AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives i...AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.展开更多
Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the uppe...Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the upper lip, the alveolar bone and the palate. The incidence in Africa ranges from 1/2000 to 1/500 births. Their multidisciplinary management is long and costly. Thus, the help provided by humanitarian organisations during free care campaigns is welcome. Materials and Methods: This is a retrospective descriptive study conducted from August 2014 to July 2016 in the Maxillofacial Surgery and Stomatology Department of the Treichville University Hospital in Abidjan, Côte d’Ivoire. The objective was to describe the epidemiological, clinical and therapeutic aspects of CLPA during a humanitarian campaign for free care. Results: 51 cases of CLPA were operated on. Males were involved in 54.9% of the cases, i.e. a sex ratio of 1.2. The average age of the patients at the time of the operation was 3.44 years with extremes of 3 months and 52 years. Patients with low socioeconomic status represented 84.3% of the cases. Cleft lips (31.4%) and cleft palates (33.33%) predominated. For cleft lips, unilateral forms were the most frequent (73.5%) and the left side was most often affected (59.2%). The most common surgical techniques used were MILLARD cheiloplasty for cleft lips (79.36%) and Dorrance pushback for cleft palates (78.05%). The postoperative course was simple in the majority of cases (80.47%). Patients and/or parents were satisfied with the postoperative results in over 90% of cases. Discussion: Cleft lip and palate are common. Their management by humanitarian missions through mass campaigns allows us to receive a large number of patients affected by this pathology who are treated with a high satisfaction rate. Conclusion: The characteristics of cleft lip and palate in this study are in many respects identical to those described in the literature, but with some differences specific to Africa, notably the absence of antenatal diagnosis and the advanced age at the time of treatment.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses ...Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonanc...BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.展开更多
Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to c...Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.展开更多
Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic t...Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.展开更多
BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI mod...BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI models,particularly those based on machine learning,have demonstrated potential in predicting surgical complications and recovery trajectories.AIM To evaluate the role of AI in predicting outcomes for GI surgeries,focusing on its efficacy in enhancing surgical planning,predicting complications,and optimizing post-operative care.METHODS A systematic review of studies published up to March 2025 was conducted across databases such as PubMed,Scopus,and Web of Science.Studies were included if they utilized AI models for predicting surgical outcomes,including morbidity,mortality,and recovery.Data were extracted on the AI techniques,performance metrics,and clinical applicability.RESULTS Machine learning models demonstrated significantly better performance than logistic regression models,with an area under the curve difference of 0.07(95%CI:0.04–0.09;P<0.001).Models focusing on variables such as patient demographics,nutritional status,and surgical specifics have shown improved accuracy.AI’s ability to integrate multifaceted data sources,such as imaging and genomics,contributes to its superior predictive power.AI has improved the early detection of gastric cancer,achieving 95%sensitivity in real-world settings.CONCLUSION AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes.However,challenges related to data quality,model transparency,and clinical integration remain.展开更多
BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To a...BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.展开更多
Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating ...Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.展开更多
BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus...BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.展开更多
BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly lethal malignancy,with approximately 50%of patients experiencing recurrence within 1-year postsurgery.Very early recurrence(VER),defined as recurrence withi...BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly lethal malignancy,with approximately 50%of patients experiencing recurrence within 1-year postsurgery.Very early recurrence(VER),defined as recurrence within 12 weeks,is an emerging concept.AIM To investigate clinicopathological characteristics and predictive factors for VER in patients with PDAC.METHODS A retrospective cohort study was conducted on 553 patients who underwent pancreatic surgery for PDAC at a single high-volume center between February 2019 and December 2024.Patients with VER(group 1,n=28)were compared to those without(group 2,n=251)after excluding 24 patients with inadequate surgical resection.Clinicopathological characteristics were compared using univariate and multivariate analyses,supplemented by random forest modeling to identify nonlinear patterns(P<0.05).RESULTS Group 1 patients were younger(65±16.85 years vs 68±9.58 years;P<0.001)and had higher 6-month mortality(32.44%vs 14.77%;P=0.032).Poorly differentiated tumors(G3)were the strongest predictor of VER(odds ratio=2.43,95%confidence interval:0.88-5.34;P<0.001,random forest feature importance:0.35).Pancreatic head tumors(P=0.031)and elevated red cell distribution width(P=0.03)were associated with VER in univariate analysis.Sensitivity analysis confirmed imaging timing(4-8 weeks vs 8-12 weeks)did not significantly alter recurrence classification(P=0.12).CONCLUSION Poorly differentiated tumors are a key predictor of VER,linked to higher mortality.Machine learning enhances predictive accuracy,and molecular studies are needed to elucidate VER mechanisms.Tailored surveillance and multi-institutional validation are recommended.展开更多
Objective:The study aimed to investigate the effect of relaxation techniques in reducing fear and anxiety in patients in need of general surgery.Materials and Methods:This quasi-experimental study with a pre-post cont...Objective:The study aimed to investigate the effect of relaxation techniques in reducing fear and anxiety in patients in need of general surgery.Materials and Methods:This quasi-experimental study with a pre-post control group design was conducted on 120 patients requiring general surgery at Saman Al-Hojjaj Hospital in Sirjan County.Patients were selected using convenience sampling and randomly assigned to the intervention group(n=60)and control group(n=60).The intervention group was taught box breathing and progressive muscle relaxation techniques by a senior psychiatric nursing expert for 15-20 min every 4 h until surgery.The control group received routine care for surgery.Data on fear and anxiety outcomes were collected using the Spielberger State-Trait Anxiety Inventory and the Surgical Fear Questionnaire.Results:The intervention group had a mean total fear score of 29.27±12.69 compared to 37.20±16.39 in the control group(P=0.012),with significant reductions in both short-term(13.57±5.93 vs.15.98±8.90;P=0.209,Cohen’s d=0.32)and long-term(15.70±7.19 vs.21.22±9.11;P=0.001,Cohen’s d=0.66)fear components(total fear:P=0.012,Cohen’s d=0.54).The total anxiety score was 91.88±6.28 in the control group and 93.60±3.62 in the intervention group,with trait anxiety significantly reduced in the intervention group(P=0.039,Cohen’s d=0.41)postintervention,but no significant change in state anxiety(P=0.577,Cohen’s d=0.16).Conclusions:Relaxation techniques significantly alleviate preoperative psychological distress,effectively reducing fear and anxiety in general surgery patients.These cost-effective,non-invasive methods enhance recovery and reduce healthcare costs.We recommend training healthcare providers to implement these techniques for optimal patient outcomes.展开更多
BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric...BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.展开更多
Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly ma...Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.展开更多
BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and ga...BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.展开更多
Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in periph...Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.展开更多
BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)...BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)versus laparoscopic liver resection(LLR)and open liver resection(OLR)for colorectal metastasis(CRLM).METHODS This study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Systematic searches in PubMed,EMBASE,Scopus,and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM.Two independent reviewers screened studies using predefined PICO(Population,Intervention,Comparator,Outcome)criteria,with data extraction focusing on conversion rates,operative outcomes,morbidity,mortality,and survival.Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2.Pooled analyses were performed for comparative data;noncomparative studies were narratively synthesized.RESULTS Pooled evidence from two comparative systematic reviews(9792 patients)demonstrated that RLR offers distinct advantages over LLR and OLR,including significantly lower conversion rates(4.7%–6.7%vs 10.4%–12.4%,P<0.001)and reduced intraoperative blood loss(190.8–266.8 mL vs 283.9–294.3 mL,P<0.001)despite longer operating times(mean 304.1 vs 191.8 min).Perioperative safety and oncologic outcomes(R0 resection>82%;5-year overall survival:53.1%–60.8%)were comparable across approaches.Three additional noncomparative reviews(n=274)highlighted the technical practicability of RLR in complex cases(zero conversions in small cohorts,median 399.5 min for simultaneous resections).However,these findings were not included in pooled analyses due to the lack of comparator groups.Noncomparative data(n=274)revealed higher upfront costs for RLR due to prolonged operating times(median 399.5 min)and the need for expensive equipment;however,no formal cost comparisons were available.CONCLUSION RLR is a safe and feasible alternative to LLR and OLR for CRLM,demonstrating superior technical performance and comparable short-term outcomes.展开更多
Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively i...Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.展开更多
Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study...Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study at the Surgery Department “A” at the University Hospital Point G from January 2001 to August 2015. Inclusion criteria were all pregnant women with ectopic pregnancy treated with coelioscopy. Sociodemographic, clinical, paracclinical and therapeutic aspects were recorded. Results: In 15 years, 42 cases of ectopic pregnancy out of 3840 gynecologic coelioscopies (1.04%) were collected. The average age was 28.5 years old with the extremes of 16 and 41 years old. Metrorragia was associated to pain in 83.3% (35/42);amenorrhea was found in 66.7% (28/41). Physical exam revealed pain with abdominal defense in 59.5% (25/42), adnexal mass in 31% (13/42), and pelvic contracture in 9.5% (4/42). In pre-operative, ectopic pregnancy was diagnosed complicated in 71.4% (30/42) and uncomplicated in 28.6% (12/42). Patients underwent salpingectomy in 85.7% (36/42), delivery from the fallopian tube in 9.8% (4/42), and hemostatic salpingectomy in 4.4% (2/42). The average duration of hospital stay was 1.88 day with the extremes of 1 and 7 days. The postoperative evolution was favorable in 97.6% (41/42), infection at the site of surgery was reported in 2.4% (1/42). Not a single death was registered. Conclusion: Treatment of ectopic pregnancy is of routine at the surgery department “A” in Point G. Fertility is preserved in the future.展开更多
基金Supported by Instituto de Investigación Sanitaria ISABIAL,No.P42022-0275.
文摘AIM To analyze the diagnostic performance of surveillance colonoscopy,computed tomography(CT),and tumor markers(TMs)in detecting CRC recurrence or metastasis during follow-up after CRC resection.Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.METHODS The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015.Follow-up was performed using TMs every 6 months,yearly CT for 5 years,and colonoscopy at years 1 and 4.Demographic,primary tumor data,and results at follow-up were collected.RESULTS Of 574 included patients included,153 had recurrences or metastases.Of this group,136(88.9%)were diagnosed by CT,10(6.5%)by CT and colonoscopy,and 7(4.6%)by colonoscopy;only 67.8%showed TMs elevation.Adherence to follow-up recommendations was 68.8%for the first colonoscopy,74%for the first CT scan,and 96.6%for the first blood test;these values declined over time.Younger age at diagnosis[odds ratio(OR)0.93;95%CI:0.91-0.95],CRC stages I-II(OR 0.38;95%CI:0.24-0.61),and adherence to follow-up recommendations(OR 0.30;95%CI:0.20-0.46)were independently associated with lower risk for all-cause death at 5 years.CONCLUSION CT scan had the highest diagnostic yield.Adherence to follow-up recommendations was low and decreased during follow-up.Younger age at diagnosis,stage,and follow-up adherence were associated with lower 5-year mortality.
文摘Introduction: Cleft lip, palate and alveolar (CLPA) are congenital malformations of the face due to a defect in the fusion of embryonic buds during the first weeks of embryogenesis. These malformations affect the upper lip, the alveolar bone and the palate. The incidence in Africa ranges from 1/2000 to 1/500 births. Their multidisciplinary management is long and costly. Thus, the help provided by humanitarian organisations during free care campaigns is welcome. Materials and Methods: This is a retrospective descriptive study conducted from August 2014 to July 2016 in the Maxillofacial Surgery and Stomatology Department of the Treichville University Hospital in Abidjan, Côte d’Ivoire. The objective was to describe the epidemiological, clinical and therapeutic aspects of CLPA during a humanitarian campaign for free care. Results: 51 cases of CLPA were operated on. Males were involved in 54.9% of the cases, i.e. a sex ratio of 1.2. The average age of the patients at the time of the operation was 3.44 years with extremes of 3 months and 52 years. Patients with low socioeconomic status represented 84.3% of the cases. Cleft lips (31.4%) and cleft palates (33.33%) predominated. For cleft lips, unilateral forms were the most frequent (73.5%) and the left side was most often affected (59.2%). The most common surgical techniques used were MILLARD cheiloplasty for cleft lips (79.36%) and Dorrance pushback for cleft palates (78.05%). The postoperative course was simple in the majority of cases (80.47%). Patients and/or parents were satisfied with the postoperative results in over 90% of cases. Discussion: Cleft lip and palate are common. Their management by humanitarian missions through mass campaigns allows us to receive a large number of patients affected by this pathology who are treated with a high satisfaction rate. Conclusion: The characteristics of cleft lip and palate in this study are in many respects identical to those described in the literature, but with some differences specific to Africa, notably the absence of antenatal diagnosis and the advanced age at the time of treatment.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.
文摘Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.
文摘BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the new faculty research fund of Ajou University School of Medicine(No.M-2024C0460-00064)。
文摘Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.
文摘Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.
文摘BACKGROUND Artificial intelligence(AI)is playing an increasingly significant role in predicting outcomes of gastrointestinal(GI)surgeries,improving preoperative risk assessment and post-surgical decision-making.AI models,particularly those based on machine learning,have demonstrated potential in predicting surgical complications and recovery trajectories.AIM To evaluate the role of AI in predicting outcomes for GI surgeries,focusing on its efficacy in enhancing surgical planning,predicting complications,and optimizing post-operative care.METHODS A systematic review of studies published up to March 2025 was conducted across databases such as PubMed,Scopus,and Web of Science.Studies were included if they utilized AI models for predicting surgical outcomes,including morbidity,mortality,and recovery.Data were extracted on the AI techniques,performance metrics,and clinical applicability.RESULTS Machine learning models demonstrated significantly better performance than logistic regression models,with an area under the curve difference of 0.07(95%CI:0.04–0.09;P<0.001).Models focusing on variables such as patient demographics,nutritional status,and surgical specifics have shown improved accuracy.AI’s ability to integrate multifaceted data sources,such as imaging and genomics,contributes to its superior predictive power.AI has improved the early detection of gastric cancer,achieving 95%sensitivity in real-world settings.CONCLUSION AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes.However,challenges related to data quality,model transparency,and clinical integration remain.
基金Supported by Universiti Sains Malaysia,Short-Term Grant,No.R501-LR-RND002-0000000342-0000.
文摘BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.
文摘Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.
文摘BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.
文摘BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly lethal malignancy,with approximately 50%of patients experiencing recurrence within 1-year postsurgery.Very early recurrence(VER),defined as recurrence within 12 weeks,is an emerging concept.AIM To investigate clinicopathological characteristics and predictive factors for VER in patients with PDAC.METHODS A retrospective cohort study was conducted on 553 patients who underwent pancreatic surgery for PDAC at a single high-volume center between February 2019 and December 2024.Patients with VER(group 1,n=28)were compared to those without(group 2,n=251)after excluding 24 patients with inadequate surgical resection.Clinicopathological characteristics were compared using univariate and multivariate analyses,supplemented by random forest modeling to identify nonlinear patterns(P<0.05).RESULTS Group 1 patients were younger(65±16.85 years vs 68±9.58 years;P<0.001)and had higher 6-month mortality(32.44%vs 14.77%;P=0.032).Poorly differentiated tumors(G3)were the strongest predictor of VER(odds ratio=2.43,95%confidence interval:0.88-5.34;P<0.001,random forest feature importance:0.35).Pancreatic head tumors(P=0.031)and elevated red cell distribution width(P=0.03)were associated with VER in univariate analysis.Sensitivity analysis confirmed imaging timing(4-8 weeks vs 8-12 weeks)did not significantly alter recurrence classification(P=0.12).CONCLUSION Poorly differentiated tumors are a key predictor of VER,linked to higher mortality.Machine learning enhances predictive accuracy,and molecular studies are needed to elucidate VER mechanisms.Tailored surveillance and multi-institutional validation are recommended.
基金funded by Sirjan Medical Sciences Faculty,Sirjan,Iran.(Project code:402000018).
文摘Objective:The study aimed to investigate the effect of relaxation techniques in reducing fear and anxiety in patients in need of general surgery.Materials and Methods:This quasi-experimental study with a pre-post control group design was conducted on 120 patients requiring general surgery at Saman Al-Hojjaj Hospital in Sirjan County.Patients were selected using convenience sampling and randomly assigned to the intervention group(n=60)and control group(n=60).The intervention group was taught box breathing and progressive muscle relaxation techniques by a senior psychiatric nursing expert for 15-20 min every 4 h until surgery.The control group received routine care for surgery.Data on fear and anxiety outcomes were collected using the Spielberger State-Trait Anxiety Inventory and the Surgical Fear Questionnaire.Results:The intervention group had a mean total fear score of 29.27±12.69 compared to 37.20±16.39 in the control group(P=0.012),with significant reductions in both short-term(13.57±5.93 vs.15.98±8.90;P=0.209,Cohen’s d=0.32)and long-term(15.70±7.19 vs.21.22±9.11;P=0.001,Cohen’s d=0.66)fear components(total fear:P=0.012,Cohen’s d=0.54).The total anxiety score was 91.88±6.28 in the control group and 93.60±3.62 in the intervention group,with trait anxiety significantly reduced in the intervention group(P=0.039,Cohen’s d=0.41)postintervention,but no significant change in state anxiety(P=0.577,Cohen’s d=0.16).Conclusions:Relaxation techniques significantly alleviate preoperative psychological distress,effectively reducing fear and anxiety in general surgery patients.These cost-effective,non-invasive methods enhance recovery and reduce healthcare costs.We recommend training healthcare providers to implement these techniques for optimal patient outcomes.
文摘BACKGROUND Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency(EPI).However,limited data are available regarding the incidence and impact of EPI on quality of life(QoL)following gastric surgery.AIM To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.METHODS EPI was assessed using fecal elastase measurement and classified into:(1)No-EPI(fecal elastase>200μg/g);(2)Moderate EPI(fecal elastase 100–200μg/g);and(3)severe EPI(fecal elastase<100μg/g).QoL was measured using the Gastrointestinal Quality of Life Index(GIQLI)questionnaire.RESULTS Sixteen out of 44(36.4%)patients developed EPI post-operatively:9(56.2%)patients had moderate EPI while 7(43.8%)patients had severe EPI.Severe EPI was more frequently observed in younger patients(5/7:71.4%;P=0.05),in more advanced disease stages(7/7:100%;P=0.05),lymph nodes metastases(7/7:100%;P=0.04)and in the mixed histotypes(4/7:66.7%;P=0.02)compared to the no-EPI and moderate EPI groups.QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score[65(59–92)]compared to the no-EPI/moderate EPI groups[89(84–100)](P=0.002).Lower scores were particularly evident in the core(P<0.0001)and disease-specific symptoms domains(P=0.002)in the severe EPI group compared to the no-EPI/moderate EPI groups.CONCLUSION Gastrectomy is a cause of EPI.Younger patients,aggressive disease and advanced stages are significant risk factors for more severe EPI.Severe EPI worsens QoL,being associated with a higher rate of gastrointestinal symptoms.
文摘Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.
文摘BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.
文摘Background: Laparoscopic surgery has many advantages among which are, decrease post operatory pain and complications. It’s practice in the capital of Cameroon is still a luxury and it is almost non-existent in peripheral zones. The aim of this study is to present the results of the first laparoscopy surgeries done at the Yokadouma district hospital located in the east region at 600 km from Yaoundé. Methods: This is a descriptive prospective study carried out from march 2020 to march 2021 in the general surgery department of the Yokadouma district hospital. Patients operated by laparoscopy during this period were included in the study giving a sample size of 40 patients. The data collected were analyzed by “Census software and Survey Processing System” (CSPRO). Results: Majority of patients, 57.5% were males and aged between 16 and 30 years (32.5% of cases). Most patients (30% of patients) were farmers. Transabdominal preperitoneal prosthesis plasty for hernia represented 55% of interventions followed by appendicectomy (15%) and cholecystectomy (7.5%). Two procedures (0.8%) required conversion into open surgery. Post-operative complications were very rare and were encountered just by one patient who presented a parietal suppuration. Interventions in 77% of cases cost less than 200,000 CFA FRANCS (400$). Conclusion: The example of Yokadouma shows that laparoscopy should be developed in peripheral zones so that its residents can benefit from its multiple advantages.
文摘BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)versus laparoscopic liver resection(LLR)and open liver resection(OLR)for colorectal metastasis(CRLM).METHODS This study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Systematic searches in PubMed,EMBASE,Scopus,and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM.Two independent reviewers screened studies using predefined PICO(Population,Intervention,Comparator,Outcome)criteria,with data extraction focusing on conversion rates,operative outcomes,morbidity,mortality,and survival.Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2.Pooled analyses were performed for comparative data;noncomparative studies were narratively synthesized.RESULTS Pooled evidence from two comparative systematic reviews(9792 patients)demonstrated that RLR offers distinct advantages over LLR and OLR,including significantly lower conversion rates(4.7%–6.7%vs 10.4%–12.4%,P<0.001)and reduced intraoperative blood loss(190.8–266.8 mL vs 283.9–294.3 mL,P<0.001)despite longer operating times(mean 304.1 vs 191.8 min).Perioperative safety and oncologic outcomes(R0 resection>82%;5-year overall survival:53.1%–60.8%)were comparable across approaches.Three additional noncomparative reviews(n=274)highlighted the technical practicability of RLR in complex cases(zero conversions in small cohorts,median 399.5 min for simultaneous resections).However,these findings were not included in pooled analyses due to the lack of comparator groups.Noncomparative data(n=274)revealed higher upfront costs for RLR due to prolonged operating times(median 399.5 min)and the need for expensive equipment;however,no formal cost comparisons were available.CONCLUSION RLR is a safe and feasible alternative to LLR and OLR for CRLM,demonstrating superior technical performance and comparable short-term outcomes.
文摘Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.
文摘Aim: To evaluate 15 years practice of coelioscopic Treatment of ectopicpregnancy in the Surgery Department “A” at the University Hospital Point G. Material and Methods: We conducted a descriptive retrospective study at the Surgery Department “A” at the University Hospital Point G from January 2001 to August 2015. Inclusion criteria were all pregnant women with ectopic pregnancy treated with coelioscopy. Sociodemographic, clinical, paracclinical and therapeutic aspects were recorded. Results: In 15 years, 42 cases of ectopic pregnancy out of 3840 gynecologic coelioscopies (1.04%) were collected. The average age was 28.5 years old with the extremes of 16 and 41 years old. Metrorragia was associated to pain in 83.3% (35/42);amenorrhea was found in 66.7% (28/41). Physical exam revealed pain with abdominal defense in 59.5% (25/42), adnexal mass in 31% (13/42), and pelvic contracture in 9.5% (4/42). In pre-operative, ectopic pregnancy was diagnosed complicated in 71.4% (30/42) and uncomplicated in 28.6% (12/42). Patients underwent salpingectomy in 85.7% (36/42), delivery from the fallopian tube in 9.8% (4/42), and hemostatic salpingectomy in 4.4% (2/42). The average duration of hospital stay was 1.88 day with the extremes of 1 and 7 days. The postoperative evolution was favorable in 97.6% (41/42), infection at the site of surgery was reported in 2.4% (1/42). Not a single death was registered. Conclusion: Treatment of ectopic pregnancy is of routine at the surgery department “A” in Point G. Fertility is preserved in the future.
