiation as well as the molecular mecha-nisms underlying these roles.
文摘AIM: To review the currently available literature comparing laparoscopic to open resection of hepatocellular carcinoma (HCC) in patients with known liver cirrhosis.
文摘Hepatocellular carcinoma(HCC)is a common malignancy and now the second commonest global cause of cancer death.HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation.As the option for curative treatments is limited to early stage cancers,diagnosis in non-symptomatic individuals is crucial.International guidelines advise regular surveillance of high-risk populations but the current tools lack sufficient sensitivity for early stage tumors on the background of a cirrhotic nodular liver.A number of novel biomarkers have now been suggested in the literature,which may reinforce the current surveillance methods.In addition,recent metabonomic and proteomic discoveries have established specific metabolite expressions in HCC,according to Warburg's phenomenon of altered energy metabolism.With clinical validation,a simple and non-invasive test from the serum or urine may be performed to diagnose HCC,particularly benefiting low resource regions where the burden of HCC is highest.
基金supported by British Journal of Anaesthesia Fellowship grant,NIAA,London,UK
文摘Hepatic ischemia-reperfusion injury is a major cause of liver transplant failure,and is of increasing significance due to increased use of expanded criteria livers for transplantation.This review summarizes the mechanisms and protective strategies for hepatic ischemia-reperfusion injury in the context of liver transplantation.Pharmacological therapies,the use of pre-and post-conditioning and machine perfusion are discussed as protective strategies.The use of machine perfusion offers significant potential in the reconditioning of liver grafts and the prevention of hepatic ischemia-reperfusion injury,and is an exciting and active area of research,which needs more study clinically.
文摘Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy for early HCC,and is currently recognized as the main ablative tool for HCC tumors<5 cm in size;however,progression and local recurrence remain the main disadvantages of this approach.To solve this clinical problem,recent efforts were concentrated on multimodal treatment,combining different strategies,including the combination of RFA and immunotherapy.This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells,significantly reduces the risk of recurrence and improves survival rates compared to RFA alone.This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies,and discuss the need for further research on this topic.
