Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no cases of recurrence during the follow-up period.CONCLUSION GEP has unique characteristics in EUS.LR and ESD seem to be good choices for treating GEP.LR is better for large GEP with a deep origin.However,due to the rarity of GEP,multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.

Development and validation of a nomogram for preoperative prediction of tumor deposits in colorectal cancer

BACKGROUND Based on the clinical data of colorectal cancer(CRC)patients who underwent surgery at our institution,a model for predicting the formation of tumor deposits(TDs)in this patient population was established.AIM To establish an effective model for predicting TD formation,thus enabling clinicians to identify CRC patients at high risk for TDs and implement personalized treatment strategies.METHODS CRC patients(n=645)who met the inclusion criteria were randomly divided into training(n=452)and validation(n=193)cohorts using a 7:3 ratio in this retrospective analysis.Least absolute shrinkage and selection operator regression was employed to screen potential risk factors,and multivariable logistic regression analysis was used to identify independent risk factors.Subsequently,a predictive model for TD formation in CRC patients was constructed based on the independent risk factors.The discrimination ability of the model,its consistency with actual results,and its clinical applicability were evaluated using receiveroperating characteristic curves,area under the curve(AUC),calibration curves,and decision curve analysis(DCA).RESULTS Thirty-four(7.5%)patients with TDs were identified in the training cohort based on postoperative pathological specimens.Multivariate logistic regression analysis identified female sex,preoperative intestinal obstruction,left-sided CRC,and lymph node metastasis as independent risk factors for TD formation.The AUCs of the nomogram models constructed using these variables were 0.839 and 0.853 in the training and validation cohorts,respectively.The calibration curve demonstrated good consistency,and the training cohort DCA yielded a threshold probability of 7%-78%.CONCLUSION This study developed and validated a nomogram with good predictive performance for identifying TDs in CRC patients.Our predictive model can assist surgeons in making optimal treatment decisions.