Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics cl...Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.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 Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains ...BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.展开更多
Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypert...Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.展开更多
BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outc...BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.展开更多
Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectom...Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.展开更多
BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due ...BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due to trauma,infection,and posto-perative stress.In the Enhanced Recovery After Surgery(ERAS)protocol,early enteral nutrition is a key strategy for promoting postoperative recovery.Com-pared with parenteral nutrition,enteral nutrition more effectively meets the physiological needs of the GI system,promotes the recovery of gut function,and reduces the risk of GI infections.AIM To evaluate the clinical efficacy of early enteral nutrition support in patients undergoing GP repair within the ERAS protocol.METHODS This retrospective study analyzed 66 patients who underwent GP repair.Patients were divided into a control group(n=32),managed with a traditional nutritional regimen,primarily consisting of total parenteral nutrition;and an observation group(n=34),which included those who received early enteral nutrition support as part of the ERAS protocol.This study examined the time to first postoperative flatus and bowel movement,changes in nutritional and immune function,inflam-matory markers on postoperative days 1 and 5,and adverse reactions.RESULTS The observation group had significantly shorter times to the first postoperative flatus and bowel movement than the control group(P<0.05).On postoperative day 5,the observation group demonstrated higher nutritional and immune function levels than the control group(P<0.05),while C-reactive protein levels were significantly lower(P<0.05).The overall incidence of adverse reactions in the observation group was 8.82%(3/34),which was lower than the 28.13%(9/32)observed in the control group(P<0.05).CONCLUSION Early enteral nutritional support facilitates GI recovery after GP repair.It improves nutritional status,enhances immune function,and attenuates inflammatory responses while also demonstrating a favorable safety profile.展开更多
In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyan...In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.展开更多
Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently b...Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice be...BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.展开更多
BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)inc...BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surger...Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.展开更多
BACKGROUND As artificial intelligence(AI)continues to expand across medical specialties,its application in medical imaging within plastic and reconstructive surgery(PRS)remains limited in the literature.Imaging plays ...BACKGROUND As artificial intelligence(AI)continues to expand across medical specialties,its application in medical imaging within plastic and reconstructive surgery(PRS)remains limited in the literature.Imaging plays a critical role in surgical planning,intraoperative decision-making,and postoperative monitoring in PRS,presenting an opportunity for AI to enhance clinical outcomes.AIM To evaluate the current applications of AI in medical imaging for plastic surgery,with a focus on its use in preoperative planning,intraoperative guidance,and postoperative monitoring.METHODS A literature search was conducted using MEDLINE,EMBASE,ScienceDirect,and OVID up to February 2025.Studies were included based on relevance to AI use in plastic surgery imaging.Extracted data included AI modality,surgical context,outcomes,and limitations.The search followed PRISMA guidelines and was registered with PROSPERO(CRD420251008741).RESULTS AI tools have improved preoperative planning through three-dimensional vascular mapping,augmented reality,and thermographic imaging.Intraoperatively,AI-enabled navigation and robotic systems have increased surgical precision.Postoperative AI applications,including deep learning algorithms and sensorbased monitoring,support early complication detection and wound healing assessment.However,persistent barriers include data variability,model generalizability,surgeon unfamiliarity,and lack of regulatory standards.CONCLUSION AI-driven imaging technologies show promise in enhancing decision-making and outcomes in PRS.To ensure safe clinical integration,future efforts must focus on structured validation,standardization,and ethical oversight.展开更多
Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although t...Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.展开更多
Background: Missions organized by international societies and humanitarian organizations play a significant role in saving many patients’ lives and improving their quality of life, despite the surrounding frustrating...Background: Missions organized by international societies and humanitarian organizations play a significant role in saving many patients’ lives and improving their quality of life, despite the surrounding frustrating conditions. Methods: A team of plastic surgery volunteers was sent to Yemen by the KSHARC. Results: A successful mission was performed on 62 patients who underwent surgery, with more than 900 patients examined and receiving appropriate medications. Conclusion: Missions in disaster-affected areas are of great importance. The role of missions and humanitarian organizations should be empowered.展开更多
基金supported by the Neurosurgery Pain Research Institute at Johns Hopkins University and by the Lehner Family Foundation.
文摘Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
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.
文摘BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
文摘Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.
文摘BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.
文摘Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
文摘BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due to trauma,infection,and posto-perative stress.In the Enhanced Recovery After Surgery(ERAS)protocol,early enteral nutrition is a key strategy for promoting postoperative recovery.Com-pared with parenteral nutrition,enteral nutrition more effectively meets the physiological needs of the GI system,promotes the recovery of gut function,and reduces the risk of GI infections.AIM To evaluate the clinical efficacy of early enteral nutrition support in patients undergoing GP repair within the ERAS protocol.METHODS This retrospective study analyzed 66 patients who underwent GP repair.Patients were divided into a control group(n=32),managed with a traditional nutritional regimen,primarily consisting of total parenteral nutrition;and an observation group(n=34),which included those who received early enteral nutrition support as part of the ERAS protocol.This study examined the time to first postoperative flatus and bowel movement,changes in nutritional and immune function,inflam-matory markers on postoperative days 1 and 5,and adverse reactions.RESULTS The observation group had significantly shorter times to the first postoperative flatus and bowel movement than the control group(P<0.05).On postoperative day 5,the observation group demonstrated higher nutritional and immune function levels than the control group(P<0.05),while C-reactive protein levels were significantly lower(P<0.05).The overall incidence of adverse reactions in the observation group was 8.82%(3/34),which was lower than the 28.13%(9/32)observed in the control group(P<0.05).CONCLUSION Early enteral nutritional support facilitates GI recovery after GP repair.It improves nutritional status,enhances immune function,and attenuates inflammatory responses while also demonstrating a favorable safety profile.
文摘In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.
基金supported by grants from the Beijing Hospitals Authority Youth Program (12022B4010)BTCH Young Talent En-lightenment Program (2024QMRC24)CAMS Innovation Fund for Medical Sciences (2019-I2M-5–056)。
文摘Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
基金Bethune Charitable Foundation Project,No.HZB-20190528-10Natural Science Foundation of Fujian Province,No.2020J011230.
文摘BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.
基金Supported by The Key Research and Development Program of Anhui Province of China,No.1804h08020273The Key Research Project of Health Commission of Anhui Province of China,No.AHWJ2022a016.
文摘BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.
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Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.
文摘BACKGROUND As artificial intelligence(AI)continues to expand across medical specialties,its application in medical imaging within plastic and reconstructive surgery(PRS)remains limited in the literature.Imaging plays a critical role in surgical planning,intraoperative decision-making,and postoperative monitoring in PRS,presenting an opportunity for AI to enhance clinical outcomes.AIM To evaluate the current applications of AI in medical imaging for plastic surgery,with a focus on its use in preoperative planning,intraoperative guidance,and postoperative monitoring.METHODS A literature search was conducted using MEDLINE,EMBASE,ScienceDirect,and OVID up to February 2025.Studies were included based on relevance to AI use in plastic surgery imaging.Extracted data included AI modality,surgical context,outcomes,and limitations.The search followed PRISMA guidelines and was registered with PROSPERO(CRD420251008741).RESULTS AI tools have improved preoperative planning through three-dimensional vascular mapping,augmented reality,and thermographic imaging.Intraoperatively,AI-enabled navigation and robotic systems have increased surgical precision.Postoperative AI applications,including deep learning algorithms and sensorbased monitoring,support early complication detection and wound healing assessment.However,persistent barriers include data variability,model generalizability,surgeon unfamiliarity,and lack of regulatory standards.CONCLUSION AI-driven imaging technologies show promise in enhancing decision-making and outcomes in PRS.To ensure safe clinical integration,future efforts must focus on structured validation,standardization,and ethical oversight.
文摘Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.
文摘Background: Missions organized by international societies and humanitarian organizations play a significant role in saving many patients’ lives and improving their quality of life, despite the surrounding frustrating conditions. Methods: A team of plastic surgery volunteers was sent to Yemen by the KSHARC. Results: A successful mission was performed on 62 patients who underwent surgery, with more than 900 patients examined and receiving appropriate medications. Conclusion: Missions in disaster-affected areas are of great importance. The role of missions and humanitarian organizations should be empowered.
