Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

Better prognostic determination of cT3 rectal cancer through measurement of distance to mesorectal fascia:A multicenter study

Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.

Short-and long-term outcomes of laparoscopic vs open surgery for T2 gallbladder cancer:A systematic review and meta-analysis

BACKGROUND With the development of laparoscopic techniques,gallbladder cancer(GBC)is no longer a contraindication to laparoscopic surgery(LS).Although LS is recommended for stage T1 GBC,the value of LS for stage T2 GBC is still controversial.AIM To evaluate the short-and long-term outcomes of LS in comparison to those of open surgery(OS)for stage T2 GBC.METHODS We searched the PubMed,Embase,Cochrane Library,Ovid,Google Scholar,and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC,with a cutoff date of September 2022.The Stata 15 statistical software was used for analysis.Relative risk(RR)and weighted mean difference(WMD)were calculated to assess binary and continuous outcome indicators,respectively.Begg’s test and Egger’s test were used for detecting publication bias.RESULTS A total of five studies were included,with a total of 297 patients,153 in the LS group and 144 in the OS group.Meta-analysis results showed that the LS group was better than the OS group in terms of operative time[WMD=-41.29,95%confidence interval(CI):-75.66 to-6.92,P=0.02],estimated blood loss(WMD=-261.96,95%CI:-472.60 to-51.31,P=0.01),and hospital stay(WMD=-5.67,95%CI:-8.53 to-2.81,P=0.0001),whereas there was no significant difference between the two groups in terms of blood transfusion(RR=0.60,95%CI:0.31-1.15,P=0.13),complications(RR=0.72,95%CI:0.39-1.33,P=0.29),number of lymph nodes retrieved(WMD=–1.71,95%CI:-4.27 to-0.84,P=0.19),recurrence(RR=0.41,95%CI:0.06-2.84,P=0.36),3-year and 5-year overall survival(RR=0.99,95%CI:0.82-1.18,P=0.89 and RR=1.02,95%CI:0.68-1.53,P=0.92;respectively),and 3-year and 5-year disease-free survival(RR=1.01,95%CI:0.84-1.21,P=0.93 and RR=1.15,95%CI:0.90-1.46,P=0.26;respectively).CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS,but LS is superior to OS in terms of operative time,intraoperative bleeding,and postoperative hospital stay.Nevertheless,these findings should be validated via high-quality randomized controlled trials and longer follow-ups.

Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages

BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.

Misdiagnosis of an elevated lesion in the esophagus:A case report

BACKGROUND Esophageal carcinosarcoma(ECS) is a rare biphasic tumor and a type of esophageal malignancy,which presents as protruding or elevated lesions.ECS patients are often not hospitalized until they have severe dysphagia.ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy.With the popularization of endoscopic treatment,these patients are often referred to endoscopic treatment,such as endoscopic submucosal dissection(ESD).However,there is a lack of consensus on the endoscopic features and therapies for ECS.Here,we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies.CASE SUMMARY A 63-year-old man was admitted to the hospital with dysphagia.During the endoscopic examination,an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation.Endoscopic ultrasonography(EUS),biopsies,and enhanced thoracic computed tomography were performed,suggesting that it was a benign lesion and located within the submucosal layer.This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip.The patient was then referred to ESD treatment.However,the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin(T1b stage),indicating that we made a misdiagnosis and achieved a noncurative resection.Due to the potential tumor residue,additional open surgery was performed at the patient’s request.In the postoperative pathological study,no tumor remnants or metastases were discovered.The patient was followed for 1 year and had no recurrence.CONCLUSION ECS can be misdiagnosed at the initial endoscopy.EUS can help to identify the tumor stage.Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.