Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various...Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.展开更多
BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs ...BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.展开更多
BACKGROUND There are several surgical options for treating early gastric cancers(EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with l...BACKGROUND There are several surgical options for treating early gastric cancers(EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection(ESD) in treating EGC is not well established,especially when compared with resection surgery cases in a long-term follow-up scope.AIM To compare the safety and efficacy of the short-and long-term outcomes between ESD and resection surgery.METHODS We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short-or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software(version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed-or random-effects models depending on heterogeneity across studies.RESULTS Fourteen studies comprising 5112 patients were eligible for analysis(2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference(WMD):-140.02 min, 95%CI:-254.23 to-34.82 min, P = 0.009], shorter hospital stay(WMD:-5.41 d, 95% CI:-5.93 to-4.89 d, P < 0.001), and lowerpostoperative complication rate [Odds ratio(OR) = 0.39, 95%CI: 0.28-0.55, P <0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate(OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients.However, the long-term survival including overall survival [Hazard ratio(HR) =0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival(HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.CONCLUSION In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the longterm survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.展开更多
AIM:To investigate endoscopic ultrasound(EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection.METHODS:Records of 111 patients seen at our institution f...AIM:To investigate endoscopic ultrasound(EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection.METHODS:Records of 111 patients seen at our institution from November 1999 to July 2011 with the postoperative pathological diagnosis of benign ampullary and duodenal adenomas were reviewed.Records of patients who underwent preoperative EUS for diagnostic purposes were identified.The accuracy of EUS in predicting the absence of muscular invasion was assessed by comparing EUS reports to the final surgical pathological results.In addition,the incidence of the post-operative complications over a period of 30 d and the subsequent long-term outcome(recurrence) over a period of 30 mo associated with endoscopic and transduodenal surgical resection was recorded,compared and analyzed.RESULTS:Among 111 patients with benign ampullary and duodenal adenomas,47 underwent preoperative EUS for 29 peri-ampullary lesions and 18 duodenal lesions.In addition,computed tomography was performed in 18 patients,endoscopic retrograde cholangio-pancreatography in 10 patients and esophagogastroduodenoscopy in 22 patients.There were 43 patients with sporadic adenomas and 4 patients with familial adenomatous polyposis(FAP)/other polyposis syndromes.In 38(81%,P < 0.05) patients,EUS reliably identified absence of submucosal and muscularis invasion.In 4 cases,EUS underestimated submucosal invasion that was proven by pathology.In the other 5 patients,EUS predicted muscularis invasion which could not be demonstrated in the resected specimen.EUS predicted tumor muscularis invasion with a specificity of 88% and negative predictive value of 90%(P < 0.05).Types of resection performed included endoscopic resection in 22 cases,partial duodenectomy in 9 cases,transduodenal ampullectomy with sphincteroplasty in 10 cases and pancreaticoduodenectomy in 6 cases.The main post-operative final pathological results included villous adenoma(n = 5),adenoma(n = 8),tubulovillous adenoma(n = 10),tubular adenoma(n = 20) and hyperplastic polyp(n = 2).Among the 47 patients who underwent resection,8(17%,5 of which corresponded to surgical resection) developed post-procedural complications which included retroperitoneal hematoma,intra-abdominal abscess,wound infection,delayed gastric emptying and prolonged ileus.After median followup of 20 mo there were 6 local recurrences(13%,median follow-up = 20 mo) 4 of which were in patients with FAP.CONCLUSION:EUS accurately predicts the depth of mucosal invasion in suspected benign ampullary and duodenal adenomas.These patients can safely undergo endoscopic or local resection.展开更多
Gastric outlet obstruction(GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract.Palliative treatment of patients' symptoms who present with GOO is an important aspect ...Gastric outlet obstruction(GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract.Palliative treatment of patients' symptoms who present with GOO is an important aspect of their care.Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life.Palliative treatment for GOO includes operative(open and laparoscopic gastrojejunostomy) and non-operative(endoscopic stenting) options.The performance status and medical condition of the patient,the extent of the cancer,the patients prognosis,the availability of a curative procedure,the natural history of symptoms of the disease(primary and secondary),the durability of the procedure,and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy.Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity.展开更多
Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Par...Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Participants: Sixty women were enrolled in a study that was conducted in Cairo from Jan-2017 to Mar-2018. Interventions: All women received the same preparations. After randomization;in the study group (N = 30), podophyllin cautery was added to surgical removal in the follow-up period. In the control group (N = 30), only surgical removal was used. Main Outcome Measure: The main outcome measure was the estimation of the recurrence of the lesion during the follow-up period. The secondary outcome measures were the incidence of adverse events. Results: Both groups were comparable (p-value > 0.05) with regard to the age and BMI. Recurrence was significantly lower (P = 0.001) in the study group than the control group. In the study group, five cases (17.2%) have recurrence whereas, in the control group, 18 (60.0%) had suffered recurrence. The ARR was 42.8% (CI 95%: 18% - 60.9%) with RR of 0.29 (CI 95%: 0.12% - 0.67%) and NNT2 (CI 95%: 6% - 2%). During the follow-up period, 19 cases (65.5%) of the study group experienced pain versus only eight cases (26.7%) in the control group (p = 0.003). However, the development of scars was less in the study group 7 (24.1%) than in the control group 19 (63.3%), (p = 0.002). Conclusion: Podophyllin cautery, when added to surgical removal, is effective in decreasing the incidence recurrence in cases with condylomata acuminata.展开更多
BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare and rapidly progressive intestinal T-cell non-Hodgkin lymphoma associated with a very poor prognosis and a median survival of 7 mo.Adva...BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare and rapidly progressive intestinal T-cell non-Hodgkin lymphoma associated with a very poor prognosis and a median survival of 7 mo.Advances in the identification of MEITL over the last two decades have led to its recognition as a separate entity.MEITL patients,predominantly male,typically present with vague and nonspecific symptoms and diagnosis is predominantly confirmed at laparotomy.Currently,there are no standardized treatment protocols,and the optimal therapy remains unclear.CASE SUMMARY We report a case of MEITL that was initially considered to be gastrointestinal stromal tumor(GIST)and Imatinib was administered for one cycle.The 62-yearold man presented with abdominal pain,abdominal distension,and weight loss of 20 pounds.Within 2 wk,the size of the mass considerably increased on computed tomography scans.The patient underwent surgery followed by chemotherapy with CHOP(cyclophosphamide,doxorubicin,vincristine,and prednisone)and stem-cell transplant.A correct diagnosis of MEITL was established based on postoperative pathology.Immunophenotypically,the neoplastic cells fulfilled the diagnostic criteria for MEITL as they were CD3+,CD4+,CD8+,CD56+,and TIA-1+.CONCLUSION Given that MEITL has no predisposing factor and presents with vague symptoms with rapid progression,the concomitant presence of abdominal symptoms and B symptoms(weight loss,fever,and night sweats)with hypoalbuminemia,anemia,low lymphocytic count and endoscopic findings of diffuse infiltrating type lesions should alert physicians to this rare disease,especially when it comes to Asian patients.Immediate laparotomy should then be carried out followed by chemotherapy and stem-cell transplant.展开更多
BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal glan...BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD:We report two cases of adrenalectomy for solitary adrenal metastasis:one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS:The patient with intrahepatic cholangiocar- cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However,he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy.The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma.He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION:Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.展开更多
Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered t...Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered the only potentially curative treatment for colorectal liver metastasis(CRLM),with a 5-year survival rate ranging from 35%to 58%.However,up to 80%of patients have initially unresectable disease,due to extrahepatic disease or bilobar multiple liver nodules.The availability of increasingly effective systemic chemotherapy has contributed to converting patients with initially unresectable liver metastases to resectable disease,improving long-term outcomes,and accessing tumor biology.In recent years,response to preoperative systemic chemotherapy before liver resection has been established as a major prognostic factor.Some studies have demonstrated that patients with regression of hepatic metastases while on chemotherapy have improved outcomes when compared to patients with stabilization or progression of the disease.Even if disease progression during chemotherapy represents an independent negative prognostic factor,some patients may still benefit from surgery,given the role of this modality as the main treatment with curative intent for patients with CRLM.In selected cases,based on size,the number of lesions,and tumor markers,surgery may be offered despite the less favorable prognosis and as an option for non-chemo responders.展开更多
Objective： In advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, it is inconclusive as to whether or not there is an im...Objective： In advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, it is inconclusive as to whether or not there is an improvement in the survival rate. We compared with gastrectomy alone to analyze the prognostic factors in T4 gastric cancers. Methods： Between January 1997 and December 2004, 115 patients underwent surgery for T4 gastric cancer; we divided them into two groups： combined resections in group Ⅰ, gastrectomy alone in group Ⅱ. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated. Results： Among the two groups, statistically significantly different factor was Borrmann type. The most commonly resected organ was the transverse colon, and no one post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors. Conclusion： In patients with T4 gastric carcinoma, surgical gastrectomy alone approach can be beneficial. Compared with the group I, non-resection （gastrectomy alone） can be performed for a better surgical approach.展开更多
Objective:The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to ...Objective:The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to study the role of nuclear medicine techniques in the initial diagnosis and preoperative localization directing surgical management of these cases. Methods: This study included 27 patients with PHPT properly diagnosed and treated in the NCI, Cairo University from January 2005 to December 2010. Preoperative neck U/S and Tc-99m-MIBI scintigraphy were done in all cases. If preoperative localization detected a single lesion, unilateral exploration was done. Bilateral exploration was done if multiple foci of active parathyroid glands or no lesions were detected. Results: This study included 27 patients (8 males and 19 females). The median age was 43 years (range from 19 to 68 years). All cases presented with bone disease in the form of bony pain in 23 patients, bony swellings in 15 patients and pathological fractures in 6 cases. Twenty one patients (77.8%) had single adenoma, 5 cases (18.5%) had parathyroid hyperplasia, and only one case had double adenomas. The sensitivity of neck U/S in detecting single adenoma was 61.9% (13/21), with 81% positive predictive value (PPV) while the sensitivity of Tc-99m-MIBI scintigraphy was 90.5% (19/21) with 100% PPV. Based on preoperative localization tests, unilateral exploration was done in 19 patients with solitary adenomas. All cases in this group were cured with no reported case of persistent or recurrent hypercalcemia. Conclusion: Presentation of PHPT may mimic malignant bone tumors but fortunately these patients were correctly diagnosed with bone scan which confirm the presence of metabolic bone disease rather than bone metastases. This was followed by estimation of serum calcium and parathormone levels for confirmation. Unilateral exploration based on the combination of ultrasound and preoperative localization by Tc-99m-MIBI scintigraphy was effective and could replace the standard bilateral neck exploration in cases with solitary adenoma. Bilateral neck exploration was required for suspected bilateral disease, hyperplasia or non visualized parathyroids.展开更多
Purpose: To highlight the role of multi-detector computed tomography in evaluation of small intestinal neoplastic lesions. Patient and Methods: Thirty patients suspected to have small bowel neaoplasms were examined wi...Purpose: To highlight the role of multi-detector computed tomography in evaluation of small intestinal neoplastic lesions. Patient and Methods: Thirty patients suspected to have small bowel neaoplasms were examined with 64 MDCT and underwent surgical exploration. Result: Contrast enhanced MDCT enterography easily diagnosed twenty patients with small intestinal neoplasms which were confirmed with surgical exploration and histopathological results. Conclusions: Our study has been proved that MDCT can be used as a front-line imaging modality for detection of small bowel neoplasms, regarding its ability to show intraluminal, mural and extraintestinal lesions with their characteristic density and features to successfully differentiate between the different neoplasms and sometimes stage them. However, operative exploration with curative resection or biopsy is still the confirmatory diagnostic method.展开更多
BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection(TLR)as a considerable way of treating patients with recurrent oropha-ryngeal malignancies.AIM To develop a foundat...BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection(TLR)as a considerable way of treating patients with recurrent oropha-ryngeal malignancies.AIM To develop a foundation of minimally invasive transoral surgical technique for patients with oropharyngeal recurrence.METHODS This study prospectively and retrospectively included patients with recurrent tumors from 2003 to 2018.Subjects were allocated into two groups:(1)Group I;underwent TLR;and(2)Group II(control);underwent open surgeries of varying volume.Evaluation was done with intraoperative blood loss,postoperative infection incidence,and quality of life using the scale for patients with head and neck tumors known as the Functional Assessment of Cancer Therapy-Head&Neck Scale.RESULTS One-hundred and forty one patients were included(103 males and 38 females),in 82 cases(85.4%),a recurrent tumor developed earlier than a year after primary tumor therapy;forty-six were in group I and 69 in group II,age ranging from 18 years to 86 years(average:57.6 years).The first group showed a statistically significant less amount of blood loss and a decreased incidence of infectious complications(P<0.05).Additionally,there was a significant difference in functional outcomes(quality of life scores)but no significant difference in survival curves.CONCLUSION In properly elected patients,TLR is not just reasonable but tends to be a favorable alternative for recurrent oropharyngeal cancers compared to the outcomes of the open surgery group.展开更多
BACKGROUND Dermatofibrosarcoma protuberans(DFSP)is a rare,low-grade,locally aggressive cutaneous sarcoma.DFSP in the periocular region is exceedingly rare,leading to diagnostic and surgical challenges due to anatomica...BACKGROUND Dermatofibrosarcoma protuberans(DFSP)is a rare,low-grade,locally aggressive cutaneous sarcoma.DFSP in the periocular region is exceedingly rare,leading to diagnostic and surgical challenges due to anatomical constraints in the periocular region.Precise diagnosis is essential to guide appropriate surgical management and prevent recurrence.CASE SUMMARY A 32-year-old female presented with a recurrent tumor in the medial canthus,previously diagnosed as a solitary fibrous tumor in an outside institution.After complete radiological and systemic workup,she was scheduled for a wide local excision followed by reconstruction after getting tumor clear margins on frozen section.Histopathology confirmed DFSP,characterized by storiform spindle cell proliferation,diffuse cluster of differentiation 34 positivity,and signal transducer and activator of transcription 6 negativity.CONCLUSION This case highlights the challenges in the diagnostic and surgical management of DFSP in periocular tumors.Comprehensive surgical excision with appropriate reconstruction is critical for achieving oncological control while preserving aesthetics and function.展开更多
Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into...Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.展开更多
BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant ...BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.展开更多
BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,an...BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.展开更多
BACKGROUND Chronic esophagitis can progress to esophageal cancer via"inflammationdysplasia-cancer"transformation,with nitric oxide(NO)serving as a critical mediator in this process.Traditional diagnostic met...BACKGROUND Chronic esophagitis can progress to esophageal cancer via"inflammationdysplasia-cancer"transformation,with nitric oxide(NO)serving as a critical mediator in this process.Traditional diagnostic methods(e.g.,endoscopic biopsy)for esophageal cancer transformation have low sensitivity and require long detection time,while existing fluorescent probes lack specificity and stability for real-time NO monitoring.High-performance fluorescent probes like DAF-FM,with NO-targeting ability,show potential for visual screening and efficacy evaluation but need systematic validation in esophageal cancer models.AIM To validate the applicability of the fluorescent probe DAF-FM for visual screening of esophageal cancer transformation,explore the underlying mechanism of NOregulated transformation,and evaluate the probe’s efficacy in monitoring therapeutic responses.METHODS Laser confocal imaging and flow cytometry were used to analyze DAF-FM’s NO concentration/time-dependent fluorescence response,lysosomal targeting(via Pearson coefficient),and cytotoxicity(with cholecystokinin-8 assay)in esophageal cells.Sprague-Dawley rat esophageal cancer models(normal,esophagitis,esophageal cancer,and drug/radiotherapy intervention)were established to monitor NO dynamics and tumor volume correlation.Clinical diagnostic comparison(50 suspected patients)with endoscopic biopsy/histopathology was conducted using Kolmogorov-Smirnov test and Student’s t-test(P<0.05).Western blot and quantitative realtime polymerase chain reaction were used to explore NO’s role in the nuclear factor-kappa B(NF-κB)pathway.RESULTS DAF-FM exhibited concentration/time-dependent fluorescence with NO(300μM NO:60-minute fluorescence intensity 458±15 arbitrary units,P<0.05)and specific lysosomal targeting(Pearson’s coefficient=0.82±0.03).It had low cytotoxicity(82.3%±4.1%cell viability at 50μM).In rat models,DAF-FM showed that NO was correlated with tumor volume(R²=0.87).Clinically,its sensitivity(92.5%)outperformed endoscopic biopsy(78.3%),with shorter detection time(30 minutes vs 48 hours,P<0.05).Mechanistically,NO regulated transformation via the NF-κB pathway(Pearson’s coefficient=0.78±0.05 between DAF-FM and NF-κB).CONCLUSION DAF-FM is a feasible tool for visual screening of esophageal cancer transformation,enabling real-time NO monitoring,high-sensitivity diagnosis,and therapeutic efficacy evaluation.It provides a new approach for esophageal cancer diagnosis and mechanism research.展开更多
BACKGROUND Ovarian cancer(OC)is the most lethal gynecological cancer among females,and its early diagnosis could help for better outcomes of the patients.AIM To investigate the utility of serum insulin-like growth fac...BACKGROUND Ovarian cancer(OC)is the most lethal gynecological cancer among females,and its early diagnosis could help for better outcomes of the patients.AIM To investigate the utility of serum insulin-like growth factors-binding proteins 2(IGFBP2),secreted phosphoprotein 1(SPP1),thrombospondin 1 protein(TSP1)and D-dimer levels in addition to currently used biomarkers[cancer antigen 125(CA125)and human epididymis protein 4(HE4)]in the diagnosis of epithelial OC(EOC).METHODS This is a case-control study that included fifty females diagnosed with EOC,10 females with benign ovarian masses recruited from the Egyptian National Cancer Institute,and 30 healthy females as a control group.All subjects were assessed for serum HE4,CA125,IGFBP2,TSP1 and SPP1 measurement by enzyme-linkedimmunosorbent assay.RESULTS There was a statistically significant difference in serum levels between EOC,benign ovarian masses,and healthy control groups regarding CA125 and SPP1(P<0.001 for both markers),while HE4 and IGFBP2 increased significantly in EOC compared to healthy control groups(P<0.001 for all markers)with no significant difference between EOC and benign ovarian masses groups.However,there was no statistically significant difference among EOC,benign ovarian masses,and healthy control groups regarding the TSP1 serum levels(P=0.051).Receiver operating characteristic analysis revealed that combined assessment of SPP1 with CA125 or TSP1 increased the diagnosis of EOC patients to a sensitivity,specificity,and area under curve of(93.3%,100%,0.968;respectively,P<0.001).CONCLUSION SPP1 may be a potential marker for the differentiation between benign and malignant ovarian masses,while IGFBP2 can differentiate between healthy females and females with ovarian masses.Combining SPP1 with CA125 or TSP1 provides high sensitivity and specificity for the detection of EOC patients.展开更多
BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necess...BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.展开更多
文摘Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.
文摘BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.
基金Supported by Municipal Science Funds of Xingtai,No.2015ZC202
文摘BACKGROUND There are several surgical options for treating early gastric cancers(EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection(ESD) in treating EGC is not well established,especially when compared with resection surgery cases in a long-term follow-up scope.AIM To compare the safety and efficacy of the short-and long-term outcomes between ESD and resection surgery.METHODS We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short-or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software(version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed-or random-effects models depending on heterogeneity across studies.RESULTS Fourteen studies comprising 5112 patients were eligible for analysis(2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference(WMD):-140.02 min, 95%CI:-254.23 to-34.82 min, P = 0.009], shorter hospital stay(WMD:-5.41 d, 95% CI:-5.93 to-4.89 d, P < 0.001), and lowerpostoperative complication rate [Odds ratio(OR) = 0.39, 95%CI: 0.28-0.55, P <0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate(OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients.However, the long-term survival including overall survival [Hazard ratio(HR) =0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival(HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.CONCLUSION In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the longterm survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.
文摘AIM:To investigate endoscopic ultrasound(EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection.METHODS:Records of 111 patients seen at our institution from November 1999 to July 2011 with the postoperative pathological diagnosis of benign ampullary and duodenal adenomas were reviewed.Records of patients who underwent preoperative EUS for diagnostic purposes were identified.The accuracy of EUS in predicting the absence of muscular invasion was assessed by comparing EUS reports to the final surgical pathological results.In addition,the incidence of the post-operative complications over a period of 30 d and the subsequent long-term outcome(recurrence) over a period of 30 mo associated with endoscopic and transduodenal surgical resection was recorded,compared and analyzed.RESULTS:Among 111 patients with benign ampullary and duodenal adenomas,47 underwent preoperative EUS for 29 peri-ampullary lesions and 18 duodenal lesions.In addition,computed tomography was performed in 18 patients,endoscopic retrograde cholangio-pancreatography in 10 patients and esophagogastroduodenoscopy in 22 patients.There were 43 patients with sporadic adenomas and 4 patients with familial adenomatous polyposis(FAP)/other polyposis syndromes.In 38(81%,P < 0.05) patients,EUS reliably identified absence of submucosal and muscularis invasion.In 4 cases,EUS underestimated submucosal invasion that was proven by pathology.In the other 5 patients,EUS predicted muscularis invasion which could not be demonstrated in the resected specimen.EUS predicted tumor muscularis invasion with a specificity of 88% and negative predictive value of 90%(P < 0.05).Types of resection performed included endoscopic resection in 22 cases,partial duodenectomy in 9 cases,transduodenal ampullectomy with sphincteroplasty in 10 cases and pancreaticoduodenectomy in 6 cases.The main post-operative final pathological results included villous adenoma(n = 5),adenoma(n = 8),tubulovillous adenoma(n = 10),tubular adenoma(n = 20) and hyperplastic polyp(n = 2).Among the 47 patients who underwent resection,8(17%,5 of which corresponded to surgical resection) developed post-procedural complications which included retroperitoneal hematoma,intra-abdominal abscess,wound infection,delayed gastric emptying and prolonged ileus.After median followup of 20 mo there were 6 local recurrences(13%,median follow-up = 20 mo) 4 of which were in patients with FAP.CONCLUSION:EUS accurately predicts the depth of mucosal invasion in suspected benign ampullary and duodenal adenomas.These patients can safely undergo endoscopic or local resection.
文摘Gastric outlet obstruction(GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract.Palliative treatment of patients' symptoms who present with GOO is an important aspect of their care.Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life.Palliative treatment for GOO includes operative(open and laparoscopic gastrojejunostomy) and non-operative(endoscopic stenting) options.The performance status and medical condition of the patient,the extent of the cancer,the patients prognosis,the availability of a curative procedure,the natural history of symptoms of the disease(primary and secondary),the durability of the procedure,and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy.Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity.
文摘Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Participants: Sixty women were enrolled in a study that was conducted in Cairo from Jan-2017 to Mar-2018. Interventions: All women received the same preparations. After randomization;in the study group (N = 30), podophyllin cautery was added to surgical removal in the follow-up period. In the control group (N = 30), only surgical removal was used. Main Outcome Measure: The main outcome measure was the estimation of the recurrence of the lesion during the follow-up period. The secondary outcome measures were the incidence of adverse events. Results: Both groups were comparable (p-value > 0.05) with regard to the age and BMI. Recurrence was significantly lower (P = 0.001) in the study group than the control group. In the study group, five cases (17.2%) have recurrence whereas, in the control group, 18 (60.0%) had suffered recurrence. The ARR was 42.8% (CI 95%: 18% - 60.9%) with RR of 0.29 (CI 95%: 0.12% - 0.67%) and NNT2 (CI 95%: 6% - 2%). During the follow-up period, 19 cases (65.5%) of the study group experienced pain versus only eight cases (26.7%) in the control group (p = 0.003). However, the development of scars was less in the study group 7 (24.1%) than in the control group 19 (63.3%), (p = 0.002). Conclusion: Podophyllin cautery, when added to surgical removal, is effective in decreasing the incidence recurrence in cases with condylomata acuminata.
文摘BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is a rare and rapidly progressive intestinal T-cell non-Hodgkin lymphoma associated with a very poor prognosis and a median survival of 7 mo.Advances in the identification of MEITL over the last two decades have led to its recognition as a separate entity.MEITL patients,predominantly male,typically present with vague and nonspecific symptoms and diagnosis is predominantly confirmed at laparotomy.Currently,there are no standardized treatment protocols,and the optimal therapy remains unclear.CASE SUMMARY We report a case of MEITL that was initially considered to be gastrointestinal stromal tumor(GIST)and Imatinib was administered for one cycle.The 62-yearold man presented with abdominal pain,abdominal distension,and weight loss of 20 pounds.Within 2 wk,the size of the mass considerably increased on computed tomography scans.The patient underwent surgery followed by chemotherapy with CHOP(cyclophosphamide,doxorubicin,vincristine,and prednisone)and stem-cell transplant.A correct diagnosis of MEITL was established based on postoperative pathology.Immunophenotypically,the neoplastic cells fulfilled the diagnostic criteria for MEITL as they were CD3+,CD4+,CD8+,CD56+,and TIA-1+.CONCLUSION Given that MEITL has no predisposing factor and presents with vague symptoms with rapid progression,the concomitant presence of abdominal symptoms and B symptoms(weight loss,fever,and night sweats)with hypoalbuminemia,anemia,low lymphocytic count and endoscopic findings of diffuse infiltrating type lesions should alert physicians to this rare disease,especially when it comes to Asian patients.Immediate laparotomy should then be carried out followed by chemotherapy and stem-cell transplant.
文摘BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD:We report two cases of adrenalectomy for solitary adrenal metastasis:one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS:The patient with intrahepatic cholangiocar- cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However,he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy.The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma.He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION:Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.
文摘Colorectal cancer represents the third most diagnosed malignancy in the world.The liver is the main site of metastatic disease,affected in 30%of patients with newly diagnosed disease.Complete resection is considered the only potentially curative treatment for colorectal liver metastasis(CRLM),with a 5-year survival rate ranging from 35%to 58%.However,up to 80%of patients have initially unresectable disease,due to extrahepatic disease or bilobar multiple liver nodules.The availability of increasingly effective systemic chemotherapy has contributed to converting patients with initially unresectable liver metastases to resectable disease,improving long-term outcomes,and accessing tumor biology.In recent years,response to preoperative systemic chemotherapy before liver resection has been established as a major prognostic factor.Some studies have demonstrated that patients with regression of hepatic metastases while on chemotherapy have improved outcomes when compared to patients with stabilization or progression of the disease.Even if disease progression during chemotherapy represents an independent negative prognostic factor,some patients may still benefit from surgery,given the role of this modality as the main treatment with curative intent for patients with CRLM.In selected cases,based on size,the number of lesions,and tumor markers,surgery may be offered despite the less favorable prognosis and as an option for non-chemo responders.
基金Supported by grants from (in part) National Natural Science Foundation Project (No. 30972939)Science and Technology Projects in Shenyang (No. 1071166-9-00/1071162-9-00)
文摘Objective： In advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, it is inconclusive as to whether or not there is an improvement in the survival rate. We compared with gastrectomy alone to analyze the prognostic factors in T4 gastric cancers. Methods： Between January 1997 and December 2004, 115 patients underwent surgery for T4 gastric cancer; we divided them into two groups： combined resections in group Ⅰ, gastrectomy alone in group Ⅱ. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated. Results： Among the two groups, statistically significantly different factor was Borrmann type. The most commonly resected organ was the transverse colon, and no one post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors. Conclusion： In patients with T4 gastric carcinoma, surgical gastrectomy alone approach can be beneficial. Compared with the group I, non-resection （gastrectomy alone） can be performed for a better surgical approach.
文摘Objective:The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to study the role of nuclear medicine techniques in the initial diagnosis and preoperative localization directing surgical management of these cases. Methods: This study included 27 patients with PHPT properly diagnosed and treated in the NCI, Cairo University from January 2005 to December 2010. Preoperative neck U/S and Tc-99m-MIBI scintigraphy were done in all cases. If preoperative localization detected a single lesion, unilateral exploration was done. Bilateral exploration was done if multiple foci of active parathyroid glands or no lesions were detected. Results: This study included 27 patients (8 males and 19 females). The median age was 43 years (range from 19 to 68 years). All cases presented with bone disease in the form of bony pain in 23 patients, bony swellings in 15 patients and pathological fractures in 6 cases. Twenty one patients (77.8%) had single adenoma, 5 cases (18.5%) had parathyroid hyperplasia, and only one case had double adenomas. The sensitivity of neck U/S in detecting single adenoma was 61.9% (13/21), with 81% positive predictive value (PPV) while the sensitivity of Tc-99m-MIBI scintigraphy was 90.5% (19/21) with 100% PPV. Based on preoperative localization tests, unilateral exploration was done in 19 patients with solitary adenomas. All cases in this group were cured with no reported case of persistent or recurrent hypercalcemia. Conclusion: Presentation of PHPT may mimic malignant bone tumors but fortunately these patients were correctly diagnosed with bone scan which confirm the presence of metabolic bone disease rather than bone metastases. This was followed by estimation of serum calcium and parathormone levels for confirmation. Unilateral exploration based on the combination of ultrasound and preoperative localization by Tc-99m-MIBI scintigraphy was effective and could replace the standard bilateral neck exploration in cases with solitary adenoma. Bilateral neck exploration was required for suspected bilateral disease, hyperplasia or non visualized parathyroids.
文摘Purpose: To highlight the role of multi-detector computed tomography in evaluation of small intestinal neoplastic lesions. Patient and Methods: Thirty patients suspected to have small bowel neaoplasms were examined with 64 MDCT and underwent surgical exploration. Result: Contrast enhanced MDCT enterography easily diagnosed twenty patients with small intestinal neoplasms which were confirmed with surgical exploration and histopathological results. Conclusions: Our study has been proved that MDCT can be used as a front-line imaging modality for detection of small bowel neoplasms, regarding its ability to show intraluminal, mural and extraintestinal lesions with their characteristic density and features to successfully differentiate between the different neoplasms and sometimes stage them. However, operative exploration with curative resection or biopsy is still the confirmatory diagnostic method.
文摘BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection(TLR)as a considerable way of treating patients with recurrent oropha-ryngeal malignancies.AIM To develop a foundation of minimally invasive transoral surgical technique for patients with oropharyngeal recurrence.METHODS This study prospectively and retrospectively included patients with recurrent tumors from 2003 to 2018.Subjects were allocated into two groups:(1)Group I;underwent TLR;and(2)Group II(control);underwent open surgeries of varying volume.Evaluation was done with intraoperative blood loss,postoperative infection incidence,and quality of life using the scale for patients with head and neck tumors known as the Functional Assessment of Cancer Therapy-Head&Neck Scale.RESULTS One-hundred and forty one patients were included(103 males and 38 females),in 82 cases(85.4%),a recurrent tumor developed earlier than a year after primary tumor therapy;forty-six were in group I and 69 in group II,age ranging from 18 years to 86 years(average:57.6 years).The first group showed a statistically significant less amount of blood loss and a decreased incidence of infectious complications(P<0.05).Additionally,there was a significant difference in functional outcomes(quality of life scores)but no significant difference in survival curves.CONCLUSION In properly elected patients,TLR is not just reasonable but tends to be a favorable alternative for recurrent oropharyngeal cancers compared to the outcomes of the open surgery group.
文摘BACKGROUND Dermatofibrosarcoma protuberans(DFSP)is a rare,low-grade,locally aggressive cutaneous sarcoma.DFSP in the periocular region is exceedingly rare,leading to diagnostic and surgical challenges due to anatomical constraints in the periocular region.Precise diagnosis is essential to guide appropriate surgical management and prevent recurrence.CASE SUMMARY A 32-year-old female presented with a recurrent tumor in the medial canthus,previously diagnosed as a solitary fibrous tumor in an outside institution.After complete radiological and systemic workup,she was scheduled for a wide local excision followed by reconstruction after getting tumor clear margins on frozen section.Histopathology confirmed DFSP,characterized by storiform spindle cell proliferation,diffuse cluster of differentiation 34 positivity,and signal transducer and activator of transcription 6 negativity.CONCLUSION This case highlights the challenges in the diagnostic and surgical management of DFSP in periocular tumors.Comprehensive surgical excision with appropriate reconstruction is critical for achieving oncological control while preserving aesthetics and function.
文摘Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.
文摘BACKGROUND In the treatment of rectal cancer,a temporary loop ileostomy(TLI)is created after low anterior resection to protect bowel function in the postoperative period.Dehydration and kidney failure are significant potential complications in loop ileostomies.Compared to late closure(3-6 months),early closure(10-14 days)of the TLI may facilitate faster patient recovery and shorter hospital stays.AIM To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.METHODS This study included patients who underwent TLI for rectal cancer,with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively.Patients whose stomas were closed in the late period(3-6 months)between June 2016 and October 2022(group A)were compared with those who underwent early closure(10-14 days)between October 2022 and 2024(group B),with the primary outcome being complication rate and the secondary outcome being quality of life.RESULTS A total of 270 TLIs were created(70.9%).Of these,120(44.4%)were closed in the late period(group A),and 150(55.6%)were closed in the early period(group B).There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics(P>0.05).Perioperative(anesthesia management,operative time,blood loss,surgical technique)and postoperative findings(anastomotic leak,infection)were similar between the two groups and were not statistically significant(P>0.05).There were no statistically significant differences in complication rates as the primary outcome between the two groups.Quality of life as a secondary outcome was significantly higher in the early closure group(P<0.05).CONCLUSION No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity.Early closure accelerated patients’psychological and social recovery.
文摘BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
基金Supported by Natural Science Foundation of Fujian Province,No.2023J011787Quanzhou Science and Technology Program Project,No.2025QZC02DW.
文摘BACKGROUND Chronic esophagitis can progress to esophageal cancer via"inflammationdysplasia-cancer"transformation,with nitric oxide(NO)serving as a critical mediator in this process.Traditional diagnostic methods(e.g.,endoscopic biopsy)for esophageal cancer transformation have low sensitivity and require long detection time,while existing fluorescent probes lack specificity and stability for real-time NO monitoring.High-performance fluorescent probes like DAF-FM,with NO-targeting ability,show potential for visual screening and efficacy evaluation but need systematic validation in esophageal cancer models.AIM To validate the applicability of the fluorescent probe DAF-FM for visual screening of esophageal cancer transformation,explore the underlying mechanism of NOregulated transformation,and evaluate the probe’s efficacy in monitoring therapeutic responses.METHODS Laser confocal imaging and flow cytometry were used to analyze DAF-FM’s NO concentration/time-dependent fluorescence response,lysosomal targeting(via Pearson coefficient),and cytotoxicity(with cholecystokinin-8 assay)in esophageal cells.Sprague-Dawley rat esophageal cancer models(normal,esophagitis,esophageal cancer,and drug/radiotherapy intervention)were established to monitor NO dynamics and tumor volume correlation.Clinical diagnostic comparison(50 suspected patients)with endoscopic biopsy/histopathology was conducted using Kolmogorov-Smirnov test and Student’s t-test(P<0.05).Western blot and quantitative realtime polymerase chain reaction were used to explore NO’s role in the nuclear factor-kappa B(NF-κB)pathway.RESULTS DAF-FM exhibited concentration/time-dependent fluorescence with NO(300μM NO:60-minute fluorescence intensity 458±15 arbitrary units,P<0.05)and specific lysosomal targeting(Pearson’s coefficient=0.82±0.03).It had low cytotoxicity(82.3%±4.1%cell viability at 50μM).In rat models,DAF-FM showed that NO was correlated with tumor volume(R²=0.87).Clinically,its sensitivity(92.5%)outperformed endoscopic biopsy(78.3%),with shorter detection time(30 minutes vs 48 hours,P<0.05).Mechanistically,NO regulated transformation via the NF-κB pathway(Pearson’s coefficient=0.78±0.05 between DAF-FM and NF-κB).CONCLUSION DAF-FM is a feasible tool for visual screening of esophageal cancer transformation,enabling real-time NO monitoring,high-sensitivity diagnosis,and therapeutic efficacy evaluation.It provides a new approach for esophageal cancer diagnosis and mechanism research.
文摘BACKGROUND Ovarian cancer(OC)is the most lethal gynecological cancer among females,and its early diagnosis could help for better outcomes of the patients.AIM To investigate the utility of serum insulin-like growth factors-binding proteins 2(IGFBP2),secreted phosphoprotein 1(SPP1),thrombospondin 1 protein(TSP1)and D-dimer levels in addition to currently used biomarkers[cancer antigen 125(CA125)and human epididymis protein 4(HE4)]in the diagnosis of epithelial OC(EOC).METHODS This is a case-control study that included fifty females diagnosed with EOC,10 females with benign ovarian masses recruited from the Egyptian National Cancer Institute,and 30 healthy females as a control group.All subjects were assessed for serum HE4,CA125,IGFBP2,TSP1 and SPP1 measurement by enzyme-linkedimmunosorbent assay.RESULTS There was a statistically significant difference in serum levels between EOC,benign ovarian masses,and healthy control groups regarding CA125 and SPP1(P<0.001 for both markers),while HE4 and IGFBP2 increased significantly in EOC compared to healthy control groups(P<0.001 for all markers)with no significant difference between EOC and benign ovarian masses groups.However,there was no statistically significant difference among EOC,benign ovarian masses,and healthy control groups regarding the TSP1 serum levels(P=0.051).Receiver operating characteristic analysis revealed that combined assessment of SPP1 with CA125 or TSP1 increased the diagnosis of EOC patients to a sensitivity,specificity,and area under curve of(93.3%,100%,0.968;respectively,P<0.001).CONCLUSION SPP1 may be a potential marker for the differentiation between benign and malignant ovarian masses,while IGFBP2 can differentiate between healthy females and females with ovarian masses.Combining SPP1 with CA125 or TSP1 provides high sensitivity and specificity for the detection of EOC patients.
文摘BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.
