World Journal of Gastrointestinal Surgery最新文献

{"title":"Watch and wait in locally advanced rectal cancer: Evolution, current evidence, and future directions.","authors":"Andrés García-Fernández, Pilar Del Pozo-Elso, Arantxa Villadóniga-Sánchez, Raquel Martínez, Miguel Suárez","doi":"10.4240/wjgs.v17.i9.107831","DOIUrl":"10.4240/wjgs.v17.i9.107831","url":null,"abstract":"<p><p>The treatment of locally advanced rectal cancer (LARC) has evolved significantly over the past century, driven by a deeper understanding of tumor biology, technological advancements, and multidisciplinary approaches. This article reviews the historical progression of LARC management, emphasizing the latest breakthroughs that are reshaping treatment paradigms. Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy, the emergence of total neoadjuvant therapy as a standard approach, and the adoption of minimally invasive surgical techniques, such as transanal endoscopic microsurgery. Watch and wait may reduce treatment-related morbidity and help preserve anorectal function, but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety. Additionally, the role of targeted therapies and immunotherapy is gaining prominence, offering new opportunities for personalized treatment. These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function, ultimately enhancing patients' quality of life. Despite these advancements, challenges remain in optimizing patient selection, refining treatment strategies, and ensuring long-term safety and efficacy. A multidisciplinary approach involving surgeons, oncologists, and radiation specialists is crucial to tailoring therapies to individual patient profiles. As research continues, integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"107831"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193280","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":"Evaluation of pathological findings in predicting postoperative endoscopic recurrence in Crohn's disease: A retrospective cohort study.","authors":"Işıl Karabulut, Erdinç Çetinkaya, Nesrin Turhan, Oyku Tayfur Yurekli, Mesut Tez","doi":"10.4240/wjgs.v17.i9.110125","DOIUrl":"10.4240/wjgs.v17.i9.110125","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) patients with intestinal involvement often require surgical intervention due to resistance to medical therapy. Postoperative recurrence remains a significant challenge, with the Rutgeerts score commonly used to predict endoscopic recurrence.</p><p><strong>Aim: </strong>To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.</p><p><strong>Methods: </strong>This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023. Resection specimens were histopathologically re-examined, and postoperative colonoscopy reports were classified according to the Rutgeerts score. The association between pathological findings and endoscopic recurrence was analyzed statistically.</p><p><strong>Results: </strong>No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence (<i>P</i> > 0.05). However, the presence and severity of neutrophilic cryptitis (<i>P</i> = 0.035) and crypt abscesses (<i>P</i> = 0.010) in microscopic findings were significantly associated with higher Rutgeerts scores, indicating a parallel increase with endoscopic recurrence. Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence. Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence, with treatment decisions made by a weekly multidisciplinary council involving General Surgery, Gastroenterology, and Radiology.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110125"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193344","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":"Hypertension and tachycardia induced by irreversible electroporation in pancreatic cancer: An analysis based on clinical data.","authors":"Hong-Mei Li, Yan-Li Xing, Zi-Qing Chen, Shi-Xiong Duan, Yang-Yang Ma, Li-Zhi Niu","doi":"10.4240/wjgs.v17.i9.110577","DOIUrl":"10.4240/wjgs.v17.i9.110577","url":null,"abstract":"<p><strong>Background: </strong>Irreversible electroporation (IRE) is a novel non-thermal ablation technology for unresectable tumors. Hypertension and tachycardia usually occur during the IRE. To date, there has been little explanation about this phenomenon.</p><p><strong>Aim: </strong>To investigate the reasons of hypertension and tachycardia and appropriate preventive measures.</p><p><strong>Methods: </strong>IRE was performed under general anesthesia and neuromuscular blockade. Systolic blood pressures, diastolic blood pressures, heart rate, and the distance of the electrode from abdominal aorta and adrenal gland during IRE were recorded.</p><p><strong>Results: </strong>All of 78 patients underwent 96 IRE sessions, 44 (56.4%) patients occurred hypertension when the electrode was close to the abdominal aorta (< 2.0 cm). The median systolic blood pressures and diastolic blood pressures was 194 and 108 mmHg. Furthermore, 11 (14.1%) patients occurred tachycardia when the electrode was close to the adrenal gland (< 1.3 cm). The median heart rate of patients with tachycardia was 114 beats per minute. Furthermore, hypertension and tachycardia can be prevented with nicardipine and esmolol before treatment.</p><p><strong>Conclusion: </strong>Intraoperative hypertension and tachycardia occur because electrodes close to the abdominal aorta (< 2.0 cm) and adrenal glands (< 1.3 cm), which can be prevented by preoperative treatment of vasoactive drugs.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110577"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192943","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":"Laparoscopic management of gallstones in a duplicate gallbladder with double cystic ducts: A case report.","authors":"Abuduniyazi Ahunayizhi, Xin-Long Zhang, Qian Chen, Hui Wang, Gang Ding, Sulaiman Akumuo, Xue-Xin Wang, Xiao-Jiao Ruan","doi":"10.4240/wjgs.v17.i9.110796","DOIUrl":"10.4240/wjgs.v17.i9.110796","url":null,"abstract":"<p><strong>Background: </strong>Duplicated gallbladder with two completely independent cystic ducts is an exceptionally rare congenital anomaly. This case report documents an example of successful laparoscopic management, adding to the limited literature by highlighting the importance of accurate preoperative imaging and surgical planning.</p><p><strong>Case summary: </strong>We present the case of a 46-year-old Uyghur woman who was admitted with intermittent right upper abdominal pain accompanied by nausea and vomiting that had persisted for 1 week. Her basic blood test results, including liver function test, were normal. Preoperative ultrasound revealed an abnormal echo in the gallbladder region, suggesting a double gallbladder malformation with one chamber containing multiple stones. Computed tomography and magnetic resonance cholangiopancreatography confirmed a double gallbladder anomaly. The patient subsequently underwent successful laparoscopic cholecystectomy. During the procedure, two gallbladder chambers were identified, with each cystic duct being independently inserted into the common bile duct. Surgery was completed without complications, and postoperative pathology confirmed the presence of gallstones and chronic cholecystitis. Because of the effective preoperative assessment, the patient recovered smoothly and was discharged 3 days after surgery, reporting no discomfort during follow-up.</p><p><strong>Conclusion: </strong>This case highlights the need for thorough evaluation of rare gallbladder anomalies; literature recommends removing both to prevent disease recurrence. We present this case to raise clinical awareness, support appropriate diagnosis, and reinforce the recommendation to remove both gallbladders to prevent recurrence of gallbladder disease.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110796"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193044","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":"Impact of non-alcoholic hepatic steatosis on prognosis and clinical outcomes in gastric cancer patients undergoing laparoscopic distal gastrectomy.","authors":"Yi-Fan Zou, Yi-Gang Zhang, Zi-Chu Zhao, Zheng Li, Hong-Da Liu, Qing-Ya Li, Ze-Tian Chen, Cheng-Jun Zhu, Hai-Tao Liu, Ji-Wei Wang, Feng-Yuan Li, Lin-Jun Wang, Dian-Cai Zhang, Li Yang, Hao Xu, Ze-Kuan Xu, Sen Wang","doi":"10.4240/wjgs.v17.i9.106198","DOIUrl":"10.4240/wjgs.v17.i9.106198","url":null,"abstract":"<p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized for its role in the pathogenesis of various cancers. However, its impact on gastric cancer (GC) outcomes, particularly in patients undergoing laparoscopic distal gastrectomy (LDG), remains unclear.</p><p><strong>Aim: </strong>To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.</p><p><strong>Methods: </strong>In this retrospective cohort study, we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022. Propensity score-matching (PSM) was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups. Survival analysis was also performed to evaluate NAFLD as a prognostic factor.</p><p><strong>Results: </strong>PSM yielded a balanced cohort of 260 patients (52 with NAFLD and 208 controls) from the original cohort. No differences in clinicopathological characteristics, including surgery time, complications, T stage, N stage, p-tumor-node-metastasis stage, neural invasion, vascular invasion, total number of retrieved lymph nodes, positive retrieved lymph nodes and positive lymph nodes rate, were observed between the two groups. Overall survival was comparable between two groups (Log-rank <i>P</i> = 0.49), whereas progression-free survival (PFS) in the NAFLD group was inferior to that in the control group (Log-rank <i>P</i> = 0.016). Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.</p><p><strong>Conclusion: </strong>GC patients with NAFLD exhibited inferior PFS, suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes. Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"106198"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193062","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":"Music therapy combined with anesthesia recovery care boosts anesthesia recovery in colorectal cancer patients undergoing laparoscopic radical resection.","authors":"Yan Zheng, Hai-Fang Ni, Yan Shi, Dan-Qian Cui, Zhen-Zhu Wu, Yu-Feng Ling, Shui-Qing He, Xiao-Yun Qin","doi":"10.4240/wjgs.v17.i9.106301","DOIUrl":"10.4240/wjgs.v17.i9.106301","url":null,"abstract":"<p><strong>Background: </strong>Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer (CRC) management, highlighting the need to explore alternative care strategies that improve clinical outcomes.</p><p><strong>Aim: </strong>To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.</p><p><strong>Methods: </strong>One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled. The patients were assigned to control (<i>n</i> = 60, receiving standard nursing care) and observation groups (<i>n</i> = 60, receiving music therapy, anesthesia recovery care, and standard nursing care). We comparatively analyzed the time to regain consciousness, extubation time, and length of stay in the postanesthesia care unit; heart rate, systolic blood pressure, and diastolic blood pressure before anesthesia and during recovery; cortisol, aldosterone, norepinephrine, and adrenaline levels before anesthesia and 24 hours postoperatively; Postoperative Quality of Recovery Scale scores; and complication rates between the groups.</p><p><strong>Results: </strong>The observation group exhibited a significantly shorter time to regain consciousness, extubation time, and postanesthesia care unit stay than the control group (<i>P</i> < 0.05). During the recovery period, heart rate, systolic blood pressure, and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels, with the levels in the observation group being significantly lower than those in the control group (<i>P</i> < 0.05). At 24 hours postoperatively, cortisol, aldosterone, norepinephrine, and adrenaline levels were elevated in both groups compared with preanesthesia levels, with levels in the observation group being significantly lower than those in the control group (<i>P</i> < 0.05). The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group (<i>P</i> < 0.05). Moreover, the complication rate in the observation group was significantly lower than that in the control group (10.00% <i>vs</i> 40.00%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection, mitigated fluctuations in vital signs and stress responses, improved postoperative recovery quality, and reduced complication rates, demonstrating substantial clinical value.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"106301"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193202","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":"Role of endoscopic ultrasound-guided portal pressure gradient measurement in assessing liver function before liver-directed therapies.","authors":"Ahmed Telbany, Youssef Soliman, Gagandeep Singh, Khaled Abouelezz, Toufic Kachaamy","doi":"10.4240/wjgs.v17.i9.101834","DOIUrl":"10.4240/wjgs.v17.i9.101834","url":null,"abstract":"<p><p>Liver-directed therapies such as resection, ablation, and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care. However, these treatments pose significant hepatic decompensation risks, particularly with underlying liver disease and chemotherapy-associated steatohepatitis. Accurate assessment of liver function and portal hypertension (PH) is critical for candidate selection. While Child-Pugh score and model for end-stage liver disease are commonly used, they have substantial limitations. Hepatic venous pressure gradient (HVPG) measurement remains the gold standard for assessing PH but is invasive and not widely available. Endoscopic ultrasound (EUS) guided portal pressure gradient (PPG) measurement has emerged as a promising minimally invasive alternative. EUS-PPG demonstrates excellent technical success rates, safety profile, and correlation with HVPG in early studies. By providing direct portal pressure measurement, EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies, particularly in detecting presinusoidal hypertension. Furthermore, it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies. However, research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"101834"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193332","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":"Comprehending and adapting to fear of cancer recurrence in geriatric gastric cancer: A call for prehabilitation pathway.","authors":"Sohan Lal Solanki, Indubala Maurya","doi":"10.4240/wjgs.v17.i9.110195","DOIUrl":"10.4240/wjgs.v17.i9.110195","url":null,"abstract":"<p><p>Fear of cancer recurrence (FCR) is a psychological worry among cancer survivors, particularly among the elderly who are at risk of developing physiological and psychological vulnerabilities. In a cross-sectional survey of 264 elderly gastric cancer (GC) patients by Zhu <i>et al</i>, a high rate (63.64%) of clinically significant FCR was observed following laparoscopic radical gastrectomy. Factors affecting the high rate of FCR were a high level of self-perceived burden, lower education level, large tumour diameter, short duration of disease, and postoperative complications. They also established a validated nomogram model to predict the risk of FCR in this patient population. In this letter, we want to emphasize that, in addition to integrating psychological screening and focused interventions into the routine postoperative care of elderly GC patients, prehabilitation interventions before surgery, including psychological support, may provide a proactive response to mitigate FCR and improve long-term outcomes.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110195"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193163","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":"Double tract reconstruction in proximal gastric tumors: A systematic review of clinical and functional outcomes.","authors":"Enver Ilhan, Gökalp Okut","doi":"10.4240/wjgs.v17.i9.109030","DOIUrl":"10.4240/wjgs.v17.i9.109030","url":null,"abstract":"<p><strong>Background: </strong>Proximal gastrectomy (PG) with double tract reconstruction (DTR) has recently emerged as a function-preserving alternative to total gastrectomy (TG) with Roux-en-Y (RNY) reconstruction in patients with proximally located gastric cancer.</p><p><strong>Aim: </strong>To evaluate the current evidence comparing PG-DTR with TG-RNY in terms of perioperative outcomes, long-term survival, complication rates, nutritional status and reflux esophagitis.</p><p><strong>Methods: </strong>A systematic literature search was conducted using PubMed, MEDLINE, Web of Science and the Cochrane Library for studies published between 2010 and January 2025. Search terms included gastric cancer, DTR and TG. Trials comparing PG-DTR with TG-RNY or PG-esophagogastrostomy (EG) were included. Data on operative details, lymph node yield, complications (Clavien-Dindo ≥ III), nutritional markers and incidence of reflux were extracted. Nineteen trials met the inclusion criteria. The review followed the PRISMA guidelines.</p><p><strong>Results: </strong>PG-DTR was found to have comparable long-term oncological outcomes to TG-RNY, despite a lower extent of lymph node dissection. Operative time and intraoperative blood loss were generally similar, with some studies favouring PG-DTR. Rates of major postoperative complications were comparable between techniques. Notably, PG-DTR showed a significantly lower incidence of reflux esophagitis than PG-EG and was comparable or superior to TG-RNY in reflux control. Nutritionally, PG-DTR was associated with better post-operative weight maintenance and biochemical parameters such as haemoglobin, albumin and vitamin B12 levels compared to TG-RNY. No significant nutritional differences were observed between PG-DTR and PG-EG. PG-DTR appears to offer a balanced approach to the surgical treatment of proximal gastric cancer, combining oncological safety with functional and nutritional benefits.</p><p><strong>Conclusion: </strong>Its superiority over TG-RNY in postoperative nutrition and reflux prevention, together with comparable complication rates and survival, supports its consideration as a preferred reconstruction method in selected patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"109030"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193126","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":"Risk modeling of delayed postoperative bleeding after endoscopic submucosal dissection for early colorectal cancer and precancerous lesions.","authors":"Jun Qian, Ya-Li Tao, Shu-Sen Zheng","doi":"10.4240/wjgs.v17.i9.107326","DOIUrl":"10.4240/wjgs.v17.i9.107326","url":null,"abstract":"<p><strong>Background: </strong>As a minimally invasive technique, endoscopic submucosal dissection (ESD) is widely used in treating early colorectal cancer (ECRC) and precancerous lesions (PCLs). However, a common postoperative complication - delayed postoperative bleeding (DPOB) - can significantly hinder patient recovery.</p><p><strong>Aim: </strong>To build and validate a predictive model for assessing post-ESD DPOB risk in ECRC and PCL patients, utilizing logistic regression methodology.</p><p><strong>Methods: </strong>A retrospective review was conducted on ECRC/PCL 302 patients who received ESD at our hospital between July 2021 and July 2024. The cohort was stratified based on the incidence of DPOB following ESD, forming DPOB and non-DPOB groups. Through allocation, they were further allocated into model and validation cohorts. Clinical variables from both cohorts were collated and subjected to univariate analysis to determine potential factors associated with post-ESD DPOB. Subsequently, we constructed a predictive model for DPOB risk employing logistic regression analysis. Model performance assessment used receiver operating characteristic curves in both the training and validation cohorts, with internal validation accomplished <i>via</i> 10-fold cross-validation.</p><p><strong>Results: </strong>The occurrence rate of DPOB was 9.93%. Univariate analysis revealed that the number of lesions, lesion size, lesion location, degree of submucosal fibrosis, and intraoperative bleeding were significantly associated with DPOB. Binary logistic regression analysis identified the number of lesions, lesion size, lesion location, and degree of submucosal fibrosis as independent DPOB determinants. A nomogram that was developed to quantify the DPOB risk exhibited that an increment in the total score corresponded to an increased risk. The model achieved area under the curve values of 0.831 and 0.821 in the model and validation groups, respectively, with <i>P</i> values of 0.853 and 0.203 in the Hosmer-Lemeshow test. The model demonstrated robust discriminative performance, with an average area under the curve of 0.795 (95% confidence interval: 0.702-0.887) in 10-fold cross-validation.</p><p><strong>Conclusion: </strong>Collectively, the presence of multiple lesions, lesion size of ≥ 3 cm, lesion localization in the rectum, and severe fibrosis are significant independent predictors of DPOB in patients undergoing surgery for ECRC or PCLs. The proposed risk prediction model, which integrates these factors, demonstrates excellent predictive accuracy and clinical utility, thereby providing a valuable tool for risk stratification and postoperative management in this patient population.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"107326"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193224","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}