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 Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in prev...BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.展开更多
BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esop...BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esophageal NEC remains unclear,and conversion surgery has only been reported for a few cases.Herein,we present the case of a 66-year-old male with locally advanced esophageal NEC initially diagnosed as squamous cell carcinoma.CASE SUMMARY The patient underwent induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil,followed by conversion surgery,including subtotal esophagectomy,three-field lymph node dissection,and distal pancreatectomy with splenectomy,due to infiltration of the pancreas by the No.11p lymph node.Postoperative pathological findings revealed a large cell-type NEC without a squamous cell carcinoma component,suspected to be a mixed neuroendocrine/non-neuroendocrine neoplasm.Hepatic metastasis was diagnosed within one month of surgery.Despite the administration of four courses of irinotecan+cisplatin chemotherapy,the treatment effect was considered a‘progressive disease’.After a multidisciplinary discussion,the patient underwent partial liver resection,followed by second-line chemotherapy with amrubicin.The patient achieved three-year survival with no new recurrence.CONCLUSION This case highlights the potential of multimodal treatment for long-term survival in advanced esophageal NEC.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
AIM： To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose （FDG-PET） in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of pat...AIM： To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose （FDG-PET） in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment. METHODS： This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens （CEA） and carbohydrate antigen 19-9 （CA29-9）. Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value （SUV）. The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer. RESULTS： The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease （bone metastasis）. For local staging, the sensitivity of CT was better than that of FDG-PEr. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference （4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024） in the SUV between patients with respectable and unresectable disease. CONCLUSION： FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.展开更多
Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer(GC)at an early stage.Due to the low incidence of lymph node metastasis and favorable prognosis in early GC,function-preserving surg...Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer(GC)at an early stage.Due to the low incidence of lymph node metastasis and favorable prognosis in early GC,function-preserving surgery which improves postoperative quality of life may be possible.Pylorus-preserving gastrectomy(PPG)is one such function-preserving procedure,which is expected to offer advantages with regards to dumping syndrome,bile reflux gastritis,and the frequency of flatus,although PPG may induce delayed gastric emptying.Proximal gastrectomy(PG)is another functionpreserving procedure,which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach,although the incidence of heartburn or gastric fullness associated with this procedure is high.However,these disadvantages may be overcome by the reconstruction method used.The other important problem after PG is remnant GC,which was reported to occur in approximately 5%of patients.Therefore,the reconstruction technique used with PG should facilitate postoperativeendoscopic examinations for early detection and treatment of remnant gastric carcinoma.Oncologic safety seems to be assured in both procedures,if the preoperative diagnosis is accurate.Patient selection should be carefully considered.Although many retrospective studies have demonstrated the utility of function-preserving surgery,no consensus on whether to adopt functionpreserving surgery as the standard of care has been reached.Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.展开更多
Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as...Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.展开更多
While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anat...While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.展开更多
AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burd...AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real- time information about the biliary structures. Theeducational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.展开更多
Gastric cancer with extensive lymph node metastasis(ELM) is usually considered unresectable and is associated with poor outcomes. Cases with clinical enlargement of the para-aortic lymph nodes and/or bulky lymph node ...Gastric cancer with extensive lymph node metastasis(ELM) is usually considered unresectable and is associated with poor outcomes. Cases with clinical enlargement of the para-aortic lymph nodes and/or bulky lymph node enlargement around the celiac artery and its branches are generally dealt with as ELM. A standard treatment for gastric cancer with ELM has yet to be determined. Two phase Ⅱ studies of neoadjuvant chemotherapy followed by surgery showed that neoadjuvant chemotherapy with S-1 plus cisplatin followed by surgical resection with extended lymph node dissection could represent a treatment option for gastric cancer with ELM. However,many clinical questions remain unresolved,including the criteria for diagnosing ELM,optimal regime,number of courses and extent of lymph node dissection.展开更多
BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopi...BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.展开更多
BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2...BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic tumors.MMP-7 is expressed in the epithelial cells and in a variety of cancers including colon tumors.Plasma MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer pathology.AIM To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer pathology.METHODS Patients enrolled in a plasma bank for whom plasma was available were eligible.Plasma obtained from preoperative(Preop)and postoperative blood samples was used.Only colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were included.Late samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time points.Plasma MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in duplicate.RESULTS Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs preop levels.CONCLUSION MMP-2 levels are elevated for 5 wk and MMP-7 levels elevated for weeks 2-6.The etiology of these changes in unclear,trauma and wound healing likely play a role.These changes may promote residual tumor growth and metastasis.展开更多
Although laparoscopic colectomy is commonly performed around the world,an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery.Thus,a certain sized s...Although laparoscopic colectomy is commonly performed around the world,an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery.Thus,a certain sized skin incision is required to remove the resected colon.Here we report the case of a pure laparoscopic ileocecal resection which involves transanal specimen extraction.We present a case characterized by a laterally spreading type of tumor of the cecum.We performed a pure laparoscopic ileocecal resection and the resected specimen was removed transanally using colonoscopy.Intracorporeal functional anastomosis was then performed using a flexible linear stapling device under supporting barbed suture traction.The patient was discharged without complications on postoperative day 4.Laparoscopic colectomy performed with minimal incision could essentially increase the usage of this surgical technique.Although our method is restricted to flat or small lesions,we think it is a feasible and realistic solution for minimization of operative invasion because it involves specimen extraction through a natural orifice.展开更多
The regenerating islet-derived members （Reg）, a group of small secretory proteins, which are involved in cell proliferation or differentiation in digestive organs, are upregulated in several gastrointestinal cancers...The regenerating islet-derived members （Reg）, a group of small secretory proteins, which are involved in cell proliferation or differentiation in digestive organs, are upregulated in several gastrointestinal cancers, functioning as trophic or antiapoptotic factors. Regenerat- ing islet-derived type Ⅳ （RegⅣ）, a member of the Reg gene family, has been reported to be overexpressed in gastroenterological cancers. RegIV overexpression in tumor cells has been associated with carcinogen- esis, cell growth, survival and resistance to apoptosis. Cancer tissue expressing RegIV is generally associated with more malignant characteristics than that with- out such expression, and RegⅣ is considered a novel prognostic factor as well as diagnostic marker in some gastroenterological cancers. We previously investigated the expression levels of RegⅣ mRNA of 202 surgical colorectal cancer specimens with quantitative real-time reverse-transcriptase polymerase chain reaction and reported that a higher level of RegⅣ gene expression was a significant independent predictor of colorec- tal cancer. The biologic functions of RegⅣ protein in cancer tissue, associated with carcinogenesis, anti- apoptosis and invasiveness, are being elucidated by molecular investigations using transfection techniques or neutralizing antibodies of RegIV, and the feasibility of antibody therapy targeting RegIV is being assessed. These studies may lead to novel therapeutic strate- gies for gastroenterological cancers expressing RegⅣ. This review article summarizes the current information related to biological functions as well as clinical impor- tance of RegⅣ gene to clarify the significance of Reg~ expression in gastroenterological cancers.展开更多
BACKGROUND Through analyzing the data from a single institution in Northeast China,this study revealed the possible clinicopathologic characteristics that influence the prognosis of patients with gastric cancer(GC).AI...BACKGROUND Through analyzing the data from a single institution in Northeast China,this study revealed the possible clinicopathologic characteristics that influence the prognosis of patients with gastric cancer(GC).AIM To evaluate the changing trends of clinicopathologic features and survival duration after surgery in patients with GC in Northeast China,which is a highprevalence area of GC.METHODS The study analyzed the difference in clinicopathologic features and survival duration after surgery of 5887 patients who were histologically diagnosed with GC at the Harbin Medical University Cancer Hospital.The study mainly analyzed the data in three periods,2000 to 2004(Phase 1),2005 to 2009(Phase 2),and 2010 to 2014(Phase 3).RESULTS Over time,the postoperative survival rate significantly increased from 2000 to 2014.In the past 15 years,compared with Phases 1 and 2,the tumor size was smaller in Phase 3(P<0.001),but the proportion of high-medium differentiated tumors increased(P<0.001).The proportion of early GC gradually increased from 3.9%to 14.4%(P<0.001).A surprising improvement was observed in the mean number of retrieved lymph nodes,ranging from 11.4 to 27.5(P<0.001).The overall 5-year survival rate increased from 24%in Phase 1 to 43.8%in Phase 3.Through multivariate analysis,it was found that age,tumor size,histologic type,tumor-node-metastasis stage,depth of invasion,lymph node metastasis,surgical approach,local infiltration,radical extent,number of retrieved lymph nodes,and age group were independent risk factors that influenced the prognosis of patients with GC.CONCLUSION The clinical features of GC in Northeast China changed during the observation period.The increasing detection of early GC and more standardized surgical treatment effectively prolonged lifetimes.展开更多
Ischemic colitis is the most common type of intestinal ischemia. The etiology of this condition is multifactorial, and the diagnosis is based on a combination of clinical symptoms, as well as endoscopic and histologic...Ischemic colitis is the most common type of intestinal ischemia. The etiology of this condition is multifactorial, and the diagnosis is based on a combination of clinical symptoms, as well as endoscopic and histological findings. Although conservative therapy is effective in most cases, surgery still plays a key role in the treatment of ischemic colitis. Here, we describe a case of a 73-year-old man in whom laparoscopy-assisted left colectomy was performed 80 d after the onset of ischemic colitis. He recovered completely after surgery, and the pathological findings were consistent with ischemic colitis. To the best of our knowledge, there are no detailed reports of laparoscopic surgery for chronic segmental stenotic ischemic colitis. We discussed the usefulness of laparoscopic surgery, comparing it with endoscopic treatment, and we propose an optimal treatment strategy from a viewpoint of stenosis length and duration of disease.展开更多
A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrastenhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band con...A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrastenhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel,suggestive of Meckel's diverticulum(MD) and a mesodiverticular band(MDB). After intestinal decompression,elective laparoscopic surgery was carried out. Using three 5-mm ports,MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel's diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman.展开更多
Statins inhibit 3-hydroxy-3-methylglutaryl-CoA reductase,the rate-limiting enzyme of the mevalonate pathway,and are widely used as an effective and safe approach handle hypercholesterolemia.The mevalonate pathway is a...Statins inhibit 3-hydroxy-3-methylglutaryl-CoA reductase,the rate-limiting enzyme of the mevalonate pathway,and are widely used as an effective and safe approach handle hypercholesterolemia.The mevalonate pathway is a vital metabolic pathway that uses acetyl-CoA to generate isoprenoids and sterols that are crucial to tumor growth and progression.Multiple studies have indicated that statins improve patient prognosis in various carcinomas.Basic research on the mechanisms underlying the antitumor effects of statins is underway.The development of new anti-cancer drugs is progressing,but increasing medical costs from drug development have become a major obstacle.Readily available,inexpensive and well-tolerated drugs like statins have not yet been successfully repurposed for cancer treatment.Identifying the cancer patients that may benefit from statins is key to improved patient treatment.This review summarizes recent advances in statin research in cancer and suggests important considerations for the clinical use of statins to improve outcomes for cancer patients.展开更多
Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortalit...Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.展开更多
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 Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.
文摘BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esophageal NEC remains unclear,and conversion surgery has only been reported for a few cases.Herein,we present the case of a 66-year-old male with locally advanced esophageal NEC initially diagnosed as squamous cell carcinoma.CASE SUMMARY The patient underwent induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil,followed by conversion surgery,including subtotal esophagectomy,three-field lymph node dissection,and distal pancreatectomy with splenectomy,due to infiltration of the pancreas by the No.11p lymph node.Postoperative pathological findings revealed a large cell-type NEC without a squamous cell carcinoma component,suspected to be a mixed neuroendocrine/non-neuroendocrine neoplasm.Hepatic metastasis was diagnosed within one month of surgery.Despite the administration of four courses of irinotecan+cisplatin chemotherapy,the treatment effect was considered a‘progressive disease’.After a multidisciplinary discussion,the patient underwent partial liver resection,followed by second-line chemotherapy with amrubicin.The patient achieved three-year survival with no new recurrence.CONCLUSION This case highlights the potential of multimodal treatment for long-term survival in advanced esophageal NEC.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘AIM： To evaluate the role of positron emission tomography using 18F-fluorodeoxyglucose （FDG-PET） in the surgical management of patients with pancreatic cancer, including the diagnosis, staging, and selection of patients for the subsequent surgical treatment. METHODS： This study involved 53 patients with proven primary pancreatic cancer. The sensitivity of diagnosing the primary cancer was examined for FDG-PET CT, cytological examination of the bile or pancreatic juice, and the serum levels of carcinoembrionic antigens （CEA） and carbohydrate antigen 19-9 （CA29-9）. Next, the accuracy of staging was compared between FDG-PET and CT. Finally, FDG-PET was analyzed semiquantitatively using the standard uptake value （SUV）. The impact of the SUV on patient management was evaluated by examining the correlations between the SUV and the histological findings of cancer. RESULTS： The sensitivity of FDG-PET, CT, cytological examination of the bile or pancreatic juice, and the serum levels of CEA and CA19-9 were 92.5%, 88.7%, 46.4%, 37.7% and 69.8%, respectively. In staging, FDG-PET was superior to CT only in diagnosing distant disease （bone metastasis）. For local staging, the sensitivity of CT was better than that of FDG-PEr. The SUV did not correlate with the pTNM stage, grades, invasions to the vessels and nerve, or with the size of the tumor. However, there was a statistically significant difference （4.6 ± 2.9 vs 7.8 ± 4.5, P = 0.024） in the SUV between patients with respectable and unresectable disease. CONCLUSION： FDG-PET is thus considered to be useful in the diagnosis of pancreatic cancer. However, regarding the staging of the disease, FDG-PET is not considered to be a sufficiently accurate diagnostic modality. Although the SUV does not correlate with the patho-histological prognostic factors, it may be useful in selecting patients who should undergo subsequent surgical treatment.
文摘Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer(GC)at an early stage.Due to the low incidence of lymph node metastasis and favorable prognosis in early GC,function-preserving surgery which improves postoperative quality of life may be possible.Pylorus-preserving gastrectomy(PPG)is one such function-preserving procedure,which is expected to offer advantages with regards to dumping syndrome,bile reflux gastritis,and the frequency of flatus,although PPG may induce delayed gastric emptying.Proximal gastrectomy(PG)is another functionpreserving procedure,which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach,although the incidence of heartburn or gastric fullness associated with this procedure is high.However,these disadvantages may be overcome by the reconstruction method used.The other important problem after PG is remnant GC,which was reported to occur in approximately 5%of patients.Therefore,the reconstruction technique used with PG should facilitate postoperativeendoscopic examinations for early detection and treatment of remnant gastric carcinoma.Oncologic safety seems to be assured in both procedures,if the preoperative diagnosis is accurate.Patient selection should be carefully considered.Although many retrospective studies have demonstrated the utility of function-preserving surgery,no consensus on whether to adopt functionpreserving surgery as the standard of care has been reached.Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.
文摘Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer.Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.
文摘While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era.
文摘AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real- time information about the biliary structures. Theeducational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.
基金Supported by A National Cancer Center Research and Development Fund(23-A-1623-A-19+3 种基金26-A-4)a Health and Labour Sciences Research Grant for Clinical Cancer Research(H22-Gan-016) from the Ministry of HealthLabour and WelfareJapan
文摘Gastric cancer with extensive lymph node metastasis(ELM) is usually considered unresectable and is associated with poor outcomes. Cases with clinical enlargement of the para-aortic lymph nodes and/or bulky lymph node enlargement around the celiac artery and its branches are generally dealt with as ELM. A standard treatment for gastric cancer with ELM has yet to be determined. Two phase Ⅱ studies of neoadjuvant chemotherapy followed by surgery showed that neoadjuvant chemotherapy with S-1 plus cisplatin followed by surgical resection with extended lymph node dissection could represent a treatment option for gastric cancer with ELM. However,many clinical questions remain unresolved,including the criteria for diagnosing ELM,optimal regime,number of courses and extent of lymph node dissection.
文摘BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
文摘BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic tumors.MMP-7 is expressed in the epithelial cells and in a variety of cancers including colon tumors.Plasma MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer pathology.AIM To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer pathology.METHODS Patients enrolled in a plasma bank for whom plasma was available were eligible.Plasma obtained from preoperative(Preop)and postoperative blood samples was used.Only colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were included.Late samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time points.Plasma MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in duplicate.RESULTS Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs preop levels.CONCLUSION MMP-2 levels are elevated for 5 wk and MMP-7 levels elevated for weeks 2-6.The etiology of these changes in unclear,trauma and wound healing likely play a role.These changes may promote residual tumor growth and metastasis.
文摘Although laparoscopic colectomy is commonly performed around the world,an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery.Thus,a certain sized skin incision is required to remove the resected colon.Here we report the case of a pure laparoscopic ileocecal resection which involves transanal specimen extraction.We present a case characterized by a laterally spreading type of tumor of the cecum.We performed a pure laparoscopic ileocecal resection and the resected specimen was removed transanally using colonoscopy.Intracorporeal functional anastomosis was then performed using a flexible linear stapling device under supporting barbed suture traction.The patient was discharged without complications on postoperative day 4.Laparoscopic colectomy performed with minimal incision could essentially increase the usage of this surgical technique.Although our method is restricted to flat or small lesions,we think it is a feasible and realistic solution for minimization of operative invasion because it involves specimen extraction through a natural orifice.
文摘The regenerating islet-derived members （Reg）, a group of small secretory proteins, which are involved in cell proliferation or differentiation in digestive organs, are upregulated in several gastrointestinal cancers, functioning as trophic or antiapoptotic factors. Regenerat- ing islet-derived type Ⅳ （RegⅣ）, a member of the Reg gene family, has been reported to be overexpressed in gastroenterological cancers. RegIV overexpression in tumor cells has been associated with carcinogen- esis, cell growth, survival and resistance to apoptosis. Cancer tissue expressing RegIV is generally associated with more malignant characteristics than that with- out such expression, and RegⅣ is considered a novel prognostic factor as well as diagnostic marker in some gastroenterological cancers. We previously investigated the expression levels of RegⅣ mRNA of 202 surgical colorectal cancer specimens with quantitative real-time reverse-transcriptase polymerase chain reaction and reported that a higher level of RegⅣ gene expression was a significant independent predictor of colorec- tal cancer. The biologic functions of RegⅣ protein in cancer tissue, associated with carcinogenesis, anti- apoptosis and invasiveness, are being elucidated by molecular investigations using transfection techniques or neutralizing antibodies of RegIV, and the feasibility of antibody therapy targeting RegIV is being assessed. These studies may lead to novel therapeutic strate- gies for gastroenterological cancers expressing RegⅣ. This review article summarizes the current information related to biological functions as well as clinical impor- tance of RegⅣ gene to clarify the significance of Reg~ expression in gastroenterological cancers.
基金Nn10 Program of Harbin Medical University Cancer Hospital,China,No.Nn10 PY 2017-03.
文摘BACKGROUND Through analyzing the data from a single institution in Northeast China,this study revealed the possible clinicopathologic characteristics that influence the prognosis of patients with gastric cancer(GC).AIM To evaluate the changing trends of clinicopathologic features and survival duration after surgery in patients with GC in Northeast China,which is a highprevalence area of GC.METHODS The study analyzed the difference in clinicopathologic features and survival duration after surgery of 5887 patients who were histologically diagnosed with GC at the Harbin Medical University Cancer Hospital.The study mainly analyzed the data in three periods,2000 to 2004(Phase 1),2005 to 2009(Phase 2),and 2010 to 2014(Phase 3).RESULTS Over time,the postoperative survival rate significantly increased from 2000 to 2014.In the past 15 years,compared with Phases 1 and 2,the tumor size was smaller in Phase 3(P<0.001),but the proportion of high-medium differentiated tumors increased(P<0.001).The proportion of early GC gradually increased from 3.9%to 14.4%(P<0.001).A surprising improvement was observed in the mean number of retrieved lymph nodes,ranging from 11.4 to 27.5(P<0.001).The overall 5-year survival rate increased from 24%in Phase 1 to 43.8%in Phase 3.Through multivariate analysis,it was found that age,tumor size,histologic type,tumor-node-metastasis stage,depth of invasion,lymph node metastasis,surgical approach,local infiltration,radical extent,number of retrieved lymph nodes,and age group were independent risk factors that influenced the prognosis of patients with GC.CONCLUSION The clinical features of GC in Northeast China changed during the observation period.The increasing detection of early GC and more standardized surgical treatment effectively prolonged lifetimes.
文摘Ischemic colitis is the most common type of intestinal ischemia. The etiology of this condition is multifactorial, and the diagnosis is based on a combination of clinical symptoms, as well as endoscopic and histological findings. Although conservative therapy is effective in most cases, surgery still plays a key role in the treatment of ischemic colitis. Here, we describe a case of a 73-year-old man in whom laparoscopy-assisted left colectomy was performed 80 d after the onset of ischemic colitis. He recovered completely after surgery, and the pathological findings were consistent with ischemic colitis. To the best of our knowledge, there are no detailed reports of laparoscopic surgery for chronic segmental stenotic ischemic colitis. We discussed the usefulness of laparoscopic surgery, comparing it with endoscopic treatment, and we propose an optimal treatment strategy from a viewpoint of stenosis length and duration of disease.
基金Supported by Department of General Surgery,Asahi General Hospital,I-1326,Asahi-shi,Chiba,Japan
文摘A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrastenhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel,suggestive of Meckel's diverticulum(MD) and a mesodiverticular band(MDB). After intestinal decompression,elective laparoscopic surgery was carried out. Using three 5-mm ports,MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel's diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman.
文摘Statins inhibit 3-hydroxy-3-methylglutaryl-CoA reductase,the rate-limiting enzyme of the mevalonate pathway,and are widely used as an effective and safe approach handle hypercholesterolemia.The mevalonate pathway is a vital metabolic pathway that uses acetyl-CoA to generate isoprenoids and sterols that are crucial to tumor growth and progression.Multiple studies have indicated that statins improve patient prognosis in various carcinomas.Basic research on the mechanisms underlying the antitumor effects of statins is underway.The development of new anti-cancer drugs is progressing,but increasing medical costs from drug development have become a major obstacle.Readily available,inexpensive and well-tolerated drugs like statins have not yet been successfully repurposed for cancer treatment.Identifying the cancer patients that may benefit from statins is key to improved patient treatment.This review summarizes recent advances in statin research in cancer and suggests important considerations for the clinical use of statins to improve outcomes for cancer patients.
基金supported by funding from“the Ministry of Science and Technology”in Taiwan,China(MOST 102-2314-B-037-043)
文摘Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.
