Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

{"title":"Modified POEM With Radial Extension for Achalasia: Short-Term Outcomes of a Prospective Single-Center Study.","authors":"Bahtiyar Muhammedoglu, Mehmet Y Pektezel, Vehbi Sirikci, Fatih Dolu, Aydin H Küpeli, Oğuzhan F Ay","doi":"10.1097/SLE.0000000000001422","DOIUrl":"10.1097/SLE.0000000000001422","url":null,"abstract":"<p><strong>Background: </strong>Achalasia is a rare esophageal motility disorder that causes dysphagia owing to impaired lower esophageal sphincter (LES) relaxation. This study aimed to evaluate a modified dissection and radial myotomy technique during peroral endoscopic myotomy (POEM) and to compare its outcomes with those of the standard approach.</p><p><strong>Methods: </strong>This prospective, single-center study was conducted between February 2022 and December 2022. Eighty total with 80 achalasia patients undergoing POEM were divided into 2 groups: Group A (n=40), treated with the novel technique, and Group B (n=40), treated with the standard approach. Demographics, Eckardt score (ES), submucosal tunnel (ST), myotomy length, intervention duration, and adverse events were recorded. The follow-up period ranged from 3 to 20 months.</p><p><strong>Results: </strong>Patients who underwent the novel radial myotomy technique (Group A) had significantly longer myotomy lengths (11.8±2.4 vs. 8.1±2.0 cm, P <0.001), greater myotomy extension beyond the esophagogastric junction (4.2±0.8 vs. 2.7±0.6 cm, P <0.001), and improved postoperative Eckardt scores (median 1 [0-1] vs. 2, 1-3P =0.006) compared with the conventional POEM group (Group B). Subgroup analysis revealed that in Type III achalasia patients, the novel approach yielded longer submucosal tunnel lengths (15.6±0.8 cm, P =0.038) and favorable symptom relief. Despite extended dissection, there was no increase in gastroesophageal reflux disease (GERD)-related symptoms.</p><p><strong>Conclusion: </strong>The novel dissection and radial myotomy technique demonstrated superior outcomes in reducing dysphagia symptoms and LES resistance compared with the standard approach. Tailoring ST and myotomy lengths based on the achalasia type and EGJ involvement may optimize outcomes without increasing the risk of GERD.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Suggestion for an Easy Laparoscopic Technique to Avoid Difficulties in Nonmidline Ventral Hernia Repair: Transabdominal Partial Extraperitoneal (TAPE) Approach.","authors":"Huseyin Kilavuz, Murat Demir, Feyyaz Gungor, Muhammed F Arslan, Idris Kurtulus","doi":"10.1097/SLE.0000000000001429","DOIUrl":"10.1097/SLE.0000000000001429","url":null,"abstract":"<p><strong>Background: </strong>Nonmidline ventral hernias (NMVH) are encountered less frequently than midline ventral hernias. Laparoscopic NMVH repairs are considered technically more difficult than midline hernias. For this reason, various intraperitoneal and extraperitoneal approach methods have been defined in the surgery of this group of hernias. In this study, we aimed to present the clinical data and follow-up results of patients who underwent laparoscopic repair of NMVH using the transabdominal partial extraperitoneal (TAPE) technique.</p><p><strong>Methods: </strong>In this single-center and retrospective study, demographic information, hernia characteristics, operative findings, and follow-up data of laparoscopic NMVH surgeries performed by a hernia-specific general surgery unit between January 2022 and June 2024 were scanned and analyzed.</p><p><strong>Results: </strong>Data from 26 patients with NMVH who underwent laparoscopic repair using the TAPE technique were analyzed. The mean age of the patients was 52.9±13.5 years. No intraoperative complications or conversion to open surgery were observed in any case. The median operative time was 100 (82.5 to 120) minutes. The median VAS score on the first postoperative day was 5 (3.75 to 6). Complications developed in 38.5% of patients during hospitalization; 26.9% were Clavien-Dindo class 1 and 11.5% were class 3a. The median hospital stay was 3 (3 to 5) days. The mean follow-up period was 17.8 (9 to 48) months, during which 2 patients (7.7%) experienced recurrence.</p><p><strong>Conclusions: </strong>The TAPE technique is among the reliable techniques that can be applied in the laparoscopic repair of NMVH with low complication and recurrence rates.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors for Postoperative Delayed Perforation Following Endoscopic Submucosal Dissection of Gastrointestinal Stromal Tumors.","authors":"Chaoshu Guo, Linyun Xue, Guofeng Pan, Sijie Chen, Xiongbo Wu, Suping Li","doi":"10.1097/SLE.0000000000001438","DOIUrl":"10.1097/SLE.0000000000001438","url":null,"abstract":"<p><strong>Background: </strong>Delayed perforation is a serious complication after endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumors (GISTs). Understanding its incidence, associated risk factors, and clinical outcomes can guide preventative measures. This study aimed to determine the incidence of delayed perforation, identify independent risk factors, and describe the clinical course and management outcomes.</p><p><strong>Methods: </strong>We retrospectively identified 57 patients who developed delayed perforation (\"cases\"). Each case was matched 1:1 by key variables (eg, age, tumor location) with 57 controls who did not experience delayed perforation. Baseline characteristics and the timing of delayed perforation were collected. We compared clinical and procedural factors in univariate analysis and conducted multivariate conditional logistic regression. Clinical course and management outcomes for delayed perforation, and subgroup analyses were assessed robustness.</p><p><strong>Results: </strong>A total of 57 patients developed delayed perforation at a median of 2 days postprocedure (IQR 1 to 7). In univariate analysis, larger tumor size ( P =0.02) and operator inexperience (<80 ESDs, P =0.03) were associated with an increased risk. In multivariate analysis, tumor size (adjusted OR 1.45 per cm, 95% CI: 1.04-2.02, P =0.03) and operator inexperience (adjusted OR 2.88, 95% CI: 1.21-6.81, P =0.02) remained significant risk factors. Most patients with delayed perforation presented with abdominal pain (61.4%), and diagnosis was primarily made via CT (66.7%). Management strategies included endoscopic closure (31.6%), surgical repair (35.1%), and conservative treatment (33.3%), with a mean hospital stay of 7.5±2.3 days. Sensitivity analyses confirmed the robustness of these findings.</p><p><strong>Conclusions: </strong>Larger tumor size and limited operator experience were independent risk factors. Endoscopic or surgical interventions resulted in satisfactory outcomes. These results highlight the need for standardized preventive measures and operator training to mitigate this complication.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Totally Extraperitoneal Release and Reinforce (TEP-RRT) With Structured Rehabilitation Program for Sportsman's Hernia and Athletic Pubalgia: Surgical Technique and 9-Year Clinical Series of 461 Athletes.","authors":"Moshe Dudai, Marah Ganiem, Rut Meruham","doi":"10.1097/SLE.0000000000001432","DOIUrl":"10.1097/SLE.0000000000001432","url":null,"abstract":"<p><strong>Objective: </strong>To describe a refined endoscopic Totally Extraperitoneal Release & Reinforce (TEP-RRT) technique for sportsman's hernia and athletic pubalgia (SH/AP) with structured rehabilitation program and to present descriptive long-term results from a nine-year clinical series.</p><p><strong>Methods: </strong>Between January 2016 and April 2024, a consecutive series of 461 athletes with chronic SH/AP grade 4 to 5 underwent bilateral TEP-RRT by a single surgeon after failure of conservative treatment. The technique involves endoscopic extraperitoneal access, meticulous release of pubic bone (PB) complex adhesions and inflamed inguinal ligament (IL) responsible for neural entrapment, followed by pre-peritoneal reinforcement with a mid-weight mesh. A standardized postoperative structured rehabilitation program (PSRP) was initiated seven days postoperatively. Nine years long-term outcomes were assessed retrospectively using a standardized telephone survey conducted between September 2024 and March 2025.</p><p><strong>Results: </strong>All 461 athletes (447 primary cases and 14 revision cases following failed SH/AP surgery performed at other centers) completed a survey-based postoperative follow-up, ranging from 6 months to 9 years. Overall, 98.5% (454/461) returned to sports activity and remained active, 75% resumed activity within 8 weeks, including all revision cases. No recurrences were reported during the follow-up period. Complications were infrequent (1.5%).</p><p><strong>Conclusions: </strong>TEP-RRT combined with a PSRP is a feasible, safe, and durable technique for primary and revision SH/AP cases.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-TD With Multiple Plastic Stents for Postoperative Pancreatic Fistula: A Retrospective Evaluation of Early Postsurgery Management.","authors":"Koichiro Miyagawa, Shinji Oe, Yasuhisa Mori, Tsuyoshi Ueda, Nobuhiko Shinohara, Kosuke Hideshima, Yudai Koya, Yuichi Honma, Masaru Harada","doi":"10.1097/SLE.0000000000001430","DOIUrl":"10.1097/SLE.0000000000001430","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pancreatic fistula (POPF) is a serious complication that can lead to potentially fatal outcomes; therefore, early intervention with drainage is warranted whenever clinically feasible. Endoscopic ultrasound-guided transmural drainage (EUS-TD) is becoming an alternative to percutaneous drainage for managing POPF. While EUS-TD is increasingly used, there is no consensus on stent type or the need for external drainage in early postoperative EUS-TD for POPF. This study aimed to evaluate the feasibility of EUS-TD using multiple plastic stents (PSs) without external drainage for managing POPF within postoperative day 15.</p><p><strong>Methods: </strong>This retrospective case series included 11 patients who developed POPF and underwent EUS-TD within postoperative day 15 between January 2021 and June 2024. The primary outcome was clinical success of EUS-TD with multiple PSs without external drainage. Secondary outcomes included technical success, complications, length of hospital stay, and recurrence rate.</p><p><strong>Results: </strong>Eleven POPF patients underwent EUS-TD. Two or more PSs were successfully placed in all cases, with clinical success achieved in 10 of 11 cases. One case required additional percutaneous drainage. A pseudoaneurysm rupture occurred in one case and was successfully managed with interventional radiology. The mean length of hospital stay was 19.1 days. No recurrences were observed during a median follow-up period of 26.0 months. Stents were removed after 6 months or later.</p><p><strong>Conclusions: </strong>EUS-TD using multiple PSs without external drainage may be a feasible approach for managing POPF within postoperative day 15. Further prospective studies are needed to validate these findings and optimize early postoperative management strategies for POPF.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Percutaneous Cholecystostomy Timing on Mortality and Morbidity in High-Risk Patients With Acute Calculous Cholecystitis.","authors":"Ali Levent Işik, Ali Bekraki","doi":"10.1097/SLE.0000000000001431","DOIUrl":"10.1097/SLE.0000000000001431","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of percutaneous cholecystostomy (PC) in acute cholecystitis remains unclear, despite its increasing adoption as a treatment option for elderly and critically ill patients. This study aimed to evaluate the impact of PC timing on complications, hospital stay, and mortality in high-risk patients with moderate and severe acute calculous cholecystitis.</p><p><strong>Materials and methods: </strong>Between 2020 and 2024, 124 consecutive patients who underwent PC were retrospectively reviewed. The time periods from admission to PC were measured. Patients with grade II cholecystitis who had a Charlson Comorbidity Index (CCI) score ≥6 and an American Society of Anesthesiologists Physical Status (ASA-PS) score ≥3, and those with grade III cholecystitis who had a CCI score ≥4 and an ASA-PS score ≥3, were defined as high-risk patients using TG18-aligned thresholds. Among these 82 high-risk patients, the median time from admission to PC was 39 hours (range: 21 to 62 h).</p><p><strong>Results: </strong>Early high-risk group (≤48 h; n=51) had shorter hospital stay [7 (5 to 8) vs. 13 (6 to 20) d; P <0.001], lower ≤90-day mortality rate (5.9% vs. 22.6%; P =0.037) and lower ≤365-day mortality rate (7.8% vs. 25.8%; P =0.049) as compared with delayed high-risk group (>48 h; n=31). Delayed PC (OR=4.80, P =0.004) and complications related to PC (OR=4.37, P =0.015) were independent risk factors for longer hospital stay. A higher CCI Score (≥7) (OR=13.68, P =0.047) and delayed PC (OR=8.64, P =0.04) were independent risk factors for in-hospital mortality.</p><p><strong>Conclusions: </strong>While emergency cholecystectomy remains the gold standard for the treatment of acute cholecystitis, PC represents a valuable initial treatment alternative in high-risk patients when performed at an early stage. Early PC provides significant advantages, including fewer complications, shorter hospitalization, and reduced in-hospital mortality.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgastric Ultra-Slim Endoscopic Tunneling NOTES for Gallbladder Preservation: Comparative Study With Conventional Technique.","authors":"Shu Shang, Jinyuan Wang, Kun Kang, Xi Liu, Jiacheng Wang","doi":"10.1097/SLE.0000000000001437","DOIUrl":"10.1097/SLE.0000000000001437","url":null,"abstract":"<p><strong>Background: </strong>To compare the clinical outcomes of transgastric natural orifice transluminal endoscopic surgery (NOTES) using an ultrathin flexible endoscopic tunneling technique with conventional flexible endoscopic NOTES for gallbladder-preserving treatment of gallstones and polyps.</p><p><strong>Methods: </strong>A retrospective study was conducted on 62 patients treated between January 2023 and February 2025 at the Fifth People's Hospital of Shenyang, including 23 in the ultrathin tunneling group and 39 in the conventional group. Clinical outcomes, operative time, blood loss, titanium clip usage, postoperative pain (VAS scores), time to flatus, oral intake, hospital stay, costs, complications, clinical success, and recurrence rates were compared. Follow-up was conducted for 1 to 3 months (median: 2 mo).</p><p><strong>Results: </strong>Both procedures demonstrated a 100% clinical success rate. The ultrathin tunneling group showed significantly lower blood loss, fewer clips, lower VAS scores on postoperative days 1 to 3, earlier oral intake, and shorter hospital stays ( P <0.05). No significant differences were observed in operative time, flatus time, hospitalization costs, complication rates, or gallstone recurrence rates ( P >0.05). Operative time correlated with blood loss, and flatus time correlated with the day 1 VAS score.</p><p><strong>Conclusions: </strong>Both NOTES techniques are effective and safe for gallbladder-preserving treatment of gallstones and polyps. The ultrathin tunneling approach offers advantages in reducing surgical trauma, enhancing recovery, and potentially lowering recurrence risk, supporting its clinical application.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Lymph Node Count for Colorectal Cancer Surgery: A Cohort Study Utilizing Real-World Data.","authors":"Xu Sun, Rui Li, Wen Zhao, Sizhe Wang, Hao Liu, Wenxing Gao, Xianqiang Liu, Dingchang Li, Guanglong Dong","doi":"10.1097/SLE.0000000000001441","DOIUrl":"10.1097/SLE.0000000000001441","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a leading global malignant tumor, and adequate lymph node (LN) examination is essential for its management.</p><p><strong>Methods: </strong>This retrospective study, conducted from January 2018 to December 2023 at the First Medical Center of the Chinese PLA General Hospital, aimed to develop a statistical model for assessing LN count adequacy. To calculate false-negative probabilities, a new statistical model based on the β-binomial distribution and maximum likelihood method in R software was used.</p><p><strong>Results: </strong>Among 4429 screened colorectal cancer patients, there were 2314 with colon cancer and 2115 with rectal cancer. For colon cancer, the excision of 7 LNs for pT1 and 11 LNs for pT2 was associated with a likelihood of encountering occult positive LNs remained below 5%. For pT3 and pT4, after the removal of 16 LNs and 20 LNs, respectively, the likelihood of overlooking a positive node was below 10%. For rectal cancer, the excision of 7 LNs for pT1 and 12 LNs for pT2 was associated with a likelihood of encountering occult positive LNs remained below 5%. For pT3 and pT4, after removing 15 LNs and 19 LNs, the likelihood of overlooking a positive node was below 10%.</p><p><strong>Conclusions: </strong>Our study establishes a novel quantitative framework that links LN harvest thresholds to the risk of false-negative metastasis in colorectal cancer, supporting adopting a more personalized approach.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-specific Differences in Preoperative Characteristics and Perioperative Outcomes of Patients Undergoing Robotic Resection Rectopexy With NOSE for Obstructive Defecation Syndrome.","authors":"Jamal Driouch, Shazadi Sajid, Omar Thaher","doi":"10.1097/SLE.0000000000001439","DOIUrl":"10.1097/SLE.0000000000001439","url":null,"abstract":"<p><strong>Purpose: </strong>Obstructive defecation syndrome (ODS) significantly impairs bowel function and often requires surgical intervention. This study evaluated sex-specific differences in outcomes after robotic-assisted resection rectopexy with natural orifice specimen extraction (NOSE).</p><p><strong>Methods: </strong>A prospective cohort of 57 patients (46 females, 11 males) undergoing robotic NOSE rectopexy for ODS was analyzed. Functional outcomes were assessed using the Wexner Constipation Score (WCS), Incontinence Score (WIS), and Altomare OD Score at baseline, 1, 3, and 12 months. To account for unequal group sizes, entropy balancing was applied and weighted analyses were performed.</p><p><strong>Results: </strong>Descriptive data indicated that rectocele was more frequent in females (73.9% vs. 27.3%), and male patients had slightly longer hospital stays (6.0 vs. 4.6 d). Constipation, ODS, and incontinence scores improved markedly in both sexes (eg, WCS at 12 mo: 2.0 in males vs. 4.8 in females). While raw values suggested somewhat faster improvement in males, weighted analyses confirmed that no significant sex effects remained. No conversions or anastomotic leaks occurred, and overall patient satisfaction was high (96.5%).</p><p><strong>Conclusion: </strong>Robotic NOSE rectopexy provides safe and effective treatment for ODS in both sexes. Descriptive analyses suggested a trend toward faster recovery in male patients, but after adjustment with entropy balancing no significant sex effects were found. Both sexes experienced marked functional improvement and high satisfaction, supporting robotic NOSE rectopexy as a valuable treatment option.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological Factors and Nomogram Development for Predicting Lymph Node Metastasis in Locally Advanced Rectal Cancer.","authors":"Xu Sun, Rui Li, Hao Liu, Sizhe Wang, Wen Zhao, Wenxing Gao, Peng Chen, Dingchang Li, Guanglong Dong","doi":"10.1097/SLE.0000000000001434","DOIUrl":"10.1097/SLE.0000000000001434","url":null,"abstract":"<p><strong>Background: </strong>Research on lymph node metastasis (LNM) in locally advanced rectal cancer (LARC) remains significantly underexplored. This study investigates the clinicopathological factors associated with LNM in LARC and develops a predictive nomogram for clinical application.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 1270 patients with LARC who underwent radical surgery between 2018 and 2023. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of LNM. A nomogram integrating these predictors was constructed and internally validated using bootstrap resampling. Subgroup analyses were carried out to compare stage N1 (n=333) and stage N2 (n=265) patients to determine the risk factors for advanced metastasis.</p><p><strong>Results: </strong>The detection rate of LNM was 47.0% (598/1270). Independent risk factors included mucinous adenocarcinoma (OR=1.529, P =0.018), bowel obstruction (OR=1.418, P =0.014), poor tumor differentiation (OR=2.468, P <0.001), perineural invasion (OR=1.784, P =0.003), and lymphovascular invasion (LVI, OR=2.741, P <0.001). Conversely, a history of alcohol consumption (OR=0.721, P =0.016) and microsatellite instability-high (MSI-H) status (OR=0.241, P =0.005) appeared to exert protective effects. The nomogram demonstrated moderate predictive accuracy ( C -index: 0.657, 95% CI: 0.627-0.686). In subgroup analyses, Ki-67 expression emerged as an additional independent risk factor for stage N2 patients (OR=1.016, P =0.040).</p><p><strong>Conclusion: </strong>This study elucidated key risk factors for LNM in LARC patients and developed a nomogram for clinical use, offering valuable insights for the design and implementation of multidisciplinary perioperative treatment strategies.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}