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.
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.
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.
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.
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 determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography (MSCT) with serum amyloid A protein (SAA) or C-reactive protein (CRP) on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+CRP group, both MSCT and CRP combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results All 165 patients were randomly assigned into MSCT+SAA group (n=83) and MSCT+CRP group (n=82). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 74.7%， 68.7%, 100% and 66.3%, respectively. For MSCT+CRP group, the accuracies of preoperative staging T, N, M and TNM were 72.0%, 86.6%, 100% and 81.7%, respectively. There were statistically significant differences in the accuracies of N staging and TNM staging between two groups (P＜0.05). However, there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups (90.4% vs. 95.1%, Pgt;0.05). The pathological T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), preoperative serum level of SAA (P=0.010), serum level of CRP (P=0.042), and distance of tumor to the dentate line (P=0.011) were associated with the operative procedures. Conclusion Combinative assessment of MSCT+CRP could improve the accuracy of preoperative staging and operative procedures prediction, which may be superior to MSCT+SAA.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.
