22 August 2025, Volume 38 Issue 4

    

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  The controversy and consensus on preserving the greater omentum in colon cancer surgery

  Li Hui, Wang Ziwei

  Journal of Abdominal Surgery. 2025, 38(4): 247-251. https://doi.org/10.3969/j.issn.1003-5591.2025.04.001

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  The greater omentum is a common site of peritoneal metastasis of colorectal cancer. Partial excision of the greater omentum is usually performed as part of radical resection of colon cancer to reduce the risk of postoperative recurrence and potential metastasis. However, at present, the greater omentum is currently required for partial resection for colon cancer, and the scope of resection varies greatly due to the lack of a unified standard and different experiences by surgeons. In principle, the greater omentum should be completely resected to reduce the risk of postoperative recurrence and metastasis. In addition, the greater omentum plays an important role in limiting the spread of abdominal infection, participating in peritoneal immunity and reducing postoperative complications. Complete excision of the greater omentum may have an important impact on the prognosis of colon cancer. Clinically, whether excision of greater omentum can improve the prognosis of gastric cancer and colorectal cancer is still controversial. Current clinical studies on the preservation of the omentum in gastric cancer have shown that prophylactic excision of the omentum cannot bring additional survival benefits to patients with early gastric cancer, while the preservation of the omentum can significantly shorten the operation time, reduce intraoperative blood loss and reduce the incidence of postoperative complications, especially in laparoscopic surgery. Therefore, whether prophylactic excision of the greater omentum is necessary in colon cancer surgery remains to be discussed, and retention of the greater omentum may become the mainstream trend of radical resection of colon cancer in the future. Whether the omentum is excised or retained still needs to be verified by large-scale randomized controlled clinical trials.
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  Prevention and management of anastomotic leakage after rectal cancer surgery

  Du Donglin, Li Xiangshu, Wei Zhengqiang

  Journal of Abdominal Surgery. 2025, 38(4): 252-256. https://doi.org/10.3969/j.issn.1003-5591.2025.04.002

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  Colorectal cancer remains highly prevalent in China, and rectal cancer is a dominant subtype. While laparoscopic total mesorectal excision has emerged as the gold standard for radical rectal cancer resection, anastomotic leakage （AL） continues to pose formidable challenges as one of the most dreaded postoperative complications. Many factors related to the occurrence of AL have been identified. In combination with these factors, preoperative optimization strategies are implemented to ensure no tension, integrity and good blood supply of the anastomosis during surgery. Strict postoperative monitoring is an important approach to prevent AL. For the treatment of postoperative AL of rectal cancer, comprehensive treatment methods like drug treatment, drainage, ostomy transfer surgery, and emerging endoscopic leak drainage, tamponade, and clamping have been formed. This article thoroughly described the prevention and treatment of AL after rectal cancer.
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  Decision optimization for conversion to laparotomy for colorectal cancer

  Yang Xinlin, Wang Shu, Huo Huade, Yang Jianjun

  Journal of Abdominal Surgery. 2025, 38(4): 257-263. https://doi.org/10.3969/j.issn.1003-5591.2025.04.003

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  Objective To explore the importance of optimizing clinical decision-making for conversion to laparotomy for colorectal cancer and its clinical application. Methods Clinical data of 50 patients with colorectal adenocarcinomas admitted to the Department of Digestive Surgery of Xijing Hospital of Gastroenterology, Air Force Military Medical University from April to December 2023 were retrospectively analyzed. Objective variables, such as age, gender, tumor characteristics （e.g., the maximum diameter of the tumor）, and intraoperative parameters （e.g., intraoperative blood loss） were collected. Univariate and multivariate binary logistic regression analyses were used to identify the key factors influencing conversion to laparotomy. Results Univariate and multivariate binary logistic analyses showed that the long diameter of the tumor and intraoperative blood loss were independent predictors. When intraoperative bleeding was difficult to be effectively controlled in a short period of time, the surgeon's clinical decision was more inclined to convert to laparotomy in a timely manner. A tumor with a long diameter greater than 5cm indicated that the difficulty of tumor separation and resection under laparoscopy was relatively high, and the probability of the surgeon deciding on conversion to an open surgery increased. Conclusion This study provides data support for understanding the clinical decision-making of surgeons and lays the foundation for formulating personalized training and support strategies in the future, aiming to improve surgical safety and the prognosis.
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  Construction of a survival prediction model for pancreatic cancer patients with multi organ metastasis based on machine learning algorithms

  Lu Cong, Song Dan, Wang Wei, Wang Chenhong, Zheng Yongbin

  Journal of Abdominal Surgery. 2025, 38(4): 264-273. https://doi.org/10.3969/j.issn.1003-5591.2025.04.004

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  Objective To identify risk factors for the prognosis of pancreatic cancer with multiple organ metastases （PCMOM） and to construct a survival prediction model based on machine learning algorithms to guide clinical practice. Methods Clinical data of PCMOM patients between 2010 and 2015 were extracted from the SEER （Surveillance, Epidemiology, and End Results） database. Patients were randomly divided into the training cohort and internal validation cohort at a 7∶3 ratio. Univariate and multivariate Cox regression analyses were used to screen for independent risk factors affecting the prognosis of PCMOM. A Cox regression model and a Random Survival Forest （RSF） model were constructed using the identified independent risk factors. The Cox regression model was selected based on its performance on time-dependent receiver operating characteristic （ROC） curves （timeROC）, followed by a visualization. Finally, the Shapley algorithm was used to rank variable importance, and calibration curves and decision curve analysis （DCA） were used to verify the accuracy and clinical applicability of the Cox regression model. Results Univariate and multivariate Cox regression analyses showed that age, race, site of metastasis, grade of differentiation, tumor diameter, surgery, and chemotherapy were independent factors affecting the prognosis of PCMOM. The Cox model outperformed the RSF model in timeROC performance in both the training and internal validation cohorts. The calibration curves and DCA indicated that the Cox regression model had good predictive accuracy and clinical applicability. Visualization results using the Shapley algorithm indicated that chemotherapy, histological grade, site of metastasis, and age were the most influential factors for the prognosis of PCMOM. Conclusion The machine learning model constructed in this study has good predictive potential for the survival of PCMOM patients, suggesting that age ≥50 years,other races,metastatic sites involving liver + lung + bonetumor diameter ≥50 mm,and differentiation gradeⅡ-Ⅳ, or other were identified as independent risk factors affecting the prognosis of patients with PCMOM. Metastatic sites involving liver+ bone or lung + bone,a history of surgery,and a history of chemotherapy were identified as independent protective factors affectingthe prognosis of PCMOM patients.
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  Analysis of influencing factors and prognosis for postoperative peritoneal metastasis in patients with colorectal cancer

  Chen Xianying, Luo Lidan, Dai Yujuan, Chen Dachao

  Journal of Abdominal Surgery. 2025, 38(4): 274-278. https://doi.org/10.3969/j.issn.1003-5591.2025.04.005

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  Objective To investigate the influencing factors and prognosis of postoperative peritoneal metastasis in patients with colorectal cancer （CRC）. Methods The clinical data of 216 postoperative CRC patients admitted to the 909th Hospital from January 2018 to December 2021 were retrospectively analyzed. According to the presence or absence of peritoneal metastasis, patients were allocated to peritoneal metastases group （n=31） and non-peritoneal metastases group （n=185）. The clinicopathological features of patients with peritoneal metastases were analyzed, and the influencing factors for postoperative peritoneal metastasis were analyzed by univariate and multivariate logistic regression. The prediction value of the multivariate logistic regression model in postoperative peritoneal metastasis in CRC patients was assessed by plotting the receiver operating characteristic curve. Kaplan-Meier method was used to analyze the prognosis of CRC patients with postoperative peritoneal metastasis, and log-rank test was performed. Results Compared with the non-peritoneal metastases group, the proportions of preoperative intestinal obstruction, tumor length ≥5 cm, T_3-4 stage, N_1-2 stage, cancer nodules, vascular invasion, nerve invasion, positive incisal margin, mismatch repair protein deletion and microsatellite instability in the peritoneal metastases group were significantly higher （P<0.05）. Multivariate logistic regression analysis showed that preoperative intestinal obstruction （OR=3.075, 95% CI： 1.023-9.422）, tumor length ≥5 cm （OR=3.490, 95% CI： 1.302-9.359）, and T_3-4 stage （OR=3.944, 95% CI： 1.526-10.196）, N_1-2 stage （OR=3.100, 95% CI： 1.197-8.028）, and neuroinvasion （OR=3.634, 95% CI： 1.157-11.416） were independent risk factors for postoperative peritoneal metastasis in CRC patient. The area under the curve of the multivariate logistic regression model in predicting postoperative peritoneal metastasis in CRC patients was 0.858 （95% CI： 0.791-0.924, P<0.001）. The Kaplan-Meier analysis showed that the survival time of CRC patients with postoperative peritoneal metastasis was significantly shorter than that of patients with liver metastasis, lung metastasis, brain metastasis and bone metastasis （P<0.001）. Conclusions Preoperative intestinal obstruction, tumor diameter ≥5 cm, T_3-4 stage, N_1-2 stage, and nerve invasion are independent risk factors for postoperative peritoneal metastasis of CRC. Patients with peritoneal metastasis have a worse prognosis and shorter survival time.
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  Risk factors for intra-abdominal infections after pancreaticoduodenectomy and construction of a prediction model

  Liang Ji, Wei Xiaoping, Dong Yunfang, Hu Zhixiong, Gao Cunbin

  Journal of Abdominal Surgery. 2025, 38(4): 279-285. https://doi.org/10.3969/j.issn.1003-5591.2025.04.006

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  Objective To explore the risk factors for intra-abdominal infections （IAI） after pancreaticoduodenectomy （PD） and to construct a nomogram to predict risk factors, followed by validations for its distinguishing ability and consistency. Methods A total of 299 patients treated with PD in the Second Affiliated Hospital of Kunming Medical University from January 2021 to January 2024 were selected for the study, and their clinical data were collected. Independent risk factors with statistical significance were screened through univariate and multivariate analyses, and a nomogram to predict the risk of IAI after PD was then created. Receiver operating characteristic and calibration curves were plotted to assess the performance of the nomogram. Its clinical applicability was finally assessed via the decision curve analysis. Results The incidence of IAI among 299 patients treated with PD was 21.7%（65/299）. Univariate and multivariate analyses showed that postoperative bleeding （OR： 6.203, 95% CI： 1.273-30.228, P=0.024）, pancreatic fistula （OR=22.412, 95% CI： 7.080-70.941, P<0.001）,abdominal effusion （OR=12.057, 95% CI： 4.375-33.233, P<0.001）, lung infection （OR=15.592, 95% CI： 5.448-46.355, P<0.001）, and C-reactive protein on day 3 postoperatively （OR=1.017, 95% CI： 1.007-1.028, P=0.001） were independent risk factors for IAI after PD. A nomogram involving the five risk factors was created, with an area under the curve of 0.938 （95% CI： 0.902-0.975）. The C index of the nomogram was 0.938, suggesting a good discriminatory degree. The nomogram was internally validated, and the Hosmer-Lemeshow goodness of fit showed a good consistency with the actual observed results. also demonstrated a high clinical value. Conclusion Abdominal fluid, lung infection, pancreatic fistula, C-reactive protein on the third day after surgery, and postoperative bleeding are risk factors for IAI after PD. The constructed nomogram can better predict the risk of IAI after PD. Clinically, targeted interventions should be developed for the above risk factors to reduce the risk of IAI after PD.
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  Short-term efficacy analysis of bariatric metabolic surgery in super-obese patients

  Wang Tianai, Hu Mengjie, Gong Cheng, Wu Tiangen, Zhang Cheng, Liu Zhisu, Pan Dingyu, Li Zhen

  Journal of Abdominal Surgery. 2025, 38(4): 286-292. https://doi.org/10.3969/j.issn.1003-5591.2025.04.007

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  Objective To investigate the short-term efficacy and impact of bariatric surgery on super-obesity （SO） patients. Methods Clinical data of 65 SO patients with the body mass index（BMI）≥50 kg/m² who underwent bariatric metabolic surgery at Surgery Center for Bariatric & Metabolic Diseases, Zhongnan Hospital of Wuhan University, between March 2019 and July 2024 were retrospectively collected. Preoperative and postoperative（1,3,6,and 12 months postoperatively） parameters were recorded and analyzed, including BMI, percentage of excess weight loss（%EWL）,percentage of total weight loss （%TWL）,glucose metabolism, lipid metabolism, liver and kidney function, and uric acid levels. Results All 65 SO patients successfully underwent bariatric surgery without conversion to open surgery, postoperative bleeding, gastric leakage, pulmonary infections, or perioperative mortality. Among them, 39 patients underwent laparoscopic sleeve gastrectomy （LSG）, and 26 patients underwent laparoscopic sleeve gastrectomy+jejunojejunal bypass （LSG+JJB）. During the 6-month postoperative follow-up, patients in both groups showed significant improvements in BMI, glucose metabolism, lipid metabolism, liver and kidney function（all P<0.05）. In details,BMI in the LSG group decreased from 53.68±2.69 kg/m² before surgery to 38.89±3.57 kg/m² at 6 months postoperatively;BMI in the LSG+JJB group decreased from 52.83±2.94 kg/m² before surgery to 38.22±3.64 kg/m² at 6 months postoperatively. The 2-hour postprandial glucose in the LSG group decreased from 9.96±4.08 mmol/L before surgery to 6.45±2.04 mmol/L at 6 months postoperatively; 2-hour postprandial glucose in the LSG+JJB group decreased from 11.4±5.61 mmol/L before surgery to 6.56±2.94 mmol/L at 6 months postoperatively.Uric acid in the LSG group decreased from 508.95±133.89 μmol/L before surgery to 389.11±102.13 μmol/L at 6 months postoperatively; Uric acid in the LSG+JJB group decreased from 504.88±118.64 μmol/L before surgery to 420.65±72.21 μmol/L at 6 months postoperatively. Conclusion Bariatric surgery has a significant short-term effect in the treatment of SO patients, and can effectively improve and cure obesity-related metabolic diseases.
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  Clinical study of reflex programmed T-tube angiography in T-tube extraction after choledocholithotomy

  Tan Yunyan, Mao Wenjun, Zuo Fei, Chen Kairui, Yan Jiapan, Luo Tianping

  Journal of Abdominal Surgery. 2025, 38(4): 293-297. https://doi.org/10.3969/j.issn.1003-5591.2025.04.008

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  Objective To investigate the safety and clinical value of reflex programmed T-tube angiography in T-tube extraction after choledocholithotomy. Methods Clinical data of patients treated with choledocholithotomy in the Integrated Chinese and Western Medicine Gastroenterology Center from January 2021 to December 2023 were retrospectively analyzed. According to the different methods of contrast, 118 patients treated with choledocholithotomy plus T-tube angiography were randomly divided into two groups. Among them, a total of 54 patients treated with reflex programmed T-tube angiography were included in the observation group （patient-controlled group）, and 64 patients treated with push-type T-tube angiography were enrolled in the control group （physician-injected group）.T Imaging time, incidence of adverse events during and after imaging, alanine aminotransferase （ALT）, and length of stay were compared. Results The incidence of adverse events during imaging was significantly lower in the patient-controlled group than the physician-injected group （14.3% vs. 32.8%,P=0.024）. The incidence of adverse events after imaging was significantly lower in the patient-controlled group than the physician-injected group （9.3% vs. 25%, P=0.026）. In elderly patients （≥60 years）, the incidence of intra- and post-imaging adverse events was significantly lower in the patient-controlled group than the physician-injected group （P=0.029 and P=0.045, respectively）. The mean length of stay in the patient-controlled group was significantly shorter than the physician-injected group （5.44±1.160 d vs. 6.44±2.152 d, P=0.002）. The rate of ALT abnormality was significantly lower in the patient-controlled group than the physician-injected group （3.7% vs. 15.6%,P=0.035）. Conclusion Reflex T-tube angiography standardizes the angiography process and enables patients to control the switch of the angiography device through their own neurofeedback of pain. It reduces the occurrence of adverse events caused by excessive injection pressure of the traditional push method, making the T-tube angiography process controllable, safe and reliable, and reducing the patients' economic burden to a certain extent.
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  A case of primary pancreatic tuberculosis and literature review

  Wang Shaoyi, Feng Sijia, Bai Qiangshan, Dang Feng, Han Xinping, Chen An

  Journal of Abdominal Surgery. 2025, 38(4): 298-302. https://doi.org/10.3969/j.issn.1003-5591.2025.04.009

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  Objective To explore the clinical characteristics, diagnosis, and treatment methods of primary pancreatic tuberculosis. Methods We reported a 51-year-old female patient admitted to the Second People's Hospital of Fuping County during the assistance period of the Second Affiliated Hospital of Air Force Medical University with a diagnosis of pancreatic mass, who was finally diagnosed with pancreatic tuberculosis. Clinical characteristics, imaging data, pathological results, treatment and prognosis were analyzed. Relevant case reports and literature were reviewed to summarize the diagnosis and treatment of pancreatic tuberculosis. Results After multidisciplinary discussion, ultrasound-guided percutaneous core needle biopsy was conducted, and the pathology indicated pancreatic tuberculosis. The patient was cured by a systematic anti-tuberculosis treatment and followed up for more than one year without recurrence. A total of 15 related reports with 16 cases were included in the literature review. Among them, male patients accounted for 56.3%（9/16）, with an onset age ranging from 22 to 60 years, and 93.8%（15/16） had lesions in the head of the pancreas. The main clinical manifestations were abdominal pain, jaundice, poor appetite, weight loss, and fatigue. Only three cases showed elevated tumor markers, and 50.0%（8/16） underwent surgical treatment due to misdiagnosis. All had a good prognosis after receiving anti-tuberculosis treatment. Conclusion Lungs are the most commonly affected organ by Mycobacterium tuberculosis, and abdominal organs can be infected. Primary pancreatic tuberculosis is extremely rare. Such cases should be fully diagnosed, and appropriate treatment options should be chosen to avoid misdiagnosis and mistreatment leading to poor p outcomes.
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  Analysis of the clinical efficacy of laparoscopic portal territory staining-guided anatomic liver resection versus laparoscopic non-anatomical hepatectomy in the treatment of primary liver cancer

  Zhang Boya, Li Xingyue, Wang Jingjing, Sun Yingui

  Journal of Abdominal Surgery. 2025, 38(4): 303-308. https://doi.org/10.3969/j.issn.1003-5591.2025.04.010

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  Objective To explore the therapeutic effects and safety of laparoscopic portal territory staining-guided anatomic liver resection （LPTAR） versus laparoscopic non-anatomical hepatectomy （LNAH） in the treatment of primary liver cancer. Methods Clinical data of patients with primary liver cancer treated in the Affiliated Hospital of Shandong Second Medical University from July 2022 to October 2024 were retrospectively analyzed. Patients were divided into two groups based on surgical methods： the LNAH group （n=93） and the LPTAR group （n=97）. The efficacy and safety of the two surgical approaches were analyzed. Results The operation time in the LPTAR group was significantly longer than the LNAH group （192.24±33.41 min vs. 167.36±28.57 min）, while the intraoperative blood loss was significantly less in the LPTAR group than the LNAH group （312.85±27.13 mL vs. 347.32±31.97 mL）. At 3 days postoperatively, the levels of alanine aminotransferase （116.49±22.64 U/L vs. 126.33±23.42 U/L）, aspartate aminotransferase （84.43±6.39 U/L vs. 87.56±7.66 U/L）, and total bilirubin （32.24±4.26 μmol/L vs. 34.15±4.74 μmol/L） were significantly lower in the LPTAR group compared to the LNAH group （P<0.05）. The disease-free survival rate was significantly higher in the LPTAR group than in the LNAH group （74.23% vs. 60.22%, P=0.004）. The overall survival rate was significantly higher in the LPTAR group than in the LNAH group （78.35% vs. 64.52%, P=0.035）. There were no significant differences between the two groups in terms of transfusion rate, hospital stay, tumor marker level, visual analogue scale and quality of recovery-15 scores or the overall incidence of complications （P>0.05）. Conclusion LPTAR and LNAH have comparable safety profiles. However, LNAH is associated with a shorter operative time. In contrast, LPTAR can reduce intraoperative blood loss, minimize liver function impairment, lower postoperative recurrence rates, and improve survival, thereby enhancing patients' outcomes.
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  Effect analysis of partial splenic embolization versus splenorrhaphy in the treatment of traumatic splenic rupture with shock

  He Zhihu, Zhou Weidong

  Journal of Abdominal Surgery. 2025, 38(4): 309-313. https://doi.org/10.3969/j.issn.1003-5591.2025.04.011

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  Objective To explore the application effect of partial splenic embolization versus splenorrhaphy in treating traumatic splenic rupture with shock. Methods A total of 94 shock patients with traumatic splenic rupture admitted in Zhangjiagang Aoyang Hospital from January 2021 to January 2024 were retrospectively selected. They were divided into group A （partial splenic embolization, 46 cases） and group B （splenorrhaphy, 48 cases） according to the surgical method. Operation-related indexes, postoperative recovery indexes, routine blood level, immune indexes, complications and rebleeding operation were compared between the two groups. Results The operation time, off-bed activity time and hospitalization time of group A were significantly shorter, and the intraoperative blood loss was significantly lower than group B （P<0.05）. One week after surgery, the levels of albumin, hemoglobin and platelets in group A were significantly higher than group B （P<0.05）. There were no significant differences in postoperative complications and rebleeding operation between the two groups （P>0.05）. Conclusion Compared with splenorrhaphy, partial splenic embolization has a better application effect on traumatic splenic rupture with shock, which can not only shorten the operation time and reduce intraoperative bleeding, but also improve the blood routine levels of patients.
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  Research progress on the role of immune cells in the tumor microenvironment in the progression and metastasis of colorectal cancer

  Wang Xin, Ding Youming

  Journal of Abdominal Surgery. 2025, 38(4): 314-320. https://doi.org/10.3969/j.issn.1003-5591.2025.04.012

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  The tumor microenvironment （TME） refers to the local environment surrounding tumor cells. Apart from tumor cells themselves, the TME encompasses a variety of non-tumor cells, extracellular matrix, blood vessels, lymphatic vessels, and an array of molecular signals. The TME plays a crucial role in the pathophysiology of tumors, thereby affecting the onset and progression of tumors. Research on the various components of the TME has been annually grown, among which immune cells have been the most extensively studied with a significant influence. Colorectal cancer （CRC） is a type of malignancy with a steadily increasing incidence rate, and TME in CRC is a hot research spotlight. Progression and metastasis of CRC often indicate a poor prognosis. This article aims to review immune cells within the TME involved in the e progression and metastasis of CRC.
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  Hyperthermic intraperitoneal chemotherapy for the prevention of peritoneal metastasis in patients receiving radical gastrectomy： current status and prospects

  Tan Huazhi, Shen Xiaojun, Han Wei, Shi Lizhou, Liu Muyang, Wang Ruijie

  Journal of Abdominal Surgery. 2025, 38(4): 321-325. https://doi.org/10.3969/j.issn.1003-5591.2025.04.013

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  Gastric cancer （GC） ranks as the fifth most prevalent malignancy globally, and peritoneal metastasis serves as the primary cause of mortality. The high incidence rate and lack of early diagnostic methods challenge the early diagnosis of GC. Most patients have been diagnosed as advanced stages. Peritoneal metastasis frequently occurs after surgery in advanced GC cases, and no particularly effective strategies currently exist to prevent postoperative peritoneal implantation metastasis. A substantial body of clinical evidence supports the efficacy of hyperthermic intraperitoneal chemotherapy （HIPEC） in treating peritoneal metastasis, and its application during the perioperative period of gastric cancer may offer a novel and effective approach for preventing postoperative peritoneal implantation metastasis. HIPEC is gaining increasing attention from clinical institutions for research and application. This review systematically examined the research progress, efficacy, indications, procedural modalities, drug selection, safety, and future perspectives of HIPEC in preventing peritoneal metastasis after GC radical surgery, aiming to provide valuable insights for its application and technological advancement.