Gastrointestinal Surgery Research Articles

A review of wrist mechanism design and the application in gastrointestinal minimally invasive surgery of multi-degree-of-freedom surgical laparoscopic instruments.

This paper aims to comprehensively review current designs of Multi-degree-of-freedom (Multi-DOF) wrist mechanisms and the applications of Multi-DOF surgical instruments in gastrointestinal minimally invasive surgery (MIS). By reviewing the advantages and limitations of traditional laparoscopic and robotic surgical instruments, we present the development of Multi-DOF surgical instruments. Then, we summarize the Multi-DOF wrist mechanisms, delineating their pros and cons. Finally, the surgical outcomes and efficiency of Multi-DOF surgical instruments are reviewed. The utilization of Multi-DOF surgical instruments for both benign and malignant gastrointestinal diseases demonstrates perioperative outcomes comparable to traditional laparoscopic and robotic surgeries. In certain aspects, it exhibits advantages such as shorter operative times and faster gastrointestinal function recovery. Further research is needed to effectively combine these driving mechanisms to achieve a new type of transmission mechanism with high rigidity and precision, ample working space, and decoupled degrees of freedom. Multi-DOF surgical instruments offer the advantages of high flexibility and lower costs, displaying good feasibility and safety in practical clinical applications within gastrointestinal surgery. Their promotion in primary care hospitals could benefit a larger patient population. However, more extensive sample-sized multicenter studies are still warranted to elucidate such surgical instruments' advantages further.

Cutting Edge Microscopic Intraoperative Tissue Assessment for Guidance in Oncologic Surgery: A Systematic Review of the Role of Optical Coherence Tomography.

There is a demand for intraoperative diagnostic support and image guidance in oncological surgery. Novel techniques can provide images similar to histopathological slides within a few minutes. Optical coherence tomography (OCT) and full-field OCT (FF-OCT) provide images with resolution greater than a hundred micrometers without the need for exogenous contrast agents or specimen staining. The aim of this systematic review was to assess the current clinical applications of OCT and dynamic cell imaging (DCI) in oncologic surgery, examining the translation challenges and proposing perspectives for improving future clinical applications. The study adhered to the PRISMA guidelines. PubMed, Google Scholar, and ClinicalTrials.gov were searched up to July 2024. Manuscripts reporting data on OCT and (D)-FF-OCT application in oncologic surgery were included in the qualitative analysis. Thirty-one studies met the inclusion criteria. Most were from the fields of dermatologic (25.8%) and breast cancer (29%) surgery, followed by prostate and bladder (9.6%), ovarian (9.6%), head and neck (6.4%), gastrointestinal (6.4%), hepato-biliary (3.2%), and general surgery (9.6%). The majority of articles focused on FF-OCT and DCI (80.6%). Compared with the gold standard of final pathology, the OCT sensitivity ranged between 66.7 and 94%, the specificity between 64 and 100%, and the accuracy between 73 and 96%. The medical use of OCT has expanded from ophtalmology to other fields including gastroenterology and oncology and, with techniques such as FF-OCT and DCI, can enable rapid intraoperative diagnosis beyond classic histopathology.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations.

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion ofnutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption anddeficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

Chinese expert consensus on standardized treatment of presacral cyst(2024 edition)

Surgical excision is the only radical treatment for presacral cysts, which are difficult and risky because of the complex anatomical structure around them, involving important blood vessels and nerves. Improper surgical procedures will lead to recurrence of presacral cysts after surgery, causing great pain to patients. With the deepening of clinical research on presacral cysts, some new problems have been found to be overcome. On the basis of the Chinese Expert Consensus on Standardized Treatment of Presacral Cysts (2021 edition), the Pelvic Tumor Integration Professional Committee of the Chinese Anti-Cancer Association organized authoritative experts in relevant professional fields including general surgery, gastrointestinal surgery, colorectal and anal surgery, gynecological oncology, bone and soft tissue surgery, neurosurgery, pathology, imaging and other departments, to formulate the Chinese Expert Consensus on the Standardized Diagnosis and Treatment of Presacral Cysts (2024 edition) after a consensus meeting. The 2024 consensus provides a comprehensive introduction to the following seven aspects, including the origin and pathology of presacral cysts, related anatomy and classification of surgery, diagnosis and differential diagnosis, surgical philosophy, surgical methods for excision, perioperative complications and management, follow-up, and subsequent treatment, and has reached a consensus after repeated discussions and revisions. Compared with the 2021 consensus, the main updates in the 2024 consensus include the following aspects: in the anatomy and classification section, the anatomical classification of high and low, single and multiple cysts of the presacral space has been added; in the surgical concept section, it is emphasized to protect the sacral nerves for presacral cysts with sacral variations; in the surgical approach section for excision, the surgical approach for different anatomical types of presacral cysts has been further clarified. For patients with preoperative enterocutaneous fistula, the use of gluteus maximus muscle flap to repair the fistula reduces the probability of preventive stoma. For suspected malignant presacral cysts, multidisciplinary consultation is required, and if radical resection is not possible, further biopsy is performed to clarify the pathology and develop a comprehensive treatment plan.

Status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery based on national clinical database (NCD) data in Japan.

To investigate the current status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery in Japan. We reviewed data on eight gastroenterological procedures from the Japanese National Clinical Database (NCD), accrued between 2018 and 2020. Patient characteristics, prophylactic methods, postoperative bleeding, cardiac arrest, and postoperative mortality rate within 30days were retrieved. Despite recommendations, approximately 30% of patients did not receive VTE prophylaxis, suggesting a lack of awareness. Pharmacological prophylaxis was associated with a higher incidence of VTE than mechanical or no prophylaxis for all procedures. Combined prophylaxis resulted in a lower incidence of VTE than pharmacological prophylaxis alone. Pharmacological prophylaxis was also associated with an increased incidence of bleeding events. The risk of cardiac arrest and death was higher in patients with pulmonary embolism (PE), but there was a trend toward lower mortality in the group that received pharmacological prophylaxis. Pharmacological prophylaxis for VTE was limited in reducing the incidence of VTE, but it may reduce the risk of death. Combining pharmacological and mechanical prophylaxis tended to be more effective for preventing VTE than either method alone. Conversely, pharmacological prophylaxis may increase the risk of bleeding.

A pan-European survey of robotic training for gastrointestinal surgery: European Robotic Surgery Consensus (ERSC) initiative.

There has been a recent rapid growth in the adoption of robotic systems across Europe. This study aimed to capture the current state of robotic training in gastrointestinal (GI) surgery and to identify potential challenges and barriers to training within Europe. A pan-European survey was designed to account for the opinion of the following GI surgery groups: (i) experts/independent practitioners; (ii) trainees with robotic access; (iii) trainees without robotic access; (iv) robotic industry representatives. The survey explored various aspects, including stakeholder opinions on bedside assisting, console operations, challenges faced and performance assessment. It was distributed through multiple European surgical societies and industry, in addition to social media and snowball sampling, between December 2023 and March 2024. A total of 1360 participants responded, with valid/complete responses from 1045 participants across 38 European countries. Six hundred and ninety-five (68.0%) experts and trainees were not aware of a dedicated robotic training curriculum for trainees, with 13/23 (56.5%) industry representatives not incorporating training for trainees in their programme. Among trainees with access to robotic systems, 94/195 (48.2%) had not performed any robotic cases, citing challenges including a lack of certified robotic trainers and training lists. Both experts and trainees agreed that trainees should start bedside assisting and operating on the console earlier than they currently do. Assessment tools of trainee performance were not being used by 139/479 (29.0%) participants. This pan-European survey highlights the need for a standardised robotic curriculum to address the gap in visceral training, assessment and certification. A greater emphasis may be required on implementing robotic training earlier through simulation training, dual console learning, bedside assisting, key clinical performance indicators, and assessment tools. The findings will guide the development of a pan-European consensus on the essential components of a comprehensive training programme for GI robotic surgery.

Cardiac output-guided haemodynamic therapy for patients undergoing major gastrointestinal surgery: OPTIMISE II randomised clinical trial

ObjectivesTo evaluate the clinical effectiveness and safety of a perioperative algorithm for cardiac output-guided haemodynamic therapy in patients undergoing major gastrointestinal surgery.DesignMulticentre randomised controlled trial.SettingSurgical services of 55 hospitals worldwide.Participants2498...

The characteristics of gastric electric rhythm in obese patients

Objective: To investigate the characteristics of gastric electric rhythm in patients with obesity. Methods: Obese patients who were scheduled to undergo weight reduction surgery in Peking Union Medical College Hospital from January 2018 to February 2024 were prospectively included. According to body mass index (BMI), the patients were divided into mild-to-moderate obesity group (28 kg/m2≤BMI<40 kg/m2) and severe obesity group (BMI≥40 kg/m2). Patients who were going to complete electrogastrography (EGG) with normal BMI (18.5 kg/m2≤BMI<25 kg/m2), without upper gastrointestinal symptoms, gastrointestinal surgery history, and underlying diseases such as diabetes mellitus were included as normal BMI group. The clinical data was recorded and EGG examination and analysis were performed. The gastric electric rhythm characteristics of patients were compared among the three groups. The correlation between BMI and gastric electric rhythm parameters was analyzed. The differences of EGG parameters between obese patients with diabetes mellitus and obese patients without diabetes mellitus were compared. Results: A total of 60 obese patients were included, including 25 males and 35 females, whose age were 18.0-59.0 (27.6±6.9) years old and BMI were (41.0±7.1) kg/m2. There were 30 patients in mild-to-moderate obesity group and 30 patients in severe obesity group. Twenty-four patients were included in normal BMI group, including 11 males and 13 females, whose age were 21.0-42.0 (30.7±6.8) years old, and BMI were (22.7±3.1) kg/m2, with no difference in age and gender compared with mild-to-moderate and severe obesity groups (both P>0.05). EGG results showed that the percentage of normal slow wave before meal (43.2%±20.0%, 37.0%±16.9%, respectively, vs 74.6%±13.6%), and the percentage of normal slow wave after meal (31.6%±13.8%, 28.5%±11.3%, respectively, vs 68.5%±14.4%) in the mild-to-moderate obesity group and the severe obesity group were significantly lower than those in the normal BMI group (all P<0.001). In the mild-to-moderate obesity group, the percentage of preprandial bradycardia [M (Q1, Q3), 3.4% (0, 15.2%) vs 0 (0, 0), P<0.001], preprandial tachycardia [0 (0, 3.3%) vs 0 (0, 0), P=0.014], postprandial bradycardia [13.3% (3.3%, 20.4%) vs 0 (0, 5.2%), P<0.001] were higher than those in the normal BMI group. In severe obese group, the percentage of preprandial bradycardia [9.4% (3.1%, 13.8%) vs 0 (0, 0), P<0.001], preprandial tachycardia[0 (0, 3.7%) vs 0 (0, 0), P=0.011], postprandial bradycardia [16.7% (7.4%, 20.0%) vs 0 (0, 5.2%), P<0.001] were all higher than those in the normal BMI group. The dominant power before meal [(57.9±12.6), (65.8±9.6), respectively, vs (46.4±4.9) μv] and after meal [(63.5±13.7), (68.3±12.6), respectively, vs (50.6±6.3) μv] in mild-to-moderate obesity group and the severe obesity group were higher than those in the normal BMI group (all P<0.001). The dominant power before meal in severe obesity group was higher than that in mild-to-moderate obesity group (P=0.008), but there were no statistically significant differences in other parameters between the two groups (P>0.017, corrected significance level α=0.017). In obese patients, the dominant power was positively correlated with BMI before and after meal (r=0.47, 0.34, respectively, both P<0.05). There was no significant difference in gastric electric rhythm between obese patients with diabetes mellitus and obese patients without diabetes mellitus (P>0.05). Conclusions: Patients with obesity have lower percentage of normal slow waves before and after meal, but increased percentage of preprandial bradycardia, tachycardia and postprandial bradycardia. The dominant power of patients with obesity before and after meals were increased, which is positively correlated with BMI.

Comparision of attributes between young and old patients who died in hospital after bowel obstruction: A multicenter retrospective cohort study

BackgroundIntestinal obstruction is one of the most frequent emergencies in gastrointestinal surgery and can concern patients of all ages and be life threatening. Postoperative mortality is reported to be higher in elderly patients, but there is currently no published study encompassing all patients regardless of their treatment. The aim of the present study was to compare outcomes between older and younger patients deceased after all kind bowel obstruction treated surgically or not. MethodsWe retrospectively included all consecutive patients declared dead following bowel obstruction, from 2007 to 2020, in 3 University hospital in Lyon, France. Patients were classified according to age, <75 and ≥75 years based on the definition of elderly patients of the French Haute Autorité de Santé. Patient's selection was made with the hospital discharge database and medical records were collected from the local electronic database. ResultsA total of 222 patients were included; 130 patients were aged ≥75 years and 92 < 75 years. Most patients did not show signs of severity at admission. Patients ≥75 years had a higher rate of death by acute respiratory distress (p = 0.02), while there is a trend to a higher frequency of death by general deterioration in a context of advanced cancer in the younger group (p = 0.06). ConclusionIntra-hospital death after bowel obstruction concerns patients of all ages, treated surgically or not. Elderly patients die from respiratory complications, and younger ones die from general deterioration in context of cancer. Most deceased patients did not show signs of severity at admission.

Changes in Skeletal Muscle Mass in the First 3 Months Following Gastrointestinal Cancer Surgery: A Prospective Study.

Surgical resection is the primary treatment for gastrointestinal (GI) cancers, but postoperative skeletal muscle loss (SML) is common and linked to poor prognosis. This study aims to identify patterns of muscle change, examine its association with quality of life (QoL), and explore predictors of SML in the first 3 months. A prospective cohort study was conducted on patients newly diagnosed with GI cancer and undergoing surgery in China between September 2021 and May 2022. Skeletal muscle mass (SMM) and QoL were assessed at admission, 7 days, 1 month, and 3 months post-surgery. Demographic, clinical data, and biomarkers were collected. Missing data were imputed using multiple imputation. Data were analyzed using growth mixture modelling, bivariate analyses, and logistic regression. A total of 483 patients completed baseline assessment. Of the 242 patients with complete muscle assessments, 92% experienced SML. Three distinct patterns of muscle change were identified: 57% had normal preoperative SMM with mild postoperative SML, 16% had low preoperative SMM with moderate SML, and 27% had normal preoperative mass but severe postoperative SML. Moderate/severe SML was associated with more postoperative complications, poorer health, and higher symptom burden. Independent predictors included advanced age, preoperative sarcopenia, advanced cancer stage, and low prognostic nutrition index (PNI ≤ 45). The results did not change when using imputed values. Although SML is prevalent, patterns of muscle change are heterogeneous among patients. Advanced age, preoperative sarcopenia, advanced cancer stage, and cancer-related inflammation are predictors for moderate/severe SML, highlighting the need for early detection and management.

Gastrointestinal cancer surgery in the elderly: The effects of preoperative oral nutritional supplements - A retrospective study.

The current study aimed to explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal cancer surgery. A retrospective study was conducted, where participants were divided into two groups based on whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n=41) adopted a nutritional prehabilitation mode (a standard energy intake of 25-30 kcal/kg· d was recommended). While the control group (n=55) received routine care. All patients underwent laparoscopic surgery according to the National Comprehensive Cancer Network (NCCN) guidelines. Changes in nutritional status, complications, psychological status, symptoms, hospitalization days, and expenditures were compared between the two groups. Both groups of patients experienced weight loss. However, the decline in body weight in the prehabilitation group was less than that in the control group (-1.88 vs. -2.56 kg, p < 0.001). In the comparison of nutritional prehabilitation group and control group, significant improvements were observed in the Hospital Anxiety Scale scores (5 vs. 5, p = 0.01) and MD Anderson Symptom Inventory scores (3 vs. 0, p < 0.001) respectively. The infection rate in the nutritional prehabilitation group was lower than that in the control group (17.1% vs. 36.4%, p = 0.04). Additionally, patients in the nutritional prehabilitation group had significantly fewer hospitalization days at discharge (14.3 vs. 17.1 days, p = 0.03). In elderly patients undergoing abdominal cancer surgery, a nutritional prehabilitation model may help maintain better physical and mental status, reduce infection rates, and shorten hospitalization days.

Effect of prehabilitation on outcomes following upper gastrointestinal surgery: a systematic review and meta-analysis

It is accepted in several areas of surgery that prehabilitation can improve post-operative outcomes. Prehabilitation describes preoperative interventions aimed at optimizing patient condition prior to surgery to improve postoperative outcomes. It is hypothesized that prehabilitation reduces postoperative complications in the setting of upper gastrointestinal surgery. A systematic search strategy was performed based on a research question formulated with reference to the PICO framework. Eligible studies were those that included a predefined prehabilitation intervention, a comparison to usual care and conducted on patients undergoing upper gastrointestinal surgery. Included studies were evaluated for bias and underwent data extraction. Meta-analysis was also performed for outcomes where possible. Eight studies met criteria for inclusion in this review. The nature and length of prehabilitation programs varied widely, with interventions lasting from two to six weeks. Reported outcomes included post-operative pulmonary complications, mortality and length of hospital stay. A meta-analysis was undertaken for mortality and postoperative pulmonary complications. Meta-analysis showed postoperative pulmonary complications were reduced (RR0.68, 95% CI 0.50-0.93) in the intervention group compared to the control group, as was mortality (RR 0.59, 95% CI 0.35-1.00). Prehabilitation, especially inspiratory muscle training appears to be effective in reducing pulmonary complications in patients scheduled for upper gastrointestinal surgery. With the available data it is uncertain if this translates to reduced length of stay or mortality. There is scope for further research to better define a role for prehabilitation in upper gastrointestinal surgery, specifically the optimal prehabilitation modality and length.

Defining Clinical Characteristics of Individuals With and Without Post-Bariatric Hypoglycemia After Gastric Bypass.

Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux-en-Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH. To identify clinical characteristics distinguishing post-RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non-hypo). Cross-sectional observational study in academic referral centre. Adults 18-70, without current diabetes, were recruited into three groups: (1) PBH (n = 39); (2) RYGB non-hypo (n = 25); and (3) individuals without history of upper gastrointestinal surgery (n = 17). Outcome measures included between-group differences in medical history and medication use, and survey-based scores for hypoglycemia, dumping syndrome, and autonomic symptoms. PBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m2, versus RYGB non-hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m2) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m2). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%-17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self-reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all p < 0.05 vs. RYGB non-hypo). Gabapentin and PPI use was more frequent in PBH. High rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self-reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH.

Reconsideration of the clinical management of hepatic hemangioma

In this letter, we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery . This article proposes a new clinical grading system based on a multidisciplinary team, which prompts us to rethink the clinical management of hepatic hemangioma. Hepatic hemangioma is the most common benign solid liver tumor. In general, follow-up and observation for the vast majority of hepatic hemangioma is reasonable. For those patients with symptoms and severe complications, surgical intervention is necessary. Specific surgical indications, however, are still not clear. An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma. In this article, we review the recent literature, summarize the surgical indications and treatment of hepatic hemangioma, and evaluate the potential of this new clinical grading system.

Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic biliary drainage for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography failure

In a recent issue of the World Journal of Gastrointestinal Surgery , a meta-analysis investigated the safety and efficacy of electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) implantation for managing malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography. This manuscript endeavors to offer a comprehensive look at the progression of endoscopic ultrasound-guided biliary drainage (EUS-BD) technologies, weighing their merits and drawbacks against traditional percutaneous methods. Several meta-analyses and randomized controlled trials have compared the performance of EUS-BD and percutaneous transhepatic cholangiodrainage (PTCD). These studies revealed that the technical success rate, clinical success rate, and adverse events were similar between EUS-BD and PTCD. Nevertheless, given that most of these studies predate 2015, the safety and effectiveness of novel EUS-BD techniques, including ECE-LAMS, compared with those of percutaneous biliary drainage remain elusive. Further investigation is imperative to ascertain whether these novel EUS-BD techniques can safely and efficaciously replace conventional percutaneous therapeutic approaches.

Preoperative gastric retention in endoscopic retrograde cholangiopancreatography

We comment on the article by Jia et al , in the World Journal of Gastrointestinal Surgery . We focus mainly on the factors that impair gastric motility and cause gastric retention in the pre-operative setting of endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a complex endoscopic therapeutic procedure, which demands great skill from the endoscopist but also has recognized complications. Gastric retention impairs the endoscopist’s visibility but also increases the risk of complications, such as aspiration pneumonia. Therefore, identifying the factors that predispose to gastric retention alerts the endoscopists of the possible risks and enables them to take evasive action. The authors in the current study by Jia et al developed and validated a predictive model, which incorporates five different factors, i.e. , gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction, which were found to influence gastric retention. This model was shown to have a high predictive value to accurately identify patients at risk for gastric retention before a therapeutic ERCP.

Unlocking the diagnostic potential of vascular endothelial growth factor and interleukin-17: Advancing early detection strategies for hepatocellular carcinoma.

Tian et al investigated the diagnostic value of serum vascular endothelial growth factor (VEGF) and interleukin-17 (IL-17) in primary hepatocellular carcinoma (PHC). Their retrospective study, published in the World Journal of Gastrointestinal Surgery, revealed that the serum levels of VEGF and IL-17 are significantly elevated in PHC patients compared with healthy controls. These biomarkers are closely associated with pathological features such as tumor metastasis and clinical tumor node metastasis stage. A receiver operating characteristic analysis further confirmed the diagnostic efficacy thereof, suggesting that VEGF and IL-17 could serve as valuable tools for early detection and treatment guidance. This study underscores the potential of integrating these biomarkers into clinical practice to increase diagnostic accuracy and improve patient management in PHC.

Immunotherapy for metastatic gastric cancer

This editorial discusses the article written by Chen et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery . The current study found that programmed cell death 1 ligand 1 (PD-L1) expression is considered as one of the pan-cancer biomarkers of immune checkpoint inhibitors (ICIs) treatment response. Four molecular subtypes are widely used to guide and evaluate the prognosis and diagnosis and treatment of gastric cancer (GC) patients. Clinical trials of ICI treatment including Nivolumab, Pembrolizumab, Avelumab have been conducted for metastatic GC (mGC). The effects of various single agent ICIs on mGC therapy varied. ICIs combined with chemotherapy can indeed bring survival benefits to patients with mGC. Combining ICIs with chemotherapy can give more patients the chance of surgery in the treatment of GC transformation. However, not all PD-L1 positive patients can benefit from it. It is urgent to find better biomarkers to predict the response of ICIs for more precise clinical treatment.

Application of dielectric properties for identification of normal and malignant gastrointestinal tumors and lymph nodes ex vivo.

A need exists for a quick, simple method to accurately assess resection margins and lymph node metastases in gastrointestinal cancer surgeries. We aimed to develop a real-time, non-destructive technique to differentiate between normal and cancerous tissues using dielectric properties. Dielectric properties of tissues from 50 gastric and 120 colorectal cancer patients were measured during surgery using an open-ended coaxial probe, spanning frequencies from 10MHz to 4GHz. Lymph nodes were classified based on pathology into metastatic and non-metastatic, and tissues were divided into cancerous and normal, the latter being 3cm from the cancer edge. Statistically significant differences in dielectric properties were found between metastatic and non-metastatic lymph nodes (P < 0.05), and between normal and malignant tissues. Metastatic lymph nodes showed higher dielectric permittivity and conductivity across the frequency range, with no significant difference between gastric and colorectal cancers. The coaxial probe method distinguishes between metastatic and non-metastatic lymph nodes by their dielectric properties within 10-4000MHz, offering a potential tool for real-time identification of malignant tissues during surgery, despite not identifying the cancer type.

Analysis of surgical volume and short‐term outcomes for upper gastrointestinal cancer post‐COVID‐19: Evidence from a nationwide Japanese database

AbstractAimPrevious studies indicated that short‐term outcomes for gastroenterological surgeries did not worsen during the COVID‐19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre‐ and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short‐term outcomes.MethodsData from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD‐established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.ResultsEsophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.ConclusionsThis study analyzed changes in surgical volume and short‐term outcomes for upper gastrointestinal cancer in the post‐COVID‐19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.