Zhonghua wai ke za zhi [Chinese journal of surgery]最新文献

{"title":"[Analysis of prognosis and influencing factors of No. 253 lymph node metastasis in descending colon, sigmoid colon, and rectal cancer: a multicenter study].","authors":"F Q Zhao,&nbsp;L Zhou,&nbsp;X H Du,&nbsp;A W Wu,&nbsp;H Yang,&nbsp;L Xu,&nbsp;X Z Liu,&nbsp;S D Hu,&nbsp;Y Xiao,&nbsp;Q Liu","doi":"10.3760/cma.j.cn112139-20230331-00132","DOIUrl":"10.3760/cma.j.cn112139-20230331-00132","url":null,"abstract":"<p><p><b>Objectives:</b> To analyze the influencing factors of No. 253 lymph node metastasis in descending colon cancer, sigmoid colon cancer, and rectal cancer, and to investigate the prognosis of No. 253 lymph node-positive patients by propensity score matching analysis. <b>Methods:</b> A retrospective analysis was performed on clinical data from patients with descending colon cancer, sigmoid colon cancer, rectosigmoid junction cancer, and rectal cancer who underwent surgery between January 2015 and December 2019 from the Cancer Hospital of the Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Peking Union Medical College Hospital, General Hospital of the Chinese People's Liberation Army, and Peking University Cancer Hospital. A total of 3 016 patients were included according to inclusion and exclusion criteria, comprising 1 848 males and 1 168 females, with 1 675 patients aged≥60 years and 1 341 patients aged<60 years. Clinical and pathological factors from single center data were subjected to univariate analysis to determine influencing factors of No. 253 lymph node metastasis, using a binary Logistic regression model. Based on the results of the multivariate analysis, a nomogram was constructed. External validation was performed using data from other multicenter sources, evaluating the effectiveness through the area under the receiver operating characteristic curve and the calibration curve. Using data from a single center, the No. 253 lymph node-positive group was matched with the negative group in a 1∶2 ratio (caliper value=0.05). Survival analysis was performed using the Kaplan-Meier method and Log-rank test. The Cox proportional hazards model was used to determine independent prognostic factors. <b>Results:</b> (1) The tumor diameter≥5 cm (<i>OR</i>=4.496,95%<i>CI</i>:1.344 to 15.035, <i>P</i>=0.015) T stage (T4 <i>vs.</i> T1: <i>OR</i>=11.284, 95%<i>CI</i>:7.122 to 15.646, <i>P</i><0.01), N stage (N2 <i>vs.</i> N0: <i>OR</i>=60.554, 95%<i>CI</i>:7.813 to 469.055, <i>P</i>=0.043), tumor differentiation (moderate <i>vs.</i> well differentiated: <i>OR</i>=1.044, 95%<i>CI</i>:1.009 to 1.203, <i>P</i>=0.044; poor <i>vs.</i> well differentiated: <i>OR</i>=1.013, 95%<i>CI</i>:1.002 to 1.081, <i>P</i>=0.013), tumor location (sigmoid colon <i>vs.</i> descending colon: <i>OR</i>=9.307, 95%<i>CI</i>:2.236 to 38.740, <i>P</i>=0.002), pathological type (mucinous adenocarcinoma <i>vs.</i> adenocarcinoma: <i>OR</i>=79.923, 95%<i>CI</i>:15.113 to 422.654, <i>P</i><0.01; signet ring cell carcinoma <i>vs.</i> adenocarcinoma: <i>OR</i>=27.309, 95%<i>CI</i>:4.191 to 177.944, <i>P</i><0.01), and positive vascular invasion (<i>OR</i>=3.490, 95%<i>CI</i>:1.033 to 11.793, <i>P</i>=0.044) were independent influencing factors of No. 253 lymph node metastasis. (2) The area under the curve of the nomogram prediction model was 0.912 (95%<i>CI</i>: 0.869 to 0.955) for the training set and 0.921 (95%<i>CI</i>: 0.903 to 0.937) for the external vali","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"760-767"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861446","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":"[Modified gasless trans-subclavian approach endoscopic lateral neck dissection for treatment of papillary thyroid carcinoma: a series of 31 cases].","authors":"D G Zhang,&nbsp;G F He,&nbsp;J J Chu,&nbsp;J X Jiang,&nbsp;J B Li,&nbsp;X X Lu,&nbsp;L Xie,&nbsp;L Gao","doi":"10.3760/cma.j.cn112139-20221201-00509","DOIUrl":"10.3760/cma.j.cn112139-20221201-00509","url":null,"abstract":"<p><p><b>Objective:</b> To examine the feasibility of the modified gasless trans-subclavian approach endoscopic thyroidectomy for lateral neck dissection (LND) in papillary thyroid carcinoma (PTC). <b>Methods:</b> The clinical data of 31 patients with PTC who underwent modified gasless trans-subclavian approach endoscopic LND in the Department of Head and Neck Surgery, Run Run Shaw Hospital, from January to October 2022 were retrospectively analyzed. There were 2 males and 29 females, aged (32.6±8.3) years (range: 17 to 55 years). The maximum diameter of the primary thyroid lesion (<i>M</i>(IQR)) was 1.06 (1.16) cm (range: 0.53 to 2.44 cm), and the maximum diameter of the metastatic lymph node was (1.04±0.37) cm (range: 0.44 to 1.88 cm). Operation time, postoperative hospital stay, number of lymph nodes dissected, and postoperative complications were recorded. Outpatient follow-up was conducted until November 30, 2022. <b>Results:</b> All operations were successfully completed with the endoscopy approach without conversion to open surgery. The operation time was 160 (20) minutes (range: 100 to 215 minutes), and the postoperative hospital stay was 4 (2) days (range: 2 to 14 days). The number of lymph nodes obtained by dissection in the central and lateral compartment of the neck was 11 (12) (range: 0 to 37) and 34.7±14.8 (range: 15 to 69), respectively. Temporary hypoparathyroidism occurred in 4 cases and all recovered within 1 month after the operation. One case suffered from recurrent laryngeal nerve injury (continuing followed up to assess whether it is a temporary injury). The complication of LND included 1 case of chylous leakage that was recovered with conservative treatment, 1 case of Horner syndrome returned to normal 3 months after surgery. During follow-up, there was no residual tumor or recurrence. <b>Conclusion:</b> The modified gasless trans-subclavian approach endoscopic LND for PTC is feasible, with a thorough dissection and concealed incision.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"801-806"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861447","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":"[Radiomics-based prediction of microsatellite instability in stage Ⅱ and Ⅲ rectal cancer patients based on T2WI MRI and diffusion-weighted imaging].","authors":"S Xiang,&nbsp;L B Zheng,&nbsp;L Zhu,&nbsp;Y Gao,&nbsp;D S Wang,&nbsp;S L Liu,&nbsp;S Zhang,&nbsp;T Y Wang,&nbsp;Y Lu","doi":"10.3760/cma.j.cn112139-20230315-00106","DOIUrl":"10.3760/cma.j.cn112139-20230315-00106","url":null,"abstract":"<p><p><b>Objective:</b> To examine the radiomics model based on high-resolution T2WI and diffusion weighted imaging (DWI) in predicting microsatellite stability in patients with stage Ⅱ and Ⅲ rectal cancer. <b>Methods:</b> From February 2016 to October 2020, 175 patients with stage Ⅱ and Ⅲ rectal cancer who met the inclusion criteria were retrospectively collected. There were 119 males and 56 females, aged (63.9±9.4) years (range: 37 to 85 years), including 152 patients with microsatellite stability and 23 patients with microsatellite instability. All patients were randomly divided into the training group (<i>n</i>=123) and the validation group (<i>n</i>=52) with a ratio of 7∶3. The region of interest was labeled on the T2WI and DWI images of each patient using the ITK-SNAP software, and PyRadiomics was used to extract seven kinds of radiomics features. After removing redundant features and normalizing features, the least absolute shrinkage and selection operation were used for feature selection. One clinical model, three radiomics models and one clinical-radiomics model were constructed in the training group based on a support vector machine. The area under receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were used to evaluate the performance of the models in the verification group. <b>Results:</b> Three clinical features (age, degree of tumor differentiation, and distance from the lower edge of the tumor to the anal edge) and six radiomics features (two DWI-related features and four T2WI-related features) most related to microsatellite status of rectal cancer patients were selected. The AUC of the clinical-radiomics model in the training group was 0.95. In the validation group, the AUC was 0.81, better than the clinical model (0.68, <i>Z</i>=0.71, <i>P</i>=0.04), and equivalent to the T2WI+DWI model (0.82, <i>Z</i>=0.21, <i>P</i>=0.83). <b>Conclusions:</b> Radiomic features based on preoperative T2WI and DWI were related to microsatellite stability in patients with stage Ⅱ and Ⅲ rectal cancer and showed a high classification efficiency. The model based on the features provided a noninvasive and convenient tool for preoperative determination of microsatellite stability in rectal cancer patients.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"782-787"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861451","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":"[Reappraisal of the lateral mesorectum and its clinical importance].","authors":"W Zhang,&nbsp;X M Zhu","doi":"10.3760/cma.j.cn112139-20230404-00140","DOIUrl":"10.3760/cma.j.cn112139-20230404-00140","url":null,"abstract":"<p><p>The mesentery has been defined as a double fold of the peritoneum connecting some regions of the intestine to the posterior abdominal wall. It emerges from the superior mesenteric root region and fans out to span the intestine from the duodenum to the rectum. The mesorectal is a continuation of the intraperitoneal mesentery in the pelvic cavity. The lateral structure of the rectum is complex and the traditional view calls it the lateral ligament of the rectal. However, this structure could be called the lateral mesorectum from the perspective of embryonic development and membrane anatomy. The lateral mesorectum is the bridge of the vessels, lymphatic, and nerves between the rectum and the pelvic wall. It anchors the rectum to the lateral pelvic wall and is the anatomical basis of lateral lymph node metastasis in low rectal cancer. Meanwhile, it is important to identify the lateral mesorectum and its surrounding structure to radically resect the tumor and protect the pelvic autonomic nerve during the total mesorectal excision procedure.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"733-737"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873293","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 influencing factors and clinical value of anterior peritoneal reflection for patients with rectal cancer].","authors":"H Q Zhang,&nbsp;S T Wang,&nbsp;Z Sun,&nbsp;G L Lin,&nbsp;B Wu,&nbsp;B Z Niu,&nbsp;J Y Lu,&nbsp;L Xu,&nbsp;Y Xiao","doi":"10.3760/cma.j.cn112139-20230408-00149","DOIUrl":"10.3760/cma.j.cn112139-20230408-00149","url":null,"abstract":"<p><p><b>Objectives:</b> To investigate the factors influencing the height of anterior peritoneal reflection (APR) for patients with rectal cancer, and to analyze the relationship between the APR and the lateral lymph node metastasis. <b>Methods:</b> Clinical data of 432 patients with tumor located within and below APR were retrospectively collected from the rectal cancer database at the Department of General Surgery, Peking Union Medical College Hospital from August 2020 to September 2022. Ninty-eight non-rectal cancer patients were also enrolled as a control group. There were 308 males and 124 females in the tumor group, aged (<i>M</i>(IQR)) 62 (16) years (range: 24 to 85 years) and 53 males and 45 females in the control group, aged 60 (22) years (range: 27 to 87 years). The APR height, pelvis, and tumor-related parameters were measured by MRI. A multifactor linear regression model was established to analyze the dependent correlation factors of APR height. These factors of the two groups were matched by propensity score matching and their APR heights were compared after matching. An ordinal Logistic regression model was established to explore the relationship between APR-related parameters and radiographic lateral lymph node metastasis. <b>Results:</b> The APR height of the tumor group was (98.7±14.4) mm (range: 43.3 to 154.0 mm) and the control group was (95.1±12.7) mm (range: 68.0 to 137.9 mm). Multivariable linear regression revealed that the greater the weight (<i>B=</i>0.519, 95%<i>CI</i>: 0.399 to 0.640, <i>P</i><0.01), the anterior pelvic depth (<i>B=</i>0.109, 95%<i>CI</i>: 0.005 to 0.213, <i>P</i>=0.039) and the smaller the bi-ischial diameter (<i>B=</i>-0.172, 95%<i>CI</i>:-0.294 to -0.049, <i>P</i>=0.006), the higher the APR height. The tumor group had a higher APR height than the control group after propensity score matching ((98.3±14.2) mm <i>vs.</i> (95.1±12.7) mm, <i>t</i>=-1.992, <i>P</i>=0.047). Ordinal Logistic regression indicated that the longer segment of the tumor invade the nonperitoneal rectum was an independent influencing factor of radiographic lateral lymph node metastasis (<i>OR</i>=1.016, 95%<i>CI</i>: 1.002 to 1.030, <i>P</i>=0.021), while the distance between the anal verge and the tumor was not (<i>OR</i>=0.986, 95%<i>CI</i>: 0.972 to 1.000, <i>P</i>=0.058). <b>Conclusions:</b> The higher the weight, the deeper and narrower the pelvis, the higher the APR height. There is a certain relationship between APR and lateral lymph node metastasis on imaging.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"788-794"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867634","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 malignant mesothelioma of the tunica vaginalis testis: a series of 7 cases].","authors":"K B Huang,&nbsp;Y Cao,&nbsp;K Yao,&nbsp;F J Zhou,&nbsp;Z W Liu,&nbsp;X D Li","doi":"10.3760/cma.j.cn112139-20221129-00504","DOIUrl":"10.3760/cma.j.cn112139-20221129-00504","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical features, diagnosis, prognosis of malignant mesothelioma of the tunica vaginalis testis (MMTVT). <b>Methods:</b> The clinicopathological data of 7 patients with MMTVT who treated at Sun Yat-sen University Cancer Center between January 2010 and October 2022 were retrospectively reviewed. Cases were first diagnosed at (<i>M</i> (IQR)) 49 (23) years old (range: 27 to 64 years old). The main clinical manifestations were scrotal enlargement (7 cases) and hydrocele (2 cases). <b>Results:</b> Three patients underwent radical orchiectomy as initial treatment, 2 cases underwent hydrocelectomy due to diagnosis of hydrocele, followed by radical orchiectomy at Sun Yat-sen University Cancer Center, and 2 cases underwent transscrotal orchiectomy. Common tumor markers of testicular cancer were not significantly elevated in MMTVT. The expression of tumor PD-L1 was positive in 2 out of the 3 cases. One patient received adjuvant chemotherapy and 2 patients received first-line chemotherapy after tumor recurrence. Chemotherapy regimens used include cisplatin+pemetrexed. Up to October 2022, 3 cases relapsed, of which 2 cases died. The median overall survival was 35 months (range: 4 to 87 months) and the median progression-free survival was 6 months (range: 2 to 87 months). <b>Conclusions:</b> MMTVT at early stage should be treated with early radical orchiectomy and followed up closely after surgery. The cisplatin+pemetrexed regimen is a common option for the treatment of metastatic MMTVT, while whether immune checkpoint inhibitors could serve as a second-line treatment option deserves further research.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"812-817"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867638","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":"[The impact of extended waiting time on tumor regression after neoadjuvant chemoradiotherapy for locally advanced rectal cancer].","authors":"K Zheng,&nbsp;L Jin,&nbsp;F Shen,&nbsp;X H Gao,&nbsp;X M Zhu,&nbsp;G Y Yu,&nbsp;L Q Hao,&nbsp;Z Lou,&nbsp;H Wang,&nbsp;E D Yu,&nbsp;C G Bai,&nbsp;W Zhang","doi":"10.3760/cma.j.cn112139-20230404-00139","DOIUrl":"10.3760/cma.j.cn112139-20230404-00139","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). <b>Methods:</b> Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (<i>M</i>(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, <i>n</i>=581) and an extended waiting time group (12 to<20 weeks, <i>n</i>=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the <i>t</i> test, Wilcoxon rank sum test, or <i>χ</i>² test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. <b>Results:</b> The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an <i>OR</i> value of 1.010 (95%<i>CI</i>: 1.001 to 1.020, <i>P</i>=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 10^th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) <i>vs.</i> 20.0%(116/581), <i>χ</i>²=3.901, <i>P</i>=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) <i>vs.</i> 10.7%(62/581), <i>χ</i>²=10.510, <i>P</i>=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (<i>χ</i>²=1.878, <i>P</i>=0.171; <i>χ</i>²=0.078, <i>P</i>=0.780; <i>χ</i>²=1.265, <i>P</i>=0.261). <b>Conclusions:</b> An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"775-781"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861448","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":"[Development and validation of a prognostic prediction model for patients with stage Ⅰ to Ⅲ colon cancer incorporating high-risk pathological features].","authors":"K X Li,&nbsp;Q B Wu,&nbsp;F Q Zhao,&nbsp;J L Zhang,&nbsp;S L Luo,&nbsp;S D Hu,&nbsp;B Wu,&nbsp;H L Li,&nbsp;G L Lin,&nbsp;H Z Qiu,&nbsp;J Y Lu,&nbsp;L Xu,&nbsp;Z Wang,&nbsp;X H Du,&nbsp;L Kang,&nbsp;X Wang,&nbsp;Z Q Wang,&nbsp;Q Liu,&nbsp;Y Xiao","doi":"10.3760/cma.j.cn112139-20230403-00137","DOIUrl":"10.3760/cma.j.cn112139-20230403-00137","url":null,"abstract":"<p><p><b>Objective:</b> To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. <b>Methods:</b> This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (<i>M</i>(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. <b>Results:</b> Age (<i>HR</i>=1.020, 95%<i>CI</i>: 1.008 to 1.033, <i>P</i>=0.001), T stage (T3:<i>HR</i>=1.995,95%<i>CI</i>:1.062 to 3.750,<i>P</i>=0.032;T4:<i>HR</i>=4.196, 95%<i>CI</i>: 2.188 to 8.045, <i>P</i><0.01), N stage (N1: <i>HR</i>=1.834, 95%<i>CI</i>: 1.307 to 2.574, <i>P</i><0.01; N2: <i>HR</i>=3.970, 95%<i>CI</i>: 2.724 to 5.787, <i>P</i><0.01) and number of lymph nodes examined (≥36: <i>HR</i>=0.438, 95%<i>CI</i>: 0.242 to 0.790, <i>P</i>=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (<i>n</i>=711), 89.0% (<i>n</i>=626) and 71.4% (<i>n</i>=313), respectively. Statistically significant difference was observed among groups (<i>P</i><0.01). <b>Conclusions:</b> The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"753-759"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861449","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":"[Updates and advances in the concept of gallbladder cancer treatment].","authors":"D M Liu,&nbsp;Q Li","doi":"10.3760/cma.j.cn112139-20230131-00045","DOIUrl":"10.3760/cma.j.cn112139-20230131-00045","url":null,"abstract":"<p><p>The gallbladder is the most common site of tumor occurrence among biliary tract cancer. Gallbladder cancer accounts for approximately 0.6% of new cancers and 0.9% of cancer-related deaths. The risk factors identified for the development of gallbladder cancer include being female,>65 years of age, asymptomatic gallstone disease,and obesity. Surgical resection is the only curative treatment for early-stage gallbladder cancer, and some intermediate or advanced gallbladder cancers can be radically cured by extended resection. However, the extent of liver resection or lymph node dissection and whether to combine it with bile duct removal, revascularisation,and multiple organ resection remain somewhat controversial. After neoadjuvant treatment, up to a third of patients with locally advanced gallbladder cancer benefit from secondary surgical treatment. Only a small proportion of patients with gallbladder cancer at high risk for recurrence will benefit from postoperative adjuvant therapy. With the advent of different target-targeted drugs and the use of genetic tests in biliary tract cancer, targeted therapy and PD-1/PD-L1 inhibitors may become the new standard of care for gallbladder cancer and need to be further explored.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"749-752"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867632","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":"[Status in clinical and molecular characteristics of differentiated thyroid carcinoma in children and adolescents].","authors":"Z H Wang,&nbsp;H Zhang","doi":"10.3760/cma.j.cn112139-20230405-00143","DOIUrl":"10.3760/cma.j.cn112139-20230405-00143","url":null,"abstract":"<p><p>The epidemiological, clinical, and molecular characteristics of differentiated thyroid carcinoma (DTC) in children and adolescents are different from those in adults. The incidence of DTC in children and adolescents is very low, with high rates of lymph node metastasis, extra-thyroidal extension and recurrence, but mortality is lower than that in adults. Younger children with DTC tend to show a higher rate of recurrence, more lymph node metastases, and more extra-thyroidal extension. Furthermore, studies on molecular characteristics suggest that the diversity of gene mutations causes the clinical manifestations of DTC in children and adolescents that are different from those in adults. The incidence of gene fusion is significantly higher than in adults, while the incidence of point mutations is lower than in adults, which may be closely related to clinicopathological characteristics such as high tumor aggressiveness and poor prognosis.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 9","pages":"744-748"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867637","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}