World Journal of Gastrointestinal Surgery最新文献

{"title":"Retrospective review of anesthesia techniques and postoperative complications in patients with uremia undergoing colorectal cancer surgery.","authors":"Xue-Jian Zheng, Zhi-Xiong Zhang, Jian Du","doi":"10.4240/wjgs.v17.i8.105970","DOIUrl":"10.4240/wjgs.v17.i8.105970","url":null,"abstract":"<p><strong>Background: </strong>Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.</p><p><strong>Aim: </strong>To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.</p><p><strong>Results: </strong>Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% <i>vs</i> 26.7%, <i>P</i> = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL <i>vs</i> 3100 mL, <i>P</i> < 0.001) and lower complication rates (19.5% <i>vs</i> 28.2%, <i>P</i> = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days <i>vs</i> 11 days; <i>P</i> < 0.001) and higher rates of major complications (27.8% <i>vs</i> 13.5%; <i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"105970"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064776","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":"Navigating anatomical complexity in laparoscopic sigmoid cancer surgery: A three-dimension reconstruction protocol for intraoperative safety and efficiency.","authors":"Zong-Xian Zhao, Run-Dong Yao, Zong-Ju Hu, Chao-Qian Chen, Shu Zhu, Yuan Yao","doi":"10.4240/wjgs.v17.i8.109069","DOIUrl":"10.4240/wjgs.v17.i8.109069","url":null,"abstract":"<p><strong>Background: </strong>Sigmoid colon cancer faces challenges due to anatomical diversity, including variable inferior mesenteric artery (IMA) branching and tumor localization complexities, which increase intraoperative risks.</p><p><strong>Aim: </strong>To comprehensively evaluate the impact of three-dimensional (3D) visualization technology on enhancing surgical precision and safety, as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.</p><p><strong>Methods: </strong>A prospective cohort of 106 patients (January 2023 to December 2024) undergoing laparoscopic sigmoid cancer resection was divided into the 3D (<i>n</i> = 55) group and the control (<i>n</i> = 51) group. The 3D group underwent preoperative enhanced computed tomography reconstruction (3D Slicer 5.2.2 & Mimics 19.0). 3D reconstruction visualization navigation intraoperatively guided the following key steps: Tumor location, Toldt's space dissection, IMA ligation level selection, regional lymph node dissection, and marginal artery preservation. Outcomes included operative parameters, lymph node yield, and recovery metrics.</p><p><strong>Results: </strong>The 3D group demonstrated a significantly shorter operative time (172.91 ± 20.69 minutes <i>vs</i> 190.29 ± 32.29 minutes; <i>P</i> = 0.002), reduced blood loss (31.5 ± 11.8 mL <i>vs</i> 44.1 ± 23.4 mL, <i>P</i> = 0.001), earlier postoperative flatus (2.23 ± 0.54 days <i>vs</i> 2.53 ± 0.61 days; <i>P</i> = 0.013), shorter hospital length of stay (13.47 ± 1.74 days <i>vs</i> 16.20 ± 7.71 days; <i>P</i> = 0.013), shorter postoperative length of stay (8.6 ± 2.6 days <i>vs</i> 10.5 ± 4.9 days; <i>P</i> = 0.014), and earlier postoperative exhaust time (2.23 ± 0.54 days <i>vs</i> 2.53 ± 0.61 days; <i>P</i> = 0.013). Furthermore, the 3D group exhibited a higher mean number of lymph nodes harvested (16.91 ± 5.74 <i>vs</i> 14.45 ± 5.66; <i>P</i> = 0.030).</p><p><strong>Conclusion: </strong>The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation, improving procedural safety and efficiency.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109069"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065579","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":"<i>Bifidobacterium</i> triple viable bacteria-assisted mirtazapine in gastric cancer postoperative rehabilitation.","authors":"Zong-Yang Li, Zhi-Cheng Liu, Yu-Ning Gao, Ying Zhao, Chun-Hua Bai, Peng Xiao, Di-Fei Wang, Hong-Qiao Cai","doi":"10.4240/wjgs.v17.i8.106860","DOIUrl":"10.4240/wjgs.v17.i8.106860","url":null,"abstract":"<p><p>This article discusses the original article published by Lu <i>et al</i> in the latest issue. The article confirmed through a cohort study the clinical efficacy of the triple live bacteria of <i>Bifidobacterium</i> combined with mirtazapine in treating postoperative depression of gastric cancer patients, also explored the multi-target therapeutic mechanisms of <i>Bifidobacterium</i> triple viable bacteria combined with mirtazapine in managing depression in patients after radical gastrectomy for gastric cancer for the first time. The results indicated that <i>Bifidobacterium</i> could alleviate depression in patients after radical gastrectomy for gastric cancer. Gastric cancer patients undergoing surgery frequently experience postoperative psychological disorders, notably depression. These conditions not only impair quality of life but also negatively impact disease-free and overall survival. This editorial explores the underestimated psychological challenges following gastric cancer surgery, including depression, anxiety, adjustment disorders, and post-traumatic stress disorder. It further examines the therapeutic potential of <i>Bifidobacterium</i> triple viable probiotics, combined with mirtazapine, in alleviating postoperative depression through microbiological, immunological, and neurological mechanisms. Clinical evidence highlights additional benefits, such as improved gastrointestinal function, enhanced immunity, and better nutritional status, underscoring a holistic approach to postoperative care. While promising, further large-scale trials are needed to optimize and personalize probiotic-based interventions.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"106860"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065691","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":"Computed tomography-dominant surveillance strategies for colorectal cancer: Improving early detection of recurrence.","authors":"Shuang Han, Ling-Xia Yu, Hai-Peng Zou, Yan-Dong Miao, Si-Xiang Lin","doi":"10.4240/wjgs.v17.i8.107340","DOIUrl":"10.4240/wjgs.v17.i8.107340","url":null,"abstract":"<p><p>Colorectal cancer (CRC) is one of the most prevalent cancers globally, with a high recurrence rate following curative surgery, especially within the first 3 to 5 years. Post-surgical follow-up plays a vital role in detecting local and distant recurrences, significantly influencing survival rates. However, despite established guidelines recommending surveillance strategies, discrepancies persist regarding the optimal surveillance modality and patient adherence to follow protocols. Sala-Miquel <i>et al</i>'s study emphasize the superiority of computed tomography in detecting metastasis and recurrence, while also shedding light on the critical role of adherence to surveillance protocols in improving patient outcomes. This editorial discusses the implications of these findings for clinical practice, providing a comprehensive overview of the current landscape of CRC surveillance and the path forward for improving patient outcomes.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107340"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065784","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":"Combined effects of nurse-patient communication and psychological nursing on physical and mental stress responses after gastrointestinal surgery.","authors":"Nan Liu, Juan Tang, Fang Fang, Hai-Juan Yuan, Lei Huang, Xiao-Yue Tan","doi":"10.4240/wjgs.v17.i8.104784","DOIUrl":"10.4240/wjgs.v17.i8.104784","url":null,"abstract":"<p><strong>Background: </strong>The integration of patient-nurse communication language and focused psychological nursing can provide a reference for nursing interventions in patients undergoing gastrointestinal surgery.</p><p><strong>Aim: </strong>To analyze the impact of patient-nurse communicative language combined with focused psychological nursing on psychological and physiological stress responses, coping styles, health behaviors, and complications in patients undergoing gastrointestinal surgery.</p><p><strong>Methods: </strong>Eighty patients who underwent gastrointestinal surgery at Northern Jiangsu People's Hospital between October 2021 and August 2024 were selected and randomly divided into two groups, with 40 patients in each group. The control group received routine nursing care, while the observation group was provided with patient-nurse communicative language combined with focused psychological nursing care. Psychological stress responses, physiological stress responses, coping styles, health behaviors, incidence of complications, and nursing satisfaction were compared between the two groups.</p><p><strong>Results: </strong>After nursing, the observation group showed a significant improvement in psychological stress responses, with the average score on the Connor-Davidson Resilience Scale increasing from 23.22 ± 1.08 to 30.14 ± 2.78 (<i>P</i> < 0.05). On postoperative awakening, the heart rate of the observation group was 78.36 ± 2.98 times/min, significantly lower than the control group's 81.14 ± 2.44 times/min (<i>P</i> < 0.05), and the mean arterial blood pressure was 12.06 ± 1.26 kPa, compared to the control group's 13.45 ± 1.17 kPa (<i>P</i> < 0.05). The coping style scale scores of the observation group improved from 17.25 ± 1.40 to 23.64 ± 1.52 for confrontation, 16.94 ± 1.24 to 12.11 ± 1.02 for avoidance, and 21.69 ± 2.63 to 15.32 ± 1.41 for submission (<i>P</i> < 0.05). The health promotion lifestyle profile scores of the observation group increased from 104.25 ± 6.77 to 133.61 ± 10.25 (<i>P</i> < 0.05). The incidence of complications, such as wound infection and abdominal distension, in the observation group was 2.50%, significantly lower than that in the control group (20.00%; <i>P</i> < 0.05). Nursing satisfaction in the observation group was 95.00%, significantly higher than that in the control group (80.00%; <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>The integration of patient-nurse communicative language and focused psychological nursing can alleviate psychological and physiological stress responses in patients undergoing gastrointestinal surgery, improve their coping styles and health behaviors, reduce the risk of complications, and enhance nursing satisfaction, yielding ideal clinical outcomes.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"104784"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065821","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":"Integrating nutritional and inflammatory biomarkers in colorectal cancer management: Implications of microsatellite instability status.","authors":"Ren-Xian Xie, Yi-Xuan Xing, Nian-Zhe Sun","doi":"10.4240/wjgs.v17.i8.108150","DOIUrl":"10.4240/wjgs.v17.i8.108150","url":null,"abstract":"<p><p>The retrospective cohort study by Zuo <i>et al</i> investigates the interplay between microsatellite instability (MSI) status, nutritional indicators, and inflammatory profiles in colorectal cancer (CRC). Analyzing 56 patients, the study reveals that MSI-high tumors are associated with significantly lower serum albumin, body mass index, and absolute lymphocyte counts, alongside elevated neutrophil-to-lymphocyte ratios compared to microsatellite stable tumors. These findings highlight distinct immunological and nutritional profiles in MSI-high CRC, suggesting potential clinical utility in risk stratification and personalized treatment. While the study underscores the importance of MSI status in CRC management, its single-center design and limited sample size warrant validation through multicenter trials. This article contextualizes these findings within the broader landscape of CRC research, emphasizing the need for integrating biomarker-driven strategies into clinical practice to optimize outcomes for patients with differing MSI statuses.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"108150"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065657","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":"Nursing interventions' impact on cardiovascular complications after gastrointestinal surgery in intensive care unit: Risk factor analysis.","authors":"Ling Wang, Peng Yang, Xue-Qing He, Han Xia","doi":"10.4240/wjgs.v17.i8.104474","DOIUrl":"10.4240/wjgs.v17.i8.104474","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular (CV) complications are common in intensive care unit (ICU) patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay. The optimization of postoperative nursing interventions, particularly pain management, is crucial for reducing such complications.</p><p><strong>Aim: </strong>To investigate the effects of enhanced recovery nursing on CV complications after gastrointestinal surgery in ICU patients and associated risk factors.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 78 adult patients who underwent gastrointestinal surgery in the ICU of our hospital between February 2023 and September 2024. Among them, 40 patients received standard care (control group), while 38 received enhanced recovery nursing (observation group). We compared the incidence of CV complications and nursing satisfaction between the two groups. Patients were divided into CV complication and non-complication groups based on complication occurrence, and logistic regression analysis was used to identify risk factors.</p><p><strong>Results: </strong>In the control and observation groups, the incidence of CV complications was 30.0% (12/40) and 18.4% (7/38), with a nursing satisfaction rate of 70.0% (28/40) and 92.1% (35/38), respectively. The postoperative pain score at 14 days was significantly lower in the observation group (0.27 ± 0.15) compared to the control group (1.65 ± 0.37), with all differences being statistically significant (<i>P</i> < 0.05). Univariate analysis indicated significant differences in age, body mass index, hypertension, diabetes, smoking history, history of heart failure, and previous myocardial infarction (<i>P</i> < 0.05). Multivariate logistic regression identified heart failure history, previous myocardial infarction, age, hypertension, and diabetes as independent risk factors, with odds ratios of 1.195, 1.528, 1.062, 1.836, and 1.942, respectively (all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Implementing enhanced recovery nursing for ICU patients after gastrointestinal surgery is beneficial in reducing the incidence of CV complications and improving nursing satisfaction.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"104474"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065753","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":"Pathological features and risk factors for submucosal infiltration of colorectal lateral spreading tumors.","authors":"Wen-Jie Shi, Jian-Bo Han, Gong-Ming Cheng, Xu-Cheng Liu, Xue-Wen Tao, Liu-Qun Shan","doi":"10.4240/wjgs.v17.i8.107230","DOIUrl":"10.4240/wjgs.v17.i8.107230","url":null,"abstract":"<p><strong>Background: </strong>To observe the endoscopic and pathological characteristics of laterally spreading tumors (LSTs) and explore the risk factors for carcinogenesis and submucosal infiltration.</p><p><strong>Aim: </strong>To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion, providing evidence-based guidance for optimal treatment strategy selection.</p><p><strong>Methods: </strong>This study retrospectively analyzed the sex, age, and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024. Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration, and the factors with statistical significance were included in multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 422 patients, including 224 males and 198 females, aged 63.45 ± 9.23 years, were included. There were 456 LST lesions in total. The length of the endoscopically resected specimens was 3.01 ± 0.48 cm, and the length of the lesions was 2.37 ± 1.59 cm. It was located in 115 rectums (25.2%), 40 sigmoid colon (8.8%), 26 descending colon (5.7%), 109 transverse colon (23.9%), 112 ascending colon (24.6%), and 54 ileocecal regions (11.8%). Endoscopic submucosal dissection (ESD) was performed in 237 patients (52.0%), and endoscopic mucosal resection (EMR) was performed in 95 patients (20.8%). There were 113 EMR with precutting cases (24.8%), 11 ESD with snare cases (2.4%), 4 delayed bleeding cases and 5 intraoperative perforations. The pathological results revealed 119 cases of low-grade intraepithelial neoplasia (26.1%), 221 cases of high-grade intraepithelial neoplasia (48.5%), 82 cases of intramucosal carcinoma (18.0%), and 34 cases of submucous invasive carcinoma (7.5%). Multiple logistic regression analyses revealed that lesion size ( > 2 cm), lesion location (rectal) and endoscopic classification [false depressed tubulovillous adenoma (LST-NG pseudodepressed type, LST-NG-PD), type 1 particles (LST-G homogenous type), and LST-G nodular mixed type], accompanied by large nodules (with) were independent risk factors for carcinogenesis; endoscopic classification (LST-NG-PD) and the presence of large nodules were independent risk factors for submucosal infiltration.</p><p><strong>Conclusion: </strong>These risk factors provide practical guidance for treatment selection: LST-NG-PD with large nodules should prioritize ESD, while high-risk rectal lesions > 2 cm may require additional imaging evaluation before endoscopic resection.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107230"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065693","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":"Comparison of complication rates after early and late closure of loop ileostomies: A retrospective cohort study.","authors":"Pırıltı Özcan, Özgül Düzgün","doi":"10.4240/wjgs.v17.i8.109432","DOIUrl":"10.4240/wjgs.v17.i8.109432","url":null,"abstract":"<p><strong>Background: </strong>In the treatment of rectal cancer, a temporary loop ileostomy (TLI) is created after low anterior resection to protect bowel function in the postoperative period. Dehydration and kidney failure are significant potential complications in loop ileostomies. Compared to late closure (3-6 months), early closure (10-14 days) of the TLI may facilitate faster patient recovery and shorter hospital stays.</p><p><strong>Aim: </strong>To compare early and late closure of TLIs and demonstrate that early stoma closure can be performed without increasing morbidity.</p><p><strong>Methods: </strong>This study included patients who underwent TLI for rectal cancer, with data collected prospectively between June 2016 and October 2024 and analyzed retrospectively. Patients whose stomas were closed in the late period (3-6 months) between June 2016 and October 2022 (group A) were compared with those who underwent early closure (10-14 days) between October 2022 and 2024 (group B), with the primary outcome being complication rate and the secondary outcome being quality of life.</p><p><strong>Results: </strong>A total of 270 TLIs were created (70.9%). Of these, 120 (44.4%) were closed in the late period (group A), and 150 (55.6%) were closed in the early period (group B). There was no statistically significant difference between group A and group B in terms of demographic and clinicopathological characteristics (<i>P</i> > 0.05). Perioperative (anesthesia management, operative time, blood loss, surgical technique) and postoperative findings (anastomotic leak, infection) were similar between the two groups and were not statistically significant (<i>P</i> > 0.05). There were no statistically significant differences in complication rates as the primary outcome between the two groups. Quality of life as a secondary outcome was significantly higher in the early closure group (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>No statistically significant difference was found between early and late loop ileostomy closure in terms of perioperative and postoperative morbidity. Early closure accelerated patients' psychological and social recovery.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109432"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065867","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":"Ultrasound-guided quadratus lumborum block with general anesthesia for perioperative circulatory stability in colorectal cancer surgery.","authors":"Hui-Jie Li, Xi Ban, Jing Li, Su-Qin Huang","doi":"10.4240/wjgs.v17.i8.105990","DOIUrl":"10.4240/wjgs.v17.i8.105990","url":null,"abstract":"<p><strong>Background: </strong>The use of an ultrasound-guided quadratus lumborum block (QLB) combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response, preserving metabolic stability, protecting renal function, and alleviating postoperative pain.</p><p><strong>Aim: </strong>To compare QLB combined with general anesthesia <i>vs</i> general anesthesia alone in the perioperative stress response, metabolic and renal function, postoperative pain, and recovery outcomes among patients undergoing colorectal cancer surgery.</p><p><strong>Methods: </strong>Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis. According to the anesthesia protocol, the patients were divided into the control (general anesthesia, <i>n</i> = 58) and experimental groups (QLB combined with general anesthesia, <i>n</i> = 58). Physiological indicators such as blood glucose (GLU), lactic acid (LAC), blood urea nitrogen (BUN), and creatinine (CRE) were measured at T0 (pre-surgery), T1 (post-surgery), T2 (6 hours post-surgery), T3 (24 hours post-surgery), and T4 (48 hours post-surgery). The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.</p><p><strong>Results: </strong>The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group (<i>P</i> < 0.001), and the LAC levels were also significantly reduced (<i>P</i> < 0.001). The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels (<i>P</i> < 0.05). Furthermore, the postoperative pain score in the experimental group was significantly lower than that in the control group [visual analogue scale (VAS)] scores differed significantly from T2 to T4, <i>P</i> < 0.05.</p><p><strong>Conclusion: </strong>Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15% and 10%-20% (<i>P</i> < 0.001), respectively. It also enhances renal function markers (BUN, CRE, <i>P</i> < 0.05) and lowers VAS scores by 15%-30% (<i>P</i> < 0.05). Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response, preserving metabolic balance and renal function, and alleviating postoperative pain. This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery. It is particularly advantageous for individuals with stress sensitivity, renal impairment, and heightened pain susceptibility.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"105990"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065444","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}