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Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer:A propensity score matching analysis

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World Journal of Gastrointestinal surgery 2024年第3期16卷 670-680页

作者： Hajime Kayano Nana Mamuro Yutaro Kamei Takashi Ogimi Hiroshi Miyakita Toshio Nakagohri Kazuo Koyanagi Masaki Mori Seiichiro Yamamoto department of gastroenterological surgery Tokai University School of MedicineIsehara 259-1193KanagawaJapan

BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

关键词： Colon cancer Intracorporeal anastomosis 3-year disease-free survival Recurrence Surgical site infection Postoperative biological response

Distal margin distance in radical resection of locally advanced rectal cancer after neoadjuvant therapy

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Chinese Journal of Cancer Research 2024年第2期36卷 226-232页

作者： Jun Luo Mingxuan Zhu Long Zhao Meiwen He Bei Li Yifan Liu Yuhan Sun Guoqing Lyu Zhanlong Shen department of Gastrointestinal surgery Peking University Shenzhen HospitalShenzhen 518036China department of gastroenterological surgery Laboratory of Surgical OncologyBeijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment ResearchPeking University People's HospitalBeijing 100044China School of Medicine the Chinese University of Hong KongShenzhen 518172China

Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.

关键词： Colorectal cancer distal resection margin neoadjuvant therapy

Adenylate cyclase activates the cAMP signalling pathway to enhance platelet-rich plasma-treated Achilles tendon disease,a theoretical bioinformatics-based study

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World Journal of Orthopedics 2024年第2期15卷 192-200页

作者： Jing-Yi Sun Cai Li Feng-Ying Du College of Basic Medical Science Qilu Medical UniversityZibo 255300Shandong ProvinceChina department of gastroenterological surgery Shandong Provincial Hospital of Shandong First Medical UniversityJinan 250021Shandong ProvinceChina

The effectiveness of platelet-rich plasma(PRP)for the treatment of Achilles tendon disorders still needs to be evaluated through a series of prospective studies,but genomic analysis can reveal the existence of complementary PRP treatment options.Based on the 96 platelet activation-related genes in the Kyoto Encyclopedia of Genes and Genomes(KEGG)database,we performed Gene Ontology functional enrichment analysis and KEGG enrichment analysis,pathway correlation analysis,and enrichment mapping to determine the enrichment results of the gene set enrichment analysis and found that the cAMP signalling pathway may be the key to enhancing the effectiveness of PRP treatment.The cAMP signalling pathway interacts with the Rap1 signalling pathway and cGMPPKG signalling pathway to mediate the entire pathophy-siological process of Achilles tendon disease.Moreover,ADCY1-9 may be the key to the activation of the cAMP signalling network.Further based on the data in the Gene Expression Omnibus database,it was found that ADCY4 and ADCY7 may be the players that play a major role,associated with the STAT4-ADCY4-LAMA5 axis and the GRbeta-ADCY7-SEMA3C axis,which is expected to be a complementary target for enhancing the efficacy of PRP in the treatment of Achilles tendon disease.

关键词： Platelet-rich plasma Achilles tendon disease cAMP Adenylate cyclase Complementary target

Endoscopic pancreatogastric anastomosis in the treatment of symptoms associated with inflammatory diseases of the pancreas

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 406-412页

作者： Mateusz Jagielski Eryk Bella Marek Jackowski department of General Gastroenterological and Oncological SurgeryNicolaus Copernicus UniversityToruń87-100Poland

BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract.However,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic duct.surgery is the treatment of choice in such cases.AIM To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)guidance.METHODS Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the department of General,gastroenterological and Oncological surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland.RESULTS In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP.Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy.Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)d.Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,especially in the absence of transpapillary access to

关键词： Pancreaticogastrostomy Chronic pancreatitis Acute pancreatitis Disconnected pancreatic duct syndrome Endotherapy

A computed tomography-based radiomic model for the prediction of strangulation risk in patients with acute intestinal obstruction

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Intelligent Medicine 2024年第1期4卷 33-42页

作者： Zhibo Wang Ruiqing Liu Shunli Liu Baoying Sun Wentao Xie Dongsheng Wang Yun Lu department of gastroenterological surgery The Affiliated Hospital of Qingdao UniversityQingdaoShandong 266003China department of Radiology The Affiliated Hospital of Qingdao UniversityQingdaoShandong 266003China Neurology department Central Hospital Affiliated to Shandong First Medical UniversityJinanShandong 250000China Lingshui People’s Hospital LingshuiHainan 572400China

Background We created and validated a computed tomography(CT)-based radiomic model using both clinical factors and the radiomic signature for assessing the strangulation risk of acute intestinal obstruction.This would assist surgeons in accurately predicting intestinal ischemia and strangulation in patients with intestinal obstruction.Methods We recruited 289 patients with acute intestinal obstruction admitted in the Affiliated Hospital of Qingdao University from January 2019 to February 2022.The patients were allocated to a training(n=226)and validation cohort(n=63).Radiomic features were collected from CT images,and the radiomic signature was extracted and used to calculate a radiomic score(Rad-score).A nomogram was constructed using the clinical features and the Rad-score,and the performance of the clinical,radiomics,and nomogram models was assessed in the two cohorts.Results Six robust features were used to construct the radiomic signature.The nomogram incorporating hemoglobin levels,C-reactive protein levels,American Society of Anesthesiologists score,time of obstruction,CT image of mesenteric fluid(P<0.05),and the signature demonstrated good predictive ability for intestinal ischemia in patients with acute intestinal obstruction,with areas under the curve of 0.892(95%confidence interval,0.837–0.947)and 0.781(95%confidence interval,0.619–0.944)for the training and validation sets,respectively.The decision curve analysis showed that this model outperformed the clinical and radiomic signature models.Conclusion The radiomic nomogram may effectively predict intestinal ischemia in patients with acute intestinal disease and may assist clinical decision-making。

关键词： Acute intestinal obstruction Radiomics Intestinal ischemia Intestinal strangulation

Goblet cell carcinoid of the appendix:Six case reports

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World Journal of Clinical Cases 2024年第22期12卷 5217-5224页

作者： Toshiaki Toshima Ryo Inada Shinya Sakamoto Eri Takeda Takahiro Yoshioka Kento Kumon Naoki Mimura Nobuo Takata Motoyasu Tabuchi Kazuyuki Oishi Takuji Sato Kenta Sui Takehiro Okabayashi Kazuhide Ozaki Toshio Nakamura Yuichi Shibuya Manabu Matsumoto Jun Iwata department of gastroenterological surgery Kochi Health Sciences CenterKochi 781-8555Japan department of Diagnostic Pathology Kochi Health Sciences CenterKochi 781-8555Japan

BACKGROUND Goblet cell carcinoid(GCC)of the appendix is a rare tumor characterized by neuroendocrine and adenocarcinoma features.Accurate preoperative diagnosis is very difficult,with most patients complaining mainly of abdominal pain.Computed tomography shows swelling of the appendix,so diagnosis is usually made incidentally after appendectomy based on a preoperative diagnosis of appendicitis.Even if a patient undergoes preoperative colonoscopy,accurate endoscopic diagnosis is very difficult because GCC shows a submucosal growth pattern with invasion of the appendiceal wall.CASE SUMMARY Between 2017 and 2022,6 patients with GCC were treated in our hospital.The presenting complaint for 5 of these 6 patients was abdominal pain.All 5 patients underwent appendectomy,including 4 for a preoperative diagnosis of appendicitis and the other for diagnosis and treatment of an appendiceal tumor.The sixth patient presented with vomiting and underwent ileocecal resection for GCC diagnosed from preoperative biopsy.Although 2 patients with GCC underwent colonoscopy,no neoplastic changes were identified.Two of the six patients showed lymph node metastasis on pathological examination.As of the last followup(median:15 mo),all cases remained alive without recurrence.CONCLUSION As preoperative diagnosis of GCC is difficult,this possibility must be considered during surgical treatments for presumptive appendicitis.

关键词： Goblet cell carcinoid Appendix Preoperative diagnosis Endoscopic diagnosis Surgical treatment Case report

Role of artificial intelligence in colorectal cancer

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Artificial Intelligence in Gastrointestinal Endoscopy 2024年第2期5卷 31-40页

作者： Gita Lingam Taner Shakir Rawen Kader Manish Chand department of General surgery Princess Alexandra HospitalHarlow CM201QXUnited Kingdom department of Colorectal surgery University College LondonLondon W1W 7TYUnited Kingdom department of Gastroenterology University College LondonUniversity College London Hospitals Nhs Foundation TrustLondon W1BUnited Kingdom gastroenterological Intervention Centre University College LondonLondon W1W 7TSUnited Kingdom

The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.

关键词： Artificial intelligence Colorectal cancer Pre-operative Intra-operative Post-operative Adjuncts Colonoscopy

Current status and future perspectives for the treatment of resectable locally advanced esophagogastric junction cancer:A narrative review

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World Journal of Gastroenterology 2023年第24期29卷 3758-3769页

作者： Yoshiaki Shoji Kazuo Koyanagi Kohei Kanamori Kohei Tajima Mika Ogimi Kentaro Yatabe Miho Yamamoto Akihito Kazuno Kazuhito Nabeshima Kenji Nakamura Takayuki Nishi Masaki Mori department of gastroenterological surgery Tokai University School of MedicineIsehara 259-1193Japan

Incidence rates for esophagogastric junction cancer are rising rapidly worldwide possibly due to the economic development and demographic changes.Therefore,increased attention has been paid to the prevention,diagnosis,and the treatment of esophagogastric junction cancer.Although there are discrepancies in the treatment strategy between Asian and Western countries,surgery remains the mainstay of treatment for esophagogastric junction cancer.Recent developments of perioperative multidisciplinary treatment may lead to better therapeutic effect,higher complete resection rate,and better control of the residual diseases,thus result in prolonged prognosis.In this review,we will focus on the treatment of locally advanced resectable esophagogastric junction cancer,and discuss the current status and future perspectives of the perioperative treatment including chemotherapy,radiation therapy,and immunotherapy,as well as the surgical strategy.Better understanding of the latest treatment strategy and future overlook may enable to standardize and individualize the treatment for esophagogastric junction cancer,thus leading to better prognosis for those patients.

关键词： Esophagogastric junction cancer Perioperative therapy Neoadjuvant therapy surgery Multidisciplinary treatment

Importance of an appropriate number of examined lymph nodes in patients with pancreatic cancer-the more the better?

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Hepatobiliary surgery and Nutrition 2022年第4期11卷 605-607页

作者： Toshiro Ogura Hiroyuki Ishida Amane Takahashi Yoshiyuki Kawashima department of gastroenterological surgery Saitama Cancer CenterSaitamaJapan

Pancreatic cancer is a highly aggressive malignant cancer with a 5-year survival rate of approximately 10%.The outcome of patients diagnosed with resectable pancreatic cancer as per the National Comprehensive Cancer Network(NCCN)classification and those who underwent resection was not satisfactory.Similar to other abdominal malignant tumors,the stages of pancreatic cancer are defined by local extension,lymph node metastasis,and distant metastasis.The presence or absence of lymph node metastasis is diagnosed by pathological examination of the retrieved lymph,the quality of the diagnosis based on lymph node(N)staging depends on the surgical and pathological aspects(1).

关键词： lymph metastasis patients