中华胃肠外科杂志最新文献

{"title":"[Economic evaluations of postoperative complications after colorectal cancer surgery].","authors":"T X Wei, T F Gu, Z Q Wu, F Shan, Z Y Li, J F Ji","doi":"10.3760/cma.j.cn441530-20241011-00338","DOIUrl":"10.3760/cma.j.cn441530-20241011-00338","url":null,"abstract":"<p><p><b>Objective:</b> This study aims to analyze the economic impact of postoperative complications after colorectal cancer surgery. <b>Methods:</b> A retrospective cohort study was conducted. Patients with a preoperative pathological diagnosis of colorectal cancer who met surgical indications and underwent surgical treatment were included, while those with incomplete hospitalization cost data were excluded. From March 2017 to March 2022, three hundred and ninety-two colorectal cancer patients treated at Peking University Cancer Hospital and Institute Gastrointestinal Cancer Center I, were enrolled. Descriptive statistics were performed on the incidence of complications, hospitalization costs, and postoperative length of stay. A cohort was established based on the presence of postoperative complications (POC) and absence of postoperative complications (non-POC) to study economic differences. Propensity score matching analysis was employed to reduce potential confounding factors. <b>Results:</b> Among 392 colorectal cancer patients, 90 (23.0%) developed POC (POC group), while 302 were in the non-POC group. Significant statistical differences were found between the two groups in terms of operation duration, extent of resection, and stoma creation (all <i>P</i> < 0.05); other baseline indicators showed no significant differences (all <i>P</i>>0.05). The median hospitalization cost for patients with postoperative anastomotic leakage was 115 973 yuan, an increase of 38 941 yuan (50.5%) over the non-POC group's 77 059 yuan; the median hospitalization cost for patients with mechanical obstruction was 111 477 yuan, an increase of 34 418 yuan (44.7%) over the non-POC group; and the median hospitalization cost for patients with wound infection was 95 860 yuan, an increase of 18 801 yuan (24.4%) over the non-POC group. The median postoperative length of stay for patients with anastomotic leakage, mechanical obstruction, and wound infection was 22.0 days, 22.0 days, and 18.5 days, respectively, compared to 9.0 days in the non-POC group, extending by 13.0 days, 13.0 days, and 9.5 days. After propensity score matching, each group had 68 patients, and there were no statistically significant differences in preoperative and intraoperative observations between the two groups (all <i>P</i>>0.05); compared to the non-POC group, the hospitali- zation costs in the POC group significantly increased (89 165 yuan vs. 75 437 yuan, <i>P</i><0.001), and the postoperative length of stay also significantly extended (14.0 days vs. 8.0 days, <i>P</i><0.001). <b>Conclusions:</b> The occurrence of POC after colorectal cancer surgery significantly increases hospitalization costs and length of stay. This study provides specific and accurate reference data for subsequent health economic decision-making. This is the first detailed economic impact analysis of postoperative complications of colorectal cancer with a large sample size, which includes an economic impact analysis for eac","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 1","pages":"41-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459735","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 plexiform angiomyxoid myofibroblastic tumor of the gastric body].","authors":"W J Liu, H L Wang, Y Wang","doi":"10.3760/cma.j.cn441530-20240328-00115","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240328-00115","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 1","pages":"86-88"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459707","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":"[Critical issues in surgical treatment for colorectal cancer].","authors":"P Lan, X S He, Z J Zhang, B Zhang","doi":"10.3760/cma.j.cn441530-20250106-00010","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250106-00010","url":null,"abstract":"<p><p>Clinical research on colorectal cancer in China has developed rapidly in recent years. Based on evidence-based medicine, the Chinese Colorectal Cancer Diagnosis and Treatment Standards and the CSCO Guidelines for Colorectal Cancer are continuously updated, which have been instrumental in optimizing the full-process management of colorectal cancer and improving cancer outcomes. While significant progress has been made, we must remain aware that there are still many urgent and key issues to be solved in the field of surgical treatment e.g. sphincter-preserving strategies, surgical approaches, management of T1 stage tumors, and surgical treatment for metastatic colorectal cancer. In the future, more high-quality, original research from China will be needed to address these challenges, standardize surgical approaches, and improve treatment effect.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 1","pages":"21-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459732","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":"[Impact of perineural invasion upon chemotherapy duration and survival benefit in stageⅢ colon cancer].","authors":"J X Chen, W L Zhang, W F Wang, J B Li, X J Wu, Z H Lu, D B Xu, J Z Lin, J H Peng","doi":"10.3760/cma.j.cn441530-20240508-00170","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240508-00170","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the prognostic impact of perineural invasion in patients with stageⅢ colon cancer and to clarify its guidance value for the duration of postoperative adjuvant chemotherapy. &lt;b&gt;Methods:&lt;/b&gt; This study employed a retrospective cohort study method. It analyzed 426 patients with stageⅢ colon cancer who underwent radical surgery at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University, between April 2008 and June 2020. Inclusion criteria: patients received at least 3 months of adjuvant CapeOX therapy post-surgery, had complete pathological data, and were followed up for at least 12 months after the last chemotherapy. Among these patients, 231 were male, the median age was 59 (50~67) years, and 263 tumors were located in the right-sided colon. Postoperative pathology indicated that 107 cases (25.12%) had neural invasion, and 131 patients (30.75%) had vascular tumor thrombus. All patients received at least 4 cycles of postoperative CapeOX adjuvant chemotherapy, with 193 patients receiving 8 cycles and 233 patients receiving 4 to 7 cycles of adjuvant chemotherapy. The study analyzed the impact of neural invasion status and the duration of adjuvant chemotherapy on disease-free survival (DFS). Furthermore, within subgroups stratified by different risk levels (referencing the criteria proposed by the IDEA study: high risk: T4, N2 or T4N2; low risk: T3N1) and different neural invasion statuses, the impact of the duration of adjuvant chemotherapy on prognosis was analyzed. &lt;b&gt;Results:&lt;/b&gt; The median follow-up time for the entire cohort was 94.00 months (55.27-128.80 months). Multivariate Cox analysis indicated that pathological T stage T4 (HR = 2.457, 95%CI: 1.499-4.029, &lt;i&gt;P&lt;/i&gt;&lt;0.001) and postoperative pathological confirmation of perineural invasion (HR = 2.465, 95% CI: 1.519-4.000, &lt;i&gt;P&lt;/i&gt;&lt;0.001) were independent adverse prognostic factors for 5-year DFS. In the perineural invasion-positive group, the 5-year DFS for patients who received 8 cycles of postoperative adjuvant CapeOX chemotherapy was 86.90%, compared to 58.22% for those who received 4-7 cycles, with statistically significant differences (both &lt;i&gt;P&lt;/i&gt;&lt;0.05). In the perineural invasion-negative group, the 5-year DFS for patients who received 8 cycles was 88.66%, compared to 90.99% for those who received 4-7 cycles, with no statistically significant differences (&lt;i&gt;P&lt;/i&gt;=0.929). Among IDEA high-risk patients with perineural invasion, the 5-year DFS was 91.81% for those who received 8 cycles versus 50.66% for those who received 4-7 cycles, showing a statistically significant difference (&lt;i&gt;P&lt;/i&gt;=0.003). In IDEA high-risk patients without perineural invasion, the 5-year DFS for those who received 8 cycles was 82.28% compared to 87.32% for those who received 4-7 cycles, with no statistically significant difference (&lt;i&gt;P&lt;/i&gt;=0.806). In the IDEA low-risk patients, no differences were observed in the 5-year DFS b","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 1","pages":"58-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459749","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":"[Pelvic floor reconstruction with gluteus maximus myocutaneous flap in the treatment of perineal wound healing failure after pelvic exenteration].","authors":"Y Tao, Y L Wang, L Zhu, Z G Wang, N Su, J Zhang","doi":"10.3760/cma.j.cn441530-20231117-00176","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20231117-00176","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the value of pelvic floor reconstruction with gluteus maximus myocutaneous flap in second-stage surgery for patients with failed perineal wound healing after pelvic exenteration (PE). <b>Methods:</b> This was a descriptive case series study. The clinical data of 24 patients with locally advanced (LARC) or recurrent (LRRC) rectal cancer who underwent PE and had long-term nonunion of postoperative perineal wounds were collected from the department of colorectal surgery of the Second Affiliated Hospital of Navy Medical University (Shanghai Changzheng Hospital) from January 2022 to January 2023. The specific operation methods of pelvic reconstruction by gluteus maximus myocutaneous flap are as follows: the necrotic tissue of the perineal wound was debrided and rinsed repeatedly, the gluteus maximus muscle was cut and separated from the gluteus superior and inferior arteries, the middle muscle pedicle was retained, part of the skin and muscle were separated from the medial margin, part of the epidermis was removed, the muscle and subcutaneous tissue at the medial margin of the flap were fixed to the medial edge of the wound, negative pressure suction tubes were placed above and below the wound cavity and in the muscle space on the right side, and the subcutaneous muscle and fat layer were sutured. The skin was sutured intersegmentally, and a negative pressure suction device was placed on the wound surface. After surgery, the patient should remain prone, and the drainage tube should be placed for at least 7 days. The drainage tube can be removed after 24-hour drainage is less than 30 ml. Perineal wound healing and complications related to gluteal major myocutaneous flap were observed. <b>Result:</b> The median reconstruction time of 24 patients was 180 (150 ~ 230) minutes, and the median intraoperative blood loss was 100 (30 ~ 200) ml. 91.7% (22/24) patients had successful healing of perineal wound within 30 d after operation. After a follow-up of 6 months, no complete or partial flap necrosis occurred. The incidence of complications related to gluteus maximus myocutaneous flap was 8.3% (2/24). One patient had flap infection and sinus tract, and one patient had flap sinus tract. All patients healed after debridement under local anesthesia. <b>Conclusion:</b> For LARC/LRRC patients with poor perineal wound healing after PE, pelvic floor reconstruction with gluteus maximus myocutaneous flap in second-stage operation is safe and feasible, and could successfully close the perineal wound, and has a low incidence of postoperative flap-related complications.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 1","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459766","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":"[Research progress of colonic electrical stimulation in the treatment of chronic constipation].","authors":"M D Cai, Y Y Lu, J L Wang","doi":"10.3760/cma.j.cn441530-20240316-00102","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240316-00102","url":null,"abstract":"<p><p>Chronic constipation refers to a reduction in the frequency of bowel movements and difficulty in defecation lasting for more than 6 months, with a comprehensive incidence rate of 15% in the population. Chronic constipation is a significant health concern that greatly affects the quality of life of patients and results in substantial healthcare resource consumption. Current common treatment strategies include lifestyle modifications, pharmacological therapy, biofeedback therapy, enemas, and surgical procedures, but the effectiveness of these approaches remains limited. Colonic electrical stimulation therapy is a newly proposed treatment strategy in recent years, which involves the application of external electrical current to correct abnormal physiological activities related to defecation. This article provides an overview of the mechanisms, efficacy, and factors influencing the use of colonic electrical stimulation in the treatment of chronic constipation, as well as a summary of the advantages of colonic electrical stimulation and possible challenges for future development.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1293-1300"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878142","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":"[Significance of disorders of brain-gut interaction in the diagnosis and management of refractory constipation].","authors":"B W Tian, T Jin, X Su, X Z Li, Z F Zhao","doi":"10.3760/cma.j.cn441530-20240328-00113","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240328-00113","url":null,"abstract":"<p><p>Chronic constipation is a common digestive disease that affects people's quality of life, with complex causes and difficult treatment. Nearly half of the patients with chronic constipation do not achieve satisfactory treatment results, which is referred to as refractory constipation.Current clinical strategies for addressing refractory constipation have predominantly focused on the mitigation of intestinal symptoms. However, emerging evidence suggests that the pathogenesis and progression of refractory constipation are multifactorial and highly intricate, and that strategies targeted solely at symptom relief may be insufficient to yield optimal therapeutic outcomes. Based on the concept of disorders of brain gut interaction disorder (DBGI) proposed by Rome IV, we found that DBGI may play a key role in patients with refractory constipation. From the perspective of DBGI, this review synthesized the contemporary insights into the pathological mechanisms underlying refractory constipation, as well as diagnostic and therapeutic strategies focusing on four aspects: the central nervous system, the peripheral nervous system, the endocrine system, and the intestinal environment.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1301-1308"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878152","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 rare case report of Lynch Syndrome associated colon cancer].","authors":"H Y Jing, D Sha, X L Zhu","doi":"10.3760/cma.j.cn441530-20240111-00022","DOIUrl":"10.3760/cma.j.cn441530-20240111-00022","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1290-1292"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877957","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":"[Comparison of effect of different medial boundaries in laparoscopic right hemicolectomy: a meta-analysis].","authors":"F Gao, B Han, Y H Zhang, H Y Zhao, H Wang, M S Guo","doi":"10.3760/cma.j.cn441530-20240116-00029","DOIUrl":"10.3760/cma.j.cn441530-20240116-00029","url":null,"abstract":"<p><p><b>Objective:</b> To investigate and compare the clinical efficacy and prognosis of D3 lymphadenectomy/complete mesocolic excision in treatment of right colon cancer with different medial boundaries. <b>Methods:</b> We searched The Cochrane Library, Pubmed, Embase, CBM, VIP, CNKI, and WanFang data bases for superior mesenteric artery (SMA)-oriented and superior mesenteric vein (SMV)-oriented D3 lymphadenectomy/complete mesocolic excision from inception to December, 2023. The resultant data were submitted to meta-analysis using RevMan 5.3 software. <b>Results:</b> In total, we identified nine eligible studies involving 2467 patients. The SMA group had 982 patients and the SMV group had 1 485 patients. Meta-analysis revealed no significant differences in intraoperative bleeding volume, postoperative time to passage of flatus, or postoperative drainage volume between the two studied approaches. The durations of surgery and of postoperative hospital stay were both significantly longer in the SMA than SMV group (weighted mean difference [WMD]=17.70, 95%CI: 6.90-28.50, <i>P</i>=0.001; WMD=0.40, 95%CI: 0.07-0.72, <i>P</i>=0.020, respectively). Furthermore, the rate of postoperative complications was greater in the SMA than SMV group. For example, the incidences of postoperative chyle leakage and diarrhea were significantly higher in the SMA than SMV group, (OR=1.25, 95%CI: 1.01-1.54, <i>P</i> = 0.040; OR=3.60, 95%CI: 2.39-5.41, <i>P</i> < 0.001; OR=2.13, 95%CI: 1.10-4.11, <i>P</i> = 0.020, respectively). In terms of oncological efficacy, the total number of lymph nodes dissected and the number of positive lymph nodes in the SMA group were significantly higher than in the SMV group (WMD=2.76, 95%CI:1.22-4.31, <i>P <</i> 0.001, WMD=0.59, 95%CI: 0.06-1.12, <i>P</i> = 0.030). <b>Conclusion:</b> Laparoscopic surgery for right colon cancer, using the left margin of the SMA as the medial boundary for dissection is associated with a higher risk of postoperative complications, such as chyle leakage and diarrhea, than is using the superior mesenteric vein as the medial boundary. The durations of surgery and postoperative hospital stay are longer. SMA left margin dissection has significant oncological advantages, including a higher total number of harvested lymph nodes and of positive lymph nodes.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1276-1283"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878023","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":"[Surgical treatment for intractable constipation: selection of procedure and perioperative management].","authors":"J Jiang","doi":"10.3760/cma.j.cn441530-20241010-00335","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241010-00335","url":null,"abstract":"<p><p>When chronic constipation develops to the stage of intractable constipation, the symptoms of constipation in patients are severe and persistent, and drug treatment is often ineffective, so surgical treatment is often considered. The clinical manifestations of patients with intractable constipation are variable, and the underlying pathophysiological changes involve various abnormal and dysfunctional anatomical structure of colorectal and pelvic floor, which are different. For the surgical treatment of intractable constipation, accurate preoperative classification diagnosis is very important, and it is necessary to formulate an exact and effective surgical plan to avoid untargeted empirical treatment. The key to maintain long-term good results after surgery is to carry out comprehensive and scientific preoperative evaluation and the correct choice of individual operation. In recent years, thanks to the progress of basic research and clinical diagnosis and treatment of intractable constipation, as well as the improvement of minimally invasive surgical techniques and perioperative management, the safety and effectiveness of surgical treatment have been significantly improved. Based on the research progress at home and abroad and the authors' clinical experience, this paper focuses on the contents of preoperative accurate assessment, scientific selection of surgical methods and perioperative intestinal microecological therapy, so as to provide references for clinical practice in the same field.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1243-1247"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878171","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}