Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?

BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.

Present and future of new systemic therapies for early and intermediate stages of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Notwithstanding the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical challenge.Emergent systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of HCC.This review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent.We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent.Finally,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.

Esophageal cancer screening,early detection and treatment:Current insights and future directions

Esophageal cancer ranks among the most prevalent malignant tumors globally,primarily due to its highly aggressive nature and poor survival rates.According to the 2020 global cancer statistics,there were approximately 604000 new cases of esophageal cancer,resulting in 544000 deaths.The 5-year survival rate hovers around a mere 15%-25%.Notably,distinct variations exist in the risk factors associated with the two primary histological types,influencing their worldwide incidence and distribution.Squamous cell carcinoma displays a high incidence in specific regions,such as certain areas in China,where it meets the cost-effect-iveness criteria for widespread endoscopy-based early diagnosis within the local population.Conversely,adenocarcinoma(EAC)represents the most common histological subtype of esophageal cancer in Europe and the United States.The role of early diagnosis in cases of EAC originating from Barrett's esophagus(BE)remains a subject of controversy.The effectiveness of early detection for EAC,particularly those arising from BE,continues to be a debated topic.The variations in how early-stage esophageal carcinoma is treated in different regions are largely due to the differing rates of early-stage cancer diagnoses.In areas with higher incidences,such as China and Japan,early diagnosis is more common,which has led to the advancement of endoscopic methods as definitive treatments.These techniques have demonstrated remarkable efficacy with minimal complications while preserving esophageal functionality.Early screening,prompt diagnosis,and timely treatment are key strategies that can significantly lower both the occurrence and death rates associated with esophageal cancer.

Development and validation of a prediction model for early screening of people at high risk for colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.

Non-participation of asymptomatic candidates in screening protocols reduces early diagnosis and worsens prognosis of colorectal cancer

The Agatsuma et al’s study shows that despite the evidence of the benefits of an early colorectal cancer(CRC)diagnosis,through screening in asymptomatic subjects,up to 50%of candidates reject this option and many of those affected are diagnosed later,in advanced stages.The efficacy of screening programs has been well-established for several years,which reduces the risk of CRC morbidity and mortality,without taking into account the test used for screening,or other tools.Nevertheless,a significant proportion of patients remain unscreened,so understanding the factors involved,as well as the barriers of the population to adherence is the first step to possibly modify the participation rate.These barriers could include a full range of social and political aspects,especially the type of financial provision of each health service.In Japan,health services are universal,and this advantageous situation makes it easier for citizens to access to these services,contributing to the detection of various diseases,including CRC.Interestingly,the symptomatic CRC group had a lower early-stage diagnosis rate than the patients detected during follow-up for other comorbidities,and symptomatic and cancer screening groups showed similar early-stage diagnosis.

Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients

BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

Gallbladder cancer(GBC)is a rare disease with a poor prognosis.Simple cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes.However,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival outcomes.The oncological roles of lymphadenectomy and liver resection is distinct.Therefore,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

Early diagnosis of esophageal cancer:How to put“early detection”into effect?

This editorial comments on the article by Qu et al in a recent edition of World Journal of Gastrointestinal Oncology,focusing on the importance of early diagnosis in managing esophageal cancer and strategies for achieving“early detection”.The five-year age-standardized net survival for esophageal cancer patients falls short of expectations.Early detection and accurate diagnosis are critical strategies for improving the treatment outcomes of esophageal cancer.While advancements in endoscopic technology have been significant,there seems to be an excessive emphasis on the latest high-end endoscopic devices and various endoscopic resection techniques.Therefore,it is imperative to redirect focus towards proactive early detection strategies for esophageal cancer,investigate the most cost-effective screening methods suitable for different regions,and persistently explore practical solutions to improve the five-year survival rate of patients with esophageal cancer.

Early colorectal cancer screening–no time to lose

In this editorial,we comment on the article entitled“Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?”by Agatsuma et al.Colorectal cancer(CRC)is emerging as an important health issue as its incidence continues to rise globally,adversely affecting the quality of life.Although the public has become more aware of CRC prevention,most patients lack screening awareness.Some poor lifestyle practices can lead to CRC and symptoms can appear in the early stages of CRC.However,due to the lack of awareness of the disease,most of the CRC patients are diagnosed already at an advanced stage and have a poor prognosis.

Recent advances in living cell nucleic acid probes based on nanomaterials for early cancer diagnosis

The early diagnosis of cancer is vital for effective treatment and improved prognosis. Tumor biomarkers, which can be used for the early diagnosis, treatment, and prognostic evaluation of cancer, have emerged as a topic of intense research interest in recent years. Nucleic acid, as a type of tumor biomarker, contains vital genetic information, which is of great significance for the occurrence and development of cancer. Currently, living cell nucleic acid probes, which enable the in situ imaging and dynamic monitoring of nucleic acids, have become a rapidly developing field. This review focuses on living cell nucleic acid probes that can be used for the early diagnosis of tumors. We describe the fundamental design of the probe in terms of three units and focus on the roles of different nanomaterials in probe delivery.

Endoscopic submucosal dissection for early gastric cancer:A major challenge for the west

Gastric cancer(GC)is the 5th most common cancer and the 3rd most common cause of cancer mortality worldwide.Two main endoscopic resective techniques exist for early GC(EGC):Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD).ESD has been widely embraced in the last decade because it allows radical en bloc resections and is associated with better outcomes,as compared to EMR.However,the lack of training opportunities and flat learning curve due to low volume of EGC cases represent major obstacles to obtain proficiency on ESD in the West.As this procedure is highly efficient for the treatment of EGC,dedicated training programs with a stepwise approach and updated guidelines for ESD embracement are needed in Western countries.

Clinical significance of peripheral blood UL16 and DR-70 for the early diagnosis and prognostic evaluation of colorectal cancer

BACKGROUND Early diagnosis of colorectal cancer(CRC)is of great significance to improve the survival rate and quality of life of patients,but early diagnosis of CRC requires more sensitive techniques.Peripheral blood UL16-binding protein 2(ULBP2)and human fibrinogen degradation products(DR-70)are the main indicators for the diagnosis of malignant tumors.AIM To assess ULBP2 and DR-70 potential for the early diagnosis and prognostic evaluation of CRC to provide a reference.METHODS This study involved 60 patients with early-stage CRC(CRC group),50 patients with benign colorectal tumors(benign group),and 50 healthy patients(control group)enrolled at the Affiliated Hospital of Jiangnan University and Jiangsu Province Official Hospital between January,2020 and January,2022.ULBP2 and DR-70 levels in the blood were determined and differences among the three groups and early diagnostic values for CRC were determined.Patients with CRC were divided into the good prognosis and poor prognosis groups,and ULBP2 and DR-70 levels in the blood and diagnostic values were compared.RESULTS ULBP2 and DR-70 serum levels were significantly higher in the CRC group than in the control and benign groups(P<0.05);however,no significant differences were observed between the benign and control groups(P>0.05).Among the 60 patients with CRC followed up for two years,two died(3.33%)and 15 exhibited tumor metastasis,progression,or recurrence(25.00%).ULBP2 and DR-70 serum levels were significantly higher in the poor prognosis group than in the good prognosis group(P<0.05).A receiver operating characteristic curve was plotted.Area under the curve,sensitivity,and specificity of serum ULBP2 with DR-70 for the early diagnosis of CRC were higher than those of the single serum indices(P<0.05)in both the good and poor prognosis groups.CONCLUSION ULBP2 and DR-70 serum levels were significantly high in patients with early-stage CRC.They improved the diagnostic rate of early-stage CRC and predicted patient prognosis,thereby showing clinical application potential.

Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Autophagy-dependent ferroptosis may play a critical role in early stages of diabetic retinopathy

Diabetic retinopathy(DR),as one of the most common and significant microvascular complications of diabetes mellitus(DM),continues to elude effective targeted treatment for vision loss despite ongoing enrichment of the understanding of its pathogenic mechanisms from perspectives such as inflammation and oxidative stress.Recent studies have indicated that characteristic neuroglial degeneration induced by DM occurs before the onset of apparent microvascular lesions.In order to comprehensively grasp the early-stage pathological changes of DR,the retinal neurovascular unit(NVU)will become a crucial focal point for future research into the occurrence and progression of DR.Based on existing evidence,ferroptosis,a form of cell death regulated by processes like ferritinophagy and chaperone-mediated autophagy,mediates apoptosis in retinal NVU components,including pericytes and ganglion cells.Autophagy-dependent ferroptosis-related factors,including BECN1 and FABP4,may serve as both biomarkers for DR occurrence and development and potentially crucial targets for future effective DR treatments.The aforementioned findings present novel perspectives for comprehending the mechanisms underlying the early-stage pathological alterations in DR and open up innovative avenues for investigating supplementary therapeutic strategies.

Clinical characteristics of patients with early gastric prematurity cancer and analysis of complications by endoscopic resection

BACKGROUND Gastric cancer,a prevalent malignancy,poses a severe threat to the health of residents in China.Timely intervention in early stages can extend patients’survival.AIM To analyze clinical characteristics of patients with early gastric cancer and efficacy and risk of complications associated with endoscopic resection.METHODS This study included 175 patients with early gastric cancer treated at our hospital,with no restrictions on sex or age.General data,pathological information,and endoscopic biopsy results were obtained.The clinical characteristics of early gastric cancer were analyzed,and endoscopic resection was performed.Postoperative efficacy and incidence of complications were monitored.Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 8.0 software.RESULTS A total of 175 patients with early gastric cancer were included,with 75.43%(n=132)males and 24.57%(n=43)females.38.29%(n=67)and 35.43%(n=62)of patients had a history of smoking and alcohol consumption,respectively.Comorbidities included diabetes(8.57%,n=15),coronary heart disease(10.29%,n=18),and hypertension(43.43%,n=76),which was highly prevalent.A history of abdominal surgery and family history of digestive system cancer accounted for 21.14%and 17.14%,respectively.The most common lesion location was the antral part of the stomach(52.00%,n=91),followed by the gastric angle,body,and fundus.The pathological types were predominantly high-grade intraepithelial neoplasia(28.00%,n=49)and well-differentiated adenocarcinoma(26.86%,n=47),followed by moderately differentiated adenocarcinoma,high-moderately differentiated adenocarcinoma,and moderate-lowly differentiated adenocarcinoma.89.14%of the patients had intestinal metaplasia and 85.14%had atrophy.After endoscopic resection,re-examination revealed that 13 patients had cancer cells at the tissue margin,with a positive margin rate of 7.43%.Postoperative complications included no cases of gastrointestinal obstruction,but incisional infection(2.86%,n=5),gastric perforation(1.14%,n=2),and gastric bleeding(4%,n=7)were present,with an overall incidence of 8.00%.CONCLUSION Analysis of the clinical characteristics indicated that early gastric cancer is more prevalent in males with a history of hypertension,with lesions most commonly occurring in the antral region of the stomach.The pathological types are often high-grade intraepithelial neoplasia and well-differentiated adenocarcinoma,with over 85%of patients having comorbid intestinal metaplasia and atrophy.Despite endoscopic resection,a positive margin rate persisted,indicating a probability of residual cancer at the margins.Postoperative complications,such as gastrointestinal obstruction,incisional infection,gastric perforation,and gastric bleeding can occur and require timely symptomatic treatment.

Early diagnosis of pancreatic cancer: Shedding light on an unresolved challenge

Diagnosing early-stage pancreatic cancer(PC)remains a clinical challenge.Hence,studying novel imaging aspects that could enhance the diagnostic accuracy of malignant pancreatic precursor lesions is imperative.This article aims to un-derscore the promising role of emerging imaging aspects that may facilitate the earlier diagnosis of PC,thereby improving its management and prognosis.

Early detection of pancreatic cancer in patients with recurrent pancreatitis:A case report

BACKGROUND Pancreatic cancer presents a challenge with its low early diagnosis and treatment rates,leading to high metastasis and mortality rates.The median survival time for advanced pancreatic cancer is a mere 3 months.However,there's hope:small pancreatic cancers diagnosed at an early stage(T1)or those less than or equal to 1 cm in diameter boast an impressive 5-year survival rate of nearly 100%.This underscores the critical importance of early pancreatic cancer detection for significantly improving prognosis.CASE SUMMARY Pancreatic cancer,a malignant tumor of the digestive tract,poses challenges in both diagnosis and treatment due to its occult and atypical clinical symptoms.Clinically,patients with recurrent pancreatitis should be vigilant,as it may be indicative of pancreatic cancer,particularly in middle-aged and elderly patients.Here,we presented the case of a patient who experienced recurrent acute pancreatitis within a span of 2 months.During the initial episode of pancreatitis,routine imaging failed to identify the cause of pancreatic cancer.However,upon recurrence of acute pancreatitis,endoscopic ultrasonography(EUS)revealed a space-occupying lesion approximately 1 cm in size in the pancreatic body.Subsequent EUS coupled with fine-needle aspiration examination demonstrated atypical pancreatic gland epithelium.Ultimately,the patient underwent surgery and was diagnosed with an intraductal papillary mucinous tumor of the pancreas(severe epithelial dysplasia,focal cancer).CONCLUSION We recommend EUS for patients with recurrent pancreatitis of unknown etiology to exclude early pancreatic cancer.

Colorectal cancer screening:The value of early detection and modern challenges

The screening of colorectal cancer(CRC)is pivotal for both the prevention and treatment of this disease,significantly improving early-stage tumor detection rates.This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment.However,the adoption of CRC screening methods faces numerous challenges,including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity.Moreover,socioeconomic factors such as regional disparities,economic conditions,and varying levels of awareness affect screening uptake.The coronavirus disease 2019 pandemic further intensified these challenges,leading to reduced screening participation and increased waiting periods.Additionally,the growing prevalence of early-onset CRC necessitates innovative screening approaches.In response,research into new methodologies,including artificial intelligence-based systems,aims to improve the precision and accessibility of screening.Proactive measures by governments and health organizations to enhance CRC screening efforts are underway,including increased advocacy,improved service delivery,and international cooperation.The role of technological innovation and global health collaboration in advancing CRC screening is undeniable.Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening,making a significant impact on the fight against this disease.Given the rise in early-onset CRC,it is crucial for screening strategies to continually evolve,ensuring their effectiveness and applicability.

Identifying timing and risk factors for early recurrence of resectable rectal cancer: A single center retrospective study

BACKGROUND Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence.Early recurrence(ER)is related to worse prognosis.To date,few observational studies have reported on the analysis of rectal cancer.Hence,we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.AIM To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.METHODS Data were retrospectively collected from the institutional database from March 2011 to January 2021.Clinicopathological data at diagnosis,perioperative and postoperative data,and first recurrence were collected and analyzed.ER was defined via receiver operating characteristic curve.Prognostic factors were evaluated using the Kaplan–Meier method and Cox proportional hazards modeling.RESULTS We included 131 patients.The optimal cut off value of recurrence-free survival(RFS)to differentiate between ER(n=55,41.9%)and late recurrence(LR)(n=76,58.1%)was 8 mo.The median post-recurrence survival(PRS)of ER and LR was 1.4 mo and 2.9 mo,respectively(P=0.008)but PRS was not strongly associated with RFS(R^(2)=0.04).Risk factors included age≥70 years[hazard ratio(HR)=1.752,P=0.047],preoperative concurrent chemoradiotherapy(HR=3.683,P<0.001),colostomy creation(HR=2.221,P=0.036),and length of stay>9 d(HR=0.441,P=0.006).CONCLUSION RFS of 8 mo was the optimal cut-off value.Although ER was not associated with PRS,it was still related to prognosis;thus,intense surveillance is recommended.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of endoscopic submucosal dissection(ESD)on gastrointestinal function and nutritional status in patients with EGC.METHODS Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups:42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection(EMR)in the EMR group.Two groups were compared in the operative indices,lesion resection rate,postoperative recovery of gastrointestinal function,nutritional status,and incidence of surgical complications.RESULTS The overall resection rate of the lesion in the ESD group was higher.The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group(P<0.05).The nutritional statuses of the two groups decreased after operation;however,the levels of albumin,prealbumin,hemoglobin,and transferrin were higher in the ESD group than in the EMR group(P<0.05).The post-operative pepsinogen(PG)I level in the ESD group was higher than that in the EMR group,and the PG II level was lower than that in the EMR group(P<0.05).The incidence of postoperative complications was compared between the two groups(P>0.05).CONCLUSION ESD can promote the immediate recovery of patient’s postoperative gastrointestinal function,improve their nutritional level,and signifies its application in patients with EGC.