中华胃肠外科杂志最新文献

{"title":"[Chinese expert consensus on the examination and evaluation of chronic constipation (2024 edition)].","authors":"","doi":"10.3760/cma.j.cn441530-20241107-00367","DOIUrl":"10.3760/cma.j.cn441530-20241107-00367","url":null,"abstract":"<p><p>Chronic constipation is a common functional bowel disease, and its diagnosis is based on history and physical examination. Laboratory examination is important for determining the cause, type, severity and treatment effect of chronic constipation. At present, the commonly used workup of chronic constipation includes X-ray, magnetic resonance, pelvic floor ultrasound, neuroelectrophysiology and colorectal manometry, etc., which are recommended in many constipation diagnosis and treatment guidelines, but there has been no consensus on various examination indications, examination methods, judgment criteria and clinical value norms in detail. Led by the Anorectal Physicians Branch of the Chinese Medical Doctor Association, the editorial department of the Chinese Journal of Gastrointestinal Surgery convened domestic experts in related fields to summarize and sort out common laboratory examination methods for chronic constipation in combination with the latest evidence-based medical evidence at home and abroad, and conducted evidence quality assessment and recommendation strength classification according to the GRADE system. The Chinese Expert Consensus on the Examination and Evaluation of Chronic Constipation (2024 edition) was thus formed to help and guide the standardized examination in clinical practice and accurately interpret its clinical value.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1191-1201"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877996","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":"[Single center study of short-term and 10-year efficacy of performing the Jinling procedure on 3 310 patients with refractory mixed constipation].","authors":"L Ni, X B Feng, X Y Li, Y Yao, Z N Hang, J Jiang","doi":"10.3760/cma.j.cn441530-20241018-00344","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241018-00344","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the safety, effectiveness, and long-term efficacy of the Jinling procedure for management of refractory mixed constipation. &lt;b&gt;Methods:&lt;/b&gt; We prospectively collected clinical data of patients with refractory mixed constipation treated by the Jinling procedure in the Institute of General Surgery of our hospital from January 2007 to August 2023. Perioperative complications, effectiveness within 1 year of surgery (as assessed by the Wexner constipation score, gastrointestinal quality of life index, frequency of spontaneous defecation, rate of satisfactory defecation, body composition, serological indicators, defecography, anorectal manometry) and 10 years after surgery (as assessed by the Wexner constipation score, patient assessment of constipation symptom, SF-36 quality of life score, and questionnaire concerning satisfaction with defecation). &lt;b&gt;Results:&lt;/b&gt; The study cohort comprised 3310 patients of mean age 44±15 years, including 653 men and 2657 women. The duration of constipation was 141±114 months. The 1-month, 3-month, 6-month, and 12-month follow-up rates were 98.07% (3246/3310), 95.11% (3148/3310), 93.38% (3091/3310), and 92.81% (3072/3310), respectively. Overall, 1100 patients had undergone surgery at least 10 years previously, 683 of whom completed the questionnaire, making the 10-year follow-up rate 62.09%. The overall incidence of postoperative complications was 21.99% (728/3310), mortality 0.45% (15/3310), and duration of postoperative hospital stay 12.5±5.4 days. Compared with preoperative values, Wexner scores decreased significantly from 1 to 12 months after surgery, whereas the gastrointestinal quality of life index scores had gradually increased by 3 months after surgery; both changes were statistically significant (both &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The frequency of spontaneous defecation increased significantly to &gt; five times/day 1 month after surgery, following which it decreased gradually with time, falling to two to five times/day by 6 months after surgery. All nutritional indicators returned to preoperative levels within 1 year except for that of inorganic salt, which did not change significantly. By 6-12 months after surgery, the proportions of rectocele, mucosal prolapse, internal rectal intussusception, visceral ptosis, perineal descent, pelvic floor spasm, and puborectalis syndrome assessed by defecography were all significantly lower than before surgery (all &lt;i&gt;P&lt;/i&gt; &lt; 0.05). By 3 months after surgery, the anal resting pressure, anal maximum systolic pressure, and anorectal depression had all returned to preoperative levels. Twelve months after surgery, the rectoanal inhibition reflex was stronger than that before surgery, whereas anal relaxation was less pronounced than that before surgery; these differences are statistically significant (both &lt;i&gt;P&lt;/i&gt; &lt; 0.05). The Wexner scores (7±2 vs. 21±6) and patient assessment of constipation symptoms scores (13±5 vs. 39±5) were significantly lower 1","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1254-1260"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878158","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":"[Somatic symptoms often comorbid with benign anorectal disorders: a study of their significance].","authors":"Z F Zhao, Q C Zhao","doi":"10.3760/cma.j.cn441530-20240918-00322","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240918-00322","url":null,"abstract":"<p><p>Benign anorectal diseases represent a prevalent and intricate category of gastrointestinal disorders, encompassing conditions such as anal fissures, fistulas, hemorrhoids, incontinence, pain, and defecation disorders. These conditions include both anatomical abnormalities and functional disorders. Some patients continue to experience discomfort such as perianal discomfort, perineal heaviness, defecation difficulties, and abdominal bloating even after anatomical issues have been addressed, severely impairing social functioning. Generally, colorectal surgeons have paid little attention to somatic symptom disorder (SSD). This article introduced the manifestation of SSD in benign anorectal diseases from a psychosomatic perspective, advocating for the establishment of a biopsychosocial medical model in the diagnosis and treatment of these conditions to enhance patient rehabilitation outcomes. It is recommended that when benign anal diseases coexist with psychological disorders, SSD treatment should be used as a prerequisite. Surgical treatment should be considered only after the improvement of psychological disorders and SSD.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1238-1242"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878167","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":"[Follow-up study on screening for early colorectal cancer in Shipai, Dongguan City, China].","authors":"Q N Wu, Z Zhang, X H Kong","doi":"10.3760/cma.j.cn441530-20240423-00151","DOIUrl":"10.3760/cma.j.cn441530-20240423-00151","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To examine follow-up data of different subgroups in order to further evaluate the performance and practical value of community colorectal cancer screening by detection of stool methylation syndecan-2 gene (m&lt;i&gt;SDC2&lt;/i&gt;) among residents of Shipai Town, Dongguan City. &lt;b&gt;Methods:&lt;/b&gt; This was an observational study. From May 2021 to February 2022, the Shipai Town government of Dongguan City completed screening for colorectal cancer by detection of stool m&lt;i&gt;SDC2&lt;/i&gt; in 10,708 residents from 18 villages who had met the initial screening criteria and been selected using whole population sampling. From May 2022 to February 2023, the research group conducted follow-up of participants about one year after the initial screening. Residents in the gray zone according to the initial screening were followed up by colonoscopy. Additionally, 1,000 residents with negative results on the initial screening were randomly sampled to undergo colonoscopy. Stool m&lt;i&gt;SDC2&lt;/i&gt; detection was performed again on residents who had had positive results on the initial screening, and colonoscopy was performed on those who again tested positive. Compliance with colonoscopy and detection of gastrointestinal lesions during follow-up were assessed in different subgroups. &lt;b&gt;Results:&lt;/b&gt; Of the 438 residents in the gray zone on the initial screening, 155 underwent colonoscopy follow-up (colonoscopy compliance rate 35.4% [155/438]). These colonoscopies revealed that 27 (17.4%) of the participants had gastrointestinal lesions, including advanced adenomas in 22 cases (14.2%) and non-adenomatous polyps in two cases (3.2%). No colorectal carcinomas was identified. Of the 1, 000 randomly sampled residents with negative results on initial screening, 286 underwent colonoscopy follow-up (colonoscopy compliance rate 28.6% [286/1000]), These colonoscopies revealed that 11 (3.8%)of these individuals had gastrointestinal lesions, including three advanced adenomas (1.0%), five non-advanced adenomas (1.7%), one serrated adenoma or polyp (0.3%), and two non-adenomatous polyps (0.7%), but no colorectal carcinomas. Of the 821 residents who tested positive in the initial screening, 511 again underwent stool mSDC2 detection one year later (follow-up rate 62.2% [511/821]). Of these participants, 66 tested positive again (rate of 12.9% [66/511]), 39 (7.6%) of them in the gray zone, whereas 406(79.5%) tested negative. Forty-seven of the residents with positive results underwent colonoscopy (colonoscopy compliance rate 71.2% [47/66]), which revealed 36 (76.6%) gastrointestinal lesions, including 10 advanced adenomas (21.3%), nine non-advanced adenomas (19.1%) and 17 non-adenomatous polyps (36.2%). &lt;b&gt;Conclusion:&lt;/b&gt; Stool m&lt;i&gt;SDC2&lt;/i&gt; detection performs well as a screening tool. In our study, colorectal cancer or precancerous lesions were extremely rare in participants who tested negative on the initial screening. However, some of the participants who tested in the gray zone on ini","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1269-1275"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878037","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":"[Giant perianal verrucous epidermal nevus].","authors":"S B Huang, H Zhang, S Liu, Y F Liu, G Shi","doi":"10.3760/cma.j.cn441530-20240801-00269","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240801-00269","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1288-1290"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878083","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 short-term outcomes of robotic and laparoscopic surgery for mid-low rectal cancer: a propensity matched analysis].","authors":"R Q Li, J J Zhou, S Zhao, D R Wang","doi":"10.3760/cma.j.cn441530-20240130-00050","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240130-00050","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer. &lt;b&gt;Methods:&lt;/b&gt; This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients. &lt;b&gt;Results:&lt;/b&gt; (1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant (&lt;i&gt;P&lt;/i&gt;=0.230 for DFS, &lt;i&gt;P&lt;/i&gt;=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ&lt;sup&gt;2&lt;/sup&gt; = 6.712; &lt;i&gt;P&lt;/i&gt; = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both &lt;i&gt;P&lt;/i&gt; &gt; 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, &lt;i&gt;t&lt;/i&gt; =8.965, &lt;i&gt;P&lt;/i&gt;=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, &lt;i&gt;t&lt;/i&gt; = =3.851, &lt;i&gt;P&lt;/i&gt; = 0.010), urinary tr","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1261-1268"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878029","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":"[Diagnosis and treatment of complex anal fistula:current status and prospects].","authors":"J Zhu, J H Ding","doi":"10.3760/cma.j.cn441530-20240912-00315","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240912-00315","url":null,"abstract":"<p><p>In recent years, although we have made significant progress in the precise diagnosis and treatment of anal fistula, we still lack a thorough and in-depth understanding about the mechanism of formation, development, nonunion and recurrence of complex anal fistula. As a result, there is still a high failure rate, recurrence rate and the risk of the fecal incontinence after treatment. There is hardly any consensus on whatever treatment options, and the various treatment also means no established standard treatment for complex anal fistula. According to recent relevant literatures and personal experience, discuss recent pathbreaking updates in the management of complex anal fistula, we systematically summarize and generalize some critical issues in the diagnosis and treatment of complex anal fistula, including the pathogenesis, reasonable classification criteria, preoperative evaluation and surgical procedure selection. At the same time, we envision the future development directions.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 12","pages":"1221-1226"},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878034","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":"[Analysis of the efficacy of adjusting the dose of imatinib with therapeutic drug monitoring in adjuvant treatment after complete resection of gastrointestinal stromal tumors].","authors":"Z L Chen, H K Tian, J N Ding, Z Y Li, G Mao, Y Y Du, Q Shen, H Zhou, Y Han, X Y Zeng, K X Tao, P Zhang","doi":"10.3760/cma.j.cn441530-20240807-00273","DOIUrl":"10.3760/cma.j.cn441530-20240807-00273","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the efficacy of adjusting the dose of imatinib dose in the context of therapeutic drug monitoring (TDM) in patients with gastrointestinal stromal tumors (GISTs) who are receiving adjuvant therapy after complete resection of their tumors. &lt;b&gt;Methods:&lt;/b&gt; This was a descriptive study. Inclusion criteria were (1) complete surgical resection with a pathological diagnosis of GIST, (2) postoperative adjuvant therapy with imatinib and dosage adjustment, (3) multiple TDM of imatinib, and (4) complete clinical, pathological, and follow-up data. The data of 70 patients with GISTs treated at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2015 and December 2023 were collected retrospectively. The study cohort comprised 15 (21.4%) men and 55 (78.6%) women of median age 60 years (range: 25-82). Of the eligible patients, 49 (70.0%) were at high-risk, 14 (20.0%) at intermediate-risk, six (8.6%) at low-risk, and one (1.4%) at very low risk. Patients were followed up by the gastrointestinal stromal tumor clinic every 2-3 months and their plasma concentrations of imatinib were checked. The dose was adjusted to 300 mg/d or 200 mg/d depending on whether they had had ≥ grade III adverse reactions, and whether the first plasma concentration of imatinib was ≥ 1,500 μg/L or between the expected range of 760 μg/L-1,100 μg/L. Studied indicators included adverse reactions, quality of life before and after dose adjustment, and overall survival and recurrence-free survival (RFS) after dose adjustment. &lt;b&gt;Results:&lt;/b&gt; Before dose adjustment, all 70 patients received 400 mg of imatinib daily, with initial TDM values of 1,900 ± 568 μg/L, for a median duration of 8.3 months. After dose adjustment, 60 patients received 300 mg daily, with a TDM of 1,216 ± 350 μg/L, whereas 10 received 200 mg daily, with a TDM of 1,023 ± 269 μg/L. The median duration of treatment after dose adjustment was 23.4 months. Compared with those whose dosages were not adjusted, the incidence of bone marrow suppression was significantly lower (74.3% [52/70] vs. 51.4% [36/70], χ&lt;sup&gt;2&lt;/sup&gt;=9.202, &lt;i&gt;P&lt;/i&gt;=0.010); as were the incidences of edema (95.7% [67/70] vs. 50.0% [35/70], χ&lt;sup&gt;2&lt;/sup&gt;=40.526, &lt;i&gt;P&lt;/i&gt;&lt;0.001); skin reactions (70.0% [49/70] vs. 32.9% [23/70), χ&lt;sup&gt;2&lt;/sup&gt;=22.495, &lt;i&gt;P&lt;/i&gt;&lt;0.001); and gastrointestinal reactions (38.6% [27/70] vs. 10.0% [7/70], χ&lt;sup&gt;2&lt;/sup&gt;=15.899, &lt;i&gt;P&lt;/i&gt;&lt;0.001) in those whose dosages were adjusted. The average total scores for physical health before and after dose adjustment were 76 ± 5 and 88 ± 4, respectively; whereas the mental health scores were 75 ± 6 and 89 ± 4, respectively. The median follow-up period was 36 months (range 6-126). During the first 3 years of follow-up, five high-risk patients with non-gastric GISTs developed recurrences. The 3-year overall survival rate was 100%, and the 3-year RFS rate was 92.8%, high-risk patients having a 3-year RFS rate of 89.8%. &lt;b&gt;C","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 11","pages":"1148-1154"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689082","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":"[Rethinking several issues related to surgical treatment for advanced GIST in the era of targeted therapy].","authors":"M Wang, H Cao","doi":"10.3760/cma.j.cn441530-20240907-00307","DOIUrl":"10.3760/cma.j.cn441530-20240907-00307","url":null,"abstract":"<p><p>Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, and tyrosine kinase inhibitors (TKIs) have achieved great success in the treatment of GISTs. The role and value of surgery in advanced GISTs are still controversial. This article aims to review the progress related to surgery for advanced GIST in the context of targeted therapy, particularly exploring the issues related to the combination of surgery and targeted therapy. Studies have shown that selected advanced GISTs can benefit from surgery, but there is still a lack of universally accepted screening criteria and operational norms, and multiple factors affect the effectiveness of surgical treatment for advanced GISTs. Different surgical strategies should be developed for imatinib-resistant GISTs or multiple TKI-resistant GISTs. During the period when the tumors respond to imatinib, cytoreductive surgery is most likely to improve the survival of patients. Early or localized progression should be identified and promptly intervened with surgery. At present, there are few studies on sunitinib or regorafenib combined with surgery, and their feasibility and value are still controversial. Ripretinib combined with cytoreductive surgery may be a new breakthrough point.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 11","pages":"1107-1116"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688850","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":"[Analysis of risk factors for adverse outcomes in 10,135 patients with gastrointestinal malignancies aged 65 years and over who underwent elective surgery].","authors":"W Wang, J P Wang, D Wang, H Z Cai, Z Q Wu, F Shan, Z Y Li","doi":"10.3760/cma.j.cn441530-20240416-00141","DOIUrl":"10.3760/cma.j.cn441530-20240416-00141","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the risk factors for postoperative adverse events in older persons with gastrointestinal malignancies and thus provide reference for selection of surgery and evaluation of such patients. &lt;b&gt;Methods:&lt;/b&gt; An observational study design was employed, the study cohort comprising patients aged 65 years and over with gastrointestinal malignancies who underwent elective surgery in Peking University Cancer Hospital from 2008 to 2022. In this study, we compared the clinical characteristics (disease type, tumor stage), surgical safety (combined organ resection, operation duration, comorbidities), and treatment outcomes (postoperative complications, unplanned reoperation, and perioperative mortality) of these patients. Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse outcomes. &lt;b&gt;Results:&lt;/b&gt; The study cohort comprised 10,135 patients, of whom 74.7% (7,568) were 65-75 years old (excluding 75 years old), 23.6% (2,391) 75-85 years old (excluding 85 years old), and 1.7% (176) ≥85 years old. The type of cancer was colorectal in 63.4% (6,427 patients) and gastric in 36.6% (3,708); 62.0% (6,284/10,135)of the patients had stage II or III disease. The proportion of stage III and stage IV tumors was higher in patients aged over 85 years (47.4% [73/154) and 11.0% [17/154]), respectively, than in those aged 75-85 years (41.6% [854/2 051) and 8.2% [168/2 051]), respectively, and those aged 65-75 years (40.1% [2,576/6,431) and 10.9% [700/6,431]); these differences are statistically significant (χ&lt;sup&gt;2&lt;/sup&gt;=27.95, &lt;i&gt;P&lt;/i&gt;&lt;0.01). Comorbidity was present in 50.6% (5,128/10,135) of the whole study cohort, comprising 58.0% (102/176) of those aged over 85 years, this being significantly higher than the 56.3% (1,346/2,391) in those aged 75-85 years and 48.6% (3,678/7,568) of those aged 65-75 years. The main comorbidities were hypertension (37.3%), diabetes (16.4%), and cardiovascular and cerebrovascular diseases (14.0%). Minimally invasive surgery was performed on 36.9% (3,740/10,135) of the whole study cohort, the 38.4% in 65-75 years old patients being significantly higher than the 32.5% in those aged 75-85 years and the 29.0% in those aged over 85 years; these differences are statistically significant (χ&lt;sup&gt;2&lt;/sup&gt;=31.97, &lt;i&gt;P&lt;/i&gt;&lt;0.01). Preoperative neoadjuvant therapy was administered to 9.1% (924/10,135) of the whole study cohort, the proportion of patients receiving preoperative neoadjuvant therapy being significantly higher in those aged 65-75 years (11.1%) than in those aged 75-85 years (3.4%) and over 85 years (0.6%); these differences are statistically significant (χ&lt;sup&gt;2&lt;/sup&gt;=148.98, &lt;i&gt;P&lt;/i&gt;&lt;0.01). Combined organ resection was performed in 4.9% (496/10,135) of the whole study cohort, the proportion undergoing combined organ resection being significantly lower in those aged over 85 years (2.3%) than in those aged 65-75 years (5.3%) and 75-85 years (3.8%); these differenc","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 11","pages":"1155-1161"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689113","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}