International journal of surgery最新文献

{"title":"In-depth cerebrovascular lipidomics profiling for discovering novel biomarkers and mechanisms in moyamoya and intracranial atherosclerotic disease.","authors":"Kangmin He, Xinmei Wang, Yu Gu, Xiao Tong, Xuanfeng Qin, Yujun Liao, Li-Hao Huang, Jiaxi Wang, Bin Xu","doi":"10.1097/JS9.0000000000002092","DOIUrl":"10.1097/JS9.0000000000002092","url":null,"abstract":"<p><strong>Background: </strong>Despite considerable research efforts, the precise etiology and underlying pathways contributing to Moyamoya Disease (MMD) remain poorly understood. Moreover, the overlapping vascular pathologies shared between MMD and Intracranial Atherosclerotic Disease (ICAD) pose challenges in clinical differentiation, even with gold-standard cerebral angiography. An in-depth exploration of lipidomic alterations in cerebral intracranial MMD vessels could offer valuable insights into the pathogenesis of MMD-related mechanisms, encompassing MMD and ICAD, and unveil novel biomarkers and potential therapeutic targets. However, to date, comprehensive lipidomic profiling has been lacking.</p><p><strong>Materials and methods: </strong>To discover novel biomarkers and unravel the pathophysiological mechanisms underlying MMD, we conducted a lipidomics analysis to characterize various lipid species in matched human extracranial and intracranial artery tissues from patients diagnosed with MMD (n=99) and ICAD (n=12).</p><p><strong>Results: </strong>Our analysis identified 569 lipid species and delineated a robust panel of lipidomic biomarkers capable of effectively distinguishing MMD from ICAD (area under curve=0.98), as determined by receiver operating characteristic curve analysis. Notably, we observed a significantly more pronounced positive correlation of diacylglycerols and a negative association of triglycerides in intracranial artery tissues of MMD patients compared to those with ICAD, suggesting a potential role of dysregulated diacylglycerol-induced signaling in MMD pathogenesis. Furthermore, our investigation into the correlations of critical differential intracranial artery vessel lipid species between MMD and ICAD and clinical parameters revealed negative associations with plasma iron levels, implying a potential link between plasma iron metabolism and artery lipid homeostasis during MMD pathogenesis.</p><p><strong>Conclusion: </strong>These findings offer promising prospects for advancing clinical diagnosis for enhanced differentiation between the two disease conditions. Additionally, they shed light on the fundamental mechanisms implicated in MMD pathogenesis and suggest potential therapeutic avenues through targeting artery vessel lipids or plasma iron levels.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RRFERV stabilizes TEAD1 expression to mediate nasopharyngeal cancer radiation resistance rendering tumor cells vulnerable to ferroptosis.","authors":"Qingqing Xu, Xin Wen, Chenglong Huang, Zaishan Lin, Zhen Xu, Ciming Sun, Li Li, Suixian Zhang, Shuanghong Song, Jiahao Lou, Zan Hou, Yuanyuan Chen, Xuan Li, Lei Chen","doi":"10.1097/JS9.0000000000002099","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002099","url":null,"abstract":"<p><strong>Background: </strong>Long noncoding RNAs (lncRNAs) regulate various essential biological processes, including cell proliferation, differentiation, apoptosis, migration, and invasion. However, in nasopharyngeal carcinoma (NPC), the clinical significance and mechanisms of lncRNAs in malignant progression are unknown.</p><p><strong>Methods: </strong>RNA sequencing and bioinformatic analysis were used to determine the potential function of RRFERV (radiation-resistant but ferroptosis vulnerable), and its biological effects were investigated using in vitro and in vivo experiments. Western blotting, quantitative real-time reverse transcription PCR, RNA immunoprecipitation (RIP) assays, and flow cytometry detected RRFERV expression. Ferroptosis and lipid peroxidation were added to evaluate the relationship between it and radiotherapy resistance.</p><p><strong>Results: </strong>LncRNA-RRFERV was both highly expressed in NPC tissues and radiation-resistant cells. RRFERV is associated with poor clinical outcomes of NPC patients and stabilizes TEAD1 by competitive binding with microRNA-615-5p and microRNA-1293. RRFERV-TEAD1 signaling axis leads to malignant progression and radiotherapy resistance of NPC. Furthermore, we observed that NPC radiotherapy resistance cells exist in a fragile oxidative stress equilibrium, which makes them more sensitive to ferroptosis inducers. Surprisingly, we found that RRFERV-TEAD1 signaling axis also plays a key role in mediating the lipid peroxidation levels of NPC radiotherapy resistance cells through transcriptional activation of ACSL4/TFRC.</p><p><strong>Conclusions: </strong>RRFERV serves as an independent prognostic factor in NPC. During the malignant progression of NPC caused by high expression of RRFERV, ferroptosis can be induced to effectively kill cancer cells and reverse the radiotherapy resistance of NPC cells, suggesting a potential treatment approach for recurrent and refractory NPC.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognosis of patients with locally advanced cervical cancer undergoing surgical versus non-surgical treatment: A retrospective cohort study based on SEER database and a single-center data.","authors":"Xinyan Gao, Yan Kong, Ying Ning, Tian Tian, Xiaojing Gai, Ke Lei, Zuimei Cui","doi":"10.1097/JS9.0000000000002098","DOIUrl":"10.1097/JS9.0000000000002098","url":null,"abstract":"<p><p>The aim of this study was to investigate the impact of surgical treatment on the survival prognosis of patients with locally advanced cervical cancer (LACC) and to identify factors that may influence the efficacy of surgery. Data from the SEER database (2000-2020) and a hospital (2013-2023) were collected for this investigation. Utilizing multivariable Cox regression analysis, Kaplan-Meier survival analysis, and log-rank tests, we assessed the effects of surgical intervention on overall survival (OS) and disease-specific survival (DSS) in LACC patients. Our results revealed that in the SEER database, the surgical group exhibited significantly better OS and DSS compared to the non-surgical group. Particularly noteworthy was the significantly higher survival rate in the surgical group for patients with tumor diameters less than 6 cm. Furthermore, both OS and DSS were improved in the surgical group regardless of whether the cancer was squamous cell carcinoma or adenocarcinoma. Additionally, patients who underwent surgery combined with radiotherapy had notably better OS and DSS compared to those who received chemoradiotherapy alone. Similarly, our hospital data showed that the surgical group demonstrated significantly better OS than the non-surgical group, especially for patients with tumors smaller than 6 cm in diameter. These findings suggest that surgery combined with radiotherapy may offer more favorable outcomes than chemoradiotherapy alone, particularly for LACC patients with smaller tumors.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a staging system for hepatoid adenocarcinoma of the stomach based on multicenter data: A retrospective cohort study: A Staging System for Hepatoid Adenocarcinoma of the Stomach.","authors":"Ying-Qi Huang, Ze-Ning Huang, Qing-Qi Hong, Peng Zhang, Zi-Zhen Zhang, Liang He, Liang Shang, Lin-Jun Wang, Ya-Feng Sun, Zhi-Xiong Li, Jun-Jie Liu, Fang-Hui Ding, En-De Lin, Yong-An Fu, Shuang-Ming Lin, Qi-Yue Chen, Chao-Hui Zheng, Chang-Ming Huang, Ping Li","doi":"10.1097/JS9.0000000000001768","DOIUrl":"https://doi.org/10.1097/JS9.0000000000001768","url":null,"abstract":"<p><strong>Background: </strong>Hepatoid adenocarcinoma of the stomach (HAS) is a rare subtype of gastric cancer (GC) with a poor prognosis. Furthermore, the current pathological staging system for HAS does not distinguish it from that for common gastric cancer (CGC).</p><p><strong>Methods: </strong>The clinicopathological data of 251 patients with primary HAS who underwent radical surgery at 14 centers in China from April 2004 to December 2019 and 5082 patients with primary CGC who underwent radical surgery at 2 centers during the same period were retrospectively analyzed. A modified staging system was established based on the differences in survival.</p><p><strong>Results: </strong>After 1:4 propensity score matching (PSM), 228 patients with HAS and 828 patients with CGC were analyzed. Kaplan-Meier (K-M) analysis showed patients with HAS had a poorer prognosis compared with CGC. Multivariate analysis identified pN stage, CEA level, and perineural invasion (PNI) as independent prognostic factors in patients with HAS. A modified pT (mpT) staging was derived using recursive partitioning analysis (RPA) incorporating PNI and pT staging. The modified pathological staging system (mpTNM) integrated the mpT and the 8th American Joint Committee on Cancer (AJCC) pN definitions. Multivariate analysis showed that mpTNM stage outperformed other pathological variables as independent predictors of OS and RFS in patients with HAS. The mpTNM staging system exhibited significantly higher predictive accuracy for 3-year OS in patients with HAS (0.707, 95% CI: 0.650-0.763) compared to that of the 8th AJCC staging system (0.667, 95% CI: 0.610-0.723, P<0.05). Analysis using the Akaike information criterion favored the mpTNM staging system over the 8th AJCC staging system (824.69 vs. 835.94) regarding the goodness of fit. The mpTNM stages showed improved homogeneity in survival prediction (likelihood ratio: 41.51 vs. 27.10). Comparatively the mpTNM staging system outperformed the 8th AJCC staging system in survival prediction, supported by improvements in the net reclassification index (NRI: 47.7%) and integrated discrimination improvement (IDI: 0.083, P<0.05). Time-dependent ROC curve showed that the mpTNM staging system consistently outperformed the 8th AJCC staging system with increasing observation time.</p><p><strong>Conclusion: </strong>The mpTNM staging system exhibited superior postoperative prognostic accuracy for patients with HAS compared to the 8th AJCC staging system.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive intraoperative peritoneal lavage with surgery, compared to surgery alone, for patients diagnosed with gastric cancer: A systematic review and meta-analysis of randomized controlled trials.","authors":"Mariam Adil, Dua Ghori, Eman Anwar, Maryam Shaukat, Muhammad Tauseef Haider Malik, Dua Atif Murtaza, Khadija Awais Sumra, Rabia Essani, Urooj Nizami, Bakhtawer Nawaz Khan, Hunaina Abid, Malik Olatunde Oduoye","doi":"10.1097/JS9.0000000000002090","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002090","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer ranks as the fifth most frequently diagnosed cancer and the seventh most prevalent overall. The lifetime risk of developing gastric cancer is 1.87% for males and 0.79% for females worldwide.</p><p><strong>Aim: </strong>This systematic review and meta-analysis aimed to determine whether Extensive Intraoperative Peritoneal Lavage (EIPL) provides short-term benefits or improved survival outcomes for patients undergoing gastrectomy.</p><p><strong>Methods: </strong>A comprehensive search spanned PubMed, Embase, Cochrane Library, clinicaltrials.gov, and Web of Science, from their inception up to October 2023, adhering to predefined inclusion and exclusion criteria. The quality of the studies was analyzed using the Cochrane Collaboration Risk of Bias Tool. Data analysis was done using Review Manager 5.3, utilizing a random-effects model.</p><p><strong>Results: </strong>Our analysis incorporated seven randomized controlled trials with 2602 patients. The follow-up time for all outcomes varied from 30-60 months. For our primary outcomes, EIPL demonstrated a significant benefit over surgery alone in terms of recurrence (RR=0.73; 95% CI: 0.65 to 0.83, P<0.00001) and postoperative complications (RR=0.67; 95% CI: 0.51 to 0.87, P=0.003). For our secondary outcomes, postoperative hospital stay (MD=-0.35; 95% CI: -1.11 to 0.41; P-value=0.37), 3-year overall survival (OR=1.44; 95% CI 0.84 to 2.47; P-value=0.19), 3-year disease-free survival (HR=0.93; 95% CI: 0.78 to 1.13; P-value=0.48), and time to first flatus (MD=-0.17; 95% CI: -0.35 to 0.01; P-value=0.06), no statistically significant differences were observed between the EIPL and control groups.</p><p><strong>Conclusion: </strong>While there is a marginal difference in survival outcomes, EIPL holds promise in significantly reducing overall cancer recurrence and suggests an enhancement in postoperative recovery.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry - a cohort study.","authors":"Andrew C Currie, Alan Askari, Chetan Parmar, James Byrne, Ahmed R Ahmed, Chris M Pring, Omar A Khan, Peter K Small, Kamal Mahawar","doi":"10.1097/JS9.0000000000002005","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002005","url":null,"abstract":"<p><strong>Aim: </strong>There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss.</p><p><strong>Methods: </strong>Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010-2019) were identified. Patient characteristics, 30-day postoperative morbidity, and 12-month total body weight loss (TBWL) were also assessed. Multivariate regression was performed for associations between 30-day postoperative morbidity and 12-month TBWL, with SG as a reference. Learning effects were assessed by factoring in the institutional OAGB caseload (0-24/25-49/50+ cases).</p><p><strong>Results: </strong>A total of 59,226 patients underwent primary BMS during the study period (RYGB, 38,434; SG, 24,702; AGB, 12,627; OAGB, 3,408; and Others, 276). The 30-day postoperative morbidity was lower for OAGB 1.8% (51/2,802) compared to RYGB 4.2% (1,391/32,853) and SG 3.4% (725/21,333) but higher than AGB 1.2% (123/9,915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (OR 0.35 (95% CI, 0.22-0.56; P<0.001) and no statistical difference to SG at lesser caseloads. Overall, 12-month greater than 25% TBWL was seen in 69.4% (27736/39971) (RYGB: 82.9% (17617/21246)), SG: 65.4% (7383/11283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (OR 3.47 (95% CI 2.75-4.39; P<0.001).</p><p><strong>Conclusion: </strong>OAGB has been safely implemented in UK national bariatric surgery practice. It has lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in mechanism and management of bone homeostasis in osteonecrosis: a review article from basic to clinical applications.","authors":"Xiao-Na Xiang, Hong-Chen He, Cheng-Qi He","doi":"10.1097/JS9.0000000000002094","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002094","url":null,"abstract":"<p><p>Osteonecrosis, characterized by bone cell death leading to impaired bone recovery, causes challenges in bone homeostasis maintenance. Bone homeostasis relies on the delicate balance between osteoclasts and osteoblasts, encompassing a series of complex and strictly regulated biological functions. Current treatments, including conservative therapies and surgeries, often fall short of expected outcomes, necessitating a reorientation towards more effective therapeutic strategies according to the pathogenesis. In this review, we hierarchically outlined risk factors, emerging mechanisms, and last-decade treatment approaches in osteonecrosis. By connecting mechanisms of bone homeostasis, we proposed future research directions should be focused on elucidating risk factors and key molecules, performing high-quality clinical trial, updating practice, and accelerating translational potential.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-cell map of diverse immune phenotypes in the metastatic brain tumor microenvironment of non-small-cell lung cancer.","authors":"Liang Wang, Min Chao, Run-Run Han, Lei Li, Lei Dong, Fan Chen, Ming-Zhu Jin, Li Gao, Yuan Wang, Da-Yun Feng, Gang Zhu, Wei Guo, Wen-Jian Zhao, Shi-Jia Jin, Dong-Ping Wei, Wei Sun, Jin-Xiang Dai, Wei-Lin Jin","doi":"10.1097/JS9.0000000000002088","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002088","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of preservation versus resection of portal/superior mesenteric vein during pancreaticoduodenectomy in pancreatic cancer patients who respond to neoadjuvant treatment: A retrospective cohort study.","authors":"Yoon Soo Chae, Hye-Sol Jung, Won-Gun Yun, Youngmin Han, Young Jae Cho, Mirang Lee, Wooil Kwon, Joon Seong Park, Jin-Young Jang","doi":"10.1097/JS9.0000000000002034","DOIUrl":"10.1097/JS9.0000000000002034","url":null,"abstract":"<p><strong>Background: </strong>R0 rates have increased as neoadjuvant treatment (NAT) has become the primary treatment for pancreatic ductal adenocarcinoma (PDAC) with venous involvement, suggesting a decrease in venous tumor infiltration. The aim of this study was to investigate the clinical outcomes of preserving the portal/superior mesenteric vein (PV/SMV) during pancreaticoduodenectomy (PD) in PDAC patients who underwent NAT.</p><p><strong>Material and methods: </strong>The 113 patients with resectable and borderline resectable PDAC with venous involvement who responded to NAT and underwent curative PD between 2012 and 2022 were retrospectively reviewed.</p><p><strong>Results: </strong>Among the 113 patients, PV/SMV preservation (PVP) was performed in 68 patients (60.2%), and PV/SMV resection (PVR) was performed in 45 patients (39.8%). There was no significant difference in the R0 rate, 5-year overall survival (OS) and recurrence-free survival between the two groups. PV/SMV stenosis within 3 months after surgery was more common in the PVR group than in the PVP group (1.5% versus 22.2%; P < 0.001), and 5-year PV/SMV stenosis-free survival was significantly higher in the PVP group than in the PVR group (76.5% versus 53.4%; P=0.014). Multivariate analysis showed that gemcitabine-based neoadjuvant chemotherapy was associated with poor OS. PVR, clinically relevant postoperative pancreatic fistula, and locoregional recurrence were independent risk factors for PV/SMV stenosis.</p><p><strong>Conclusion: </strong>The PVP group had similar oncologic outcomes and better vessel-functional outcomes than the PVR group. Therefore, if dissection is possible and there is a high likelihood of achieving R0 resection after NAT, routine PVR may be unnecessary in PDAC patients with venous involvement.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation-Emitting metallic stent for unresectable bismuth type III or IV perihilar cholangiocarcinoma: a multicenter randomized trial.","authors":"Qi Chen, Nai-Jian Ge, Yu-Liang Li, Ming Huang, Wen-Hui Li, Dong Lu, Ning Wei, Peng-Hua Lv, Jian-Fei Tu, Cheng-Jian He, Wu-Jie Wang, Rong Ding, Bo Peng, Xue-Jun Wang, Fu-An Wang, Guang-Yu Zhu, Yong Wang, Li Chen, Jie Min, Jin-He Guo, Gao-Jun Teng, Jian Lu","doi":"10.1097/JS9.0000000000002089","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002089","url":null,"abstract":"<p><strong>Background aims: </strong>Self-expandable metallic stents (SEMSs) have been recommended for patients with unresectable malignant biliary obstruction while radiation-emitting metallic stents (REMSs) loaded with 125I seeds have recently been approved to provide longer patency and overall survival in malignant biliary tract obstruction. This trial is to evaluate the efficacy and safety of REMS plus hepatic arterial infusion chemotherapy (REMS-HAIC) versus SEMS plus HAIC (SEMS-HAIC) for unresectable perihilar cholangiocarcinoma (pCCA).</p><p><strong>Methods: </strong>This multicenter randomized controlled trial recruited patients with unresectable Bismuth type III or IV pCCA between March 2021 and January 2023. Patients were randomly assigned (1:1 ratio) to receive either REMS-HAIC or SEMS-HAIC using permuted block randomization, with a block size of six. The primary endpoint was overall survival (OS). The secondary endpoints were time to symptomatic progression (TTSP), stent patency, relief of jaundice, quality of life, and safety.</p><p><strong>Results: </strong>A total of 126 patients were included in the intent-to-treat population, with 63 in each group. The median OS was 10.2 months versus 6.7 months (P=0.002). The median TTSP was 8.6 months versus 5.4 months (P=0.003). The median stent patency was longer in the REMS-HAIC group than in the SEMS-HAIC group (P=0.001). The REMS-HAIC group showed better improvement in physical functioning scale (P<0.05) and fatigue symptoms (P<0.05) when compared to the SEMS-HAIC group. No significant differences were observed in relief of jaundice (85.7% vs. 84.1%; P=0.803) or the incidence of grade 3 or 4 adverse events (9.8% vs. 11.9%; P=0.721).</p><p><strong>Conclusion: </strong>REMS plus HAIC showed better OS, TTSP, and stent patency compared with SEMS plus HAIC in patients with unresectable Bismuth type III or IV pCCA with an acceptable safety profile.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}