BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Cons...BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.展开更多
BACKGROUND Along with the unceasing progress of medicine,Crohn's disease(CD),especially complex CD,is no longer a taboo for minimally invasive surgery.However,considering its special disease characteristics,more c...BACKGROUND Along with the unceasing progress of medicine,Crohn's disease(CD),especially complex CD,is no longer a taboo for minimally invasive surgery.However,considering its special disease characteristics,more clinical trials are needed to confirm the safety and feasibility of laparoscopic surgery for CD.AIM To investigate the safety and feasibility of laparoscopic enterectomy for CD,assess the advantages of laparoscopy over laparotomy in patients with CD,and discuss comprehensive minimally invasive surgical techniques in complex CD.METHODS This study prospectively collected clinical data from patients with CD who underwent enterectomy from January 2017 to January 2020.It was registered in the Chinese clinical trial database with the registration number ChiCTR-INR-16009321.Patients were divided into a laparoscopy group and a traditional laparotomy group according to the surgical method.The baseline characteristics,operation time,intraoperative blood loss,temporary stoma,levels of abdominal adhesion,pathological characteristics,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,and hospitalization cost were compared between the two groups.RESULTS A total of 120 eligible patients were enrolled into the pre-standardized groups,including 100 in the laparoscopy group and 20 in the laparotomy group.Compared with the laparotomy group,the postoperative hospitalization time in the laparoscopy group was shorter(9.1±3.9 d vs 11.0±1.6 d,P<0.05),the days to flatus were fewer(2.8±0.8 d vs 3.5±0.7 d,P<0.05),the days to soft diet were fewer(4.2±2.4 d vs 6.2±2.0 d,P<0.05)and the intraoperative blood loss was less(103.3±80.42 mL vs 169.5±100.42 mL,P<0.05).There were no statistically significant differences between the two groups in preoperative clinical data,operation time(149.0±43.8 min vs 159.2±40.0 min),stoma rate,levels of abdominal adhesion,total cost of hospitalization,incidence of postoperative complications[8.0%(8/100)vs 15.0%(3/20)],or readmission rate within 30 days[1.0%(1/100)vs 0.00(0/20)].CONCLUSION Compared with laparotomy,laparoscopic enterectomy promotes the recovery of gastrointestinal function,shortens the postoperative hospitalization time,and does not increase the incidence of postoperative complications.Laparoscopic enterectomy combined with varieties of minimally invasive surgical techniques is a safe and acceptable therapeutic method for CD patients with enteric fistulas.展开更多
BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore import...BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.AIM To compare the safety,feasibility,and short-term and long-term outcomes of laparoscopic IR(LIR)vs open IR(OIR)for the treatment of CD.METHODS The baseline characteristics,operative data,and short-term(30-d)and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.RESULTS Of the 60 patients enrolled in this study,LIR was performed for 48 and OIR for 12.There were no statistically significant differences in baseline characteristics,operation time,intraoperative blood loss,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,length of hospitalization,hospitalization costs,or reoperation rate after IR between the two groups.However,patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group(87.5%vs 41.7%,respectively,P<0.05).Notably,following exclusion of patients who underwent enterectomy plus IR,OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.CONCLUSION The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.展开更多
Crohn’s disease(CD)is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide.Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to ...Crohn’s disease(CD)is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide.Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications.Surgical intervention plays a vital role in comprehensive therapy.However,deciding the optimal timing for surgical intervention has long been a focus of controversy.This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.展开更多
基金Supported by Horizontal Project of Shanghai Tenth People’s Hospital,No.DS05!06!22016 and No.DS05!06!22017.
文摘BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.
文摘BACKGROUND Along with the unceasing progress of medicine,Crohn's disease(CD),especially complex CD,is no longer a taboo for minimally invasive surgery.However,considering its special disease characteristics,more clinical trials are needed to confirm the safety and feasibility of laparoscopic surgery for CD.AIM To investigate the safety and feasibility of laparoscopic enterectomy for CD,assess the advantages of laparoscopy over laparotomy in patients with CD,and discuss comprehensive minimally invasive surgical techniques in complex CD.METHODS This study prospectively collected clinical data from patients with CD who underwent enterectomy from January 2017 to January 2020.It was registered in the Chinese clinical trial database with the registration number ChiCTR-INR-16009321.Patients were divided into a laparoscopy group and a traditional laparotomy group according to the surgical method.The baseline characteristics,operation time,intraoperative blood loss,temporary stoma,levels of abdominal adhesion,pathological characteristics,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,and hospitalization cost were compared between the two groups.RESULTS A total of 120 eligible patients were enrolled into the pre-standardized groups,including 100 in the laparoscopy group and 20 in the laparotomy group.Compared with the laparotomy group,the postoperative hospitalization time in the laparoscopy group was shorter(9.1±3.9 d vs 11.0±1.6 d,P<0.05),the days to flatus were fewer(2.8±0.8 d vs 3.5±0.7 d,P<0.05),the days to soft diet were fewer(4.2±2.4 d vs 6.2±2.0 d,P<0.05)and the intraoperative blood loss was less(103.3±80.42 mL vs 169.5±100.42 mL,P<0.05).There were no statistically significant differences between the two groups in preoperative clinical data,operation time(149.0±43.8 min vs 159.2±40.0 min),stoma rate,levels of abdominal adhesion,total cost of hospitalization,incidence of postoperative complications[8.0%(8/100)vs 15.0%(3/20)],or readmission rate within 30 days[1.0%(1/100)vs 0.00(0/20)].CONCLUSION Compared with laparotomy,laparoscopic enterectomy promotes the recovery of gastrointestinal function,shortens the postoperative hospitalization time,and does not increase the incidence of postoperative complications.Laparoscopic enterectomy combined with varieties of minimally invasive surgical techniques is a safe and acceptable therapeutic method for CD patients with enteric fistulas.
基金The study protocol was approved by the Ethics Committee of the Shanghai Tenth People’s Hospital Affiliated to the Tongji University School of Medicine(approval No.21K53).
文摘BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.AIM To compare the safety,feasibility,and short-term and long-term outcomes of laparoscopic IR(LIR)vs open IR(OIR)for the treatment of CD.METHODS The baseline characteristics,operative data,and short-term(30-d)and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.RESULTS Of the 60 patients enrolled in this study,LIR was performed for 48 and OIR for 12.There were no statistically significant differences in baseline characteristics,operation time,intraoperative blood loss,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,length of hospitalization,hospitalization costs,or reoperation rate after IR between the two groups.However,patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group(87.5%vs 41.7%,respectively,P<0.05).Notably,following exclusion of patients who underwent enterectomy plus IR,OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.CONCLUSION The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.
文摘Crohn’s disease(CD)is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide.Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications.Surgical intervention plays a vital role in comprehensive therapy.However,deciding the optimal timing for surgical intervention has long been a focus of controversy.This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.
