Integrating nutritional and immune-inflammation-based index predicts disease-free survival of colorectal cancer patients undergoing radical surgery

Endoscopic treatment and outcome-oriented classification of biliary strictures after liver transplantation: a multicenter retrospective cohort study

Background The optimal surgical strategy for early-stage gallbladder cancer (GBC) remains controversial. This study aimed to compare the long-term survival outcomes of simple cholecystectomy (SC) and extended cholecystectomy (EC) in patients with stage I GBC. Methods Patients diagnosed with stage I GBC between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and categorized into SC and EC groups. Kaplan–Meier survival analyses, propensity score matching (PSM), and competing risk models were applied. Competing risk nomograms were subsequently constructed and externally validated. Results A total of 902 patients were included, along with 33 patients from Hangzhou TCM Hospital as the external validation cohort. After 1:1 PSM, the EC group demonstrated lower cancer-specific death (CSD) rates at 1, 3, and 5 years compared with the SC group (1-year: 6.43% vs. 11.5%; 3-year: 12.5% vs. 24.4%; 5-year: 15.3% vs. 28.9%; P = 0.002). Subgroup analyses indicated that SC was associated with increased CSD in patients with T1b disease, grade II–IV tumors, and adenocarcinoma. Nomograms incorporating grade, T stage, tumor size, and chemotherapy accurately predicted individualized 1-, 3-, and 5-year CSD probabilities. The models exhibited strong discriminative ability (AUC values) and good calibration performance. Conclusions Competing risk analysis suggested that EC should be recommended for patients with T1b GBC, whereas SC alone may be sufficient for T1a disease. The proposed nomograms demonstrated robust predictive performance and may aid clinical decision-making.

Objective Obstructive colorectal cancer (OCC) often has a poor prognosis. The traditional TNM stage does not effectively predict disease prognosis, so there is an urgent need to establish a more suitable prognostic staging system for patients with OCC. Methods This study analyzed 164 patients treated for OCC at a single center between February 1, 2010, and January 31, 2020. The integrative two-step cluster (TSC) stage was used to self-classify OCCs into two groups on the basis of postoperative clinicopathological features. The Kaplan‒Meier method was subsequently used to compare the 3-year overall survival (OS) and disease-free survival (DFS) of patients grouped by TNM stage and integrative TSC stage. Machine learning classifiers were then applied to predict the integrative TSC stage using preoperative clinical features and radiomics. To evaluate the performance of the classifiers, we used the receiver operating characteristic (ROC) curve and the area under the receiver operating characteristic curve (AUC). Results After the integrative TSC stage was constructed, 164 patients with OCC were divided into an integrative superior group (iSG, n = 99) and an integrative inferior group (iIG, n = 65). In the integrative TSC staging system, lymphovascular invasion (1.00) was identified as the most valuable risk factor. The iSG outperformed the iIG in both OS and DFS (OS-months: 31.42 (27.96–34.88) vs. 19.30 (15.43–23.17), p < 0.001; DFS-months: 31.15 (27.49–34.82) vs. 18.12 (14.32–21.92), p < 0.001). Compared with the TNM stage, the integrative TSC stage was more effective in discriminating OS (integrative TSC stage, p < 0.001; TNM stage, p = 0.036) and DFS (integrative TSC stage, p < 0.001; TNM stage, p = 0.011). To predict the integrative TSC stage, the linear discriminant analysis (LDA) classifier based on carcinoembryonic antigen (CEA) and 15 radiomics features performed best (testing dataset: AUC 0.85, 95% CI: 0.74–0.96). In the stratified analysis, patients who underwent BTS were reclassified into the iSG group. These patients had lower CEA levels [3.22 (interquartile range[IQR], 1.60–5.50) ng/ml, p = 0.036] and higher ct_wavelet-LHH_gldm_SmallDependenceHighGray-LevelEmphasis (HGLE) levels [0.26 (IQR, 0.09–0.41), p = 0.044]. Conclusion The integrative TSC stage surpasses the TNM staging system in distinguishing OCC prognosis, with LVI serving as a vital component. The LDA classifier using 16-dimensional features can effectively predict the integrative TSC stage.

Predictive factors for successful conversion therapy in gastric cancer with peritoneal metastasis: a case-control study

Developing and validating a nomogram to forecast clinically relevant postoperative pancreatic fistula following distal pancreatectomy

Background & Aims Probe-based confocal laser endomicroscopy (pCLE) provides real-time, cellular-level “optical biopsy” during endoscopy. This review synthesizes the technology, diagnostic performance, clinical use, safety, costs, and future directions of pCLE across gastrointestinal indications. Methods Targeted narrative review of randomized trials, meta-analyses, and observational studies on pCLE in Barrett’s esophagus, gastric intestinal metaplasia (GIM), colorectal neoplasia, inflammatory bowel disease (IBD), and indeterminate biliary strictures. Outcomes included sensitivity/specificity, impact on biopsy yield and management, adverse events, and cost effectiveness. Results pCLE combines a fiber-optic probe and IV fluorescein with 488-nm excitation to generate optical sections (~ 1 µm lateral resolution; depth ~ 55–70 µm). In Barrett’s esophagus, adding pCLE to high-definition endoscopy nearly doubled neoplasia detection sensitivity versus standard protocols. For GIM, pooled sensitivity and specificity reached 97% and 94%. For colorectal lesions, sensitivity 81–91% and specificity 75–91% allowed in vivo characterization and fewer unnecessary resections. In IBD surveillance, pCLE identified more neoplasia with fewer biopsies (up to ~ 4.7-fold increase) and pooled sensitivity/specificity of 87–100%/90–94%. In indeterminate biliary strictures, pCLE integrated with ERCP/EUS improved accuracy and achieved negative predictive values up to 100%. Safety is favorable; risks relate mainly to fluorescein. Limitations include superficial penetration, narrow field of view, operator dependence, image-interpretation variability, procedure time, and high capital and per-case costs. Current guidelines view pCLE as an adjunct rather than routine standard. Emerging AI-assisted interpretation and molecular/ multispectral probes may standardize reads, expand indications, and improve yield. Conclusions pCLE strengthens endoscopic decision-making by enabling immediate, near-histologic assessment, targeted sampling, and earlier therapy. Broader adoption hinges on standardized training, validated image criteria, multicenter randomized trials with health-economic endpoints, and integration of AI and molecular imaging to reduce variability and cost.

Background This study aimed to evaluate whether laparoscopic splenectomy and azygoportal disconnection (LSD) can promote decompensated cirrhotic portal hypertension (CPH) patients to achieve recompensation as defined by Baveno VII. Methods This retrospective study reviewed clinical records and follow-up data of decompensated CPH patients diagnosed with gastroesophageal variceal bleeding (GEVB) and hypersplenism at our hepatobiliary center from 2013 to 2023. According to treatment strategy, patients were categorized into the LSD arm or the endoscopic therapy (ET) arm. Post-treatment liver function, incidence of decompensation events, recompensation, and overall survival were analyzed across the two arms. Furthermore, the mediating effect of LSD on survival through recompensation was analyzed. Results This study enrolled 568 eligible patients, with 300 undergoing LSD and 268 receiving ET. Most patients in both groups showed varying degrees of liver function improvement post-treatment. Overall, 307 patients (54.05%) met the Baveno VII criteria for recompensation. More patients achieved recompensation among those treated with LSD as opposed to ET (73.0% VS. 32.8%, OR = 4.569; 95% CI 3.088–6.760; P < 0.001). Mediation assessment indicated that recompensation accounted for 43.3%, 32.4%, and 16.4% of the effect of LSD on mortality at 3, 5, and 8 years, respectively. Furthermore, younger patients were more likely to achieve recompensation after LSD. Conclusions LSD was found to significantly promote recompensation and extend survival in decompensated cirrhosis patients with CPH bleeding and hypersplenism. Graphical abstract

Background Postoperative pancreatic fistula (POPF) is the major complication following pancreatic surgery, significantly impacting patient outcomes. Intraoperative blood loss (IBL) represents a modifiable risk factor for POPF, but its actual clinical relevance is not clearly defined. This study explores the available literature to reappraise the association of IBL and the development of POPF. Methods A systematic review and meta-analysis of original studies published between January 2006 and August 2025, reporting IBL in patients undergoing pancreatic resections and its association with POPF were performed. Studies that used the International Study Group on Pancreatic Surgery (ISGPS) or the International Study Group on Pancreatic Fistula Definition (ISGPF) definitions for POPF were included. Qualitative synthesis included all eligible studies; quantitative meta-analysis was conducted for studies reporting IBL in both POPF and no-POPF groups. Results A total of 26 studies were included in the qualitative review and 12 in the meta-analysis. Among 13,108 patients who underwent pancreatic resections, the overall POPF rate was 20%. IBL was identified as an independent risk-factor of POPF in 17 studies. The meta-analysis, which included 10,008 patients, showed that IBL was significantly higher in the POPF group compared to the no-POPF group [Mean difference (MD): 112.46 ml (30.39, 194.53), p = 0.01]. Conclusions IBL is an independent predictor of POPF. Intraoperative measures to minimize its occurrence and magnitude are key to ameliorate the outcomes of pancreas surgery.

BackgroundPatients who undergo radical gastrectomy for gastric cancer often experience multiple complications that affect the recovery process and reduce qua...

Gastric cancer with peritoneal involvement is becoming increasingly common, particularly among younger patients with diffuse-type disease. This aggressive subtype carries a high symptom burden and severely impacts quality of life (QoL). Novel therapeutic strategies targeting peritoneal metastases, including normothermic intraperitoneal and systemic chemotherapy (NIPS), pressurised intraperitoneal aerosol chemotherapy (PIPAC), and cytoreductive surgery with HIPEC, are reshaping the treatment landscape. Among these, only NIPS has demonstrated a clear overall survival benefit, as shown in the phase III DRAGON-01 trial. PIPAC and CRS with HIPEC hold promise and are currently being investigated in randomised studies. However, patient-reported outcomes (PROs) remain inconsistently captured. For example, neither DRAGON-01 nor PHOENIX-GC reported QoL data despite their clinical impact. By contrast, PERISCOPE II and PIPAC VER-ONE have incorporated PRO measures, including EORTC QLQ-C30 and QLQSTO22, which are expected to provide more patient-centred insights. These instruments, while valuable, may not fully capture peritoneal-specific symptoms, highlighting the need for tailored tools. Routine integration and standardised reporting of PROs are critical to ensure that survival gains are accompanied by meaningful improvements in patient experience. As therapeutic strategies evolve, embedding PROs in trial design is essential for delivering value-based, patient-centred care in gastric cancer with peritoneal metastases. [KD1]LE: Structured abstract is required in this type of journal. Please consider providing the aforesaid.

BackgroundPost-hepatectomy liver failure (PHLF) is a serious complication after liver resection and is associated with increased morbidity and mortality. The...