World Journal of Gastrointestinal Surgery最新文献

{"title":"Resection of a ganglioneuroma encasing major blood vessels using three-dimensional laparoscopy combined with organ suspension: A case report.","authors":"Guo-Zhen Wu, Shen-Zhe Fang, Shi-An Yu, Min Yu","doi":"10.4240/wjgs.v17.i8.109213","DOIUrl":"10.4240/wjgs.v17.i8.109213","url":null,"abstract":"<p><strong>Background: </strong>Ganglioneuroma is a rare, well-differentiated, slow-growing benign tumor of the peripheral nerves, with surgical resection being the only curative treatment. Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge. Traditionally, these cases often require open abdominal surgery or combined organ resections, and in some instances, the tumors are considered unresectable. Currently, no reports have described the resection of such tumors <i>via</i> laparoscopy.</p><p><strong>Case summary: </strong>A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion. Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it. A neurogenic tumor was suspected, with ganglioneuroma being the most likely diagnosis. Following comprehensive preoperative preparation, the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique. The surgical approach involved incising the tumor along the vascular axis and conducting meticulous, vascular-preserving tumor excision. The operation lasted approximately 458 minutes, with an estimated blood loss of 50 mL. The patient was discharged on the 8th postoperative day. A transient liver injury occurred after surgery but improved rapidly. After 11 months of postoperative follow-up, no complications or tumor recurrence were observed.</p><p><strong>Conclusion: </strong>This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109213"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065731","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 the clinical value of gemstone spectral computed tomography imaging in the preoperative assessment of colorectal cancer.","authors":"Wei Liu, De-Min Kong, Jian-Kun An, Li-Tao Song","doi":"10.4240/wjgs.v17.i8.105391","DOIUrl":"10.4240/wjgs.v17.i8.105391","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer (CRC) remains suboptimal. To address this limitation, our study investigates the potential of gemstone spectral computed tomography imaging (GSI) to improve diagnostic accuracy in lymph node metastasis (LNM) assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023. All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention. During the research, meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes. Moreover, for both metastatic and non-metastatic lymph nodes, the short diameter at the maximum cross-sectional area (covering the axial, sagittal, and coronal planes), morphological features (including manifestations such as margin blurring, aggregation, and enhancement), and spectral parameters in the arterial and venous phases [specifically iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve (λ&lt;sub&gt;HU&lt;/sub&gt;)] were measured and recorded, and a comparative analysis was conducted. The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic (ROC) curve. Concurrently, receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897, with sensitivity, specificity, and accuracy of 92.59%, 85.87%, and 89.50%, respectively. A total of 265 lymph nodes were analyzed from the 200 participants with CRC, with metastatic lymph nodes accounting for 56.60%. Compared with non-metastatic lymph nodes, the short diameters of metastatic lymph nodes in the axial, sagittal, and coronal planes were significantly increased, whereas the IC values in the arterial and venous phases, the NIC value in the arterial phase, and the λ&lt;sub&gt;HU&lt;/sub&gt; values in the arterial and venous phases were significantly decreased. The short axial, sagittal, and coronal diameters, arterial-phase IC, venous-phase IC, arterial-phase NIC, arterial-phase λ&lt;sub&gt;HU&lt;/sub&gt;, and venous-phase λ&lt;sub&gt;HU&lt;/sub&gt; for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631, 0.681, 0.659, 0.862, 0.808, 0.831, 0.801, and 0.706, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;GSI exhibits substantial clinical significance in the preoperative assessment of CRC. Among the parameters assessed, the arterial-phase IC demon","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"105391"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065736","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 Barrett's esophagus and gastroesophageal reflux disease 5 years after laparoscopic sleeve gastrectomy: A retrospective study.","authors":"Adnan Alzanbagi, Laeeque A Qureshi, Mohammed S Khan, Salem Alotaibi, Abdulaziz Tashkhandi, Saad Alzahrani, Mahmoud A Eliouny, Aly ElBahrawy, AlWahhaj Khogeer, Mohammed Hazazi, Suhail Hezry, Feras Fatani, Mohammed K Shariff","doi":"10.4240/wjgs.v17.i8.105607","DOIUrl":"10.4240/wjgs.v17.i8.105607","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a significant global health concern, with laparoscopic sleeve gastrectomy (LSG) being the most commonly performed bariatric surgery in the Middle East, including Saudi Arabia, due to its simplicity and effectiveness in achieving weight loss. However, the long-term effects of LSG on gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) remain areas of active investigation.</p><p><strong>Aim: </strong>To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia. Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included. Data on demographics, comorbidities, GERD symptoms, and endoscopic findings were extracted. GERD was defined clinically, esophagitis was graded per the Los Angeles classification, and BE was defined histologically. Multivariate logistic regression was used to identify predictors of GERD, endoscopic esophagitis (EE), and BE.</p><p><strong>Results: </strong>The study included 114 patients (mean age: 44 years; 61% female). GERD prevalence increased from 16% preoperatively to 64% 5 years post-LSG, with 54% of cases representing <i>de novo</i> GERD. EE prevalence rose to 30%, with 23% of cases being <i>de novo</i>. BE was detected in 2.6% of patients, all presenting with short-segment BE without intestinal metaplasia. On univariate analysis, the pre-LSG body mass index was significantly associated with EE (<i>P</i> = 0.038), and age was significantly associated with BE (<i>P</i> = 0.037). However, on multivariate analysis, only hypertension was independently associated with GERD development (odds ratio = 5.09; <i>P</i> = 0.01). No factors were significantly associated with EE or BE on multivariate analysis.</p><p><strong>Conclusion: </strong>This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG, with a relatively low but notable incidence of BE. The findings underscore the need for long-term endoscopic surveillance, particularly for older patients, even in populations with lower baseline.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"105607"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065741","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":"Binding and interlocking pancreaticojejunostomy <i>vs</i> duct to mucosa pancreaticojejunostomy: A retrospective cohort study.","authors":"Xi Chen, Chong-Yu Wang, Rui-Biao Fu, Zi-Yu Liu, Meng-Qiu Yin, Jin-Hui Zhu","doi":"10.4240/wjgs.v17.i8.107228","DOIUrl":"10.4240/wjgs.v17.i8.107228","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy. pancreaticojejunostomy (PJ), also known as pancreatoenterostomy, is a critical step in surgical reconstruction after pancreatic resection. However, the laparoscopic performance of PJ presents additional technical challenges, especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.</p><p><strong>Aim: </strong>To evaluate the effectiveness and safety of binding and interlocking PJ (BIPJ) as a novel technique in laparoscopic pancreatic surgery.</p><p><strong>Methods: </strong>Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed. According to the different PJ methods used during surgery, the patients were divided into two groups: The BIPJ group and the duct-to-mucosa PJ (DMPJ) group.</p><p><strong>Results: </strong>BIPJ was performed in 33 patients, and DMPJ was performed in 34 patients. The operative time was significantly shorter in the BIPJ group (median, 340 minutes; interquartile range, 310-350) than in the DMPJ group (median, 388 minutes; interquartile range, 341-464) (<i>P</i> = 0.004). No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula, intra-abdominal hemorrhage, intra-abdominal abscess, postoperative biliary fistula, reoperation, or postoperative hospital stay.</p><p><strong>Conclusion: </strong>The suitability of laparoscopic PJ for all pancreatic textures, ability to perform full laparoscopy, shorter operation time, and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107228"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065775","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":"Differential effects of the <i>KRAS</i> gene on recurrence in right- <i>vs</i> left-sided colorectal liver metastases undergoing radiofrequency ablation.","authors":"Bin-Bin Jiang, Ji-Chen Wang, Kun Yan, Zhong-Yi Zhang, Song Wang, Wei Wu, Wei Yang","doi":"10.4240/wjgs.v17.i8.108418","DOIUrl":"10.4240/wjgs.v17.i8.108418","url":null,"abstract":"<p><strong>Background: </strong><i>KRAS</i> mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases (CLMs). Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.</p><p><strong>Aim: </strong>To investigate the association of <i>KRAS</i> mutations with recurrence in patients with CLM who underwent radiofrequency ablation (RFA) according to the primary tumor location.</p><p><strong>Methods: </strong>This retrospective study analyzed 164 patients with <i>KRAS</i>-determined CLM treated with percutaneous RFA between January 2012 and December 2018. The clinicopathological characteristics, recurrence patterns, and survival outcomes were systematically evaluated.</p><p><strong>Results: </strong>A total of 164 patients (mean age: 58.0 ± 9.8 years, range: 34-83 years) who underwent percutaneous RFA of 325 CLMs (mean size: 2.2 ± 1.0 cm, range: 0.7-5.0 cm) were included in the study. Eighty-nine (54.3%) patients had wild-type <i>KRAS</i>, and 75 (45.7%) patients had mutated <i>KRAS</i>. Compared with wild-type patients, patients with <i>KRAS</i> mutations presented significantly higher local tumor progression rates (30.7% <i>vs</i> 14.6%, <i>P</i> = 0.013). Among 126 patients (76.8%) who experienced post-RFA recurrence, 61.6% developed intrahepatic metastases, and 53.7% developed extrahepatic metastases. Primary tumor location significantly modified <i>KRAS</i>-related outcomes: Compared with wild-type patients, left-sided colorectal cancer (CRC) patients with <i>KRAS</i> mutations presented higher intrahepatic recurrence rates (77.2% <i>vs</i> 52.5%, <i>P</i> = 0.003) and shorter median intrahepatic recurrence-free survival (15 <i>vs</i> 25 months, <i>P</i> = 0.007). No significant differences in <i>KRAS</i> expression were detected in right-sided tumors.</p><p><strong>Conclusion: </strong><i>KRAS</i> mutation status predicts differential recurrence patterns after CLM ablation, with significant prognostic implications, specifically in left-sided CRCs. These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"108418"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065224","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 low-density lipoprotein cholesterol on lymph node metastasis after radical esophagectomy.","authors":"Xin-Jian Xu, Shi-Wei Liu, Jia-Qi Li, Ming He, Hui Wang, Qing-Ju Meng","doi":"10.4240/wjgs.v17.i8.106898","DOIUrl":"10.4240/wjgs.v17.i8.106898","url":null,"abstract":"<p><strong>Background: </strong>Esophageal cancer (EC) is one of the most common malignancies worldwide, and lymph node (LN) metastasis remains one of the leading causes of EC recurrence. Metabolic disorders critically affect cancer progression, and lipid levels are closely associated with the occurrence of EC and several other tumor types. This study analyzed pretreatment lipid levels to determine their association with LN metastasis.</p><p><strong>Aim: </strong>To dissect the possible mechanisms underlying LN metastasis and clarify the prognostic role of lipid profiles in EC.</p><p><strong>Methods: </strong>Serum lipid levels and clinicopathological information were retrospectively collected from 294 patients, and risk factors for LN metastasis were confirmed using a logistic regression model. Latent factors were explored using information from publicly accessible databases and immunofluorescence and immunohistochemical staining techniques.</p><p><strong>Results: </strong>High serum levels of low-density lipoprotein (LDL) cholesterol promote LN metastasis in EC, while high-density lipoprotein cholesterol has the opposite role. Information of a public database revealed that LDL receptors LRP5 and LRP6 are highly expressed in ECs, and LRP6 overexpression positively correlated with the infiltration of B lymphocytes and a poor prognosis. Immunofluorescence and immunohistochemical staining revealed that the expression of LRP6 and infiltrated B lymphocytes in patients with ≥ 1 regional LN metastasis, containing N1-3 (N+ group) were significantly higher than those in the N0 group. LRP6 was also highly expressed in the B lymphocytes of the N+ group. There was no difference in CXCL13 expression between the N+ and N0 groups. However, CXCR5 expression was significantly higher in the N0 group than in the N+ group.</p><p><strong>Conclusion: </strong>High serum LDL levels can promote LN metastasis in EC, and the mechanisms may be related to LRP6 expression and the infiltration of B lymphocytes.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"106898"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065426","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":"Surgical resection for simultaneous intraductal papillary mucinous neoplasm of the bile duct and pancreatic duct: A case report.","authors":"Xiao-Rui Huang, Deng-Sheng Zhu, Ya-Hong Yu","doi":"10.4240/wjgs.v17.i8.108767","DOIUrl":"10.4240/wjgs.v17.i8.108767","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasm (IPMN) and intraductal papillary neoplasm of the bile duct (IPNB) are mucinous cystic tumors with intraductal papillary growth and malignant potential. Their concurrent occurrence is exceptionally rare.</p><p><strong>Case summary: </strong>A 58-year-old Chinese man presented with recurrent upper abdominal pain. Imaging and laboratory tests revealed lesions consistent with IPNB and IPMN. Postoperative pathological examination confirmed IPNB with high-grade dysplasia and main-duct type IPMN with low-grade dysplasia. The patient underwent extrahepatic bile duct resection with Roux-en-Y choledochoenterostomy and distal pancreatectomy. He had an excellent prognosis with no tumor recurrence during the 30-month follow-up.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of comprehensive preoperative assessment and individualized management for these complex tumors. Further research is needed to understand their pathogenesis and improve treatment strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"108767"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065456","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":"Invasive inflammatory fibrotic polyp of the duodenum: A case report.","authors":"Fen-Ming Zhang, Long-Gui Ning, Jing-Jie Wang, Hua-Tuo Zhu, Mei-Bao Feng, Hong-Tan Chen","doi":"10.4240/wjgs.v17.i8.107558","DOIUrl":"10.4240/wjgs.v17.i8.107558","url":null,"abstract":"<p><strong>Background: </strong>An inflammatory fibrotic polyp (IFP) of the gastrointestinal tract is generally considered benign and noninvasive. An IFP in the duodenum is very rare. Here we report the case of an aggressive and infiltrative duodenal IFP resembling a malignancy and the patient subsequently underwent surgery. To the best of our knowledge, this is the first case of duodenal IFP invading the subserosa.</p><p><strong>Case summary: </strong>A 50-year-old female patient presented with recurrent epigastric pain for more than 1 month. Gastroscopy revealed a mass in the duodenal bulb involving the pylorus. Endoscopic ultrasound suggested that the lesion was a hypoechoic mass involving the muscularis propria, and duodenal bulb stromal tumor was considered based on abdominal computed tomography and gastric magnetic resonance imaging findings. A distal gastrectomy was subsequently performed. Based on the histopathology and immunohistochemical results, the lesion was finally diagnosed as duodenal IFP. The patient recovered well after surgery and had no recurrence at the 27-month follow-up.</p><p><strong>Conclusion: </strong>This duodenal IFP invading subserosa indicates that IFP has specific invasion characteristics, and accurate diagnosis is critical to avoid inadequate treatment.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"107558"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065621","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":"Preoperative performance status was associated with postoperative fatal complications in elderly patients with refractory ulcerative colitis.","authors":"Yuki Horio, Motoi Uchino, Yusuke Tomoo, Kazunori Nomura, Kentaro Nagano, Kurando Kusunoki, Ryuichi Kuwahara, Kei Kimura, Toshiyuki Sato, Kozo Kataoka, Masataka Igeta, Shinichiro Shinzaki, Masataka Ikeda, Hiroki Ikeuchi","doi":"10.4240/wjgs.v17.i8.109326","DOIUrl":"10.4240/wjgs.v17.i8.109326","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients with refractory ulcerative colitis (UC) have a poor prognosis, and timely surgical intervention should not be delayed. However, with the advent of biologics, therapy has become more complex, and there are no clear criteria for the timing of surgical conversion.</p><p><strong>Aim: </strong>To investigate the risk factors for postoperative complications in elderly patients with UC.</p><p><strong>Methods: </strong>Elderly patients (≥ 60 years old) with refractory UC who underwent colectomy at Hyogo Medical University between April 2012 and March 2024 were included in this study. Fatal complications included life-threatening complications requiring intensive care unit management and death. The primary outcome was defined by possible risk factors for fatal complications in older patients with refractory UC.</p><p><strong>Results: </strong>A total of 191 elderly patients with UC were analyzed in this series. The rate of fatal complications was 18/191 (9.4%), and the most common complication was pneumonia due to disuse syndrome. Body mass index (BMI) < 17 kg/m² [odds ratio (OR) = 4.08, 95% confidence interval (95%CI): 1.19-13.97, <i>P</i> = 0.02] and Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥ 3 (OR = 14.5, 95%CI: 3.43-61.64, <i>P</i> < 0.01) were identified as independent risk factors for fatal complications.</p><p><strong>Conclusion: </strong>Among the elderly patients with refractory UC, the risk factors for fatal complications were low BMI and ECOG-PS score. Prompt surgical intervention is recommended before the patient loses weight or has difficulty walking. These factors may allow for early surgical decision-making before patients become debilitated.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109326"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065671","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":"Correlation between laparoscopic radical resection and tumor markers in peritoneal irrigation fluid.","authors":"Jin-Feng Zhou, Wei Qiu, Jian-Sheng Chen, Bao-Quan Yan, Xiao-Hui Feng, Mei-Zhen Xu, Ji-Ping Yang","doi":"10.4240/wjgs.v17.i8.109155","DOIUrl":"10.4240/wjgs.v17.i8.109155","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) is one of the most common malignancies and types of cancer worldwide.</p><p><strong>Aim: </strong>To compare the differences in tumor markers of GC with GC dissection, we evaluated the efficacy of recent tumor removal.</p><p><strong>Methods: </strong>A prospective cohort study was conducted to analyze the clinical data of patients with GC. Patients were divided into two groups based on the surgical approach: The membrane dissection (MD) group, which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision, and the D2 group, which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection. Abdominal lavage fluid was collected pre- and postoperatively from patients in both groups. The expression of carcinoembryonic antigen (CEA) and cytokeratin-19 (CK-19) message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction. The factors influencing the increase of the tumor markers were analyzed, and the short-term efficacy of the two surgery types was compared.</p><p><strong>Results: </strong>In total, 135 eligible patients were included in this study, with 69 and 66 cases in the MD and D2 groups, respectively. Fourteen patients with benign gastric lesions were selected to detect tumor marker expression. After excluding patients positive for preoperative cancer leakage, we found that 9.52% and 26.67% of patients in the MD and D2 groups developed postoperative CEA positivity, respectively. Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity. The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity. Surgical time, intraoperative blood loss, number of lymph nodes dissected, time to first postoperative flatus, and time to first liquid intake were all significantly different between the two surgical approaches. There were no significant differences in the incision length, duration of postoperative hospital stays, or postoperative complications.</p><p><strong>Conclusion: </strong>MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"109155"},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065808","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}