Lin Fan

Background: Postoperative pleural effusions (PPE) are common complications following gastrectomy, particularly in patients diagnosed with Siewert type II/III esophagogastric cancer. The red blood cell distribution width-to-albumin ratio (RAR) is a marker indicative of systemic inflammation and nutritional status. This study investigates the association between preoperative RAR and the incidence of PPE in patients with Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) who have undergone gastrectomy. Methods: A retrospective analysis was performed on data from 299 patients with Siewert type II/III AEG who underwent gastrectomy between January 2020 and December 2024. Logistic regression analysis was utilized to assess the relationship between RAR and PPE, while the receiver operating characteristic curve was employed to evaluate the predictive capability of RAR for PPE risk, with results expressed as the area under the curve (AUC). Results: PPE was diagnosed in 85 patients, representing 28.43% of the study cohort. After adjusting for relevant covariates, a positive association between the RAR and PPE following gastrectomy was observed (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.22–2.34, P = 0.002). The incidence of PPE demonstrated a progressive increase across ascending RAR quartiles, with patients in the highest quartile experiencing a significantly increased risk of PPE compared to those in the lowest quartile (OR = 4.15, 95% CI: 1.28–13.45, P = 0.02). Furthermore, RAR exhibited a strong predictive capacity for PPE risk, as indicated by an AUC of 0.796. Subgroup analysis further confirmed a significant positive association between RAR and PPE. Stratified analysis revealed significant interactions between hemoglobin levels (P = 0.04) and the effect of RAR on PPE. Conclusion: An elevated RAR is independently associated with an increased risk of PPE, suggesting its potential utility as a pragmatic, clinically feasible supplementary index for patients with Siewert type II/III AEG prior to undergoing gastrectomy. However, due to the study’s single-center, retrospective design and absence of external validation, further research with external cohorts is needed before RAR can be considered for widespread clinical implementation.

Introduction: The role of prophylactic ileostomy (PI) and its potential to reduce the risk of postoperative complications such as anastomotic leakage remains unclear. Methods: The PILLAR study (2018–2020, China, 17 centers) prospectively compared PI versus nonprophylactic ileostomy (NPI) in patients undergoing laparoscopic low anterior resection for rectal cancer. The primary endpoint was the anastomotic leakage rate. Secondary endpoints included postoperative complications, leakage management/outcomes, and leakage-associated risk factors. Results: A prospective study was conducted to gather data from 728 patients who underwent laparoscopic low anterior resection for rectal cancer, 192 (26.4%) of whom underwent PI. Seven cases of anastomotic leakage were observed in the PI group (3.6%) and 25 cases were observed in the NPI group (4.7%). Statistical analysis revealed no significant difference in the incidence of anastomotic leakage between the two groups. Moreover, the total complication rates were 17.2% in the PI group and 10.3% in the NPI group ( P = 0.012). However, the patients with anastomotic leakage in the NPI group had more severe abdominal infections, as evidenced by the C-reactive protein (CRP) values on postoperative day 5 (184.1 ± 72.2 and 77.2 ± 17.0 mg/L in the NPI and PI groups, respectively) ( P < 0.001). Patients’ postoperative procalcitonin (PCT) values similarly support this conclusion. Notably, despite this difference in infection severity, there was no statistically significant difference in the treatment or outcomes of patients with anastomotic leakage in either group. Furthermore, male sex and CRP levels on the fifth postoperative day are identified as independent risk factors for anastomotic leakage. Conclusions: PI may have failed to decrease the incidence of anastomotic leakage in patients who underwent laparoscopic low anterior resection for rectal cancer. Given the higher complication rate associated with PI, its use as a preventive measure for patients at risk of anastomotic leakage should be carefully considered.

Background The traditional method of prophylactic loop ileostomy is time-consuming and prone to complications like stoma stenosis, peristomal adhesions, or dermatitis. The aim of this study is to evaluate the clinical application value and potential benefits of a novel approach named linea alba support method (LASM) of prophylactic loop ileostomy via lower abdominal midline incision. Methods The clinical data of rectal cancer patients admitted to the General Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University between January 2021 and December 2023 were retrospectively analyzed. The patients were divided into two groups based on different methods for prophylactic loop ileostomy they received, and clinical outcomes were further compared between the two groups. Results A total of 102 patients, including 48 patients underwent LASM (LASM group) and 54 patients underwent traditional method (TM group) were included in this study. The LASM group exhibited significantly shorter operative time (201.8 vs. 223.0 min, p = 0.011), ileostomy time (10 vs. 22 min, p < 0.001), the length of postoperative visual incision (5 vs. 8 cm, p < 0.001), and operative time of stoma closure (75 vs. 90 min, p < 0.001) compared to the TM group. There were no significant differences between the two groups in postoperative complications and stoma-related complications. In addition, LASM was an independent influencing factor for shorter operative time of ileostomy. Conclusion LASM of prophylactic loop ileostomy via lower abdominal midline incision, seamlessly integrating simplicity, safety, and exceptional cosmetic outcomes, merits extensive promotion and adoption. Graphical abstract

Aim: The reconstruction methods after proximal gastrectomy (PG) are varied but not standardized. This study was performed to evaluate the short‐term clinical outcomes between double tract reconstruction (DTR) and double flap technique (DFT).Methods: We retrospectively reviewed and collected data of patients who underwent DTR and DFT after laparoscopic proximal gastrectomy (LPG), respectively, between January 2020 and March 2023. Propensity score matching (PSM) was used to balance the baseline data of the two groups, then we compared their short‐term clinical outcomes.Results: A total of 72 patients (48 and 24 patients in the DTR and DFT groups, respectively) were included. The anastomosis time was significantly longer in the DFT group than that in the DTR group (70.1 vs. 52.7 min, p < 0.001). DFT was associated with shorter times of gas‐passing, start of diet, and postoperative length of hospital stay (p < 0.001). There were no significant differences between the two groups in terms of early and late postoperative complications (p = 0.710, p = 1.000, respectively). DFT was superior to DTR in maintaining body weight (p < 0.001), total protein (p = 0.011) and albumin levels (p = 0.018). As for QOL, DTR showed better results in the meal‐related distress subscale (p < 0.001). However, DFT was superior to DTR in terms of reducing diarrhea, constipation, and dumping related symptoms (p < 0.05).Conclusion: Double flap technique emerged as a superior alternative to DTR in terms of facilitating early postoperative recovery, sustaining nutritional status, and improving QOL. DFT could potentially be the preferred reconstruction method following laparoscopic proximal gastrectomy.

Background: The coronavirus disease 2019 (COVID-19) cases continue to rise, and the demand for medical treatment and resources in healthcare systems surges. Assessing the viral shedding time (VST) of patients with COVID-19 can facilitate clinical decision making. Although some studies have been conducted on the factors affecting the VST of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), few prediction models are currently available. Methods: This retrospective study included the consecutive patients with COVID-19 admitted to Xi’an Chest Hospital in Shaanxi, China, for treatment between December 19, 2021 and February 5, 2022. The clinical data of the patients were extracted from their electronic medical records. Combining significant factors affecting the VST, a nomogram was developed to predict the VST of the SARS-CoV-2 Delta variant in patients with COVID-19. Results: We included 332 patients in this study. The average VST was 21 d. VST was significantly prolonged in patients with severe clinical symptoms, sore throat, old age, long time from onset to diagnosis, and an abnormal white blood cell count. Consequently, we developed a nomogram prediction model using these 5 variables. The concordance index (C-index) of this nomogram was 0.762, and after internal validation using bootstrapping (1000 resamples), the adjusted C-index was 0.762. The area under the nomogram’s receiver operator characteristic curve showed good discriminative ability (0.965). The calibration curve showed high consistency. The VST was prolonged in the group with lower model fitting scores according to the Kaplan-Meier curve (χ²=286, log-rank P < 0.001). Conclusions: We developed a nomogram for predicting VST based on 5 easily accessible factors. It can effectively estimate the appropriate isolation period, control viral transmission, and optimize clinical strategies.