Background: Ambient air pollution is an emerging risk factor for cancer development, but its impact on post-operative recovery and survival in gastric cancer remains unclear. This study aimed to assess the association between long-term preoperative exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) and post-operative complications and survival in patients undergoing curative gastric cancer surgery. Materials and methods: This multi-center cohort study included 2194 patients from three major gastric cancer centers in Southwest China between 2011 and 2024. Individual exposure to PM 2.5 , NO 2 , and O 3 was estimated using high-resolution geographic models. Multivariate logistic and Cox regression models were used to assess the association between air pollutants and post-operative complications and overall survival, adjusting for clinical, environmental, and socioeconomic variables. Results: Higher PM 2.5 exposure was significantly associated with increased risk of overall complications (OR = 1.014, 95% CI 1.007–1.020, P < 0.001) and reduced overall survival (HR = 1.008, 95% CI 1.003–1.013, P = 0.002). PM 2.5 primarily affected respiratory complications (OR = 1.012, 95% CI 1.003–1.021, P = 0.008) and nutrition and metabolism complications (OR = 1.020, 95% CI 1.010–1.030, P < 0.001). O 3 exposure was inversely associated with complication risk (OR = 0.971, 95% CI 0.957–0.986, P < 0.001), while NO 2 showed no significant association with either outcome. The associations remained robust in multi-pollutant and sensitivity analyses. Conclusions: PM 2.5 is an independent risk factor for post-operative complications and poor survival in gastric cancer patients. O 3 may confer a protective effect. Environmental exposures should be integrated into perioperative risk assessments and public health strategies, particularly in regions with high air pollution levels.

The purpose of this current study was to explore whether one-stitch method (OM) of temporary ileostomy influenced the surgical outcomes after laparoscopic low anterior resection (LLAR). We retrospectively identified rectal cancer (RC) patients who underwent LLAR plus temporary ileostomy in a single teaching hospital from Jan 2011 to June 2023. According to the different methods of ileostomy, the patients were divided into the OM group and the traditional method (TM) group. A propensity score matching (PSM) analysis was performed to eliminate bias and compare the surgical outcomes. A total of 469 RC patients were included in this study. There were 57 patients in the OM group and 412 patients in the TM group. After 1:1 PSM, there were 57 patients in each group, and no significant difference was found in baseline information (P > 0.05). In terms of surgical outcomes of primary RC surgery, we found that patients in the OM group had shorter operation time (P < 0.01), less blood loss (P < 0.01), and shorter postoperative hospital stay (P < 0.01) than in the TM group after PSM. Moreover, there was no significant difference in both overall complications and stoma-related complications. As for the outcomes of stoma reversal surgery, patients in the OM group had shorter postoperative hospital stay (P = 0.002) than in the TM group before PSM. However, no significant difference was found after PSM (P > 0.05). The OM of temporary ileostomy was easier, more effective and time-saving than the TM, which did not increase the incidence of both postoperative complications and stoma-related complications.

Supplementary Fig. 4 A. Progression-free survival by PD-L1 status. B. Overall survival by PD-L1 status. Dot marks indicate censored data.

Supplementary Fig. 3 A. Progression-free survival by CD8+ TIL density. B. Overall survival by CD8+ TIL density. Dot marks indicate censored data.

Supplementary Fig. 4 A. Progression-free survival by PD-L1 status. B. Overall survival by PD-L1 status. Dot marks indicate censored data.

Supplementary Fig. 1 Forest plot of subgroup analysis for progression-free survival (A) and overall survival (B).

During laparoscopic right hemihepatectomy (LRH), two principal techniques for right Glissonean pedicle management are employed: sectoral pedicle transection of the right anterior and posterior sectional pedicles, or main trunk transection of the entire pedicle. It remains controversial whether these approaches differ in safety and efficacy. This study was therefore designed to compare the perioperative outcomes of these two techniques to determine if significant differences exist. This was a multicenter retrospective analysis of 246 patients with hepatocellular carcinoma (HCC) undergoing LRH, with data collected from 8 centers. Outcome measurements were intraoperative blood loss, operative time and postoperative complications, etc. We conducted propensity score matching (PSM) analysis to evaluate perioperative outcomes. In this study, 90 HCC patients used the sectoral pedicle transection approach, while 156 HCC patients used the main trunk transection approach. 90 patients with well-matched baseline levels were enrolled in each group after 1:1 PSM. The sectoral pedicle transection group had less surgical margin (mean, 11.32 vs. 15.02 mm, P = 0.0024). However, the intraoperative blood loss, operative time, postoperative hospital stays, and overall postoperative complications were comparable between the two groups. Additionally, there was no significant difference in the incidence of biliary strictures or bile leakage between the two groups. The main trunk and sectoral pedicle transection approach for LRH in HCC patients were both safe and effective when performed by experienced surgeons. In our study, the main trunk transection technique provided the technical advantage of a wider surgical margin. Furthermore, it was not associated with an increased incidence of biliary complications.

Supplementary Fig. 2 The association of CD8+ TIL density and PD-L1 expression with tumor objective response.

BACKGROUND Previous studies have reported that low hematocrit levels indicate poor survival in patients with ovarian cancer and cervical cancer, the prognostic value of hematocrit for colorectal cancer (CRC) patients has not been determined. The prognostic value of red blood cell distribution width (RDW) for CRC patients was controversial. AIM To investigate the impact of RDW and hematocrit on the short-term outcomes and long-term prognosis of CRC patients who underwent radical surgery. METHODS Patients who were diagnosed with CRC and underwent radical CRC resection between January 2011 and January 2020 at a single clinical center were included. The short-term outcomes, overall survival (OS) and disease-free survival (DFS) were compared among the different groups. Cox analysis was also conducted to identify independent risk factors for OS and DFS. RESULTS There were 4258 CRC patients who underwent radical surgery included in our study. A total of 1573 patients were in the lower RDW group and 2685 patients were in the higher RDW group. There were 2166 and 2092 patients in the higher hematocrit group and lower hematocrit group, respectively. Patients in the higher RDW group had more intraoperative blood loss (P < 0.01) and more overall complications (P < 0.01) than did those in the lower RDW group. Similarly, patients in the lower hematocrit group had more intraoperative blood loss (P = 0.012), longer hospital stay (P = 0.016) and overall complications (P < 0.01) than did those in the higher hematocrit group. The higher RDW group had a worse OS and DFS than did the lower RDW group for tumor node metastasis (TNM) stage I (OS, P < 0.05; DFS, P = 0.001) and stage II (OS, P = 0.004; DFS, P = 0.01) than the lower RDW group; the lower hematocrit group had worse OS and DFS for TNM stage II (OS, P < 0.05; DFS, P = 0.001) and stage III (OS, P = 0.001; DFS, P = 0.001) than did the higher hematocrit group. Preoperative hematocrit was an independent risk factor for OS [P = 0.017, hazard ratio (HR) = 1.256, 95% confidence interval (CI): 1.041-1.515] and DFS (P = 0.035, HR = 1.194, 95%CI: 1.013-1.408). CONCLUSION A higher preoperative RDW and lower hematocrit were associated with more postoperative complications. However, only hematocrit was an independent risk factor for OS and DFS in CRC patients who underwent radical surgery, while RDW was not.

The aim of this study was to compare the clinic outcomes between new single-port laparoscopic appendectomy (NSLA) and conventional three-port laparoscopic appendectomy (CTLA) for patients with acute appendicitis. Patients who were diagnosed with acute appendicitis and underwent appendectomy were retrospectively collected from a single clinical center from September 2021 to June 2023. Baseline characteristics, surgical information, and postoperative information were compared between the NSLA group and the CTLA group. Univariate and multivariate logistic regression analyses were used to find out the predictors of overall complications. A total of 296 patients were enrolled from a single clinical medical center. There were 146 (49.3

BACKGROUND Gastric cancer (GC) and colorectal cancer (CRC) are the fifth and third most common cancer worldwide, respectively. Nowadays, GC is reported to have a potential predictive value for CRC, especially for advanced CRC. AIM To evaluate the necessity of colonoscopy for gastric neoplasm (GN) patients. METHODS Four databases, including PubMed, EMBASE, the Cochrane Library, and Ovid, were used to perform the search strategy on May 2, 2023. The prevalence of colorectal neoplasms (CRN) and baseline characteristics were compared between the neoplasm group and the control group. Continuous variables are expressed as the mean difference and standard deviation. Relationships of categorical variables in the two groups are expressed as odds ratios (OR) and 95% confidence intervals (95%CIs). Subgroup analysis according to different kinds of GNs was conducted for more in-depth analysis. The results of this study are represented by forest plots. Publication bias was evaluated by a funnel plot. All data analyses were performed by STATA SE 16.0 software. RESULTS A total of 3018 patients with GNs and 3905 healthy controls (age and sex matched) were enrolled for analysis. After comparing the prevalence of CRNs between the two groups, CRNs were detected significantly more frequently in GN patients than in controls (OR = 1.69, 95%CI = 1.28 to 2.23, I 2 = 85.12%, P = 0.00), especially in patients with GC (OR =1.80, 95%CI = 1.49 to 2.18, I 2 = 25.55%, P < 0.1). Moreover, other risk factors including age (OR = 1.08, 95%CI = 1.00 to 1.17, I 2 = 90.13%, P = 0.00) and male sex (OR = 2.31, 95%CI = 1.26 to 4.22, I 2 = 87.35%, P = 0.00), were related to the prevalence of CRNs. For patients in the GN group, body mass index (BMI, OR = 0.88, 95%CI = 0.80 to 0.98, I 2 = 0.00%, P = 0.92) and smoking (OR = 1.03, 95%CI = 1.01 to 1.05, I 2 = 0.00%, P = 0.57) were protective and risk factors for CRNs, respectively. CONCLUSION Patients are recommended to undergo colonoscopy when diagnosed with GNs, especially GC patients with a low BMI and a history of smoking.

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery (ERAS) in elderly patients with gastric cancer (GC). AIM To evaluate the safety of ERAS in elderly patients with GC. METHODS The PubMed, EMBASE, and Cochrane Library databases were used to search for eligible studies from inception to April 1, 2023. The mean difference (MD), odds ratio (OR) and 95% confidence interval (95%CI) were pooled for analysis. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores. We used Stata (V.16.0) software for data analysis. RESULTS This study consists of six studies involving 878 elderly patients. By analyzing the clinical outcomes, we found that the ERAS group had shorter postoperative hospital stays (MD = -0.51, I 2 = 0.00%, 95%CI = -0.72 to -0.30, P = 0.00); earlier times to first flatus (defecation; MD = -0.30, I² = 0.00%, 95%CI = -0.55 to -0.06, P = 0.02); less intestinal obstruction (OR = 3.24, I 2 = 0.00%, 95%CI = 1.07 to 9.78, P = 0.04); less nausea and vomiting (OR = 4.07, I 2 = 0.00%, 95%CI = 1.29 to 12.84, P = 0.02); and less gastric retention (OR = 5.69, I 2 = 2.46%, 95%CI = 2.00 to 16.20, P = 0.00). Our results showed that the conventional group had a greater mortality rate than the ERAS group (OR = 0.24, I 2 = 0.00%, 95%CI = 0.07 to 0.84, P = 0.03). However, there was no statistically significant difference in major complications between the ERAS group and the conventional group (OR = 0.67, I 2 = 0.00%, 95%CI = 0.38 to 1.18, P = 0.16). CONCLUSION Compared to those with conventional recovery, elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

BACKGROUND In recent years, the association between oral health and the risk of gastric cancer (GC) has gradually attracted increased interest. However, in terms of GC incidence, the association between oral health and GC incidence remains controversial. Periodontitis is reported to increase the risk of GC. However, some studies have shown that periodontitis has no effect on the risk of GC. Therefore, the present study aimed to assess whether there is a relationship between oral health and the risk of GC. AIM To assess whether there was a relationship between oral health and the risk of GC. METHODS Five databases were searched to find eligible studies from inception to April 10, 2023. Newcastle-Ottawa Scale score was used to assess the quality of included studies. The quality of cohort studies and case-control studies were evaluated separately in this study. Incidence of GC were described by odds ratio (OR) and 95% confidence interval (CI). Funnel plot was used to represent the publication bias of included studies. We performed the data analysis by StataSE 16. RESULTS A total of 1431677 patients from twelve included studies were enrolled for data analysis in this study. According to our analysis, we found that the poor oral health was associated with higher risk of GC (OR = 1.15, 95%CI: 1.02-1.29; I 2 = 59.47%, P = 0.00 < 0.01). Moreover, after subgroup analysis, the outcomes showed that whether tooth loss (OR = 1.12, 95%CI: 0.94-1.29; I 2 = 6.01%, P > 0.01), gingivitis (OR = 1.19, 95%CI: 0.71-1.67; I 2 = 0.00%, P > 0.01), dentures (OR = 1.27, 95%CI: 0.63-1.19; I 2 = 68.79%, P > 0.01), or tooth brushing (OR = 1.25, 95%CI: 0.78-1.71; I 2 = 88.87%, P > 0.01) had no influence on the risk of GC. However, patients with periodontitis (OR = 1.13, 95%CI: 1.04-1.23; I 2 = 0.00%, P < 0.01) had a higher risk of GC. CONCLUSION Patients with poor oral health, especially periodontitis, had a higher risk of GC. Patients should be concerned about their oral health. Improving oral health might reduce the risk of GC.

Purpose: The purpose of this study was to investigate the relationship between remission of nonalcoholic fatty liver disease (NAFLD) and radical surgery for colorectal cancer (CRC) patients. Methods: From January 2014 to December 2021, data of patients with concurrent CRC and NAFLD who underwent radical surgery in a single -center hospital were retrospectively collected. NAFLD was defined as a mean computed tomography (CT) liver attenuation value of <40 Hounsfield units (HUs). Comparison of preoperative and 1 -year postoperative CT images was performed to evaluate the change of NAFLD. Multivariate logistic regression analysis was performed to identify independent predictive factors for NAFLD remission. The Kaplan-Meier method was used to estimate overall survival (OS) and disease -free survival (DFS) between the remission group and no remission group. Results: In this study, a total of 55 eligible patients were included. The remission group had 33 (60.0%) patients and the no remission group had 22 (40.0%) patients. The mean preoperative weight was 66.1 +/- 9.9 kg. The mean preoperative body mass index (BMI) was 25.4 +/- 2.5 kg/m(2). We found that the average weight was significantly decreased (P <0.01), average BMI was significantly decreased (P < 0.01), and HU score was significantly increased (P <0.01). By comparing baseline characteristics between the remission group and no remission group, we found that the remission group exhibited larger tumor sizes (P = 0.036) than the no remission group. In the multivariate logistic regression analysis, we found that weight change was a predictor for NAFLD (odds ratio = 0.764, 95% confidence interval = 0.618-0.944, P =0.013). We did not find any statistically significant differences in OS (P = 0.182) or DFS (P = 0.248) between the remission group and no remission group. Conclusions: The NAFLD remission rate reached 60.0% for CRC patients 1 year after radical surgery. In addition, we found that weight change was a predictor of NAFLD remission.

The current study aimed to investigate whether previous abdominal surgery (PAS) could affect the outcomes of colorectal cancer (CRC) surgery. We conducted the search strategy in three databases (PubMed, Embase, and the Cochrane Library) from inception to May 26, 2022. The short-term and long-term outcomes were compared between the PAS group and the non-PAS group. Odds ratios (ORs) and 95

The current study aimed to evaluate the effect of lymph node ratio (LNR) on the short-term and long-term outcomes of colorectal cancer (CRC) patients who underwent radical CRC surgery. We retrospectively collected CRC patients who underwent radical surgery from Jan 2011 to Jan 2020 in a single-center hospital. The patients were divided into the high LNR group and the low group according to the median. The baseline information and the short-term outcomes were compared between the high group and the low group. Univariate and multivariate logistic regression was performed to analyze the independent predictors for overall survival (OS) and disease-free survival (DFS). A 1:1 proportional propensity score matching (PSM) was used to reduce the selection bias between the two groups. Kaplan-Meier method was used to estimate the OS and DFS between the two groups in different T stages. A total of 1434 CRC patients undergoing radical surgery were enrolled in this study, and there were 730 (50.9%) patients in the low LNR group and 704 (49.1%) patients in the high LNR group. After the PSM, there were 618 patients in both groups, the baseline characteristics between the two groups had no significant difference (p > 0.05). After comparing the Surgery-related information and The Short-term outcomes, the high LNR group had a longer hospital stay (after PSM, p < 0.01). In univariate and multivariate logistic regression analyses, age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.020; multivariate analysis, p = 0.024), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor size (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were independent risk factors for OS, and age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.032; multivariate analysis, p = 0.031), T stage (univariate analysis, p < 0.01; multivariate analysis, p = 0.014), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were identified as independent risk factors for DFS. The high LNR group had a worse OS in T3 (p < 0.01) and T4 (p < 0.01) as well as a worse DFS in T3 (p < 0.01) and T4 (p < 0.01). No association was found between LNR and postoperative complications, but the high LNR group had a longer hospital stay. LNR was identified as an independent predictor for OS and DFS. Furthermore, high LNR had a worse OS and DFS under T3 and T4 stages. Therefore, LNR was more prognostically significant for CRC patients under T3 and T4 stages.

This current study attempted to investigate whether one-stitch method (OM) of temporary ileostomy influenced the stoma-related complications after laparoscopic low anterior resection (LLAR). We searched for eligible studies in four databases including PubMed, Embase, Cochrane Library, and CNKI from inception to July 20, 2023. Both surgical outcomes and stoma-related complications were compared between the OM group and the traditional method (TM) group. The Newcastle–Ottawa Scale (NOS) was adopted for quality assessment. RevMan 5.4 was conducted for data analyzing. Totally 590 patients from six studies were enrolled in this study (272 patients in the OM group and 318 patients in the TM group). No significant difference was found in baseline information (P > 0.05). Patients in the OM group had shorter operative time in both the primary LLAR surgery (MD = − 17.73, 95

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer (CRC) surgery and perforation or to relieve intestinal obstruction. AIM To analyze the complications after transverse colostomy closure. METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center. The differences between the complication group and the no complication group were compared. Logistic regression analyses were conducted to find independent factors for overall complications or incision infection. RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study. Seventy (68.6%) patients underwent transverse colostomy because of CRC related causes. Postoperative complications occurred in 30 (29.4%) patients and the most frequent complication occurring after transverse colostomy closure was incision infection (46.7%). The complication group had longer hospital stays (P < 0.01). However, no potential risk factors were identified for overall complications and incision infection. CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection. The operation time, interval from transverse colostomy to reversal, and method of anastomosis might have no impact on the postoperative complications. Surgeons should pay more attention to aseptic techniques.

Purpose The current pooling up analysis aimed to evaluate whether aortic calcification (AC) was a potential risk factor for anastomotic leakage (AL) after colorectal surgery. Methods In this study, we searched studies in three databases including PubMed, Embase, and the Cochrane Library on April 20, 2022. In order to investigate the association between AC and AL, the hazard ratios (HRs) and 95% confidence intervals (CIs) of AC were pooled up. Our study was performed with RevMan 5.3 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results We finally enrolled eight studies involving 1955 patients for statistical analysis. As for all patients, we found that AC could significantly increase the risk of AL after surgery (HR = 2.31, I 2 = 0%, 95%CI = 1.58 to 3.38, P < 0.01). In five studies including patients undergoing colorectal surgery (benign diseases and cancers), AC was also a risk factor for AL (HR = 3.30, I 2 = 2%; 95%CI = 1.83 to 5.95, P < 0.01). In terms of the other three studies that only included CRC patients, there was still a correction between AC and AL (HR = 1.80, I 2 = 0%, 95%CI = 1.10 to 2.96, P = 0.02). Conclusion Patients with AC were more likely to develop AL after colorectal surgery. Moreover, subgroup analysis suggested that AC was a predictor for AL after CRC surgery.