World Journal of Gastrointestinal Surgery最新文献

{"title":"Evaluating the predictive value of endoscopic findings for residual colorectal cancer following neoadjuvant combination immunotherapy.","authors":"Yue-Gang Li, Cheng-Cheng Han, Meng Zhuang, Wei Zhao, Gang Hu, Wen-Long Qiu, Xi-Shan Wang, Jian-Qiang Tang","doi":"10.4240/wjgs.v17.i1.98263","DOIUrl":"10.4240/wjgs.v17.i1.98263","url":null,"abstract":"<p><strong>Background: </strong>Endoscopy allows for the direct observation of primary tumor characteristics and responses after neoadjuvant treatment. However, reports on endoscopic evaluation following neoadjuvant immunotherapy remain limited.</p><p><strong>Aim: </strong>To examine the predictive value of endoscopic findings of primary tumors for responses to neoadjuvant immunotherapy.</p><p><strong>Methods: </strong>This retrospective study, conducted at a tertiary center in China, evaluated 74 patients with colorectal cancer, including 17 with deficient mismatch repair (dMMR) and 15 with proficient mismatch repair (pMMR) tumors. Patients underwent neoadjuvant immunotherapy followed by surgery. Endoscopic findings before and after neoadjuvant immunotherapy were reviewed and compared with the pathology of the resected specimens.</p><p><strong>Results: </strong>In the pMMR group (<i>n</i> = 57 evaluable patients), endoscopy identified 11/17 patients who achieved a complete response (CR), while misidentifying 1/40 patients with residual disease as CR (64.7% <i>vs</i> 2.5%, <i>P</i> < 0.01). Conversely, 22/40 patients with residual disease were accurately identified as achieving a partial response (PR), with 1/17 patients who achieved CR misclassified as PR (55.0% <i>vs</i> 5.9%, <i>P</i> < 0.01). The sensitivity, specificity, and accuracy of endoscopic diagnosis for pathological CR were 64.7%, 97.5%, and 87.7%, respectively. In the dMMR cohort, endoscopy classified 9/17 patients as CR and 2 of the remaining patients with residual tumors as PR (64.3% <i>vs</i> 66.7%, <i>P</i> = 0.73). The method demonstrated 100% sensitivity and 82.4% accuracy in diagnosing pathological CR.</p><p><strong>Conclusion: </strong>Endoscopic evidence of CR or PR was well correlated with postoperative pathological outcomes in the pMMR cohort. Despite endoscopic indications of tumor residue, a complete pathological response post-surgery was possible in the dMMR cohort.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"98263"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053797","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":"Microwave ablation for liver metastases from colorectal cancer: A comprehensive review of clinical efficacy and safety.","authors":"Fang Li, Yuan-Yuan Zhang, Ming Li, Sheng-Kai Chen","doi":"10.4240/wjgs.v17.i1.101162","DOIUrl":"10.4240/wjgs.v17.i1.101162","url":null,"abstract":"<p><p>Microwave ablation (MWA) is emerging as a highly effective treatment for colorectal liver metastases (CRLMs). This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy, safety, and technical considerations. MWA offers significant benefits, including higher intratumoral temperatures, larger ablation zones, and reduced susceptibility to the heat-sink effect, which make it particularly suitable for tumors near large blood vessels. This review details the patient selection criteria, procedural approaches, and the use of advanced imaging techniques to improve the precision and effectiveness of MWA. Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile. This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors. By summarizing recent studies and clinical trials, this review highlights the comparative effectiveness, safety, and integration with systemic therapies of MWA. In conclusion, MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques. Future research should focus on optimizing technical parameters, integrating MWA with systemic therapies, and conducting large-scale randomized controlled trials to establish standardized treatment protocols. Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"101162"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053404","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":"Construction of a nomogram prediction model for early postoperative stoma complications of colorectal cancer.","authors":"Ming-Qin Ba, Wen-Lin Zheng, Yu-Ling Zhang, Lin-Lin Zhang, Jing-Jing Chen, Jie Ma, Jia-Li Huang","doi":"10.4240/wjgs.v17.i1.100547","DOIUrl":"10.4240/wjgs.v17.i1.100547","url":null,"abstract":"<p><strong>Background: </strong>Postoperative enterostomy is increasing in patients with colorectal cancer, but there is a lack of a model that can predict the probability of early complications.</p><p><strong>Aim: </strong>To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.</p><p><strong>Methods: </strong>A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital. The patients' basic information, surgical details, pathological results, and preoperative inflammatory and nutritional indicators were reviewed. We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.</p><p><strong>Results: </strong>Binary logistic regression analysis revealed that diabetes [odds ratio (OR) = 3.088, 95% confidence interval (CI): 1.419-6.719], preoperative radiotherapy and chemotherapy (OR = 6.822, 95%CI: 2.171-21.433), stoma type (OR = 2.118, 95%CI: 1.151-3.898), Nutritional risk screening 2002 score (OR = 2.034, 95%CI: 1.082-3.822) and prognostic nutritional index (OR = 0.486, 95%CI: 0.254-0.927) were risk factors for early stoma complications after colorectal cancer surgery (<i>P</i> < 0.05). On the basis of these results, a prediction model was constructed and the area under the receiver operating characteristic curve was 0.740 (95%CI: 0.669-0.811). After internal validation, the area under the receiver operating characteristic curve of the validation group was 0.725 (95%CI: 0.631-0.820). The calibration curves for the modeling group and validation group are displayed. The predicted results have a good degree of overlap with the actual results.</p><p><strong>Conclusion: </strong>A previous history of diabetes, preoperative radiotherapy and chemotherapy, stoma type, Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery. The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"100547"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053780","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":"Diagnostic implications of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammatory index for gastric carcinoma.","authors":"Huang-Min Wu, Xiao-Xuan Ying, Li-Li Lv, Jian-Wen Hu","doi":"10.4240/wjgs.v17.i1.100130","DOIUrl":"10.4240/wjgs.v17.i1.100130","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of gastric carcinoma (GC) is essential for improving clinical outcomes. However, the biomarkers currently used for GC screening are not ideal.</p><p><strong>Aim: </strong>To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) for GC.</p><p><strong>Methods: </strong>The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed. The information on peripheral blood platelet, neutrophil, and lymphocyte counts in each patient was collected, and the NLR, PLR, and SII levels of both groups were calculated. Additionally, multivariate logistic regression analysis was conducted, and the diagnostic implications of NLR, PLR, and SII in differentiating patients with precancerous gastric conditions, compared with those with GC, were analyzed through receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>The data indicated that NLR, PLR, and SII had abnormally increased levels in the patients with GC. Gender and body mass index were risk factors for the occurrence of GC. ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions, who were differentiated from those with GC, were 0.824, 0.787, and 0.842, respectively.</p><p><strong>Conclusion: </strong>NLR, PLR, and SII are all abnormally expressed in GC and have diagnostic implications, especially when used as joint indicators, in distinguishing patients with precancerous gastric conditions from those with GC.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"100130"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053783","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 retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones.","authors":"Zhi-Liang Chen, Hong Fu","doi":"10.4240/wjgs.v17.i1.100544","DOIUrl":"10.4240/wjgs.v17.i1.100544","url":null,"abstract":"<p><strong>Background: </strong>Intrahepatic and extrahepatic bile duct stones (BDSs) have a high rate of residual stones, a high risk of recurrence, and a high rate of reoperation. It is very important to take timely and effective surgical intervention for patients.</p><p><strong>Aim: </strong>To analyze the efficacy, postoperative rehabilitation, and quality of life (QoL) of patients with intra- and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography (ERCP) + endoscopic papillary balloon dilation (EPBD) + laparoscopic hepatectomy (LH).</p><p><strong>Methods: </strong>This study selected 114 cases of intra- and extrahepatic BDSs from April 2021 to April 2024, consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP + EPBD + LH. Efficacy, surgical indicators [operation time (OT) and intraoperative blood loss (IBL)], postoperative rehabilitation (time for body temperature to return to normal, time for pain relief, and time for drainage to reduce jaundice), hospital stay, medical expenses, and QoL [Gastrointestinal Quality of Life Index (GIQLI)] were comparatively analyzed. Further, Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra- and extrahepatic BDSs.</p><p><strong>Results: </strong>The data demonstrated a higher overall effective rate in the observation group compared to the control group (<i>P</i> = 0.011), together with notably reduced OT, less IBL, shorter body temperature recovery time, pain relief time, time for drainage to reduce jaundice, and hospital stay (all <i>P</i> < 0.05). The postoperative GIQLI of the observation group was more significantly increased compared to the control group (<i>P</i> < 0.05). The two groups demonstrated no marked difference in medical expenses (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The above indicates that ERCP + EPBD + LH is effective in treating patients with intra- and extrahepatic BDSs, which is conducive to postoperative rehabilitation and QoL improvement, with promising prospects for clinical promotion.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"100544"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053791","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 submucosal dissection in the treatment of adult cystic lymphangioma: A case report.","authors":"Luo-Wei Qu, Qiu-Xia Li, Wen-Ying Zhu, Min Kang","doi":"10.4240/wjgs.v17.i1.98891","DOIUrl":"10.4240/wjgs.v17.i1.98891","url":null,"abstract":"<p><strong>Background: </strong>Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract. In the early stage, most patients are asymptomatic; after the onset of symptoms, there is often no specificity regarding symptoms.</p><p><strong>Case summary: </strong>Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon. One patient who came to our hospital with \"dull pain in the left lower abdomen for 2 days\" was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection. The final pathological results suggested cystic lymphangioma. One year later, no recurrence was found on re-examination <i>via</i> colonoscopy.</p><p><strong>Conclusion: </strong>Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed. Endoscopy, imaging, histology, and immunohistochemical staining are useful for diagnosis. Surgical resection is the preferred treatment.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"98891"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053793","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":"Machine learning and deep learning to improve prevention of anastomotic leak after rectal cancer surgery.","authors":"Francesco Celotto, Quoc R Bao, Giulia Capelli, Gaya Spolverato, Andrew A Gumbs","doi":"10.4240/wjgs.v17.i1.101772","DOIUrl":"10.4240/wjgs.v17.i1.101772","url":null,"abstract":"<p><p>Anastomotic leakage (AL) is a significant complication following rectal cancer surgery, adversely affecting both quality of life and oncological outcomes. Recent advancements in artificial intelligence (AI), particularly machine learning and deep learning, offer promising avenues for predicting and preventing AL. These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition, body composition, and radiological features. AI-based models have demonstrated superior predictive power compared to traditional statistical methods, potentially guiding clinical decision-making and improving patient outcomes. Additionally, AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes, minimizing the risk of intraoperative complications and reducing the likelihood of AL development.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"101772"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053383","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":"Trans-jugular intrahepatic portosystemic stent shunting benefits and limits.","authors":"Salvatore Stefano Sciarrone, Lucia Fini, Luca De Luca","doi":"10.4240/wjgs.v17.i1.100554","DOIUrl":"10.4240/wjgs.v17.i1.100554","url":null,"abstract":"<p><p>Trans-jugular intrahepatic portosystemic stent shunting (TIPSS) has been in use for many years with great results and many evolutions. The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt. Over time, TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension. From the outset, this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery. Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy, in fact this method is applicable to many patients with severe liver disease not suitable for it. TIPSS has been studied for the management of variceal bleeding, ascites, hepatic hydrothorax, hepatorenal syndrome, and other types of cirrhosis. However, some drawbacks of the TIPSS, such as shunt stenosis and hepatic encephalopathy, have also been reported in the literature. On the basis of the available evidence and the new epidemiological findings regarding liver disease, the following question may be posed: What is the place of TIPSS in current clinical practice?</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"100554"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053645","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 intracorporeal anastomosis <i>vs</i> open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study.","authors":"Wei-Hang Liu, Mao Xiong, Guo-Qing Chen, Zhui Long, Chao Xu, Li Zhu, Jing-Song Wu","doi":"10.4240/wjgs.v17.i1.98269","DOIUrl":"10.4240/wjgs.v17.i1.98269","url":null,"abstract":"<p><strong>Background: </strong>There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR).</p><p><strong>Aim: </strong>To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD.</p><p><strong>Methods: </strong>This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.</p><p><strong>Results: </strong>Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay (<i>P</i> = 0.045), lower incidence of enteral nutrition intolerance symptoms (<i>P</i> = 0.019), and earlier postoperative total enteral nutrition initiation (<i>P</i> = 0.033); however, it incurred higher total hospital costs (<i>P</i> = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"98269"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053362","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":"Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision <i>vs</i> laparoscopic transanal mesorectal excision for low-lying rectal cancer.","authors":"Feng Lu, Shu-Guang Tan, Juan Zuo, Hai-Hua Jiang, Jian-Hua Wang, Yu-Ping Jiang","doi":"10.4240/wjgs.v17.i1.100364","DOIUrl":"10.4240/wjgs.v17.i1.100364","url":null,"abstract":"<p><strong>Background: </strong>With the continuous development of laparoscopic techniques in recent years, laparoscopic total mesorectal excision (LapTME) and laparoscopic-assisted transanal total mesorectal excision (TaTME) have gradually become important surgical techniques for treating low-lying rectal cancer (LRC). However, there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.</p><p><strong>Aim: </strong>To compare the efficacy of LapTME <i>vs</i> TaTME in patients with LRC.</p><p><strong>Methods: </strong>Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University & Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME (<i>n</i> = 44) and TaTME (<i>n</i> = 50) groups. Clinical operation indexes, postoperative recovery indicators, and postoperative complications were recorded. The anal resting pressure (ARP), anal maximum systolic pressure (MSP), and maximum tolerated volume (MTV) of the anal canal were also measured. The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function questionnaire. Serum norepinephrine (NE), adrenaline (AD), and cortisol (Cor) levels were measured. The Quality of Life Questionnaire Core 30 (QLQ-C30) was used for quality of life assessment.</p><p><strong>Results: </strong>Compared with the LapTME group, the surgery time in the TaTME group was longer; intraoperative blood loss was low; time of anal exhaust, first postoperative ambulation, intestinal recovery, and hospital stay were shorter; and the distal incisal margin and specimen lengths were longer. The TaTME group also showed higher ARP, MSP, and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively. Cor, AD, and NE levels were lower in the TaTME group than those in the LapTME group during recovery.</p><p><strong>Conclusion: </strong>We demonstrated that TaTME better improved anal function, reduced postoperative stress, and accelerated postoperative recovery and, hence, was safer for patients with LRC.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 1","pages":"100364"},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053774","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}