Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.
Objective To analyze the relationship between the residence and oncological characteristics of colorectal patients served by Sichuan University West China Hospital as a regional center in the current version of the Database from Colorectal Cancer (DACCA). Methods The DACCA version selected for this data analysis was the updated version on January 5, 2022. The data items analyzed included: residence, precancerous lesions, family history of cancer, tumor location, tumor morphology, tumor orientation, tumor pathology, tumor differentiation and preoperative TNM staging. According to the regional distribution of colorectal cancer patients' residence in the database, they were divided into Sichuan group and non-Sichuan group, and the Sichuan group was further divided into Sichuan-Chengdu group and Sichuan-non-Chengdu group. Results The DACCA database was filtered by conditions to obtain 7 232 valid data. ① The composition ratio of precancerous lesions in different places of residence: The difference between the Sichuan group and the non-Sichuan group was statistically significant (χ2=14.462, P=0.003), and the difference between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group was not statistically significant (χ2=7.591, P=0.101). ② Composition ratio of family history of cancer in different places of residence: In the family history of cancer in oneself, the difference between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group were not statistically significant (χ2=1.121, P=0.606; χ2=1.047, P=0.621). In the family history of cancer in relatives, the differences in the composition ratio of different tumor histories between the Sichuan group and the non-Sichuan group, and between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group were not statistically significant (χ2=0.813, P=0.692; χ2=2.696, P=0.262). ③ Tumor site composition ratios in different places of residence: The difference between Sichuan group and non-Sichuan group was not statistically significant (χ2=0.476, P=0.490), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was statistically significant (χ2=36.216, P<0.001). ④ Tumor morphology composition ratio in different places of residence: The difference between Sichuan group and non-Sichuan group was statistically significant (χ2=19.560, P<0.001), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was not statistically significant (χ2=5.377, P=0.247). ⑤ Composition ratio of tumor orientation in different places of residence: The differences in composition ratio of tumor orientation between Sichuan group and non-Sichuan group and between Sichuan-Chengdu group and Sichuan-non-Chengdu group were statistically significant (χ2=17.484, P=0.005; χ2=26.820, P<0.001). ⑥ Composition ratio of tumor pathological properties under different residence: The differences in the comparison of pathological properties between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group of CRC patients were not statistically significant (χ2=8.136, P=0.408; χ2=7.278, P=0.506). ⑦ Composition ratio of tumor differentiation degree under different residence groupings: the differences in the composition ratio of tumors with different degrees of differentiation were not statistically significant between Sichuan group and non-Sichuan group, and between Sichuan-Chengdu group and Sichuan-non-Chengdu group (H=0.289, P=0.591; H=0.156, P=0.693). ⑧ The composition ratio of TNM staging of tumors before operation in different places of residence: between the Sichuan group and the non-Sichuan group, the difference in the composition ratio of preoperative TNM staging of CRC patients was statistically significant (H=8.023, P=0.005); between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group, the difference in the composition ratio of preoperative TNM staging of CRC patients was not statistically significant (H=0.218, P=0.640). Conclusions Data analysis in DACCA reveal multiple associations between the place of residence and oncological characteristics of CRC patients. There are differences in the composition of the types of precancerous lesions among CRC patients in different places of residence. The proportion of CRC is higher in the family history of cancer. In terms of the site of tumor occurrence, the proportion of tumors located in the rectum is higher than that in the colon. In the composition of tumor morphology in all regions, the ulcerative type is the most frequent. The composition of tumor orientation is different in patients with CRC, and those who has involved a circle of the intestinal wall are the most frequent. Most CRC patients are already in middle or late stage when the tumor is discovered, and the proportion of middle or late stage patients in non-Sichuan provinces was even higher.
Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.
With the publication of a vast amount of clinical research on hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases (AASLD), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the National Health Commission of China have all updated their diagnostic and treatment guidelines for HCC. There are no differences in the definition of HCC risk populations among the AASLD 2023, NCCN 2024, and China Liver Cancer Staging and Treatment Guideline (CNLC) 2024. Notably, CNLC 2024 has updated its guidance on high-risk factors and prospective surveillance for HCC based on the characteristics of HCC patients in China. The four guidelines have seen significant updates in the areas of neoadjuvant and adjuvant therapies, local treatments, and systemic treatments for HCC. CNLC 2024 refines the indications for local treatment, improves systemic treatment, and introduces new first-line therapy, including camrelizumab combined with rivoceranib or tislelizumab. The second-line therapy nivolumab plus ipilimumab for advanced HCC are recommended by AASLD 2023, NCCN 2024, and ASCO 2024, which may become a new first-line therapeutic option for patients with advanced HCC. We compare and interpret these four guidelines in this paper.
Diffuse large B-cell lymphoma is highly heterogeneous and is diagnosed according to the 2016 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. The decision of treatment should be upon age, International Prognostic Index score and the tolerability of chemotherapy. High-dose chemotherapy and autologous stem cell transplantation is the standard care for relapsed, chemotherapy sensitive patients. Clinical trials are recommended in specific conditions.
The 2024 American Society of Clinical Oncology Gastrointestinal Cancers Symposium (ASCO-GI) was held in San Francisco, the USA from January 18th to 20th, 2024 (local time). The multiple studies presented in this symposium will have a significant impact on the clinical practice of esophageal cancer. This article will focus on the surgical methods of esophageal cancer, perioperative immunotherapy, drug therapy for advanced esophageal cancer, rescue treatment after immunotherapy resistance, and other relevant aspects. It aims to summarize and interpret the significant advancements in the field of esophageal cancer presented in this symposium.
ObjectivesTo systematically review the efficacy of problem-based learning (PBL) model in clinical oncology teaching.MethodsPubMed, EMbase, CNKI, WanFang Data, CBM databases were electronically searched to collect randomized controlled trials (RCTs) of PBL model used in clinical oncology teaching in China from January, 2000 to March, 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software.ResultsA total of 29 RCTs involving 2 238 subjects were included. The results of meta-analysis showed that: PBL model in clinical oncology teaching was superior to traditional lecture-based learning (LBL) model on the total score (MD=6.50, 95%CI 4.44 to 8.55, P<0.000 01), theoretical knowledge score (MD=4.58, 95%CI 3.38 to 5.78, P<0.000 01), case analysis score (MD=4.26, 95%CI 3.38 to 5.78, P<0.000 01), skill operation score (MD=6.10, 95%CI 4.77 to 7.43, P<0.000 01), overall course satisfaction (RR=1.74, 95%CI 1.34 to 2.27, P<0.000 01), increased learning interest (RR=1.52, 95%CI 1.28 to 1.81, P<0.000 1), improved teamwork cooperation (RR=1.67, 95%CI 1.39 to 2.01, P=0.002), and improved self-study ability (RR=1.51, 95%CI 1.20 to 1.90, P<0.000 1), the differences were statistically significant.ConclusionsCurrent evidence shows that the PBL model can improve clinical teaching effect of oncology and learning satisfaction. Due to limited quality and quantity of the included studies accumulated, more high quality studies are required to verify above conclusion.
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.