World Journal of Gastrointestinal Surgery最新文献

{"title":"Effects of totally implantable venous access ports on complications and quality of life in gastrointestinal cancer chemotherapy.","authors":"Xiao-Hui Ye, Rong-Hong Cui, Lei Xu, Ling-Rong Ye, Mei-Jun Wang","doi":"10.4240/wjgs.v17.i8.109333","DOIUrl":"10.4240/wjgs.v17.i8.109333","url":null,"abstract":"<p><strong>Background: </strong>Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer. Peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP) are widely used, but comparative data regarding their impact on catheter-related complications and quality of life (QoL) remain limited.</p><p><strong>Aim: </strong>To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.</p><p><strong>Methods: </strong>This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024. Inclusion criteria encompassed indications for intermittent intravenous chemotherapy, anticipated treatment duration of ≥ 12 weeks, an adequate preoperative hematologic profile, accessible upper body veins, and complete medical records. Patients were excluded if they had an anticipated survival of less than three months, active systemic infection, severe thrombosis or coagulopathy, communication barriers, or an urgent need for dialysis access. Patients were assigned to either the PICC or TIVAP group based on device type. Data collected included demographic variables, cancer characteristics, insertion procedure details, complications, and QoL, assessed <i>via</i> the EuroQol 5-Dimensions-3 levels, visual analogue scale, and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.</p><p><strong>Results: </strong>A total of 346 patients were analyzed. Baseline demographic, clinical, and cancer characteristics were similar between groups. The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group, with no pneumothorax occurring in either group. QoL assessments at baseline were comparable. At one month, the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores. Multivariate analysis identified TIVAP use, catheter tip placement in the distal superior vena cava/right atrium, prophylactic antibiotic administration, and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.</p><p><strong>Conclusion: </strong>In patients with gastrointestinal cancer undergoing chemotherapy, TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs. Optimal device selection, precise catheter tip positioning, and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109333"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065377","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":"Non-tumoral portal vein thrombosis in liver transplantation: Surgical perspectives and institutional protocol.","authors":"Pablo Duarte Rodrigues, Gabriel Lazzarotto-da-Silva, Flávia Heinz Feier, Tomaz J M Grezzana Filho, Cleber Rosito Pinto Kruel, Ian Leipnitz, Marcio Fernandes Chedid","doi":"10.4240/wjgs.v17.i8.107941","DOIUrl":"10.4240/wjgs.v17.i8.107941","url":null,"abstract":"<p><p>Non-tumoral portal vein thrombosis (PVT) is a frequent and challenging complication in liver transplant candidates. The prevalence reaches up to 26% in patients with cirrhosis on a transplant waiting list. Its severity increases with liver disease progression and significantly impacts post-transplant outcomes. Advanced PVT increases postoperative mortality to 30%. Effective management requires a multidisciplinary approach, especially in advanced cases. Preoperative strategies emphasize anticoagulation with low molecular weight heparin, while interventional radiology, including transjugular intrahepatic portosystemic shunts, offers alternatives in some cases. Intraoperatively, management is guided by PVT classification systems, ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases. This manuscript explores the management of PVT in liver transplantation candidates, discusses strategies to optimize outcomes, and presents our institutional protocol for addressing this high-risk condition.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107941"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065576","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":"Intestinal fibrosis attenuates the prophylactic effect of anti-tumour necrosis factor therapy on the postoperative recurrence of Crohn's disease.","authors":"Ze-Yu Ding, Yu-Jie Wang, Dan-Hua Yao, Tao Tian, Yu-Hua Huang, You-Sheng Li","doi":"10.4240/wjgs.v17.i8.106455","DOIUrl":"10.4240/wjgs.v17.i8.106455","url":null,"abstract":"<p><strong>Background: </strong>In the biologic era, postoperative recurrence (POR) of Crohn's disease (CD) remains a significant concern. The underlying cause of this phenomenon remains unclear at present.</p><p><strong>Aim: </strong>To examine whether intestinal fibrosis increases the likelihood of POR when anti-tumor necrosis factor biologics are used following ileocecal resection (ICR).</p><p><strong>Methods: </strong>We performed a single-centre, retrospective cohort study of patients with CD who underwent ICR. Recurrence was defined by endoscopy (Rutgeerts score ≥ i2), radiography (active inflammation in the neoterminal ileum) or surgery (another resection > 3 months post-ICR), and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.</p><p><strong>Results: </strong>Among 102 patients with CD who underwent ICR and received infliximab within 3 months, 69 (67.6%) had intestinal fibrosis. In addition, 60 patients (58.8%) experienced POR in various forms: 52.6%, 41.2%, and 10.8% had endoscopic, radiographic, and surgical recurrence, respectively. Patients with intestinal fibrosis experienced faster radiographic recurrence (log rank <i>P</i> = 0.03). After adjusting for risk factors associated with POR, intestinal fibrosis increased the risk of early radiographic recurrence (adjusted hazard ratio = 4; 95% confidence interval: 1.03-15.56; <i>P</i> = 0.045).</p><p><strong>Conclusion: </strong>Despite the limited sample size, our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factor α prophylaxis.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"106455"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065587","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":"Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes.","authors":"Run-Nan Zhang, Jian-Yong Cui, Zhong-Hua Zhao, Ya-Tong Li, Zhi-Wei Liu, Ji-Yue Zhang, Qiang Wei, Yan-Min Lu, Qiang-Pu Chen","doi":"10.4240/wjgs.v17.i8.107209","DOIUrl":"10.4240/wjgs.v17.i8.107209","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction. Usually, it is considered an age-related process influenced by genetic, lifestyle factors, and diseases. Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body. However, the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study was conducted from December 2019 to January 2024. Data retrieved included patient demographics, disease entities, sarcopenia-related parameters (including grip strength, 6-m walking time, and limb skeletal muscle mass index), postoperative complications, and length of hospital stay. Sarcopenia was confirmed using Asian Working Group standards. Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia. The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 1708 patients met the inclusion criteria, with a mean age of 60.09 ± 13.52 years (sex: 52.28% male). There were 383 patients (22.42%) with obstructive jaundice and 1325 (77.58%) without jaundice. Sarcopenia, low walking speed, low grip strength, and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice. The odds ratio (OR) for sarcopenia in patients with obstructive jaundice was 1.689 [95% confidence interval (CI): 1.295-2.203, &lt;i&gt;P&lt;/i&gt; &lt; 0.001], indicating that jaundice is a significant risk factor for sarcopenia. The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice (39.3% &lt;i&gt;vs&lt;/i&gt; 22.8%, &lt;i&gt;P&lt;/i&gt; &lt; 0.05). Obstructive jaundice was positively correlated with reduced walking speed (OR = 1.627, 95%CI: 1.185-2.234, &lt;i&gt;P&lt;/i&gt; = 0.003) and decreased grip strength (OR = 1.669, 95%CI: 1.212-2.300, &lt;i&gt;P&lt;/i&gt; = 0.002). Age (OR = 1.077, 95%CI: 1.040-1.114, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and body mass index (OR = 0.703, 95%CI: 0.630-0.784, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) were independent risk factors of sarcopenia in patients with obstructive jaundice. Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications (46.3% &lt;i&gt;vs&lt;/i&gt; 33.1%, &lt;i&gt;P&lt;/i&gt; = 0.032), longer postoperative hospital stays (11.33 ± 6.75 days &lt;i&gt;vs&lt;/i&gt; 9.19 ± 7.32 days, &lt;i&gt;P&lt;/i&gt; = 0.016), and longer total hospital stays (17.10 ± 7.69 days &lt;i&gt;vs&lt;/i&gt; 15.98 ± 8.55 days, &lt;i&gt;P&lt;/i&gt; = 0.032) than those without sarcopenia.&lt;/p","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107209"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065718","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":"Exploration of doctor-patient communication characteristics and optimization path for gastrointestinal surgery of acute abdomen.","authors":"Lun Yang, Qi Zhang, Dong-Hao Wang, Qing Zhou","doi":"10.4240/wjgs.v17.i8.106245","DOIUrl":"10.4240/wjgs.v17.i8.106245","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal surgical acute abdomen conditions. These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families.</p><p><strong>Aim: </strong>To investigate communication characteristics in gastrointestinal surgical acute abdomen cases (such as appendicitis and pancreatitis) and explore optimization pathways.</p><p><strong>Methods: </strong>Eighty-two patients with gastrointestinal surgical acute abdomen (including appendicitis and pancreatitis) admitted to the hospital between November 2022 and June 2024 were selected. Physician-patient communication characteristics were analyzed. Patients were randomly divided into two groups (41 each) using a random draw method. The control group received conventional physician-patient communication. The observation group received an optimized communication model based on the conventional method. The two groups were compared for treatment efficacy and outcomes, psychological status, coping strategies, sleep quality, and compliance.</p><p><strong>Results: </strong>Significant differences were observed between the two groups in terms of time to ambulation and duration of hospital stay (<i>P</i> < 0.05), whereas hospitalization costs were not significantly different (<i>P</i> > 0.05). After the intervention, the psychological status scale scores in both groups decreased significantly (<i>P</i> < 0.05), with significant differences between the groups (<i>P</i> < 0.05). Following the intervention, the facing subscale scores of the medical coping questionnaire increased, while the avoidance and submission subscale scores decreased (<i>P</i> < 0.05), with significant differences between the groups (<i>P</i> < 0.05). The observation group had lower scores on the sleep quality scale (<i>P</i> < 0.05). The compliance rate was higher in the observation group (97.56% <i>vs</i> 80.49%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Physician-patient communication presented contradictions between professionalism and laymen's expression and rigid communication methods. Optimizing communication models can improve sleep quality, coping strategies, patient compliance, and treatment outcomes and reduce negative emotions.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"106245"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065665","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":"Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease.","authors":"Ahmet Erkek, Muhammed K Yıldırak, Abdullah Yıldız, Barış Sevinç","doi":"10.4240/wjgs.v17.i8.107476","DOIUrl":"10.4240/wjgs.v17.i8.107476","url":null,"abstract":"<p><strong>Background: </strong>Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease, being particularly effective for grade III and IV hemorrhoids. The procedure is associated with better short-term outcomes, including less postoperative pain, shorter operative time, faster return to work, and higher patient satisfaction. However, there is a risk-benefit debate surrounding SH due to significant complications from the procedure, such as anal stenosis, rectovaginal fistula, fecal incontinence, and recurrence.</p><p><strong>Aim: </strong>To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.</p><p><strong>Methods: </strong>This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis. Early (less than 7 days after SH) and late (7 or more days after SH) complications were analyzed. Recurrence rates were calculated as well.</p><p><strong>Results: </strong>Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups. Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids. Postoperative bleeding, incomplete defecation, urgent defecation, incontinence, skin tags, and anal fissure were complications reported by both groups.</p><p><strong>Conclusion: </strong>Due to the high recurrence rate, SH is not an appropriate treatment option for patients with grade IV hemorrhoids. Open surgery may be a more suitable option for these patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107476"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065766","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":"Effects of early diet resumption on the incidence of complications following polypectomy: A randomized controlled trial.","authors":"Hui-Hui Yan, Zhu-Yun Ding, Lei-Lei Wang, Dan-Dan Zhong, Xi-Feng Jin, Xiao-Chen Liu, Jian-Ting Cai, Xin-Liang Lu","doi":"10.4240/wjgs.v17.i8.108669","DOIUrl":"10.4240/wjgs.v17.i8.108669","url":null,"abstract":"<p><strong>Background: </strong>Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications. However, no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.</p><p><strong>Aim: </strong>To determine the timing, feasibility, and clinical benefits of early diet resumption following colorectal polypectomy.</p><p><strong>Methods: </strong>In the Second Affiliated Hospital of Zhejiang University School of Medicine, a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group (<i>n</i> = 751) and a control group (<i>n</i> = 751). Following polypectomy, the experimental group consumed rice soup at 2 hours, while the control group received rice soup at 6 hours. The study focused on delayed post-polypectomy bleeding (DPPB), with secondary evaluation of post-polypectomy perforation, hypoglycemia, fever, and length of stay (LOS).</p><p><strong>Results: </strong>The comparison between the two groups revealed no significant differences in DPPB rates (4.7% <i>vs</i> 5.5%, <i>P</i> = 0.480) and major bleeding rates (1.5% <i>vs</i> 2.1%, <i>P</i> = 0.332). Both groups displayed median bleeding times of 2 days. No notable differences in perforation (0.0% <i>vs</i> 0.3%, <i>P</i> = 0.479) and fever rates (2.1% <i>vs</i> 2.9%, <i>P</i> = 0.324) were observed between the two groups. However, the experimental group showed significantly lower incidence of hypoglycemia (0.4% <i>vs</i> 1.5%, <i>P</i> < 0.05) and shorter LOS [1 (1, 2) day <i>vs</i> 2 (1, 2) days, <i>P</i> < 0.001] following polypectomy. Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients, irrespective of polyp count, size, pathology, or polypectomy modalities.</p><p><strong>Conclusion: </strong>Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"108669"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076073","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":"Transforming biliary surgery: Innovations in fluorescence-guided imaging and indocyanine green application.","authors":"Thai-Hau Koo, Xue-Bin Leong, Yi-Lin Lee, Firdaus Hayati, Mohd Hazeman Zakaria, Andee Dzulkarnaen Zakaria","doi":"10.4240/wjgs.v17.i8.102921","DOIUrl":"10.4240/wjgs.v17.i8.102921","url":null,"abstract":"<p><p>In this editorial, we comment on the article by Li <i>et al</i>. We specifically focus on the novel use of multicolor near-infrared fluorescence imaging (MCFI) with indocyanine green in laparoscopic cholecystectomy, which is an innovative approach for enhancing biliary visualization during laparoscopic cholecystectomy. This study also highlighted the limitations of conventional single-color fluorescence imaging (SCFI), which relies solely on a green fluorescence signal, leading to challenges such as visual fatigue and difficulty in distinguishing biliary structures from background hepatic tissue. Given the complex anatomy of the biliary system and the challenges of visual fatigue encountered with SCFI, MCFI addresses these issues by enabling the differentiation of biliary structures by mapping the fluorescence intensity across a unique blue-to-purple color spectrum, thus improving the clarity of anatomical structures and reducing the visual strain for surgeons. We also focus specifically on the complications and cautious usage of indocyanine green in this context, as well as the advantages and disadvantages of MCFI and SCFI. Overall, MCFI represents a significant advancement in fluorescence-guided surgery, with the potential to become a standard imaging modality for safer and more effective laparoscopic procedures.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"102921"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065438","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":"Adjuvant chemotherapy for gallbladder cancer: Current evidence, controversies, and future directions.","authors":"Jin-Wei Dai, Yi-Xuan Xing, Nian-Zhe Sun","doi":"10.4240/wjgs.v17.i8.108160","DOIUrl":"10.4240/wjgs.v17.i8.108160","url":null,"abstract":"<p><p>Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges, even at early stages. In their recent work, Kim <i>et al</i> utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer. The use of adjuvant chemotherapy following curative surgery in this patient population has been a long-standing source of debate. Historically, the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent, sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy. Consequently, many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery, aiming to minimize recurrence risk. Given the rarity, high mortality rate, and the small sample sizes typical in gallbladder cancer studies, Kim <i>et al</i>'s contribution represents a significant and commendable effort to address these challenges. Kim <i>et al</i> designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications. Notably, their findings suggested that in stage II gallbladder cancer, adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone. These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively, prompted clinicians to reconsider their approach. Furthermore, this controversy directly influences clinical decisionmaking and guideline recommendations, as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions. This article critically assessed the research design, methodology, and clinical implications of the study by Kim <i>et al</i>. It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer, highlighting the necessity of rigorous study designs to produce reliable evidence.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"108160"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065720","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":"Artificial intelligence in gastrointestinal surgery: A systematic review.","authors":"Burak Tasci, Sengul Dogan, Turker Tuncer","doi":"10.4240/wjgs.v17.i8.109463","DOIUrl":"10.4240/wjgs.v17.i8.109463","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is gaining widespread traction in surgical disciplines, particularly in gastrointestinal (GI) surgery, where it offers opportunities to enhance decision-making, improve accuracy, and optimize patient outcomes across the entire surgical continuum.</p><p><strong>Aim: </strong>To comprehensively evaluate current AI applications in GI surgery, highlighting its role in preoperative planning, intraoperative guidance, postoperative monitoring, endoscopic diagnosis, and surgical education.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with PRISMA guidelines. We searched the Web of Science Core Collection through March 31, 2025 using the terms \"artificial intelligence\" AND \"gastrointestinal surgery\". Inclusion criteria: Original, English-language, full-text articles indexed under the \"Surgery\" category reporting quantitative AI performance metrics in GI surgery. Exclusion criteria: Reviews, editorials, letters, conference abstracts, non-English publications, ESCI/SSCI/Index Chemicus-only papers, studies without full text, and articles outside the surgical domain. Full texts of potentially eligible studies were assessed, yielding 45 studies from an initial 955 records for qualitative and quantitative synthesis.</p><p><strong>Results: </strong>The included studies demonstrated that AI has superior performance compared to traditional clinical tools in areas such as risk prediction, lesion detection, nerve identification, and complication forecasting. Notably, convolutional neural networks, random forests, support vector machines, and reinforcement learning models were commonly used. AI-enhanced systems improved diagnostic accuracy, procedural safety, documentation quality, and educational feedback. However, there are several limitations, such as lack of external validation, dataset standardization, and explainability.</p><p><strong>Conclusion: </strong>AI is transforming GI surgery from preoperative risk assessment to postoperative care and training. While many tools now match or exceed expert-level performance, successful clinical adoption requires transparent, validated models that seamlessly integrate into surgical workflows. With continued multidisciplinary collaboration, AI is positioned to become a trusted companion in surgical practice.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109463"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065824","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}