BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscop...BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscopy,thereby avoiding surgical intervention and postoperative complications such as peritonitis,are pivotal for effective EFTR.AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors.METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted.The total operation time,tumor dissection time,wound closure time,intraoperative bleeding volume,length of hospital stay and incidence of complications were analyzed.RESULTS There were 93 patients,aged 55.1±12.1 years.Complete tumor resection was achieved in all cases,resulting in a 100% success rate.The average total operation time was 67.4±27.0 min,with tumor dissection taking 43.6±20.4 min.Wound closure times varied,with gastric body closure time of 24.5±14.1 min and gastric fundus closure time of 16.6±8.7 min,showing a significant difference(P<0.05).Intraoperative blood loss was 2.3±4.0 mL,and average length of hospital stay was 5.7±1.9 d.There was no secondary perforation after suturing in all cases.The incidence of delayed bleeding was 2.2%,and the incidence of abdominal infection was 3.2%.No patient required other surgical intervention during and after the operation.CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss,making it a viable approach for gastric submucosal tumors.展开更多
Objective： To study the value of high enhanced serosa sign on contrast-enhanced computed tomography（CT）in differentiating T3 from T4a gastric cancer in different Lauren classification.Methods： This study included ...Objective： To study the value of high enhanced serosa sign on contrast-enhanced computed tomography（CT）in differentiating T3 from T4a gastric cancer in different Lauren classification.Methods： This study included 276 consecutive patients with surgically confirmed p T3 or p T4a gastric cancers.The pre-operative CT images were reviewed by two radiologists blinded. The demonstration of the high enhanced serosa on CT between T3 and T4a was compared with chi-square test. The diagnostic performance of this sign on CT in the differentiation of T4a from T3 in different Lauren classification was calculated.Results： The accuracy, sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） for the judgement of serosa invasion using the high enhanced serosa sign on CT was 74.6%, 63.7%, 83.6%,76.0% and 73.8% by one radiologist and 76.4%, 66.1%, 84.9%, 78.1% and 75.4% by the other radiologist.Compared to the intestinal-type, the sensitivity of the judgement of serosa invasion using the high enhanced serosa sign on CT in diffuse-type was significant higher（80% in both readers）, while the specificity trended to be lower（65.9% and 80.5%, respectively）. There is no significant difference in the accuracy of diagnosis between intestinaltype and diffuse-type of gastric cancers（the P-values of two radiologists were 0.968, 0.591, respectively）. The combination of the high enhanced serosa sign with conventional CT signs is significant different in diagnosis of T3 and T4a（P〈0.001）. The diagnostic accuracy was increased in both radiologists after the combination. The two readers achieved substantial agreement, with Kappa coefficient of 0.63, P〈0.001.Conclusions： The high enhanced serosa sign on CT is associated with serosa involvement. The sensitivity of the judgement of serosa invasion using this sign on CT in diffuse-type was significant higher than that in intestinal-type.展开更多
Background In both the seventh edition of the International Union Against Cancer （UICC） staging system for gastric cancer and the 14th edition of the Japanese Gastric Cancer Association （JGCA） system, T4a is defin...Background In both the seventh edition of the International Union Against Cancer （UICC） staging system for gastric cancer and the 14th edition of the Japanese Gastric Cancer Association （JGCA） system, T4a is defined as ＂Tumor perforates serosa （visceral peritoneum） without invasion of adjacent structures.＂ The aim of this study was to investigate the differences in prognosis between patients with serosa-penetrating and serosa-invading T4aN0M0 gastric carcinomas. Methods Data were collected from 221 patients with T4aNoMo gastric carcinoma who underwent D2 resection at our cancer center between January 1990 and December 2008. The cohort included 42 patients with serosa-penetrating tumors and 179 patients with serosa-invading tumors. The average follow-up time was 85.5 months. Spearman＇s rank correlation, Kaplan-Meier plots, and Cox proportional hazards regression models were used to analyze the data. Results The 5-year survival rate of patients with serosa-penetrating and serosa-invading gastric cancers were 31% and 62% respectively （P 〈0.05）. The relapse rates after D2 radical surgery were 16.2% in patients with serosa-invading gastric cancer versus 59.5% in those with serosa-penetrating tumors （P 〈0.05）. Peritoneal dissemination and distant organ/lymph node metastatic rates were 76.0% and 24.0% respectively in patients with penetrating tumors, versus 44.8% and 55.2% respectively in patients with invading tumors （P 〈0.05）. Multivariate analysis showed that penetration of the serosa was an independent prognostic indicator of overall survival. Conclusions Our findings provide a basis for the concept that serosa-penetrating TaaNoMo gastric carcinoma represents a more aggressive cancer than serosa-invading T4aN0M0 gastric carcinoma. Serosa penetration is an independent factor for poor prognosis of patients with gastric carcinoma.展开更多
文摘BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscopy,thereby avoiding surgical intervention and postoperative complications such as peritonitis,are pivotal for effective EFTR.AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors.METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted.The total operation time,tumor dissection time,wound closure time,intraoperative bleeding volume,length of hospital stay and incidence of complications were analyzed.RESULTS There were 93 patients,aged 55.1±12.1 years.Complete tumor resection was achieved in all cases,resulting in a 100% success rate.The average total operation time was 67.4±27.0 min,with tumor dissection taking 43.6±20.4 min.Wound closure times varied,with gastric body closure time of 24.5±14.1 min and gastric fundus closure time of 16.6±8.7 min,showing a significant difference(P<0.05).Intraoperative blood loss was 2.3±4.0 mL,and average length of hospital stay was 5.7±1.9 d.There was no secondary perforation after suturing in all cases.The incidence of delayed bleeding was 2.2%,and the incidence of abdominal infection was 3.2%.No patient required other surgical intervention during and after the operation.CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss,making it a viable approach for gastric submucosal tumors.
基金funding by National Natural Science Foundation of China (No. 81471640, 81371715)
文摘Objective： To study the value of high enhanced serosa sign on contrast-enhanced computed tomography（CT）in differentiating T3 from T4a gastric cancer in different Lauren classification.Methods： This study included 276 consecutive patients with surgically confirmed p T3 or p T4a gastric cancers.The pre-operative CT images were reviewed by two radiologists blinded. The demonstration of the high enhanced serosa on CT between T3 and T4a was compared with chi-square test. The diagnostic performance of this sign on CT in the differentiation of T4a from T3 in different Lauren classification was calculated.Results： The accuracy, sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） for the judgement of serosa invasion using the high enhanced serosa sign on CT was 74.6%, 63.7%, 83.6%,76.0% and 73.8% by one radiologist and 76.4%, 66.1%, 84.9%, 78.1% and 75.4% by the other radiologist.Compared to the intestinal-type, the sensitivity of the judgement of serosa invasion using the high enhanced serosa sign on CT in diffuse-type was significant higher（80% in both readers）, while the specificity trended to be lower（65.9% and 80.5%, respectively）. There is no significant difference in the accuracy of diagnosis between intestinaltype and diffuse-type of gastric cancers（the P-values of two radiologists were 0.968, 0.591, respectively）. The combination of the high enhanced serosa sign with conventional CT signs is significant different in diagnosis of T3 and T4a（P〈0.001）. The diagnostic accuracy was increased in both radiologists after the combination. The two readers achieved substantial agreement, with Kappa coefficient of 0.63, P〈0.001.Conclusions： The high enhanced serosa sign on CT is associated with serosa involvement. The sensitivity of the judgement of serosa invasion using this sign on CT in diffuse-type was significant higher than that in intestinal-type.
文摘Background In both the seventh edition of the International Union Against Cancer （UICC） staging system for gastric cancer and the 14th edition of the Japanese Gastric Cancer Association （JGCA） system, T4a is defined as ＂Tumor perforates serosa （visceral peritoneum） without invasion of adjacent structures.＂ The aim of this study was to investigate the differences in prognosis between patients with serosa-penetrating and serosa-invading T4aN0M0 gastric carcinomas. Methods Data were collected from 221 patients with T4aNoMo gastric carcinoma who underwent D2 resection at our cancer center between January 1990 and December 2008. The cohort included 42 patients with serosa-penetrating tumors and 179 patients with serosa-invading tumors. The average follow-up time was 85.5 months. Spearman＇s rank correlation, Kaplan-Meier plots, and Cox proportional hazards regression models were used to analyze the data. Results The 5-year survival rate of patients with serosa-penetrating and serosa-invading gastric cancers were 31% and 62% respectively （P 〈0.05）. The relapse rates after D2 radical surgery were 16.2% in patients with serosa-invading gastric cancer versus 59.5% in those with serosa-penetrating tumors （P 〈0.05）. Peritoneal dissemination and distant organ/lymph node metastatic rates were 76.0% and 24.0% respectively in patients with penetrating tumors, versus 44.8% and 55.2% respectively in patients with invading tumors （P 〈0.05）. Multivariate analysis showed that penetration of the serosa was an independent prognostic indicator of overall survival. Conclusions Our findings provide a basis for the concept that serosa-penetrating TaaNoMo gastric carcinoma represents a more aggressive cancer than serosa-invading T4aN0M0 gastric carcinoma. Serosa penetration is an independent factor for poor prognosis of patients with gastric carcinoma.
