中华胃肠外科杂志最新文献

{"title":"[Impacts of participation in surgical clinical trial on safety and survival outcomes in patients with right-sided colon cancer].","authors":"H Q Zhang, G Q Wang, B Wu, G L Lin, H Z Qiu, B Z Niu, J Y Lu, L Xu, X Y Sun, G N Zhang, Y Xiao","doi":"10.3760/cma.j.cn441530-20240129-00048","DOIUrl":"10.3760/cma.j.cn441530-20240129-00048","url":null,"abstract":"<p><p><b>Objective:</b> To explore the impact on safety and prognosis in patients with right-sided colon cancer participating in surgical clinical research. <b>Methods:</b> This retrospective cohort study utilized data from a randomized controlled trial (RELARC study) conducted by the colorectal surgery group at Peking Union Medical College Hospital in which laparoscopic complete mesocolic excision (CME) was compared with D2 radical resection for the management of right-sided colon cancer. The eligibility criteria were age 18-75 years, biopsy-proven colon adenocarcinoma, tumor located between the cecum and right 1/3 of the transverse colon, enhanced chest, abdomen, and pelvic CT scans suggesting tumor stage T2-T4N0M0 or TanyN+ M0, and having undergone radical surgical treatment from January 2016 to December 2019. Exclusion factors included multiple primary colorectal cancers, preoperative stage T1N0 or enlarged central lymph nodes, tumor involving surrounding organs requiring their resection, definite distant metastasis or otherwise unable to undergo R0 resection, history of any other malignant tumors within previous 5 years, intestinal obstruction, perforation, or gastrointestinal bleeding requiring emergency surgery, and assessed as unsuitable for laparoscopic surgery. Patients who had participated in the RELARC study were included in the RELARC group, whereas those who met the inclusion criteria but refused to participate in the RELAEC study were included in the control group. The main indicators studied were the patient's baseline data, surgery and perioperative conditions, pathological characteristics, adjuvant treatment, and postoperative follow-up (including average frequency of follow-up within the first 3 years) and survival (including 3-year disease-free survival rate (DFS) and 3-year overall survival rate (OS). Differences in these indicators between the RELARC and control groups were compared. <b>Results:</b> The study cohort comprised 290 patients, 173 in the RELARC group (RELARC-CME group, 82; RELARC-D2 group, 91) and 117 in the control group (CME control group, 72; D2 control group, 45). There was a significantly higher proportion of overweight patients (BMI ≥24 kg/m<sup>2</sup>) in the RELARC-CME than in the CME control group (67.1% [55/82] vs. 33.3% [24/72], χ<sup>2</sup>=17.469, <i>P</i><0.001). There were no other statistically significant differences in baseline characteristics (all <i>P</i>>0.05). No significant disparities were found between the CME and D2 groups in terms of operation duration, intraoperative blood loss, rate of conversion to open surgery, combined organ resection, intraoperative blood transfusion, or intraoperative complications (all <i>P</i>>0.05). There was a trend toward Clavien-Dindo grade II or higher postoperative complications in the RELARC-CME group (24.4% [20/82]) than in the CME control group (18.1% [13/72]); however, this difference was not statistically significant (χ<sup>2</sup>=0.914, <i>P</i>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"928-937"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chinese expert consensus on the surgical treatment of right-sided colon cancer (2024 edition)].","authors":"","doi":"10.3760/cma.j.cn441530-20240817-00287","DOIUrl":"10.3760/cma.j.cn441530-20240817-00287","url":null,"abstract":"<p><p>In the past two decades, with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision, significant changes have occurred in the surgical treatment of right-sided colon cancer. The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium (CCRC) Organized national experts in colorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy, taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures, with a view to standardizing the surgical treatment of right colon cancer. The consensus recommendations were focused on three main aspects: (1) surgical anatomy: the key structures and its definitions related to the mesentery and vascular anatomy were clarified. It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision; (2) surgical technique: laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer; (3) surgical principles: D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer. Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis. Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis. Additionally, consensus recommendations were made regarding the location of vascular ligation, the extent of bowel resection, and anastomosis techniques.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"879-890"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comprehensive evaluation of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in obese patients based on efficacy and nutrition].","authors":"L F Hu, L Wang, S X Li, Y Liu, Z Zhang, M H Xiao, Z H Zhang, Z Q Wei, L Cui, T Jiang","doi":"10.3760/cma.j.cn441530-20230810-00041","DOIUrl":"10.3760/cma.j.cn441530-20230810-00041","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients. &lt;b&gt;Methods:&lt;/b&gt; This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m&lt;sup&gt;2&lt;/sup&gt; regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m&lt;sup&gt;2&lt;/sup&gt;. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18-61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m&lt;sup&gt;2&lt;/sup&gt;. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. &lt;b&gt;Results:&lt;/b&gt; (1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all &lt;i&gt;P&lt;/i&gt; &lt; 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all &lt;i&gt;P&lt;/i&gt; &lt; 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically ","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"945-952"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case report of Roux-en-Y gastric bypass combined with radical gastrectomy for severe obesity complicated with gastric cancer].","authors":"J D Li, J C Zhang, J M Wu, Z Y Dong, N Cai, C C Wang","doi":"10.3760/cma.j.cn441530-20231020-00142","DOIUrl":"10.3760/cma.j.cn441530-20231020-00142","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"978-979"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics, treatment strategy, and clinical outcomes in type 2 intestinal failure].","authors":"X L Ge, W L Qi, W Liu, H L Xu, L N Ye, Q Cao, N Li, W Zhou","doi":"10.3760/cma.j.cn441530-20231222-00229","DOIUrl":"10.3760/cma.j.cn441530-20231222-00229","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the characteristics, clinical management and clinical outcomes of type 2 intestinal failure (IF). <b>Methods:</b> A descriptive case-control study was carried out. The inclusion criteria were as follows: (1) the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus statement. (2) using a requirement for parenteral nutrition (PN) of 28 days or more as surrogate marker. (3) a multidisciplinary team (MDT) included surgeons, nutritionist, pharmacist, stoma therapists, and critical care physicians. (4) complete laboratory data. Patients with type 1 and type 3 IF and those who do not cooperate with follow-up. All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023. The pathophysiology, clinical management, and outcomes of type II IF were analyzed. <b>Results:</b> A total of 67 type II IF were included. The median age was 54 (15-83) with 43 males and 24 females. The body mass index was (17.5±3.8) kg/m², the incidence of malnutrition was 67.2% (45/67), the incidence of sarcopenia was 74.6% (50/67), the median number of previous surgeries was 2.0 (1-13), and the median duration time of PN was 2.1 (1-12) months. The underlying disease of type 2 IF included 36 Crohn`s disease, 2 ulcerative colitis, 3 radiation enteritis, 2 intestinal Behcet's disease, 4 mesenteric infarction, 1 aggressive fibromatosis, 5 abdominal cocoon syndrome, 5 gastrointestinal perforation, 1 hernia, 4 intestinal dysmotility, and 4 other reasons (gastrointestinal tumor, trauma, and non-Hodgkin's lymphoma). According to the pathophysiology of IF, there were 33 intestinal fistula, 12 intestinal dysmotility, 6 mechanical obstruction, 13 short bowel syndrome, and 3 extensive small bowel mucosal disease. After treatment with MDT, 67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment, of which 36 patients recovered with oral diet or enteral nutrition, 31 patients underwent reconstructive surgery after intestinal rehabilitation treatment failure. The median duration time of reconstructive surgery was 2.7 (1-9) months. 24 patients recovered intestinal autonomy after surgery, with 7 deaths, including 6 deaths due to abdominal infections and 1 case of intestinal dysmotility with abiotrophy and liver failure. <b>Conclusion:</b> Standardized multidisciplinary treatment plays an important role in type II intestinal failure, and it promotes patients with intestinal failure regain enteral autonomy.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"966-969"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Membrane anatomy-toward a new era of pelvic surgery].","authors":"H L Liu, H H Jiang, M B Lin","doi":"10.3760/cma.j.cn441530-20240704-00234","DOIUrl":"10.3760/cma.j.cn441530-20240704-00234","url":null,"abstract":"<p><p>The concept of membrane anatomy has been widely accepted and applied in clinical practice, but there are still many theoretical and practical conflicts. This article elucidates the fundamental concepts and manifestations of membrane anatomy, delineating its comprehensive integration of anatomical and surgical disciplines. Thereafter, this article specifically discusses its differences from the traditional anatomy and surgery, and then clarifies the important role of membrane anatomy as the third generation of surgical anatomy and the new surgical concept for the development of pelvic surgery.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"891-897"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Shanghai consensus on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy(2024 edition)].","authors":"","doi":"10.3760/cma.j.cn441530-20240819-00290","DOIUrl":"10.3760/cma.j.cn441530-20240819-00290","url":null,"abstract":"<p><p>Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing <i>de novo</i> gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"863-878"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lymph distant and skip metastasis of esophageal cancer based on the membrane anatomy theory].","authors":"G J Wang","doi":"10.3760/cma.j.cn441530-20240710-00241","DOIUrl":"10.3760/cma.j.cn441530-20240710-00241","url":null,"abstract":"<p><p>This study elaborates the essence of distant lymph node metastasis and skip metastasis of esophageal cancer according to the membrane anatomy theory. Lymph distant metastasis of esophageal cancer is essentially the phenomenon of cancer cells shedding from the primary focus of esophageal cancer and transferring along the direction of lymphatic drainage to the root of the esophageal mesentery. Because the metastasis is relatively distant, it is called distant metastasis. Despite the long distance, this metastasis is still limited to the envelope-like-membrane structure of the esophageal mesentery and belongs to the category of mesangial carcinoma. The lymph node skip metastasis of esophageal cancer refers to the process in which esophageal cancer cells detach from the primary lesion and migrate along the lymphatic drainage direction within the envelope-like-membrane structure of the mesentery to the central lymph nodes at the root of the mesentery. During this metastatic process, the surrounding mesenteric lymph nodes which are tightly attached to the esophagus will not be affected by cancer metastasis because of the isolation barrier effect of the envelope-like membrane structure of the esophageal mesentery. Applying the theory of membrane anatomy to esophageal cancer radical surgery will make the surgery more scientific, reasonable, and standardized, and is expected to achieve dual benefits of both surgical and oncological effects in esophageal cancer radical surgery.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"904-908"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Distribution pattern of the rectal circumferential fascia and its clinical significance: An anatomical study].","authors":"X J Wang, Y Deng, Z F Zheng, Y Huang, P Chi","doi":"10.3760/cma.j.cn441530-20240710-00242","DOIUrl":"10.3760/cma.j.cn441530-20240710-00242","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the pattern of distribution of the circumferential fascia of the rectum and elucidate its clinical implications. &lt;b&gt;Methods:&lt;/b&gt; In this descriptive study, we examined the gross anatomy of four male hemipelvic cadaveric specimens from the Department of Anatomy at Fujian Medical University and the histological features of 16 fresh postoperative specimens from patients who had undergone total mesorectal excision for rectal cancer at the Department of Colorectal Surgery, Union Hospital, Fujian Medical University, between January and December 2022. The resultant combination of gross anatomical and histological features was employed to assess the following areas: (1)the morphology of the anterior mesorectum and fascia at the peritoneal reflection; (2)the caudal attachment point of Denonvilliers' fascia; (3) the fusion area of the pelvic plexus and the pre-hypogastric fascia; (4)the lateral and posterior attachment edges of the rectosacral fascia; and (5) selected histological features. &lt;b&gt;Results:&lt;/b&gt; Our findings were as follows. (1) At the peritoneal reflection, the anterior mesorectum forms a triangular fat pad with a dense fascial structure. The base of this pad extends anteriorly across the most caudal point of the peritoneal reflection, with Denonvilliers' fascia originating from the anterior side of the triangle, near the bladder side of the peritoneum craniad to the peritoneal reflection. (2) The caudal attachment of Denonvilliers' fascia is at the angle between the seminal vesicles, the ampulla of the vas deferens, and the prostate. It adheres tightly to the prostatic capsule and vascular bundles pass through its cephalic side. (3) The pre-hypogastric fascia transitions laterally to merge with Denonvilliers' fascia; its middle part being inseparable from the main body of the pelvic plexus, which gives rise to the nerves that innervate the rectum. (4) The rectosacral fascia is formed by fusion of the fascia propria with the pre-hypogastric fascia. The resultant fused fascia bifurcates into two leaves on the right side; the outer leaf being the pre-hypogastric fascia and the inner leaf the fascia propria. (5) Histologically, the peritoneal reflection zone shows cuboidal epithelium of the peritoneum at its lowest point with no detectable origin of Denonvilliers' fascia. The anterior side of the peritoneal reflection, from which Denonvilliers' fascia originates, has a dense double-layered fascial structure comprising thick collagen fiber (16/16). The fascia propria exhibits a thinner and looser collagen fiber structure and its origin varies between individuals, 13/16 originating together with Denonvilliers' fascia from the craniad side of the peritoneal reflection, and 3/16 originating separately from the most caudal point of the peritoneal reflection. The caudal edge of Denonvilliers' fascia has a double-layered fascial structure with multiple S100-stained areas. The posterior edge of the rectosacral fascia","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"919-927"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Learning curve for a five-step procedure, transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction].","authors":"H P Zeng, Y H Chen, L J Luo, Z J Zhang, Z Y Lin, Y Chen, Y H Peng, T Wang, Y S Zheng, W W Xiong, W Wang","doi":"10.3760/cma.j.cn441530-20240116-00028","DOIUrl":"10.3760/cma.j.cn441530-20240116-00028","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction. &lt;b&gt;Methods:&lt;/b&gt; In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ&lt;sup&gt;2&lt;/sup&gt; test or Fisher's exact test. Normally distributed measurement data are presented as &lt;i&gt;x±s&lt;/i&gt;, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as &lt;i&gt;M&lt;/i&gt;(&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;, &lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;3&lt;/sub&gt;) and the Mann-Whitney U test was used for inter group comparison. &lt;b&gt;Results:&lt;/b&gt; The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x&lt;sup&gt;3&lt;/sup&gt;-4.4757x&lt;sup&gt;2&lt;/sup&gt;+164.97x-264.4 (&lt;i&gt;P&lt;/i&gt;&lt;0.001, &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor (&lt;i&gt;P&lt;/i&gt;&gt;0.05). The following factors differed significantly (all &lt;i&gt;P&lt;/i&gt;&lt;0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, &lt;i&gt;U&lt;/i&gt;=-3.940, &lt;i&gt;P&lt;/i&gt;&lt;0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, &lt;i&gt;t&lt;/i&gt;=5.034, &lt;i&gt;P&lt;/i&gt;&lt;0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], &lt;i&gt;U&lt;/i&gt;=-2.518, &lt;i&gt;P&lt;/i&gt;=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, &lt;i&gt;U&lt;/i&gt;=-4.016, &lt;i&gt;P&lt;/i&gt;&lt;0.001), earlier time to first ","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"938-944"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}