The landscape of hepatobiliary surgical education has undergone a significanttransformation with the integration of advanced technologies such as threedimensionalmodeling,virtual reality,augmented reality,and artifici...The landscape of hepatobiliary surgical education has undergone a significanttransformation with the integration of advanced technologies such as threedimensionalmodeling,virtual reality,augmented reality,and artificial intelligence.This review synthesizes recent advancements in surgical education,examiningthe role of these technologies in improving anatomical understanding,surgicalskill acquisition,and overall trainee engagement.Evidence from randomizedcontrolled trials,systematic reviews,and cohort studies shows that immersivetraining tools,including virtual reality,augmented reality,and haptic feedback,outperform traditional apprenticeship methods in fostering cognitive and psychomotorskills.Artificial intelligence applications provide real-time feedback,furtherenhancing learning efficiency.However,these technologies should complement,rather than replace,traditional hands-on training.Some challenges remain to beaddressed,such as high costs,infrastructure requirements,and limited long-termvalidation of these technologies.The review concludes that while these innovationsoffer promising educational benefits,further research is needed to standardizetheir application and evaluate their long-term impact on surgical outcomes.展开更多
Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy pe...Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.展开更多
Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and ...Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.展开更多
BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery o...BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery offers comparable safety and efficacy to open surgery,with added benefits in recovery outcomes.AIM To compare clinical outcomes between laparoscopic and open approaches in complex hepatolithiasis.METHODS This retrospective cohort study was conducted at Ningde Municipal Hospital,a tertiary care center,and included 80 patients with complex hepatolithiasis treated between January 2020 and August 2024.Patients were non-randomly allocated to laparoscopic(n=40)or open surgery(n=40)groups based on the treatment period.Clinical,intraoperative,and postoperative data were analyzed using appropriate parametric or nonparametric tests;categorical data were analyzed using χ^(2) or Fisher’s exact test.RESULTS Laparoscopic surgery was associated with a longer median operative time(250.0 minutes vs 207.0 minutes,P=0.003)but shorter postoperative hospital stay(9.0 days vs 14.0 days,P<0.001)compared to open surgery.Wound infection rates were significantly less frequent in the laparoscopic group(5.0%vs 22.5%,P=0.023).Stone clearance rates and overall complications were comparable.One case of perioperative mortality occurred in the open surgery cohort.CONCLUSION Laparoscopic surgery is a feasible and safe alternative to open surgery for complex hepatolithiasis,offering faster recovery and reduced wound-related complications.展开更多
Background:Despite advances in surgical treatment,high recurrence after surgery remains a challenge for patients with hepatocellular carcinoma(HCC).This study aimed to investigate the association between compliance to...Background:Despite advances in surgical treatment,high recurrence after surgery remains a challenge for patients with hepatocellular carcinoma(HCC).This study aimed to investigate the association between compliance to regular follow-up and long-term oncological outcomes among patients undergoing curative resection for HCC.Methods:This multicenter study included patients who underwent curative resection for early-stage HCC between January 2012 and December 2021 at 12 liver surgery centers.Patients were stratified into a regular follow-up group(follow-up every 2–3 months for the first 2 years and every 3–6 months thereafter)and an irregular/no follow-up group.Overall survival(OS),time to recurrence(TTR),and post-recurrence survival(PRS)were compared between the two groups.Results:Among 1544 patients,786(50.9%)underwent regular follow-up during postoperative follow-up.The regular follow-up group had better OS(median:113.4 vs.94.5 months,P=0.010)and PRS(median:37.9 vs.16.3 months,P<0.001)than the irregular/no follow-up group,although TTR was comparable(median:61.4 vs.66.2 months,P=0.161).Furthermore,patients in the regular follow-up group had a lower incidence of tumor beyond the Milan criteria at recurrence(41.6%vs.50.4%,P=0.013)and were more likely to receive curative treatments for recurrence(56.1%vs.49.3%,P=0.061).On multivariate analysis,compliance to regular follow-up was an independent factor associated with better OS[hazard ratio(HR)=0.777,95%confidence interval(CI):0.663–0.910,P=0.002]and PRS(HR=0.523,95%CI:0.428–0.638,P<0.001).Conclusions:Compliance to regular follow-up improved OS and PRS after curative resection for HCC,highlighting the importance of postoperative regular follow-up for early detection of recurrence and timely intervention.展开更多
Introduction With the continuous advancement of surgical technique,combined vascular resection has become increasingly common during complex surgical procedures.In such cases,ensuring the safe and effective reconstruc...Introduction With the continuous advancement of surgical technique,combined vascular resection has become increasingly common during complex surgical procedures.In such cases,ensuring the safe and effective reconstruction of blood vessels after resection is of paramount importance.When direct vascular reconstruction is not feasible,the application of vascular grafts becomes necessary to restore vascular continuity and function.Commonly employed vascular grafts in clinical practice include allogeneic graft vessels(AGVs),autologous vessels,and artificial vessels.Among these,AGVs offer distinct advantages particularly in its complex structures and satisfying histocompatibility,making it a valuable option for vascular reconstruction.展开更多
Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
Background:Cancer-related fatigue(CRF)is a common and debilitating symptom experienced by patients with advanced-stage cancer,especially those undergoing antitumor therapy.This study aimed to evaluate the efficacy and...Background:Cancer-related fatigue(CRF)is a common and debilitating symptom experienced by patients with advanced-stage cancer,especially those undergoing antitumor therapy.This study aimed to evaluate the efficacy and safety of Renshenguben(RSGB)oral solution,a ginseng-based traditional Chinese medicine,in alleviating CRF in patients with advanced hepatocellular carcinoma(HCC)receiving antitumor treatment.Methods:In this prospective,open-label,controlled,multicenter study,patients with advanced HCC at BCLC stage C and a brief fatigue inventory(BFI)score of≥4 were enrolled.Participants were assigned to the RSGB group(RSGB,10 mL twice daily)or the control group(with supportive care).Primary and secondary endpoints were the change in multidimensional fatigue inventory(MFI)score,and BFI and functional assessment of cancer therapy-hepatobiliary(FACT-Hep)scores at weeks 4 and 8 after enrollment.Adverse events(AEs)and toxicities were assessed.Results:A total of 409 participants were enrolled,with 206 assigned to the RSGB group.At week 4,there was a trend towards improvement,but the differences were not statistically significant.At week 8,the RSGB group exhibited a significantly lower MFI score(P<0.05)compared to the control group,indicating improved fatigue levels.Additionally,the RSGB group showed significantly greater decrease in BFI and FACT-Hep scores at week 8(P<0.05).Subgroup analyses among patients receiving various antitumor treatments showed similar results.Multivariate linear regression analyses revealed that the RSGB group experienced a significantly substantial decrease in MFI,BFI,and FACT-Hep scores at week 8.No serious drug-related AEs or toxicities were observed.Conclusions:RSGB oral solution effectively reduced CRF in patients with advanced HCC undergoing antitumor therapy over an eight-week period,with no discernible toxicities.These findings support the potential of RSGB oral solution as an adjunctive treatment for managing CRF in this patient population.展开更多
In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery.It investigates the potential mechanism of alcohol use disorder(AUD)following weight loss and ...In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery.It investigates the potential mechanism of alcohol use disorder(AUD)following weight loss and its future prospects.We are particularly interested in this issue.According to existing research,the occurrence of AUD is closely linked to social factors,and the prevalence of AUD varies across different regions.However,there are limited studies on bariatric surgery and postoperative AUD in the Asian population,leaving ample room for further re-search in this area.Additionally,we believe that postoperative follow-up and dietary management are crucial.A multi-system integrated approach to manage-ment is the future direction for treating obesity.展开更多
Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the hea...Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
Background:Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma(HCC).Based on age,sex,alpha-fetoprote...Background:Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma(HCC).Based on age,sex,alpha-fetoprotein(AFP),and protein induced by vitamin K absence II(PIVKA-II)with/without AFP-L3,ASAP and GALAD models are potential diagnostic panels.The diagnostic performances of these two panels were compared relative to HCC detection among patients with various etiologies of chronic liver diseases(CLDs).Methods:A multicenter case-control study recruited CLDs patients with and without HCC from 14 Chi-nese hospitals.The etiologies of CLDs included hepatitis B virus(HBV),hepatitis C virus(HCV),alcoholic liver disease(ALD),and nonalcoholic fatty liver disease(NAFLD).Using area under the receiver operating characteristic curve(AUC)values,the diagnostic performances of ASAP and GALAD models were com-pared to detect HCC among patients with various etiologies of CLDs.Results:Among 248 HCC patients and 722 CLD controls,the ASAP model demonstrated the highest AUC(0.886)to detect HCC at any stage,outperforming the GALAD model(0.853,P=0.001),as well as any individual biomarker(0.687-0.799,all P<0.001).In the subgroup analysis of various CLDs etiologies,the ASAP model outperformed the GALAD model to HCC independent of CLDs etiology.In addition,the ASAP model performed better in detecting early-stage(BCLC stage 0/A)HCC versus the GALAD model.Conclusions:Despite using one less laboratory variable(AFP-L3),the ASAP model demonstrated better diagnostic performance than the GALAD model to detect all-stage HCC among patients with various eti-ologies of CLDs-related HCC.展开更多
BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in de...BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in detecting precancerous lesions.In contrast,real-time computer-aided detection(CAD)systems enhanced by artificial intelligence(AI)systems,although they may increase unnecessary medical procedures,can provide immediate feedback during examination,thereby improving the accuracy of lesion detection.This article aims to conduct a meta-analysis of the diagnostic performance of CAD systems in identifying precancerous lesions of UGI tract cancer during esophagogastroduodenoscopy(EGD),evaluate their potential clinical application value,and determine the direction for further research.AIM To investigate the improvement of the efficiency of EGD examination by the realtime AI-enabled real-time CAD system(AI-CAD)system.METHODS PubMed,EMBASE,Web of Science and Cochrane Library databases were searched by two independent reviewers to retrieve literature with per-patient analysis with a deadline up until April 2025.A meta-analysis was performed with R Studio software(R4.5.0).A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity.RESULTS The initial search identified 802 articles.According to the inclusion criteria,2113 patients from 10 studies were included in this meta-analysis.The pooled accuracy difference,logarithmic difference of diagnostic odds ratios,sensitivity,specificity and the area under the summary receiver operating characteristic curve(area under the curve)of both AI group and endoscopist group for detecting precancerous lesion were 0.16(95%CI:0.12-0.20),-0.19(95%CI:-0.75-0.37),0.89(95%CI:0.85-0.92,AI group),0.67(95%CI:0.63-0.71,endoscopist group),0.89(95%CI:0.84-0.93,AI group),0.77(95%CI:0.70-0.83,endoscopist group),0.928(95%CI:0.841-0.948,AI group),0.722(95%CI:0.677-0.821,endoscopist group),respectively.CONCLUSION The present studies further provide evidence that the AI-CAD is a reliable endoscopic diagnostic tool that can be used to assist endoscopists in detection of precancerous lesions in the UGI tract.It may be introduced on a large scale for clinical application to enhance the accuracy of detecting precancerous lesions in the UGI tract.展开更多
Hepatocellular carcinoma(HCC)remains one of the leading causes of cancerrelated mortality worldwide,with approximately 35%-50%of patients presenting concurrent portal vein tumor thrombus(PVTT).Untreated HCC patients w...Hepatocellular carcinoma(HCC)remains one of the leading causes of cancerrelated mortality worldwide,with approximately 35%-50%of patients presenting concurrent portal vein tumor thrombus(PVTT).Untreated HCC patients with PVTT have a median survival of only 2.5-4 months,posing significant challenges to liver transplantation outcomes.Downstaging therapies play a pivotal role in improving transplant eligibility rates and optimizing post-transplant outcomes.This systematic review summarizes current downstaging therapies,including transarterial chemoembolization,transarterial radioembolization,proton beam therapy,intraportal radiofrequency ablation,and other novel systemic modalities.In-depth analysis of their clinical applications,efficacy,and safety profiles were performed.Furthermore,the review critically evaluates future challenges,including optimized downstaging criteria,personalized and precision medicine approaches,and novel biomaterials for localized therapy for downstaged HCC patients.This review provides comprehensive theoretical and practical insights into pre-transplant downstaging for HCC with PVTT,while highlighting critical avenues for future research and clinical decision-making.展开更多
Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as s...Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as selective internal radiation therapy,has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma.This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function.This editorial provides a comprehensive overview of the mechanism,technical considerations,and clinical efficacy of radioembolization in advanced HCC.Landmark trials such as SARAH,SIRveNIB,and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib,particularly when personalized dosimetry is applied.Radioembolization contributes to tumor downstaging,transplant bridging,and improved disease control rates.The integration of radioembolization with systemic therapies,including immune checkpoint inhibitors and tyrosine kinase inhibitors,represents a key area of ongoing research.Despite current challenges such as microsphere heterogeneity,dosimetry standardization,and limited accessibility,emerging innovations in imaging,isotopes,and personalized treatment strategies are expected to refine its application.Overall,radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.展开更多
This editorial discusses Thompson et al's original article,which is published in the most recent edition of the World Journal of Clinical Oncology and sheds critical light on the intertwined issues of health anxie...This editorial discusses Thompson et al's original article,which is published in the most recent edition of the World Journal of Clinical Oncology and sheds critical light on the intertwined issues of health anxiety and work loss in individuals diagnosed with serrated polyposis syndrome(SPS).SPS is rare,characterized by the development of multiple serrated colorectal polyps.This editorial provides an overview of SPS,including its pathophysiology,clinical presentation,diagnostic criteria,management strategies,and the psychosocial impact.SPS is linked to molecular alterations,which drive carcinogenesis.Colonoscopy and histological analysis are used for diagnosis.Genetic testing is also considered where there is a family history.Quality of life can be greatly impacted by the psychosocial effects of SPS,especially health anxiety.Further understanding of the molecular mechanisms and creating individualized surveillance are required.展开更多
BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical manage...BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical management.AIM To evaluate and analyze the 3-year survival outcomes and associated risk factors in patients with primary gastric cancer who underwent laparoscopic surgery.METHODS A total of 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021 were enrolled.These patients were monitored for 3 years,and their survival statuses were recorded.Patients were categorized into survival and non-survival groups based on their outcomes.Data on sex,age,American Society of Anesthesiologists classification,tumor size,depth of invasion,postoperative adjuvant radio-chemotherapy,postoperative carcinoembryonic antigen(CEA)levels,and other clinical parameters were collected and contrasted across groups to identify factors impacting 3-year survival.RESULTS After a 3-year follow-up,the survival rate was 73.00%(73 of 100 patients).No significant differences were observed in sex,tumor location,alcohol consumption,smoking status,tumor differentiation,histological type,intraoperative blood loss,or surgical outcomes between patients with varying prognoses(P>0.05).However,notable disparities were found in age,American Society of Anesthesiologists classification,tumor-node-metastasis(TNM)stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications(P<0.05).Multivariate logistic regression analysis identified age,TNM stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery(P<0.05).CONCLUSION The 3-year survival outcome for patients undergoing laparoscopic surgery for primary gastric cancer was 73.00%.Key determinants of survival included age,TNM stage,tumor size,depth of invasion,and lymph node metastasis.This analysis of 3-year survival and its influencing factors offers novel perspectives for optimizing clinical interventions in patients with primary gastric cancer treated via laparoscopic surgery.展开更多
Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progre...Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progression of non-alcoholic fatty liver disease.This article examines the current understanding of this association,focusing on mechanisms such as altered bile acid metabolism,gut microbiota dysbiosis,and changes in lipid homeostasis.It addresses resolved challenges,including short-term metabolic effects,and highlights key unresolved questions,such as the long-term impact on liver health and specific at-risk populations.Finally,the review discusses future research directions and practical strategies for monitoring and managing liver health in patient’s post-cholecystectomy,aiming to improve outcomes and guide clinical practice.展开更多
Pancreatic ductal adenocarcinoma(PDAC)remains one of the most lethal ma-lignancies with limited treatment efficacy.Advances in precision oncology,enabled by next-generation sequencing,have highlighted key molecular ta...Pancreatic ductal adenocarcinoma(PDAC)remains one of the most lethal ma-lignancies with limited treatment efficacy.Advances in precision oncology,enabled by next-generation sequencing,have highlighted key molecular targets.Kirsten rat sarcoma viral oncogene homolog mutations,present in up to 90%of cases,drive aggressive biology,though most variants remain undruggable;allele-specific inhibitors and exosome-based RNA interference are under exploration.Breast cancer susceptibility gene 1/2 mutations occur in 4%-7%of patients,con-ferring sensitivity to platinum agents and poly(ADP-ribose)polymerase inhi-bitors.Other rare but actionable alterations-such as v-raf murine sarcoma viral oncogene homolog B1(V600),neurotrophic tyrosine receptor kinase,fibroblast growth factor receptor 2,and RET fusions-show benefit in tumor-agnostic trials,broadening options for selected subgroups.Immunotherapy is limited,as high tumor mutational burden and mismatch repair deficiency are uncommon in PDAC,though predictive when present.Co-mutations in tumor protein p53,cyclin-dependent kinase inhibitor 2A,and SMAD4 further stratify prognosis and influence therapy response.Cross-cancer analyses underscore the necessity of PDAC-specific strategies despite shared genomic drivers.Collectively,these insights support routine germline and somatic testing,enrollment in biomarker-matched trials,and rational combination strategies,establishing molecular profiling as central to advancing precision treatment in pancreatic cancer.展开更多
BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports ofte...BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports often have complex research directions,and the focal points frequently change.Therefore,a comprehensive review and organization of the literature in this field is necessary.AIM To summarize current research,predict future hotspots and trends,and provide insights for MIPD development.METHODS To conduct the study,the Web of Science Core Collection was searched for relevant articles.The analysis focused on the top 100 articles in the field.Two widely used bibliometric tools,CiteSpace and VOSviewer,were used to examine various aspects,including research directions,authors,countries,institutions,journals,and keywords.RESULTS The top 100 articles were published between 2005 and 2022,with the majority originating from the United States(n=51).Among the contributing institutions,Pancreas Center of the University of Chicago and the Health System of the University of Chicago had the highest number of publications(n=17).In terms of individual authors,“Zeh HJ”and“Zureikat AH”led with 13 articles each.The high-frequency keywords in the literature encompassed three main areas:Surgical modality,perioperative outcomes,and the learning curve.These keywords were further categorized into seven primary clusters,with the largest being“laparoscopic pancreaticoduodenectomy”.CONCLUSION The most influential studies predominantly originate from the United States,and there is growing interest in robotic surgery.Despite MIPD’s potential benefits,further research is required to address technical challenges and improve outcomes.展开更多
文摘The landscape of hepatobiliary surgical education has undergone a significanttransformation with the integration of advanced technologies such as threedimensionalmodeling,virtual reality,augmented reality,and artificial intelligence.This review synthesizes recent advancements in surgical education,examiningthe role of these technologies in improving anatomical understanding,surgicalskill acquisition,and overall trainee engagement.Evidence from randomizedcontrolled trials,systematic reviews,and cohort studies shows that immersivetraining tools,including virtual reality,augmented reality,and haptic feedback,outperform traditional apprenticeship methods in fostering cognitive and psychomotorskills.Artificial intelligence applications provide real-time feedback,furtherenhancing learning efficiency.However,these technologies should complement,rather than replace,traditional hands-on training.Some challenges remain to beaddressed,such as high costs,infrastructure requirements,and limited long-termvalidation of these technologies.The review concludes that while these innovationsoffer promising educational benefits,further research is needed to standardizetheir application and evaluate their long-term impact on surgical outcomes.
文摘Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.
文摘Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders,with probiotics playing a pivotal role in maintaining bacterial equilibrium.Surgical preparations,trauma,and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora,prompting interest in the potential role of probiotics in postoperative recovery.Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis,revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility,offering a novel therapeutic avenue for accelerated postoperative recovery.This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery.Within the framework of enhanced recovery after surgery,the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.
基金Supported by the Fujian Natural Science Foundation,China,No.2021J011164。
文摘BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery offers comparable safety and efficacy to open surgery,with added benefits in recovery outcomes.AIM To compare clinical outcomes between laparoscopic and open approaches in complex hepatolithiasis.METHODS This retrospective cohort study was conducted at Ningde Municipal Hospital,a tertiary care center,and included 80 patients with complex hepatolithiasis treated between January 2020 and August 2024.Patients were non-randomly allocated to laparoscopic(n=40)or open surgery(n=40)groups based on the treatment period.Clinical,intraoperative,and postoperative data were analyzed using appropriate parametric or nonparametric tests;categorical data were analyzed using χ^(2) or Fisher’s exact test.RESULTS Laparoscopic surgery was associated with a longer median operative time(250.0 minutes vs 207.0 minutes,P=0.003)but shorter postoperative hospital stay(9.0 days vs 14.0 days,P<0.001)compared to open surgery.Wound infection rates were significantly less frequent in the laparoscopic group(5.0%vs 22.5%,P=0.023).Stone clearance rates and overall complications were comparable.One case of perioperative mortality occurred in the open surgery cohort.CONCLUSION Laparoscopic surgery is a feasible and safe alternative to open surgery for complex hepatolithiasis,offering faster recovery and reduced wound-related complications.
基金This study was supported by grants from the National Natural Science Foundation of China(82425049,81972726 and 82273074)Dawn Project Foundation of Shanghai(21SG36)+4 种基金Shanghai Health and Hygiene Discipline Leader Project(2022XD001)Shanghai Out-standing Academic Leader Program(23XD1424900)the Natural Science Foundation of Shanghai(22ZR1477900)Shanghai Science and Technology Committee Rising-Star Program(22QA1411600)the Special Clinical Project of Shanghai Municipal Health Com-mission(20244Y0233)。
文摘Background:Despite advances in surgical treatment,high recurrence after surgery remains a challenge for patients with hepatocellular carcinoma(HCC).This study aimed to investigate the association between compliance to regular follow-up and long-term oncological outcomes among patients undergoing curative resection for HCC.Methods:This multicenter study included patients who underwent curative resection for early-stage HCC between January 2012 and December 2021 at 12 liver surgery centers.Patients were stratified into a regular follow-up group(follow-up every 2–3 months for the first 2 years and every 3–6 months thereafter)and an irregular/no follow-up group.Overall survival(OS),time to recurrence(TTR),and post-recurrence survival(PRS)were compared between the two groups.Results:Among 1544 patients,786(50.9%)underwent regular follow-up during postoperative follow-up.The regular follow-up group had better OS(median:113.4 vs.94.5 months,P=0.010)and PRS(median:37.9 vs.16.3 months,P<0.001)than the irregular/no follow-up group,although TTR was comparable(median:61.4 vs.66.2 months,P=0.161).Furthermore,patients in the regular follow-up group had a lower incidence of tumor beyond the Milan criteria at recurrence(41.6%vs.50.4%,P=0.013)and were more likely to receive curative treatments for recurrence(56.1%vs.49.3%,P=0.061).On multivariate analysis,compliance to regular follow-up was an independent factor associated with better OS[hazard ratio(HR)=0.777,95%confidence interval(CI):0.663–0.910,P=0.002]and PRS(HR=0.523,95%CI:0.428–0.638,P<0.001).Conclusions:Compliance to regular follow-up improved OS and PRS after curative resection for HCC,highlighting the importance of postoperative regular follow-up for early detection of recurrence and timely intervention.
基金supported by grants from the Research and Demonstration Application of Clinical Diagnostic and Treatment Techniques in the Capital(Z211100002921025)Capital’s Funds for Health Improvement and Research(CFH2020-2-2036)。
文摘Introduction With the continuous advancement of surgical technique,combined vascular resection has become increasingly common during complex surgical procedures.In such cases,ensuring the safe and effective reconstruction of blood vessels after resection is of paramount importance.When direct vascular reconstruction is not feasible,the application of vascular grafts becomes necessary to restore vascular continuity and function.Commonly employed vascular grafts in clinical practice include allogeneic graft vessels(AGVs),autologous vessels,and artificial vessels.Among these,AGVs offer distinct advantages particularly in its complex structures and satisfying histocompatibility,making it a valuable option for vascular reconstruction.
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
基金This study was supported by grants from the National Natural Science Foundation of China(81972726,82273074 and 82372813)Dawn Project Foundation of Shanghai(21SG36)+2 种基金Shanghai Health Academic Leader Program(2022XD001)the Natural Science Foundation of Shanghai(22ZR1477900)Adjunct Talent Fund of Zhejiang Provincial People’s Hospital(2021-YT).
文摘Background:Cancer-related fatigue(CRF)is a common and debilitating symptom experienced by patients with advanced-stage cancer,especially those undergoing antitumor therapy.This study aimed to evaluate the efficacy and safety of Renshenguben(RSGB)oral solution,a ginseng-based traditional Chinese medicine,in alleviating CRF in patients with advanced hepatocellular carcinoma(HCC)receiving antitumor treatment.Methods:In this prospective,open-label,controlled,multicenter study,patients with advanced HCC at BCLC stage C and a brief fatigue inventory(BFI)score of≥4 were enrolled.Participants were assigned to the RSGB group(RSGB,10 mL twice daily)or the control group(with supportive care).Primary and secondary endpoints were the change in multidimensional fatigue inventory(MFI)score,and BFI and functional assessment of cancer therapy-hepatobiliary(FACT-Hep)scores at weeks 4 and 8 after enrollment.Adverse events(AEs)and toxicities were assessed.Results:A total of 409 participants were enrolled,with 206 assigned to the RSGB group.At week 4,there was a trend towards improvement,but the differences were not statistically significant.At week 8,the RSGB group exhibited a significantly lower MFI score(P<0.05)compared to the control group,indicating improved fatigue levels.Additionally,the RSGB group showed significantly greater decrease in BFI and FACT-Hep scores at week 8(P<0.05).Subgroup analyses among patients receiving various antitumor treatments showed similar results.Multivariate linear regression analyses revealed that the RSGB group experienced a significantly substantial decrease in MFI,BFI,and FACT-Hep scores at week 8.No serious drug-related AEs or toxicities were observed.Conclusions:RSGB oral solution effectively reduced CRF in patients with advanced HCC undergoing antitumor therapy over an eight-week period,with no discernible toxicities.These findings support the potential of RSGB oral solution as an adjunctive treatment for managing CRF in this patient population.
文摘In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery.It investigates the potential mechanism of alcohol use disorder(AUD)following weight loss and its future prospects.We are particularly interested in this issue.According to existing research,the occurrence of AUD is closely linked to social factors,and the prevalence of AUD varies across different regions.However,there are limited studies on bariatric surgery and postoperative AUD in the Asian population,leaving ample room for further re-search in this area.Additionally,we believe that postoperative follow-up and dietary management are crucial.A multi-system integrated approach to manage-ment is the future direction for treating obesity.
文摘Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
基金supported by grants from the National Natural Science Foundation of China(81972726 and 82273074)Abbott Diagnostics(ADD-China-2016).
文摘Background:Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma(HCC).Based on age,sex,alpha-fetoprotein(AFP),and protein induced by vitamin K absence II(PIVKA-II)with/without AFP-L3,ASAP and GALAD models are potential diagnostic panels.The diagnostic performances of these two panels were compared relative to HCC detection among patients with various etiologies of chronic liver diseases(CLDs).Methods:A multicenter case-control study recruited CLDs patients with and without HCC from 14 Chi-nese hospitals.The etiologies of CLDs included hepatitis B virus(HBV),hepatitis C virus(HCV),alcoholic liver disease(ALD),and nonalcoholic fatty liver disease(NAFLD).Using area under the receiver operating characteristic curve(AUC)values,the diagnostic performances of ASAP and GALAD models were com-pared to detect HCC among patients with various etiologies of CLDs.Results:Among 248 HCC patients and 722 CLD controls,the ASAP model demonstrated the highest AUC(0.886)to detect HCC at any stage,outperforming the GALAD model(0.853,P=0.001),as well as any individual biomarker(0.687-0.799,all P<0.001).In the subgroup analysis of various CLDs etiologies,the ASAP model outperformed the GALAD model to HCC independent of CLDs etiology.In addition,the ASAP model performed better in detecting early-stage(BCLC stage 0/A)HCC versus the GALAD model.Conclusions:Despite using one less laboratory variable(AFP-L3),the ASAP model demonstrated better diagnostic performance than the GALAD model to detect all-stage HCC among patients with various eti-ologies of CLDs-related HCC.
文摘BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in detecting precancerous lesions.In contrast,real-time computer-aided detection(CAD)systems enhanced by artificial intelligence(AI)systems,although they may increase unnecessary medical procedures,can provide immediate feedback during examination,thereby improving the accuracy of lesion detection.This article aims to conduct a meta-analysis of the diagnostic performance of CAD systems in identifying precancerous lesions of UGI tract cancer during esophagogastroduodenoscopy(EGD),evaluate their potential clinical application value,and determine the direction for further research.AIM To investigate the improvement of the efficiency of EGD examination by the realtime AI-enabled real-time CAD system(AI-CAD)system.METHODS PubMed,EMBASE,Web of Science and Cochrane Library databases were searched by two independent reviewers to retrieve literature with per-patient analysis with a deadline up until April 2025.A meta-analysis was performed with R Studio software(R4.5.0).A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity.RESULTS The initial search identified 802 articles.According to the inclusion criteria,2113 patients from 10 studies were included in this meta-analysis.The pooled accuracy difference,logarithmic difference of diagnostic odds ratios,sensitivity,specificity and the area under the summary receiver operating characteristic curve(area under the curve)of both AI group and endoscopist group for detecting precancerous lesion were 0.16(95%CI:0.12-0.20),-0.19(95%CI:-0.75-0.37),0.89(95%CI:0.85-0.92,AI group),0.67(95%CI:0.63-0.71,endoscopist group),0.89(95%CI:0.84-0.93,AI group),0.77(95%CI:0.70-0.83,endoscopist group),0.928(95%CI:0.841-0.948,AI group),0.722(95%CI:0.677-0.821,endoscopist group),respectively.CONCLUSION The present studies further provide evidence that the AI-CAD is a reliable endoscopic diagnostic tool that can be used to assist endoscopists in detection of precancerous lesions in the UGI tract.It may be introduced on a large scale for clinical application to enhance the accuracy of detecting precancerous lesions in the UGI tract.
文摘Hepatocellular carcinoma(HCC)remains one of the leading causes of cancerrelated mortality worldwide,with approximately 35%-50%of patients presenting concurrent portal vein tumor thrombus(PVTT).Untreated HCC patients with PVTT have a median survival of only 2.5-4 months,posing significant challenges to liver transplantation outcomes.Downstaging therapies play a pivotal role in improving transplant eligibility rates and optimizing post-transplant outcomes.This systematic review summarizes current downstaging therapies,including transarterial chemoembolization,transarterial radioembolization,proton beam therapy,intraportal radiofrequency ablation,and other novel systemic modalities.In-depth analysis of their clinical applications,efficacy,and safety profiles were performed.Furthermore,the review critically evaluates future challenges,including optimized downstaging criteria,personalized and precision medicine approaches,and novel biomaterials for localized therapy for downstaged HCC patients.This review provides comprehensive theoretical and practical insights into pre-transplant downstaging for HCC with PVTT,while highlighting critical avenues for future research and clinical decision-making.
文摘Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as selective internal radiation therapy,has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma.This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function.This editorial provides a comprehensive overview of the mechanism,technical considerations,and clinical efficacy of radioembolization in advanced HCC.Landmark trials such as SARAH,SIRveNIB,and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib,particularly when personalized dosimetry is applied.Radioembolization contributes to tumor downstaging,transplant bridging,and improved disease control rates.The integration of radioembolization with systemic therapies,including immune checkpoint inhibitors and tyrosine kinase inhibitors,represents a key area of ongoing research.Despite current challenges such as microsphere heterogeneity,dosimetry standardization,and limited accessibility,emerging innovations in imaging,isotopes,and personalized treatment strategies are expected to refine its application.Overall,radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.
文摘This editorial discusses Thompson et al's original article,which is published in the most recent edition of the World Journal of Clinical Oncology and sheds critical light on the intertwined issues of health anxiety and work loss in individuals diagnosed with serrated polyposis syndrome(SPS).SPS is rare,characterized by the development of multiple serrated colorectal polyps.This editorial provides an overview of SPS,including its pathophysiology,clinical presentation,diagnostic criteria,management strategies,and the psychosocial impact.SPS is linked to molecular alterations,which drive carcinogenesis.Colonoscopy and histological analysis are used for diagnosis.Genetic testing is also considered where there is a family history.Quality of life can be greatly impacted by the psychosocial effects of SPS,especially health anxiety.Further understanding of the molecular mechanisms and creating individualized surveillance are required.
文摘BACKGROUND This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery,providing meaningful guidance for clinical management.AIM To evaluate and analyze the 3-year survival outcomes and associated risk factors in patients with primary gastric cancer who underwent laparoscopic surgery.METHODS A total of 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021 were enrolled.These patients were monitored for 3 years,and their survival statuses were recorded.Patients were categorized into survival and non-survival groups based on their outcomes.Data on sex,age,American Society of Anesthesiologists classification,tumor size,depth of invasion,postoperative adjuvant radio-chemotherapy,postoperative carcinoembryonic antigen(CEA)levels,and other clinical parameters were collected and contrasted across groups to identify factors impacting 3-year survival.RESULTS After a 3-year follow-up,the survival rate was 73.00%(73 of 100 patients).No significant differences were observed in sex,tumor location,alcohol consumption,smoking status,tumor differentiation,histological type,intraoperative blood loss,or surgical outcomes between patients with varying prognoses(P>0.05).However,notable disparities were found in age,American Society of Anesthesiologists classification,tumor-node-metastasis(TNM)stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications(P<0.05).Multivariate logistic regression analysis identified age,TNM stage,tumor size,depth of invasion,lymph node metastasis,lymph node dissection,postoperative adjuvant radio-chemotherapy,postoperative CEA levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery(P<0.05).CONCLUSION The 3-year survival outcome for patients undergoing laparoscopic surgery for primary gastric cancer was 73.00%.Key determinants of survival included age,TNM stage,tumor size,depth of invasion,and lymph node metastasis.This analysis of 3-year survival and its influencing factors offers novel perspectives for optimizing clinical interventions in patients with primary gastric cancer treated via laparoscopic surgery.
文摘Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progression of non-alcoholic fatty liver disease.This article examines the current understanding of this association,focusing on mechanisms such as altered bile acid metabolism,gut microbiota dysbiosis,and changes in lipid homeostasis.It addresses resolved challenges,including short-term metabolic effects,and highlights key unresolved questions,such as the long-term impact on liver health and specific at-risk populations.Finally,the review discusses future research directions and practical strategies for monitoring and managing liver health in patient’s post-cholecystectomy,aiming to improve outcomes and guide clinical practice.
文摘Pancreatic ductal adenocarcinoma(PDAC)remains one of the most lethal ma-lignancies with limited treatment efficacy.Advances in precision oncology,enabled by next-generation sequencing,have highlighted key molecular targets.Kirsten rat sarcoma viral oncogene homolog mutations,present in up to 90%of cases,drive aggressive biology,though most variants remain undruggable;allele-specific inhibitors and exosome-based RNA interference are under exploration.Breast cancer susceptibility gene 1/2 mutations occur in 4%-7%of patients,con-ferring sensitivity to platinum agents and poly(ADP-ribose)polymerase inhi-bitors.Other rare but actionable alterations-such as v-raf murine sarcoma viral oncogene homolog B1(V600),neurotrophic tyrosine receptor kinase,fibroblast growth factor receptor 2,and RET fusions-show benefit in tumor-agnostic trials,broadening options for selected subgroups.Immunotherapy is limited,as high tumor mutational burden and mismatch repair deficiency are uncommon in PDAC,though predictive when present.Co-mutations in tumor protein p53,cyclin-dependent kinase inhibitor 2A,and SMAD4 further stratify prognosis and influence therapy response.Cross-cancer analyses underscore the necessity of PDAC-specific strategies despite shared genomic drivers.Collectively,these insights support routine germline and somatic testing,enrollment in biomarker-matched trials,and rational combination strategies,establishing molecular profiling as central to advancing precision treatment in pancreatic cancer.
基金Supported by the Project of the Hospital Management of the General Hospital of Western Theater Command,No.2024-YGLC-A01.
文摘BACKGROUND Minimally invasive pancreaticoduodenectomy(MIPD)is considered one of the most complex procedures in general surgery.The number of articles on MIPD has been increasing annually.However,published reports often have complex research directions,and the focal points frequently change.Therefore,a comprehensive review and organization of the literature in this field is necessary.AIM To summarize current research,predict future hotspots and trends,and provide insights for MIPD development.METHODS To conduct the study,the Web of Science Core Collection was searched for relevant articles.The analysis focused on the top 100 articles in the field.Two widely used bibliometric tools,CiteSpace and VOSviewer,were used to examine various aspects,including research directions,authors,countries,institutions,journals,and keywords.RESULTS The top 100 articles were published between 2005 and 2022,with the majority originating from the United States(n=51).Among the contributing institutions,Pancreas Center of the University of Chicago and the Health System of the University of Chicago had the highest number of publications(n=17).In terms of individual authors,“Zeh HJ”and“Zureikat AH”led with 13 articles each.The high-frequency keywords in the literature encompassed three main areas:Surgical modality,perioperative outcomes,and the learning curve.These keywords were further categorized into seven primary clusters,with the largest being“laparoscopic pancreaticoduodenectomy”.CONCLUSION The most influential studies predominantly originate from the United States,and there is growing interest in robotic surgery.Despite MIPD’s potential benefits,further research is required to address technical challenges and improve outcomes.
