Robotic gastric cancer surgery had developed rapidly in recent years, and its clinical application had come a long way. More and more studies had demonstrated that the robotic gastric cancer surgery was a safe and feasible procedure, and showed the technical advantages in the lymph node dissection, bleeding control, precise surgery, and postoperative recovery over laparoscopic surgery. However, some limitations such as the high surgical costs, lack of high-quality evidence, insufficient intelligence limited the development of robotic gastric cancer surgery. In the future, with more high-quality evidence-based medicine research and the development of intelligent surgical robots, the robotic gastric cancer surgery will be further standardized and promoted. We believe that robotic gastric cancer surgery will become the mainstream of minimally invasive surgery for the treatment of gastric cancer.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.
Objective To explore a new rotation training mode suitable for residency standardized non-professional radiological trainees in radiology department, so as to improve the training quality. Methods The residency standardized non-professional radiological trainees who rotated in the Department of Radiology, West China Hospital, Sichuan University between June 2021 and January 2022 were retrospectively included as the research objects. According to the training mode, they were divided into traditional training mode group and innovative training mode group. The training results of the two groups were compared by taking process assessment, final examination and final score as evaluation indicators. Results Finally, 122 residents were included, including 45 in the traditional training model group and 77 in the innovative training model group. There was no significant difference in gender, major, identity and grade between the two groups (P>0.05). There was no significant difference between the two groups in the first film reading skill examination and their usual homework performance (P>0.05). The score of the second film reading skill examination [15 (14, 16) vs. 12 (11, 13)], the score of the final examination [34 (31, 36) vs. 29 (25, 31)] and the final score [80 (76, 83) vs. 71 (67, 74)] in the innovative training mode group were better than those in the traditional training mode group (P<0.05). Conclusion The innovative training mode of online teaching platform combined with offline teaching can improve the training effect of residency standardized non-professional radiological trainees in radiology department.
Hepatoid adenocarcinoma (HAC) of the pancreas is a rare, highly malignant tumor with poor prognosis. This article presents the CT and MR features of HAC of the pancreas, while also reviewing the relevant literatures to succinctly summarize the underlying pathophysiological mechanism, imaging diagnosis, and differential diagnosis. The objective is to enhance the understanding of HAC of the pancreas among clinicians and radiologists.
ObjectiveTo make a comprehensive review of the value of radiomics for prediction of therapeutic responses to neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).MethodRelevant literatures about the therapeutic response evaluation of LARC by using radiomics were collected to make an review.ResultRadiomics had good predictive value in terms of complete pathologic response (pCR) and treatment effectiveness of NCRT in patients with LARC.ConclusionRadiomics, a new imaging diagnostic technique, plays an important role in the prediction of the efficacy of NCRT in LARC.
ObjectiveTo explore the value of a decision tree (DT) model based on CT for predicting pathological complete response (pCR) after neoadjuvant chemotherapy therapy (NACT) in patients with locally advanced rectal cancer (LARC).MethodsThe clinical data and DICOM images of CT examination of 244 patients who underwent radical surgery after the NACT from October 2016 to March 2019 in the Database from Colorectal Cancer (DACCA) in the West China Hospital were retrospectively analyzed. The ITK-SNAP software was used to select the largest level of tumor and sketch the region of interest. By using a random allocation software, 200 patients were allocated into the training set and 44 patients were allocated into the test set. The MATLAB software was used to read the CT images in DICOM format and extract and select radiomics features. Then these reduced-dimensions features were used to construct the prediction model. Finally, the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), sensitivity, and specificity values were used to evaluate the prediction model.ResultsAccording to the postoperative pathological tumor regression grade (TRG) classification, there were 28 cases in the pCR group (TRG0) and 216 cases in the non-pCR group (TRG1–TRG3). The outcomes of patients with LARC after NACT were highly correlated with 13 radiomics features based on CT (6 grayscale features: mean, variance, deviation, skewness, kurtosis, energy; 3 texture features: contrast, correlation, homogeneity; 4 shape features: perimeter, diameter, area, shape). The AUC value of DT model based on CT was 0.772 [95% CI (0.656, 0.888)] for predicting pCR after the NACT in the patients with LARC. The accuracy of prediction was higher for the non-PCR patients (97.2%), but lower for the pCR patients (57.1%).ConclusionsIn this preliminary study, the DT model based on CT shows a lower prediction efficiency in judging pCR patient with LARC before operation as compared with homogeneity researches, so a more accurate prediction model of pCR patient will be optimized through advancing algorithm, expanding data set, and digging up more radiomics features.
Objective To investigate the relationship of serum amyloid A protein (SAA) and surgical choice in low locally advanced rectal cancer (LLARC). Methods Fifty-two patients with LLARC at West China Hospital of Sichuan University were retrospectively analyzed. According to operative methods the patients were divided into 2 groups: curative surgery group (n=35) and palliative surgery group (n=17). Then, venous blood specimens were taken to measure preoperative serum SAA level. Results The analysis showed the option of surgical procedures was associated with preoperative SAA concentration (P=0.004) in LLARC, but irrelative with pathological characteristics and preoperative imaginologic staging (Pgt;0.05). High concentration of serum SAA (≥10.5 mg/L) significantly increased the odds of palliative surgery 〔OR=7.47, 95% CI (1.62-34.40), P＝0.010〕.Conclusion High level of SAA is a useful marker to predict the possibility of palliative surgery in LLARC, which is helpful to screen the patients for the surgical decision and adjuvant therapy.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
