中华胃肠外科杂志最新文献

{"title":"[Research progress on peritoneal metastasis of gastric cancer in the era of immunotherapy].","authors":"J Q Yang, K W Jiang, S Wang","doi":"10.3760/cma.j.cn441530-20241008-00032","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241008-00032","url":null,"abstract":"<p><p>Peritoneal metastasis is a common form of metastasis and recurrence in advanced gastric cancer. In recent years, immunotherapy has shown promising applications in the treatment of various malignancies, including gastric cancer. Given the limited efficacy of conventional treatment modalities, such as surgery and chemotherapy, in managing gastric cancer peritoneal metastasis, immunotherapy has garnered increasing attention and recognition among researchers worldwide. However, the application of immunotherapy in gastric cancer peritoneal metastasis still faces significant challenges, including the immunosuppressive tumor microenvironment, drug delivery barriers, and tumor resistance. This review aims to summarize the immunological mechanisms underlying gastric cancer peritoneal metastasis and discuss the latest advances in immunotherapy from both domestic and international studies, with the goal of providing insights for the development of novel immunotherapeutic agents and the optimization of treatment strategies for patients.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"557-563"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128845","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 study on endoscopic resection of giant submucosal tumors in the esophagus or gastric cardia].","authors":"Z Q Li, Y Wang, S L Lin, P H Zhou, P T Gao","doi":"10.3760/cma.j.cn441530-20250303-00079","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250303-00079","url":null,"abstract":"<p><p><b>Objective:</b> Endoscopic resection of giant submucosal tumors (SMTs) in the esophagus and gastric cardia is challenging. The aim of this study was to investigate the safety and efficacy of various endoscopic procedures for resection of esophageal or gastric cardia SMTs with longitudinal diameter ≥7 cm and/or transverse diameter ≥3.5 cm. <b>Methods:</b> In this retrospective cohort study, we analyzed data of 109 patients with giant esophageal/cardia SMTs originating in the muscularis propria who had undergone endoscopic resection in Zhongshan Hospital from July 2017 to February 2022. Inclusion criteria were as follows: (1) SMT diameter ≥7 cm longitudinally or ≥3.5 cm transversely; (2) presence of symptoms requiring intervention; and (3) tumor originating in the muscularis propria. Exclusion criteria included severe comorbidities, coagulation disorders, prior surgery, or tumor adjacent to vital organs precluding endoscopic treatment. The primary outcomes were en bloc and piecemeal resection rates, whereas secondary outcomes comprised adverse events and long-term survival. <b>Results:</b> Among the 109 patients who had successfully undergone endoscopic resection, the median tumor diameters were 7.5 (4.0-15.0) cm, and 4.5 (1.5-7.0) cm. Submucosal tunneling endoscopic resection, endoscopic full-thickness resection, and endoscopic submucosal excavation were performed on 77, 22, and 10 patients, respectively. The median duration of the procedures was 90 (30-300) minutes. The overall en bloc resection rate was 78.9% (86/109), and piecemeal resection rate 21.1% (23/109). Major adverse events occurred in 12.8% of patients (14/109), comprising pneumothorax or pleural effusion (<i>n</i>=12), esophageal-pleural fistula (<i>n</i>=3), severe delayed bleeding (<i>n</i>=1), tunnel infection with abdominal abscess (<i>n</i>=1), pulmonary abscess (<i>n</i>=1), abdominal abscess (<i>n</i>=1), and postoperative esophageal stricture (<i>n</i>=1). During a median follow-up period of 33.6 (15.4-70.4) months, no tumor recurrences or metastases were detected. Multivariate analysis revealed that transverse diameter ≥4.5 cm was an independent risk factor for piecemeal resection (OR=6.016, 95%CI: 2.180-16.597, <i>P</i><0.001); longitudinal diameter ≥9.0 cm (OR=2.728, 95%CI: 1.005-7.405, <i>P</i>=0.049) and transverse diameter ≥4.5 cm (OR=2.942, 95%CI: 1.099-7.874, <i>P</i>=0.032) were independent risk factors for prolonged operation time; and longitudinal diameter ≥9.0 cm (OR=5.040, 95%CI: 1.425-17.828, <i>P</i>=0.012) and piecemeal resection (OR=6.280, 95%CI: 1.741-22.656, <i>P</i>=0.005) were independent risk factors for major adverse events. <b>Conclusion:</b> Endoscopic resection is a safe and effective treatment modality for giant esophageal or gastric cardia SMTs of longitudinal diameter ≥9.0 cm and transverse diameter ≥4.5 cm.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"544-550"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128948","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 value and implementation strategies of normothermic intraperitoneal and systemic chemotherapy (NIPS) in the treatment of gastric cancer with peritoneal metastasis].","authors":"C Yan, S Lu, Z G Zhu","doi":"10.3760/cma.j.cn441530-20250308-00110","DOIUrl":"10.3760/cma.j.cn441530-20250308-00110","url":null,"abstract":"<p><p>Peritoneal metastasis of gastric cancer is a common metastatic form in advanced gastric cancer, and conventional systemic chemotherapy has shown unsatisfactory efficacy. This article systematically examines the clinical value and implementation strategies of normothermic intraperitoneal chemotherapy and systemic therapy (NIPS) in the treatment of gastric cancer peritoneal metastasis. It covers aspects such as the precise selection of treatment candidates, optimization of drug regimens, standardized management of intraperitoneal chemotherapy ports, determination of the appropriate timing for conversion surgery, and postoperative treatment optimization. The aim is to provide scientific guidance for the clinical application of NIPS, promote its standardization, and improve the prognosis for patients with gastric cancer peritoneal metastasis.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"481-486"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128951","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":"[Expert consensus on the diagnosis and treatment of colorectal cancer peritoneal metastasis (2025 edition)].","authors":"","doi":"10.3760/cma.j.cn441530-20250303-00077","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250303-00077","url":null,"abstract":"<p><p>Colorectal cancer (CRC) is one of the most common malignant tumors in China, ranking second in morbidity and fourth in mortality. Metastasis and recurrence are the leading causes of patient death, and the peritoneum is a frequent site of metastasis in CRC, second only to liver and lung metastases. However, the prognosis of peritoneal metastasis is much worse than hepatic and pulmonary metastasis. CRC peritoneal metastasis is challenging early diagnosis, presents with severe symptoms, and has a poor prognosis. It is crucial to emphasize standardized diagnosis and treatment for CRC peritoneal metastasis to improve patients' outcome and enhance their quality of life. This consensus, based on evidence-based medical evidence, revised the \"Chinese Expert Consensus on the Diagnosis and Treatment of Colorectal Cancer Peritoneal Metastasis (2022 edition)\" and reached a preliminary consensus on the definition, diagnosis, treatment, and prevention of CRC peritoneal metastasis, with the aim of guiding and standardizing the diagnosis and treatment of CRC peritoneal metastasis, developing reasonable and effective comprehensive treatment plans, prolonging survival time and improving quality of life for CRC peritoneal metastasis patients, thereby raising the overall level of diagnosis and treatment for CRC in China.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"441-449"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127729","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":"[Selection and research advances of intraperitoneal drug treatment for colorectal peritoneal metastasis].","authors":"X Y Huang, J W Xie, X S Qin, Y X Zhang, R Luo, H B Hu, J W Ye, H M Wang, L L Chu, R K Huang, H Wang, X Y Li","doi":"10.3760/cma.j.cn441530-20250110-00018","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250110-00018","url":null,"abstract":"<p><p>Peritoneal metastasis is a common form of distant metastasis in patients with colorectal cancer, and it is typically associated with a poor prognosis. The development of peritoneal metastasis involves complex molecular mechanisms and multifactorial regulation of the tumor microenvironment. Due to the presence of the blood-peritoneal barrier, only a small amount of systemic medication reaches the peritoneal cavity, resulting in limited efficacy against peritoneal metastasis. Intraperitoneal administration shows significant therapeutic advantages as it can directly target the tumor microenvironment, maintain high local drug concentrations, and reduce systemic toxicity. Intraperitoneal chemotherapy, especially hyperthermic intraperitoneal chemotherapy, has become a cornerstone therapeutic strategy in the clinical treatment of peritoneal metastasis. When selecting chemotherapy drugs and drug combinations, pharmacokinetic properties, efficacy, and safety must be comprehensively considered to optimize the treatment outcomes. In addition, the unique microenvironment of the peritoneal cavity provides new treatment approaches for biological treatment strategies, including antitoxins, vaccines, immune checkpoint inhibitors, etc. Techniques such as pressurized intraperitoneal aerosol chemotherapy and novel drug delivery systems demonstrate potential for enhanced efficacy, offering promising alternatives to improve patient outcomes. This article will review peritoneal barrier characteristics, intraperitoneal drug transport, intraperitoneal chemotherapy, and intraperitoneal biological therapies, thereby establishing a theoretical framework for precision therapy in colorectal cancer peritoneal metastasis.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"564-573"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128849","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":"[Application and clinical significance of the \"Four-Step Procedure\" of laparoscopic exploration in the diagnosis of gastric cancer with peritoneal metastasis].","authors":"H J Li, X L Chen, J K Hu","doi":"10.3760/cma.j.cn441530-20250304-00084","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250304-00084","url":null,"abstract":"<p><p>Gastric cancer is one of the most common malignant tumors of the digestive tract globally, causing a heavy burden on society due to its high incidence and mortality rates. Patients with gastric cancer and peritoneal metastasis suffer poor prognosis, and peritoneal metastasis is a major factor in the recurrence and metastasis of gastric cancer. Currently, the diagnosis of peritoneal metastasis mainly relies on contrast-enhanced CT, PET-CT, and other imaging techniques, but these technologies have a limited capability to detect small lesion of peritoneal metastases. Laparoscopic exploration is still considered as the most reliable method to diagnose peritoneal metastasis of gastric cancer. It allows direct visualization of the abdominal cavity and peritoneal regions, facilitating the detection of metastases. Furthermore, it enables the collection of histological or cytological specimens for definitive pathological diagnosis. However, the area formed by the parietal peritoneum and visceral peritoneum is large and has many folds in space. To explore the tumor and peritoneum as comprehensively as possible, our team has proposed the \"Four-Step Procedure\" of laparoscopic exploration for gastric cancer to standardize the operation process of laparoscopic exploration, which is characterized by its safety, comprehensiveness, precision and ease of implementation. This article primarily discusses the limitation of routine clinical techniques in diagnosing peritoneal metastasis in gastric cancer and introduce the significant value of the \"Four-Step Procedure\" in diagnosing peritoneal metastasis in gastric cancer.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"508-513"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128941","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":"[Prospects for the treatment of malignant intestinal obstruction associated with peritoneal metastasis in colorectal cancer].","authors":"Z Q Chu, R K Huang, X S Qin, H Wang","doi":"10.3760/cma.j.cn441530-20250103-00007","DOIUrl":"10.3760/cma.j.cn441530-20250103-00007","url":null,"abstract":"<p><p>Malignant intestinal obstruction is one of the common clinical symptoms of peritoneal metastasis of colorectal cancer, and its pathophysiological mechanism involves various factors such as local invasion and compression of tumors, intestinal adhesions caused by the formation of scattered nodules in the abdominal cavity, inflammatory response in the abdominal cavity, and neuromodulation disorders. Patients with traditional intestinal obstruction are generally treated with surgery, but patients with malignant intestinal obstruction associated with peritoneal metastasis of colorectal cancer can present with multi-level obstruction, complex and diverse symptoms. Combined with multiple metastases in the abdominal cavity and even accompanied by cachexia, malignant intestinal obstruction as a major treatment problem in the field of colorectal surgery is often difficult to be treated by surgery. What's more, it is worth noting that new progress and breakthroughs have been made in the diagnosis and treatment of peritoneal metastasis of colorectal cancer, and the treatment of cancerous intestinal obstruction has also begun to receive extensive attention. Therefore, this article summarizes the clinical features of peritoneal metastasis-related malignant intestinal obstruction in colorectal cancer and looks forward to its treatment challenges.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"514-520"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128838","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":"[Feasibility and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal metastatic gastrointestinal cancer: a preliminary report].","authors":"R J Li, R J Chen, D Q Wu, J J Wang, Z F Yang, Y Li","doi":"10.3760/cma.j.cn441530-20250311-00097","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250311-00097","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to summarize and analyze the preliminary application experience of a novel pressurized intraperitoneal aerosol chemotherapy (PIPAC) device in patients with peritoneal metastases of gastrointestinal malignancies. <b>Methods:</b> In this descriptive case series study, four patients with pathologically confirmed peritoneal metastatic gastrointestinal malignancies were enrolled, receiving PIPAC treatment at Guangdong Provincial People's Hospital from December 2024 to February 2025. The PIPAC treatment was performed five times on these patients . Key procedural steps included equipment preparation, operation platform construction, cytologic examination of ascites, Peritoneal Cancer Index (PCI) scoring, biopsy of peritoneal metastases, drug preparation, connection and testing of the PIPAC device, PIPAC treatment, and aerosol evacuation. Preoperative and postoperative clinical data were collected and analyzed to assess the safety and feasibility of PIPAC treatment. <b>Results:</b> 3 males and 1 female patients were enrolled; median age was 57 (range, 36-70) years old; median body mass index was 22.5 (range, 18.0-24.6) kg/m², and the preoperative Eastern Cooperative Oncology Group (ECOG) score was 1 for all cases. Four patients successfully completed the five PIPAC treatments without any intraoperative adverse events. The PIPAC treatment time ranged from 34 minutes to 36 minutes, with a median preoperative PCI score of 18 (range, 5-25). The average Peritoneal Regression Grading Score (PRGS) before the first and second PIPAC treatments were 2.1±0.8 and 1.7±0.6, respectively. The median Visual Analog Scale (VAS) scores for pain on postoperative days 1, 2, and 3 were 2 (range, 2-4), 1 (range, 0-2), and 1 (range, 0-2), respectively. All patients resumed the oral intake and ambulation on the first postoperative day, with a postoperative hospital stay of 3 days. No postoperative complications or perioperative death occurred. <b>Conclusion:</b> The preliminary study results indicate that the use of the novel PIPAC device for the treatment of peritoneal metastases of gastrointestinal malignant tumors is safe and feasible.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"551-556"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128071","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":"[Key measures to improve the efficacy of diagnosis and treatment of gastric cancer with peritoneal metastasis].","authors":"Z G Zhu","doi":"10.3760/cma.j.cn441530-20250304-00080","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250304-00080","url":null,"abstract":"<p><p>Once peritoneal metastasis occurs, the prognosis of gastric cancer is extremely poor, and the median survival time is only about 6-9 months. In recent years, the clinical research on peritoneal metastasis of gastric cancer has become a hot spot. Based on the research results at home and abroad, the author put forward several important measures, which will contribute to further improve the curative effect of gastric cancer with peritoneal metastasis. (1) Improving the preoperative diagnostic rate of peritoneal metastasis is a prerequisite factor; (2) actively preventing peritoneal metastasis is the priority strategy; (3) combining systemic and intraperitoneal therapy is the key mode. (4) performing radical conversion surgery is the fundamental means. In this paper, the above important issues are discussed to communicate with colleagues.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"450-454"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128828","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":"[Pressurized intraperitoneal aerosol chemotherapy in the treatment of peritoneal metastases from gastrointestinal cancers].","authors":"Z F Yang, R J Chen, R J Li, Y Li","doi":"10.3760/cma.j.cn441530-20250311-00096","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250311-00096","url":null,"abstract":"<p><p>Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an emerging therapeutic modality for peritoneal carcinomatosis. This review aims to evaluate the safety, efficacy, and current clinical application of PIPAC in the treatment of peritoneal metastases originating from gastrointestinal malignancies. This review outlines the technical principles, historical development, procedural steps, commonly used drugs, and administration protocols of PIPAC; analyses the current clinical application status of PIPAC technology; discusses the current challenges and future directions of PIPAC; suggests that PIPAC technology still needs to conduct more high-quality and large-sample clinical trials to further establish the safety and efficacy of PIPAC, optimize its indications and formulate standardized operation specifications. In the future, multi-centre cooperation, multi-disciplinary cooperation, precision medicine strategies and new drug research and development will promote the clinical transformation and standardized application of PIPAC technology.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 5","pages":"497-507"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128835","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}