World Journal of Gastrointestinal Surgery最新文献

{"title":"Perioperative multidisciplinary nursing model for endoscopic gastric submucosal dissection development and effect evaluation.","authors":"Yu-Ping Qian, Hui Cai, Shu-Yin Tang, Hong-Ping Zhou, Qian Han, Hui-Ming Tu","doi":"10.4240/wjgs.v18.i2.113441","DOIUrl":"10.4240/wjgs.v18.i2.113441","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for early gastric cancer (EGC), offering high <i>en bloc</i> resection and curative resection rates. However, despite its minimally invasive nature, ESD is still associated with potential complications such as bleeding, perforation, and delayed recovery, which can prolong hospital stays and affect patient outcomes. While advancements in digestive endoscopy have improved procedural precision and safety, perioperative care remains a critical factor influencing recovery. Conventional nursing models often lack coordination across specialties and fail to address the comprehensive needs of EGC patients undergoing ESD. In contrast, multidisciplinary team (MDT) approaches have demonstrated efficacy in improving care quality and patient satisfaction in oncology settings. Yet, the application and effectiveness of a structured perioperative MDT nursing model specifically tailored for ESD patients with EGC have not been fully explored. Therefore, developing and validating an evidence-based MDT nursing protocol is essential to optimize perioperative management and enhance clinical outcomes in this patient population.</p><p><strong>Aim: </strong>To construct ESD for patients with EGC assisted by digestive endoscopy, the perioperative MDT nursing model for ESD treatment was adopted, and its effect was evaluated.</p><p><strong>Methods: </strong>A total of 99 patients diagnosed with EGC in our hospital from April 2022 to April 2025 were prospectively selected as the observation group research subjects to receive the MDT nursing mode. Another 99 patients were selected in a 1:1 ratio as the control group to receive the conventional nursing mode. Both groups received ESD treatment. The recovery of intestinal rumbling sounds after surgery, the time of first getting out of bed for activities, the average length of hospital stay, and the satisfaction situation were compared between the two groups.</p><p><strong>Results: </strong>Intergroup comparisons revealed that the observation group patients had significantly better outcomes in terms of time to bowel sound recovery (12.53 ± 1.21) hours, first time out of bed activity (23.53 ± 2.34) hours, length of hospital stay (6.63 ± 0.46) days, and overall complication rate (3.03%), along with a significantly higher satisfaction rate of 100% compared to 80.81% in the control group (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>MDT can significantly promote the recovery of EGC patients after ESD treatment assisted by digestive endoscopy, improve the treatment effect of patients, and increase patient satisfaction. It is worthy of clinical promotion and application.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"113441"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435992","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":"Acupuncture regulating the gut-brain axis for postoperative ileus: Neuroimmune mechanisms and clinical translation prospects.","authors":"De-Hui Li, Jia Yuan, Chang Qiao, Xiao-Tong Tian, Qian Yang","doi":"10.4240/wjgs.v18.i2.114417","DOIUrl":"10.4240/wjgs.v18.i2.114417","url":null,"abstract":"<p><p>Postoperative ileus remains a significant challenge in surgical recovery. Increasing evidence highlights the gut-brain axis as a promising target for managing gastrointestinal motility disorders. Acupuncture, particularly at Zusanli (ST36), has shown considerable potential to regulate gut function, although its mechanisms warrant further investigation. This editorial discusses a clinical study demonstrating that electroacupuncture at Zusanli (ST36) accelerates gastrointestinal recovery in patients with postoperative ileus by activating the vagus nerve-cholinergic anti-inflammatory pathway, suppressing pro-inflammatory cytokines, and rebalancing gastrointestinal hormones. We further summarize how acupuncture modulates the gut-brain axis through neural, immune, endocrine, microbial, and central pathways, supporting integration with modern neuroimmunology. These findings support incorporating acupuncture into enhanced recovery after surgery protocols. Future studies should prioritize mechanistic investigations using multi-omics technologies, large-scale clinical trials to enable standardization, and exploration of acupuncture-microbiota-gut-brain interactions to broaden clinical applications in gastrointestinal disorders.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"114417"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436027","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":"Individual chemotherapy for patients colorectal cancer based on patient-derived tumor-like cell clusters.","authors":"Fu-Lin Lin, Li-Min Zhou, Yun-Jie Ye, Xiao-Long Luo, Xue-Lin Ji, Si-Qi Chen, Ji-Guang Xie, Bing-Feng Jin, Zhen-Dong Liu","doi":"10.4240/wjgs.v18.i2.114286","DOIUrl":"10.4240/wjgs.v18.i2.114286","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is among the most common malignant tumors. Chemotherapy remains central to CRC management, yet many patients still fail to derive optimal benefit. Patient-derived tumor-like cell clusters (PTCs), a preclinical three-dimensional tumor model containing primary epithelial cells, fibroblasts, and immune cells, can more accurately predict drug efficacy because they closely resemble the original tumor tissue.</p><p><strong>Aim: </strong>To evaluate the feasibility of using PTCs to guide personalized chemotherapy for patients with CRC.</p><p><strong>Methods: </strong>Fresh tumor tissues from 54 patients with resectable CRC were used to establish PTCs. Culture duration, diameter, and morphology were monitored. Hematoxylin-eosin staining was performed to assess PTC morphology. Drug sensitivity was evaluated through the PTC drug assay.</p><p><strong>Results: </strong>PTCs exhibited inter- and intrapatient variability in growth rate, diameter, and morphology. Comparable proportions of PTCs showed strong or effective inhibition in response to FOLFOX and FOLFIRI. FOLFOXIRI demonstrated robust antitumor activity in 97% of PTC models. However, responses to FOLFOX and FOLFIRI varied considerably among individuals. FOLFOXIRI showed cell-killing activity similar to FOLFOX or FOLFIRI.</p><p><strong>Conclusion: </strong>Accounting for patient's pathological and clinical characteristics, PTC-based drug-sensitivity testing can help accurately identify effective agents for CRC <i>in vitro</i>. This novel preclinical platform may reduce unnecessary chemotherapy and support precision oncology.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"114286"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435906","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 nutritional status on treatment completion and prognosis during adjuvant chemotherapy following gastric cancer surgery.","authors":"Ke Zhou, Ren-Feng Tu, Li-Huai Lu, Hong Zhang","doi":"10.4240/wjgs.v18.i2.114607","DOIUrl":"10.4240/wjgs.v18.i2.114607","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Malnutrition is highly prevalent in gastric cancer patients receiving adjuvant chemotherapy and may compromise treatment completion and survival outcomes. The comparative predictive value of various nutritional assessment tools in this clinical setting remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the impact of nutritional status on treatment completion and prognosis during adjuvant chemotherapy following gastric cancer surgery, providing scientific evidence for clinical nutritional intervention strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on clinical data of 80 patients who received adjuvant chemotherapy after gastric cancer surgery from January 2020 to June 2024. Nutritional status was assessed using Nutritional Risk Screening 2002 (NRS2002), Controlling Nutritional Status, Prognostic Nutritional Index (PNI), and Glasgow Prognostic Score before and after chemotherapy. Patients were divided into nutritional risk group (NRS2002 ≥ 3 points, &lt;i&gt;n&lt;/i&gt; = 37) and non-nutritional risk group (&lt; 3 points, &lt;i&gt;n&lt;/i&gt; = 43) based on NRS2002 scores. Treatment completion, adverse reactions, and survival prognosis were evaluated. Logistic regression analysis was used to identify risk factors affecting treatment completion, and Cox regression analysis was used to analyze prognostic factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-seven patients (46.2%) had nutritional risk before chemotherapy. The nutritional risk group had significantly lower treatment completion rate compared to the non-nutritional risk group (75.7% &lt;i&gt;vs&lt;/i&gt; 95.3%, &lt;i&gt;P&lt;/i&gt; = 0.009), insufficient relative dose intensity (78.6% ± 14.2% &lt;i&gt;vs&lt;/i&gt; 92.1% ± 8.7%, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and significantly higher incidence rates of ≥ grade 3 hematologic and non-hematologic toxicities (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). With a median follow-up of 28 months, the nutritional risk group had significantly lower 3-year disease-free survival (DFS) and overall survival (OS) rates compared to the non-nutritional risk group (62.1% &lt;i&gt;vs&lt;/i&gt; 83.7%, &lt;i&gt;P&lt;/i&gt; = 0.018; 72.4% &lt;i&gt;vs&lt;/i&gt; 90.7%, &lt;i&gt;P&lt;/i&gt; = 0.023). Multivariate analysis showed that NRS2002 ≥ 3 points was an independent risk factor for treatment completion [odds ratio = 4.829, 95% confidence interval (CI): 1.542-15.114, &lt;i&gt;P&lt;/i&gt; = 0.007], DFS [hazard ratio (HR) = 2.847, 95%CI: 1.124-7.214, &lt;i&gt;P&lt;/i&gt; = 0.027], and OS (HR = 3.524, 95%CI: 1.089-11.404, &lt;i&gt;P&lt;/i&gt; = 0.036).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Nutritional status significantly affects treatment completion and prognosis in gastric cancer patients receiving postoperative adjuvant chemotherapy. Both NRS2002 and PNI demonstrate important predictive value, with NRS2002 showing the most consistent performance in predicting treatment completion and survival outcomes. Clinical practice should emphasize nutritional risk assessment and dynamic monitoring, and develop individualized nutritional intervention strategies to improve chemotherapy comp","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"114607"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435893","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":"Protective effect of ischemic preconditioning against hepatic ischemia-reperfusion injury and associated remote organ damage.","authors":"Christina Mouratidou, Efstathios T Pavlidis, Georgios Katsanos, Serafeim-Chrysovalantis Kotoulas, Athanasios Kofinas, Alexandra G Marneri, Eleni Massa, Georgios Tsoulfas, Ioannis N Galanis, Theodoros E Pavlidis","doi":"10.4240/wjgs.v18.i2.114997","DOIUrl":"10.4240/wjgs.v18.i2.114997","url":null,"abstract":"<p><p>Hepatic ischemia-reperfusion injury is a significant complication of liver surgery, including major hepatectomy, trauma surgery and liver transplantation. It is a key factor in postoperative organ failure, which negatively affects prognosis and overall patient survival. Beyond its localized hepatic effects, ischemia-reperfusion injury is increasingly recognized as a potent trigger of the systemic inflammatory response and remote organ damage. The cellular and molecular mechanisms involved are highly complicated and have yet to be entirely elucidated. The core pathophysiological mechanisms of hepatic ischemia-reperfusion injury include a transition to anaerobic metabolism and adenosine triphosphate depletion; the development of intracellular acidosis and calcium overload; the impairment of mitochondrial function; oxidative stress; the activation and accumulation of distinct cell populations, notably Kupffer cells, neutrophils and platelets; the upregulation and downregulation of microRNAs; increased nitric oxide production; and the triggering of an immune system response with the activation of the complement system and excessive cytokine release. Ischemic preconditioning (IP) is a surgical technique in which brief cycles of controlled ischemia followed by reperfusion are applied directly to an organ, aiming to enhance its tolerance to subsequent prolonged ischemia. Hepatic IP has been demonstrated to reduce ischemia-reperfusion injury by decreasing the release of proinflammatory cytokines and damage-associated molecular patterns; suppressing reactive oxygen species production; activating the antioxidant enzyme heme-oxygenase 1, caspase, heat shock proteins and protein kinase cascades; modulating energy supplies and electrolyte homeostasis; and intervening in cell death pathways. In addition to its local effects on the liver, growing evidence indicates that IP also provides systemic advantages by reducing the inflammatory response and limiting injury to distant organs following major hepatic injury. This review integrates current data on IP, highlighting its role in hepatic protection and prevention of remote organ damage, while exploring the underlying mechanisms and translational potential of this approach in hepatic surgery and transplantation.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"114997"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436094","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":"Beyond stapled transanal rectal resection <i>vs</i> ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome.","authors":"Michele Schiano di Visconte, Sonia Sarnari","doi":"10.4240/wjgs.v18.i2.116100","DOIUrl":"10.4240/wjgs.v18.i2.116100","url":null,"abstract":"<p><p>Obstructed defecation syndrome (ODS) is a heterogeneous pelvic floor disorder in which a persistent focus on \"stapled transanal rectal resection (STARR) <i>vs</i> ventral rectopexy (VR)\" has encouraged procedure-driven rather than phenotype-guided care. This opinion review synthesizes contemporary evidence on STARR and VR and proposes a phenotype-guided algorithm for surgical decision-making in ODS. We first summarize comparative outcome data, highlighting higher rates of late recurrence and urgency after STARR in contrast to more durable functional relief but greater invasiveness and mesh-related concerns after VR. We then outline a structured preoperative workup that integrates symptom scores, fluoroscopic or magnetic resonance defecography, and high-resolution anorectal manometry to discriminate between isolated structural disease, complex multilevel prolapse, functional defecatory disorders, mixed phenotypes, and ODS with impaired continence or excessive perineal descent. For each phenotype, we discuss the optimal role of STARR, VR, perineal resections, pelvic organ prolapse suspension, neuromodulation, and transverse perineal support within staged, multimodal pathways. Finally, we identified research priorities, including stratified randomized trials and phenotype-indexed multicenter registries, to validate this algorithm and refine the indications. Reframing ODS management around phenotyping, rather than procedural dichotomies, may improve patient selection, reduce functional failure, and align pelvic floor surgery with a broader movement toward precision medicine.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"116100"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435522","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":"Somatostatin and its analogs in the management of postoperative pancreatic fistulas: A comprehensive review.","authors":"Lydia Lazaridou, Alexandra Dimaki, Kalliopi Vakalou, Vasilios Zervas, Panagiotis Papadopoulos, Konstantinos E Koumarelas, Grigorios Christodoulidis","doi":"10.4240/wjgs.v18.i2.115417","DOIUrl":"10.4240/wjgs.v18.i2.115417","url":null,"abstract":"<p><p>A significant post-pancreatic surgery effect we could mention is the postoperative pancreatic fistula (POPF). In this way, it contributes to a large degree to morbidity and long-term recovery. Only clinically significant fistulas (grades B/C) are associated with notable deviations in care according to the current International Study Group on Pancreatic Surgery definitions. The development of POPF depends on many factors. This development includes mechanical damage that occurs at the anastomosis or the stump, and enzymatic autodigestion that results from pancreatic secretions. The somatostatin analogs include octreotide, lanreotide, and pasireotide. Somatostatin and its analogs inhibit exocrine pancreatic secretion and have been shown to be used as preventive agents. The data from clinical trials and meta-analyses remain questionable even today, and it has been found in some studies that it reduces the overall rate of fistulas. On the other hand, there is another view that the stable benefit in clinical relative POPF morbidity or survival has not yielded the desired results. Today, instead of universal prophylaxis, the use of somatostatin is recommended as part of a multimodal perioperative management. However, it has also been found that somatostatin may have positive effects only in certain patients. Ongoing research should aim to clarify the best patient selection. Additionally, it should have the goal of not only being economically beneficial but also being integrated into treatment based on somatostatin for the most precise preoperative care.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"115417"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436228","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":"Ligation of the intersphincteric fistula tract <i>vs</i> conventional surgery for anal fistula in Chinese patients.","authors":"Xue Li, Cong-Cong Zhi, Xiao-Long Wang, Li-Hua Zheng, Yi-Cheng Cheng","doi":"10.4240/wjgs.v18.i2.113979","DOIUrl":"10.4240/wjgs.v18.i2.113979","url":null,"abstract":"<p><strong>Background: </strong>Anal fistula is a common anorectal disorder for which conventional surgical procedures often result in relatively high recurrence and complication rates. Ligation of the intersphincteric fistula tract (LIFT), a sphincter-preserving technique, has emerged as a potential alternative.</p><p><strong>Aim: </strong>To systematically evaluate and compare the clinical efficacy, safety, and postoperative outcomes of LIFT <i>vs</i> conventional surgical approaches in the management of anal fistula using evidence from randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a comprehensive systematic search of both Chinese and international databases to identify RCTs published during January 2014 to 2025. Studies were deemed eligible if they directly compared LIFT with conventional surgical approaches, such as seton placement, fistulotomy, and fistulectomy. The extracted data were analyzed using Review Manager; the methodological quality of the included trials was rigorously evaluated by using the Cochrane risk-of-bias tool.</p><p><strong>Results: </strong>In total, 107 RCTs involving 9401 participants met the inclusion criteria. LIFT yielded higher healing rates and significantly lower recurrence and complication rates than conventional surgery. Patients undergoing LIFT reported a lower postoperative pain, shorter wound-healing duration, and better preservation of the anal sphincter function. No significant difference was recorded in the operative time between the two groups.</p><p><strong>Conclusion: </strong>The LIFT procedure demonstrated clear advantages over conventional surgical methods in terms of clinical efficacy, safety, and postoperative recovery, supporting the former's role as an effective and sphincter-preserving treatment for anal fistula. Nevertheless, most available trials are limited by short follow-up durations and heterogeneous outcome definitions, underscoring the need for undertaking large, multicenter RCTs employing standardized endpoints.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"113979"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435862","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":"Efficacy of endoscopic submucosal dissection in the treatment of early gastrointestinal lesions.","authors":"Ying Ling, Jun Wang, Chun-Hui Xi, Juan Liu","doi":"10.4240/wjgs.v18.i2.112776","DOIUrl":"10.4240/wjgs.v18.i2.112776","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) is applicable to early-stage gastrointestinal cancers, but its role in early gastrointestinal lesions is insufficiently researched.</p><p><strong>Aim: </strong>To evaluated the efficacy and safety profile of ESD compared with conventional gastrectomy for managing early gastrointestinal lesions, emphasizing clinical outcomes and postoperative recovery.</p><p><strong>Methods: </strong>A retrospective review was conducted on 206 patients diagnosed with early-stage gastrointestinal lesions at the Affiliated Hospital of North Sichuan Medical College between June 2021 and June 2024. Patients were divided into two groups: 98 underwent gastrectomy and 108 received ESD. Outcomes assessed included overall treatment efficacy, postoperative complications, serum tumor marker levels, gastrointestinal hormone concentrations, and mucosal barrier integrity indices.</p><p><strong>Results: </strong>The ESD group showed higher overall treatment efficacy (98.15% <i>vs</i> 92.86%; <i>P</i> > 0.05) and a significant lower complication rate (5.56% <i>vs</i> 13.27%). ESD was also associated with reduced intraoperative blood loss (58.36 mL <i>vs</i> 60.31 mL; <i>P</i> < 0.001) and shorter operative durations (69.21 minutes <i>vs</i> 69.86 minutes; <i>P</i> = 0.001). Gastrointestinal function recovered more rapidly following ESD, with an earlier return to oral intake (2.43 days <i>vs</i> 2.65 days; <i>P</i> = 0.006). Preoperatively, ESD patients exhibited lower thymidine kinase 1 and D-lactate levels, indicating enhanced preservation of mucosal integrity.</p><p><strong>Conclusion: </strong>For early gastrointestinal lesions, ESD represents a safe and effective alternative to conventional gastrectomy. It enables precise lesion excision with fewer complications and faster postoperative recovery.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"112776"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435835","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":"Spatial immune cell architecture after gastric cancer surgery predicts prognosis.","authors":"Heng-Jin Yang, Ben Liu","doi":"10.4240/wjgs.v18.i2.113530","DOIUrl":"10.4240/wjgs.v18.i2.113530","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gastric cancer remains a major global health burden with high mortality due to late-stage diagnosis and limited treatment efficacy. Emerging evidence demonstrates that the tumor microenvironment, particularly immune cell infiltration patterns and hypoxia-induced immunosuppression, plays a critical role in cancer progression. This study investigates the spatial immune cell architecture in postoperative gastric cancer tissues to identify prognostic biomarkers and guide personalized immunotherapy strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the spatial distribution pattern, density, and proportional features of important immune cells in the tumor microenvironment following radical gastrectomy for gastric cancer, assess their relationships with patients' 5-year overall survival (OS) and recurrence-free survival following surgery, and provide an immunological foundation for prognostic assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 112 patients with stage I-III gastric cancer who underwent R0 resection between June 2018 and June 2020 were included retrospectively. Paraffin-embedded specimens of postoperative cancer tissues and adjacent tissues were collected. The multicolor immunohistochemistry technique was used, and pan-cytokeratin staining was performed synchronously with 4,6-diamidino-2-phenylindole nuclear staining. The sections were scanned by the Vectra Polaris™ full-spectrum imaging system, and cell phenotype identification and spatial localization analysis were performed &lt;i&gt;via&lt;/i&gt; InForm&lt;sup&gt;®&lt;/sup&gt; 2.6 software. The independent prognostic value of OS/disease-free survival and immunological markers was assessed (tumor-node-metastasis stage, Lauren classification), and the Kaplan-Meier survival curve was used to analyze the survival differences between the high/low immune infiltration groups (log-rank test).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The density of CD8+ T cells in the invasion margin area (median: 248.5/mm&lt;sup&gt;2&lt;/sup&gt;) was significantly greater than that in the tumor core area (108.3/mm&lt;sup&gt;2&lt;/sup&gt;, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The 5-year OS rate was high in patients with a high CD8+ density (&gt; 220/mm&lt;sup&gt;2&lt;/sup&gt;; 68.2%), low-density group: 42.1%, &lt;i&gt;P&lt;/i&gt; = 0.003. An independent correlation between extended disease-free survival and a CD8+/forkhead box protein 3+ (FoxP3+) ratio &gt; 2.5 was found [hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.29-0.76]. The risk of death was greater for those with a fraction of programmed death ligand 1+ tumor cells &gt; 10% (HR = 2.15, 95%CI: 1.32-3.51). The enrichment of CD68+CD163+ M2 macrophages in the core area of the tumor predicted an increased risk of recurrence (HR = 1.72, &lt;i&gt;P&lt;/i&gt; = 0.018). An immune prognosis scoring system was constructed on the basis of least absolute shrinkage and selection operator (regression, integrating the density of the CD8+ marginal zone, the CD8+/FoxP3+ ratio, and the 5-year OS prediction area under the curve was 0.81 (9","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"18 2","pages":"113530"},"PeriodicalIF":2.1,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436296","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}