Effects of laparoscopic cholecystectomy on lung function:A systematic review

AIM:To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.METHODS:We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometricvalues,arterial blood gases,respiratory muscle performance and aspects of breathing control,by critically analyzing physiopathologic interpretations and clinically important conclusions.A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology.The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals.A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic(LC)and open(OC)procedures.A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test.RESULTS:Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range(IQR)of preoperative values in forced vital capacity(FVC),forced expiratory volume in 1 s and forced expiratory flow(FEF)at 25%-75%of FVC(FEF25%-75%)expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows:[77.6(73.0,80.0)L vs 55.4(50.0,64.0)L,P<0.001;76.0(72.3,81.0)L vs 52.5(50.0,56.7)L,P<0.001;and 78.8(68.8,80.9)L/s vs 60.0(36.1,66.1)L/s,P=0.005].Concerning arterial blood gases,partial pressure of oxygen[Pa O2(k Pa)]at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC[LC median 1.0,IQR(0.6,1.3);OC median 2.4,IQR(1.2,2.6),P=0.019].Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures(P<0.01);and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance(P<0.001)and minimal reduction of duty cycle(P=0.01)compared with preoperative data.CONCLUSION:Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure.

Tumor organoids:synergistic applications,current challenges,and future prospects in cancer therapy

Patient-derived cancer cells(PDCs)and patient-derived xenografts(PDXs)are often used as tumor models,but have many shortcomings.PDCs not only lack diversity in terms of cell type,spatial organization,and microenvironment but also have adverse effects in stem cell cultures,whereas PDX are expensive with a low transplantation success rate and require a long culture time.In recent years,advances in three-dimensional(3D)organoid culture technology have led to the development of novel physiological systems that model the tissues of origin more precisely than traditional culture methods.Patient-derived cancer organoids bridge the conventional gaps in PDC and PDX models and closely reflect the pathophysiological features of natural tumorigenesis and metastasis,and have led to new patient-specific drug screening techniques,development of individualized treatment regimens,and discovery of prognostic biomarkers and mechanisms of resistance.Synergistic combinations of cancer organoids with other technologies,for example,organ-on-a-chip,3D bio-printing,and CRISPR-Cas9-mediated homology-independent organoid transgenesis,and with treatments, such as immunotherapy, have been useful in overcoming their limitations and led to the development of more suitable model systems that recapitulate the complex stroma of cancer, inter-organ and intra-organ communications,and potentially multiorgan metastasis. In this review, we discuss various methods for the creation of organ-specific cancer organoids and summarize organspecific advances and applications, synergistic technologies, and treatments aswell as current limitations and future prospects for cancer organoids. Furtheradvances will bring this novel 3D organoid culture technique closer to clinicalpractice in the future.