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Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

World Journal of Gastroenterology 2024年第10期30卷 1358-1367页

作者： Martin Löfling Skogar Magnus Sundbom department of surgical Sciences Uppsala UniversityUppsala 75185Sweden

BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children,respectively,requiring long-term enteral nutrition support.Procedure-related mortality is a rare event,often reported to be zero in smaller studies.National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term(<30 d)and long-term survival.METHODS In this retrospective,population-based cohort study,individuals that had received a gastrostomy between 1998-2019 in Sweden were included.Individuals were identified in the Swedish National Patient Register,and survival analysis was possible by cross-referencing the Swedish Death Register.The cohort was divided into three age groups:Children(0-18 years);adults(19-64 years);and elderly(≥65 years).Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.RESULTS In total 48682 individuals(52%males,average age 60.9±25.3 years)were identified.The cohort consisted of 12.0%children,29.5%adults,and 58.5%elderly.An increased use of gastrostomies was observed during the study period,from 13.7/100000 to 22.3/100000 individuals(P<0.001).The use of PEG more than doubled(about 800 to 1800/year),with a corresponding decrease in open gastrostomy(about 700 to 340/year).Laparoscopic gastrostomy increased more than ten-fold(about 20 to 240/year).Overall,PEG,open gastrostomy,and laparoscopic gastrostomy constituted 70.0%(n=34060),23.3%(n=11336),and 4.9%(n=2404),respectively.Procedure-related mortality was 0.1%(n=44)overall(PEG:0.05%,open:0.24%,laparoscopic:0.04%).The overall 30-d mortality rate was 10.0%(PEG:9.8%,open:12.4%,laparoscopic:1.7%)and decreased from 11.6%in 1998-2009 vs 8.5%in 2010-2019(P<0.001).One-year and ten-year survival rates for children,adults,and elderly were 93.7%,67.5%,and 42.1%and 79.9%,39.2%,and 6.8%,respectively.Th

关键词： Gastrostomy Percutaneous endoscopic gastrostomy Dysphagia Enteral nutrition Long-term Survival Complication

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Why is early detection of colon cancer still not possible in 2023?

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World Journal of Gastroenterology 2024年第3期30卷 211-224页

作者： Valeria Tonini Manuel Zanni department of Medical and surgical Sciences University of BolognaBologna 40138Italy

Colorectal cancer(CRC)screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers.Over the years,screening,particularly in those settings where it is well organized,has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them.Despite considerable advancements in screening technologies and strategies,the effectiveness of CRC screening programs remains less than optimal.This paper examined the multifaceted reasons behind the persistent lack of effect-iveness in CRC screening initiatives.Through a critical analysis of current methodologies,technological limitations,patient-related factors,and systemic challenges,we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates.While acknowledging the ad-vancements that have improved aspects of screening,we emphasized the necessity of addressing the identified barriers comprehensively.This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease.Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage.Spending more sooner can mean saving money later.

关键词： Colorectal cancer Colorectal cancer screening Colorectal screening test Colon and rectal cancer

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Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1227-1235页

作者： Wen-Jing Hu Gang Bai Yan Wang Dong-Mei Hong Jin-Hua Jiang Jia-Xun Li Yin Hua Xin-Yu Wang Ying Chen Intensive Care Unit Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China department of Anesthesia and Perioperative Medicine Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China department of Nursing Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China department of Thyroid Breast and Vascular SurgeryShanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbal

关键词： Elderly patients Abdominal cancer Postoperative delirium Synthetic minority oversampling technique Predictive modeling surgical outcomes

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Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1017-1029页

作者： Savvas Symeonidis Ioannis Mantzoros Elissavet Anestiadou Orestis Ioannidis Panagiotis Christidis Stefanos Bitsianis Vasiliki Bisbinas Konstantinos Zapsalis Trigona Karastergiou Dimitra Athanasiou Stylianos Apostolidis Stamatios Angelopoulos fourth department of Surgery Medical SchoolAristotle University of ThessalonikiThessaloniki 57010Greece ENT department Royal Cornwall Hospitals NHS TrustCornwall TR13LJUnited Kingdom 1^(st)Propedeutic surgical department University Hospital of ThessalonikiAristotle University of ThessalonikiThessaloniki 54636Greece

Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into

关键词： Minimally invasive cholecystectomy Laparoscopic cholecystectomy Biliary tract mapping Indocyanine green Near-infrared fluorescent cholangiography Intracystic indocyanine green Intragallbladder indocyanine green Bile duct injury

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Quality assessment of surgery for colorectal cancer:Where do we stand?

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 982-987页

作者： Stefan Morarasu Cristian Livadaru Gabriel-Mihail Dimofte The Second department of surgical Oncology Regional Institute of OncologyIasi 707483Romania

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past decade.It has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units today.Total mesorectal excision,complete mesocolic excision(CME),and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical societies.However,there are still ongoing discrepancies in outcomes largely based on surgeon performance.This is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume centers.Defining markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional level.With the evolution of CME surgery,various quality markers have been described,mostly based on measurements on the surgical specimen and lymph node yield,while others have proposed radiological markers(i.***.arterial stumps)measured on postoperative scans as part of the routine cancer follow-up.There is no ideal marker;however,taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

关键词： Colorectal cancer Colon surgery Arterial stump Complete mesocolic excision surgical quality

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Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 810-818页

作者： Xu-Min Yang Xu-Yan Yang Xin-Yu Wang Yue-Xia Gu department of Nursing The First Affiliated Hospital of Naval Medical University(Changhai Hospital)Shanghai 200433China department of Thyroid Breast and Vascular SurgeryShanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China department of Nursing Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200434China

BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy,and transcatheter arterial embolization(TAE)has emerged as a pivotal therapeutic modality.How-ever,TAE may induce symptom distress and fatigue,adversely affecting the quality of life of patients.AIM To investigate symptom distress,fatigue,and associated factors in HCC patients undergoing TAE.METHODS We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022.Question-naires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE.RESULTS Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE.Pain,fatigue,insomnia,fever and abdominal dis-tension were the most common symptoms troubling patients during the first 3 d post-TAE.Marital status,presence of family support,physical functional status,age,and symptom distress were identified as predictors of fatigue in patients.CONCLUSION Healthcare professionals should educate HCC patients on symptom distress and INTRODUCTION Hepatocellular carcinoma(HCC)ranks as the fifth most prevalent cancer and the third leading cause of cancer-related mortality globally.surgical intervention remains the cornerstone of HCC treatment;however,due to the challenges associated with early diagnosis and the lack of specific diagnostic markers,a considerable proportion of patients are diagnosed at advanced stages,rendering them ineligible for surgical interventions.Transcatheter arterial embolization(TAE)is an interventional therapeutic approach involving the insertion of a fine catheter via the femoral artery to reach the vasculature near the tumor site.TAE aims to obstruct the arterial supply to the tumor by deploying embolic agents,thereby inducing necrosis in cancer cells.This procedure is suitable for patients with good liver function and overall health,particularly those with large HCCs that have not invaded the portal vein[1,2].Nonetheless,

关键词： Transcatheter arterial embolization Fatigue Symptom distress Hepatocellular carcinoma Influencing factors

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Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery:A meta-analysis

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1420-1429页

作者： Jia Song Cong Zhou Tian Zhang department of Operating Room The Fourth Affiliated Hospital of Nanjing Medical UniversityNanjing 210031Jiangsu ProvinceChina department of Gastrointestinal Surgery Tongji Hospital of Huazhong University of Science and TechnologyWuhan 430073Hubei ProvinceChina department of Disinfection Supply Center The Fourth Affiliated Hospital of Nanjing Medical UniversityNanjing 210031Jiangsu ProvinceChina

BACKGROUND Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery.AIM To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients.METHODS Systematically searched the relevant literature from PubMed,Web of Science,Cochrane Library,Embase,CNKI,China Biomedical Database,Wanfang Database,and Weipu Chinese Journal Database self-established until October 1,2022.Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature,extracted data,and evaluated the risk of bias in the included studies.RESULTS A total of 23 pieces of literature were included,the quality of which was medium or above,and the total sample size was 43878.The results of meta-analysis showed that the patients were male(OR=1.58,95%CI:1.25-2.01,P=0.002)and≥60 years old(OR=2.60,95%CI:1.76-2.87,Psurgical site(OR=1.2,95%CI:1.40-2.62,P<0.001),operation method(OR=1.68,95%CI:1.08-2.62,P=0.020),operation duration(OR=2.65,95%CI:1.92-3.67,P<0.001),abdominal adhesion grade(OR=2.52,95%CI:1.90-3.56,P<0.001),postoperative opioid history(OR=5.35,95%CI:3.29-8.71,P<0.001),tumor TNM staging(OR=2.58,95%CI:1.84-3.62,P<0.001),postoperative blood transfusion(OR=2.92,95%CI:0.88-9.73,P=0.010)is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors.CONCLUSION There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients

关键词： Gastrointestinal tumor surgery Postoperative gastrointestinal dysfunction Intestinal paralysis Risk factors Metaanalysis

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Ileal collision tumor associated with gastrointestinal bleeding: A case report and review of literature

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 628-634页

作者： Yu-Qi Wu Hong-Yan Wang Mu-Min Shao Lin Xu Xiao-Yan Jiang Shao-Ju Guo department of Gastroenterology Shenzhen Traditional Chinese Medicine HospitalThe Fourth Clinical Medical College of Guangzhou University of Chinese MedicineShenzhen 518033Guangdong ProvinceChina department of Pathology Shenzhen Traditional Chinese Medicine HospitalThe Fourth Clinical Medical College of Guangzhou University of Chinese MedicineShenzhen 518033Guangdong ProvinceChina

BACKGROUND Collision tumors involving the small intestine,specifically the combination of a hamartomatous tumor and a lipoma,are extremely rare.To our knowledge,no previous case report has described a collision tumor composed of two benign tumors of different origins in the small intestine.CASE SUMMARY Here,we present the case of an 82-year-old woman who presented with hemorrhagic shock and was found to have a mass measuring approximately 50 mm×32 mm×30 mm in the terminal ileum.Based on computed tomography scan findings,the mass was initially suspected to be a lipoma.A subsequent colonoscopy revealed a pedunculated submucosal elevation consisting of two distinct parts with a visible demarcation line.A biopsy of the upper portion suggested a juvenile polyp(JP).Owing to the patient’s advanced age,multiple comorbidities,and poor surgical tolerance,a modified endoscopic submucosal dissection was performed.Histopathological examination of the excised mucosal mass revealed a lipoma at the base and a JP at the top,demonstrating evidence of rupture and associated bleeding.The patient’s overall health remained satisfactory,with no recurrence of hematochezia during the six-month follow-up period.CONCLUSION This case report provides new evidence for the understanding of gastrointestinal collision tumors,emphasizing their diverse clinical presentations and histopathological characteristics.It also offers diagnostic and therapeutic insights as well as an approach for managing benign collision tumors.

关键词： Collision tumor Gastrointestinal bleeding Hamartomatous tumor Lipoma Modified endoscopic submucosal dissection Case report

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Rehabilitation care for pain in elderly knee replacement patients

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World Journal of Clinical Cases 2024年第4期12卷 721-728页

作者： Li Liu Qiao-Zhen Guan Li-Fang Wang Wuhan fourth Hospital Wuhan 430033Hubei ProvinceChina department of Orthopaedics Wuhan Third HospitalWuhan 430074Hubei ProvinceChina

BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after dis

关键词： Programmed pain nursing Collaborative nursing Total knee arthroplasty

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Development and validation of a machine learning-based early prediction model for massive intraoperative bleeding in patients with primary hepatic malignancies

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 90-101页

作者： Jin Li Yu-Ming Jia Zhi-Lei Zhang Cheng-Yu Liu Zhan-Wu Jiang Zhi-Wei Hao Li Peng department of Hepatological Surgery The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011Hebei ProvinceChina department of General Surgery II Baoding First Central HospitalBaoding 071000Hebei ProvinceChina

BACKGROUND surgical resection remains the primary treatment for hepatic malignancies,and intraoperative bleeding is associated with a significantly increased risk of death.Therefore,accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment.AIM To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes.METHODS The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery department of the fourth Hospital of Hebei Medical University between 2010 and 2020.Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding.A prediction model was developed using Python programming language,and its accuracy was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Among 406 primary liver cancer patients,16.0%(65/406)suffered massive intraoperative bleeding.Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients:ascites[odds ratio(OR):22.839;P<0.05],history of alcohol consumption(OR:2.950;P<0.015),TNM staging(OR:2.441;P<0.001),and albumin-bilirubin score(OR:2.361;P<0.001).These variables were used to construct the prediction model.The 406 patients were randomly assigned to a training set(70%)and a prediction set(30%).The area under the ROC curve values for the model’s ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set.CONCLUSION The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors:ascites,history of alcohol consumption,TNM staging,and albumin-bilirubin score.Consequently,this model holds promise for enhancing individ

关键词： Primary liver cancer Intraoperative bleeding Machine learning Model

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