Objective:To evaluate the safety and feasibility of Da Vinci robot-assisted proximal gastrectomy (PG) for proximal gastric cancer (PGC) and adenocarcinoma of the esophagogastric junction (AEG).Method:Twenty-five patients (PGC: n=7; AEG: n=18) undergoing Da Vinci-assisted PG at the First Affiliated Hospital of Dalian Medical University from Jan 2021 to Mar 2025 were divided into (indocyanine green ,ICG) ( n=9) and non-ICG ( n=16) groups based on whether intraoperative ICG navigation was used. Perioperative outcomes and pathological data were compared. Results:All operations were successfully completed without conversion to open surgery. The median proximal resection margin was 3.0 cm (2.5-3.0) cm, and the median distal resection margin was 4.0 cm (3.0-5.0) cm. Operative time in the ICG and non-ICG groups was (294.4±41.3) min and (354.4±67.4) min, respectively, with a statistically significant difference ( t=2.760， P< 0.05). The total number of lymph nodes harvested, as well as D 1 and D 2 LN stations, was (29.3±14.8) vs. (21.8±6.3), 17.0 (10.0-24.8) vs. 14.0 (11.0-22.5), and 10.0 (2.0-17.0) vs. 7.2 (2.0-7.5) in the ICG and non-ICG groups, respectively. Although the ICG group showed a trend toward higher LN yield, the difference was not statistically significant ( P>0.05). Conclusions:Da Vinci robotic assisted proximal gastrectomy is safe and feasible for treating PGC and AEG. ICG fluorescence imaging demonstrates promising clinical value.

Objective:To evaluate the safety and feasibility of Da Vinci robot-assisted proximal gastrectomy (PG) for proximal gastric cancer (PGC) and adenocarcinoma of the esophagogastric junction (AEG).Method:Twenty-five patients (PGC: n=7; AEG: n=18) undergoing Da Vinci-assisted PG at the First Affiliated Hospital of Dalian Medical University from Jan 2021 to Mar 2025 were divided into (indocyanine green ,ICG) ( n=9) and non-ICG ( n=16) groups based on whether intraoperative ICG navigation was used. Perioperative outcomes and pathological data were compared. Results:All operations were successfully completed without conversion to open surgery. The median proximal resection margin was 3.0 cm (2.5-3.0) cm, and the median distal resection margin was 4.0 cm (3.0-5.0) cm. Operative time in the ICG and non-ICG groups was (294.4±41.3) min and (354.4±67.4) min, respectively, with a statistically significant difference ( t=2.760， P< 0.05). The total number of lymph nodes harvested, as well as D 1 and D 2 LN stations, was (29.3±14.8) vs. (21.8±6.3), 17.0 (10.0-24.8) vs. 14.0 (11.0-22.5), and 10.0 (2.0-17.0) vs. 7.2 (2.0-7.5) in the ICG and non-ICG groups, respectively. Although the ICG group showed a trend toward higher LN yield, the difference was not statistically significant ( P>0.05). Conclusions:Da Vinci robotic assisted proximal gastrectomy is safe and feasible for treating PGC and AEG. ICG fluorescence imaging demonstrates promising clinical value.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome