Annali Italiani di Chirurgia

Effects of Network-based Positive Psychological Nursing Model on Negative Emotions, Cancer-related Fatigue, and Quality of Life in Cervical Cancer Patients with Post-operative Chemotherapy

AIM: Cervical cancer patients with post-operative chemotherapy experience anxiety, depression, and cancer-related fatigue, leading to a decline in their quality of life and posing challenges to the rehabilitation of patients. Therefore, it is necessary to explore effective nursing methods. This study aimed to investigate the effects of a web-based positive psychological nursing model on negative emotions, cancer-related fatigue, self-management efficacy, treatment compliance, and quality of life among cervical cancer patients with post-operative chemotherapy. METHODS: This retrospective study included 101 cervical cancer patients who underwent surgical intervention at our hospital between January 2019 and December 2023. Patients who received the usual mode of care were included in the control group (n = 48), while those who received the web-based positive psychological care mode were included in the study group (n = 53). For all study subjects, various assessment indices were evaluated, including baseline characteristics, treatment adherence, and the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Revised Piper Fatigue Scale (RPFS), the Chinese version of the Strategies Used by Patients to Promote Health (C-SUPPH), and European Organization for Research and Treatment of Cancer Quality of Life questionnaire -Core 30 (EORTC QLQ-C30). Additionally, anxiety/depression, cancer-related fatigue, self-management efficacy, treatment compliance, and quality of life were compared between the two groups. RESULTS: After the intervention, the HAMA score, HAMD score, and RPFS score were significantly decreased for both groups compared to before intervention (p < 0.05). However, the C-SUPPH score was significantly increased than before intervention (p < 0.05). We observed that HAMA, HAMD, and RPFS scores were substantially lower in the study group than those in the control group after intervention (p < 0.05). In contrast, C-SUPPH scores were significantly higher (p < 0.05). After the intervention, treatment compliance was significantly better in the study group compared to the control group. Furthermore, the EORTC QLQ-C30 score was substantially higher than that of the control group (p < 0.05). CONCLUSIONS: The network-based positive psychological nursing model can effectively alleviate negative emotions and cancer-related fatigue in cervical cancer patients who have undergone post-operative chemotherapy, thereby improving their quality of life. Additionally, this model improves patients' self-management effectiveness and treatment compliance. These findings provide novel insights into the nursing of cervical cancer patients with post-operative chemotherapy, underscoring its clinical significance.

Risk Factors for Recurrence and Complications Following Cytoreductive Surgery in Platinum-Resistant Ovarian Cancer: A Retrospective Cohort Study

AIM: This study aims to identify independent risk factors for tumor recurrence and postoperative complications in platinum-resistant ovarian cancer patients undergoing cytoreductive surgery. METHODS: This study retrospectively included 96 patients with platinum-resistant ovarian cancer who underwent cytoreductive surgery between January 2020 and December 2022. Of these, 76 patients were in the recurrence group, and 20 patients were in the non-recurrence group. Among them, 84 patients developed postoperative complications and 12 did not. Recurrence was defined as disease progression evidenced by radiological findings according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, or tumor recurrence confirmed by histopathology. Complications within 30 days were graded using the Clavien–Dindo system (grade ≥II). Collected clinicopathological variables included surgical duration, peritoneal cancer index (PCI), surgical complexity score (SCS), and postoperative cancer antigen 125 (CA125), the latter measured after two cycles of adjuvant chemotherapy to assess recurrence. Variables with p < 0.05 in univariate analysis were included in a multivariate logistic regression model to identify independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative power of the identified predictors. RESULTS: Recurrence was significantly associated with longer surgical duration, elevated postoperative CA125, increased PCI, fewer chemotherapy cycles, and suboptimal cytoreductive surgery (all p < 0.05). Multivariate analysis identified surgical duration (odds ratio (OR) = 2.076), postoperative CA125 (OR = 1.193), and PCI (OR = 1.247) as independent risk factors for recurrence. Exploratory ROC analysis suggested moderate discriminative ability of the combined factors (area under the curve (AUC): 0.84), although no model validation was performed. Surgical duration, CA125, and PCI each demonstrated moderate predictive values, with AUCs of 0.77, 0.66, and 0.67, respectively. Complications were independently associated with elevated postoperative CA125; however, the complication model demonstrated only modest discriminative ability (AUC = 0.71). These results should be interpreted as exploratory. CONCLUSIONS: Prolonged surgical duration, elevated postoperative CA125 levels, and higher PCI scores were independently associated with recurrence in patients with platinum-resistant ovarian cancer, while elevated postoperative CA125 levels were also associated with postoperative complications. These factors demonstrated moderate discriminative ability and may serve as potential markers for postoperative risk stratification. However, these findings are exploratory in nature and require external validation.

The Impact of Anesthesia and Surgical Intervention on Liver and Kidney Function in Patients With Gynecological Malignancies

AIM: Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes. METHODS: This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes. RESULTS: Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT (p = 0.044), AST (p < 0.001), TBIL (p < 0.001), creatinine (p = 0.026), and urea (p < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all p < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, p < 0.001), with significant postoperative decreases in red blood cell (RBC) count (p < 0.001), hemoglobin (Hb) levels (p < 0.001), and platelet count (p = 0.003), alongside a substantial increase in white blood cell (WBC) count (p < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT (p = 0.001), AST (p < 0.001), TBIL (p < 0.001), and urea (p = 0.002) levels; however, its association with creatinine levels did not reach statistical significance (p > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine (p = 0.002) and urea (p = 0.015) levels and TBIL (p = 0.002), whereas no significant effects were observed on ALT or AST (p > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST (p = 0.015), TBIL (p = 0.018), and urea levels (p < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST (p = 0.002), TBIL (p = 0.003), and urea levels (p = 0.003), while its associations with ALT (p = 0.083) and creatinine (p = 0.089) were not significant. Notably, pathological grade (G3 vs. G1), mode of anesthesia (general vs. local anesthesia), and age were not significantly associated with these biomarkers (p > 0.05). Furthermore, survival analysis revealed significantly reduced 5-year survival in patients with hepatorenal dysfunction, with survival curves diverging markedly from 32 months post-surgery (p < 0.001). CONCLUSIONS: Perioperative hepatorenal injury in gynecological malignancies is independently associated with tumor stage, open surgery, prolonged operative time, intraoperative blood loss, and tumor biology, and it critically impacts long-term survival. Therefore, minimally invasive techniques and optimizing perioperative management are essential to reduce organ damage and improve patient outcomes.

Chylous Leakage after Endometrial Carcinoma Surgery: A Case Report

AIM: This report represents a case of chylous leakage after endometrial carcinoma surgery, providing therapeutic insights into similar cases in future. CASE PRESENTATION: This report describes a case of chylous leakage after endometrial carcinoma surgery. A 67-year-old woman with a 25-year of menopause was admitted to the hospital due to vaginal bleeding that had persisted for 5 days. She was diagnosed with high-grade serous carcinoma with partial sarcomatoid changes. Subsequently, she received surgical treatment for a malignant endometrial carcinoma, and chylous leakage occurred afterwards. A series of treatments were administered, eventually achieving satisfactory control over the patient's condition. RESULTS: The patient was managed with a multidisciplinary approach, including conservative measures such as bowel rest, total parenteral nutrition, and octreotide to reduce chyle production. Despite initial conservative treatment, chylous leakage persisted, leading to the decision for surgical intervention. Post-surgery, the patient showed significant improvement, with cessation of chylous drainage, and she was eventually discharged with a plan for follow-up care. CONCLUSIONS: Chylous leakage after endometrial carcinoma surgery is a serious complication that requires timely diagnosis and comprehensive treatment. This case provides valuable therapeutic insights into treatment plans and ways to improve prognosis of patients grappling with the same condition.

Impact of Intraoperative Ultrasound-Guided Loop Electrosurgical Excision Procedure With Individualized Marking on Perioperative Stress Responses, Immune Parameters, and Clinical Outcomes: A Comparative Study With Conventional Surgery

AIM: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence. METHODS: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II–III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates. RESULTS: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05). CONCLUSIONS: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.

Risk Factors Predicting Positive Surgical Margins Following Conization and Residual Disease in Subsequent Hysterectomy Among Postmenopausal Women With Cervical Intraepithelial Neoplasia

AIM: To assess the risk factors for positive margin and residual high-grade lesions after cold knife conization (CKC) in postmenopausal patients. METHODS: This retrospective study included a total of 173 postmenopausal patients aged ≥50 years who underwent hysterectomy after CKC at Peking University Third Hospital between September 2012 and February 2023. Statistical analyses were carried out using SPSS 22.0 for Windows. Variables with p-values ≤ 0.05 on univariate analysis were included in multiple logistic regression analysis, which utilized the forward likelihood ratio method. RESULTS: Among the 173 patients, 27.17% (47/173) patients exhibited positive endocervical margins after conization, including seven patients (14.89%) with cervical intraepithelial neoplasia (CIN)2, and 40 patients (85.11%) with CIN3. Independent predictors of positive endocervical margin (> CIN1) were identified, including abnormal ThinPrep cytologic test (TCT) type (> low-grade squamous intraepithelial lesion, LSIL) (odds ratio [OR] = 2.193, 95% CI: 1.058–4.546, p = 0.035). All patients received hysterectomy. Pathological findings of uterine specimens revealed residual CIN2 in 18 patients (10.40%), CIN3 in 18 patients (10.40%), and cervical cancer in 3 patients (1.73%). Endocervical curettage (ECC) results (> CIN1) (odds ratio (OR) = 2.663, 95% CI: 1.049–6.764; p = 0.039) along with endocervical margin status (OR = 6.510, 95% CI: 2.935–14.444; p < 0.001) were identified as significant independent predictors of residual lesions. A regular post-hysterectomy follow-up in 97 patients revealed vaginal intraepithelial neoplasia (VaIN) grade 2/3 in two individuals six months later. CONCLUSIONS: CKC can serve as a primary diagnostic modality for high-grade intraepithelial lesions in postmenopausal patients. Although this study did not identify cone height as a risk factor for positive endocervical margins, it is still recommended to maintain sufficient cone height, given that atrophy and upward migration of the cervical transformation zone are common in postmenopausal patients. For menopausal patients with positive endocervical margin, glandular involvement, and abnormal ECC results (> CIN1), immediate treatment such as hysterectomy is recommended.

An Explainable Deep Learning Framework for Predicting Postoperative Radiotherapy-Induced Vaginal Stenosis in Surgically Treated Cervical Cancer Patients

AIM: Surgery (e.g., radical hysterectomy) combined with radiotherapy is the mainstay of treatment strategy for locally advanced cervical cancer. However, the beneficial effects of adjuvant radiotherapy are frequently offset by late-onset toxicities, such as vaginal stenosis (VS), which significantly impact patients' quality of life. Although imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) are key for both surgical planning and radiotherapy targeting, their ability to predict VS risk before treatment remains limited. This challenge underscores the need for accurate and interpretable predictive models specifically adapted to surgical oncology contexts. This study aims to develop and validate an explainable deep learning framework, integrating Squeeze-and-Excitation (SE) networks and Gradient-weighted Class Activation Mapping (Grad-CAM) visualization, for predicting radiotherapy-induced VS to enable early, personalized intervention strategies. METHODS: Pre-treatment (i.e., post-surgical, pre-radiotherapy) CT images of cervical cancer patients diagnosed between January 2017 and March 2022 were retrospectively collected. These patients underwent radical hysterectomy (or equivalent surgical resection) followed by radiotherapy. Each patient was categorized as either positive or negative for subsequent VS development. Following normalization and augmentation, we employed a Squeeze-and-Excitation enhanced Inception network (SE-Inception) to distinguish between high- and low-risk cases. Model performance was compared to a conventional Random Forest and a deep learning baseline (ResNet50). Additionally, Grad-CAM visualization was integrated to highlight discriminative image regions for enhanced interpretability and clinical validation. RESULTS: Among the 140 patients included in the study, 51 developed VS after treatment, representing an incidence rate of 36.4%. The SE-Inception model yielded superior performance (accuracy: 0.93; area under the receiver operating characteristic curve [AUC]: 0.95), surpassing both ResNet50 (accuracy: 0.85; AUC: 0.90) and Random Forest (accuracy: 0.59; AUC: 0.65). Recall and F1 scores also improved markedly, indicating robust sensitivity and precision. Calibration curves demonstrated excellent agreement between predicted and observed risks, while decision curve analysis (DCA) consistently indicated superior net clinical benefits of the SE-Inception model across various threshold probabilities compared to ResNet50 and Random Forest. Grad-CAM consistently localized to anatomically relevant regions correlating with surgeon- and radiologist-identified risk sites, strengthening the clinical interpretability and trustworthiness of the predictive framework. CONCLUSIONS: Taking the surgical context into account, our SE-Inception framework demonstrated enhanced accuracy and interpretability in identifying patients at risk for postoperative radiotherapy-induced VS. Through alignment with expert clinical assessments and enabling early, personalized intervention strategies, this approach has the potential to improve outcomes and long-term quality of life in cervical cancer survivors, supporting more proactive, surgery-informed treatment planning.

Research Progress on BRCA1/2 Mutations in Sporadic Gastric Cancer: Risk Stratification, Surgical Prognosis, and Individualized Treatment

Gastric cancer is one of the most prevalent malignant tumors worldwide. Sporadic gastric cancer accounts for more than 80% of all gastric cancer cases, and its pronounced heterogeneity underlies the substantial variability in clinical outcomes and the complexity of treatment strategies. The breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are core regulators of the DNA damage homologous recombination repair (HRR) pathway, and their pathogenic mutations are closely associated with hereditary breast and ovarian cancer syndrome. Recent evidence has shown that BRCA1/2 mutations also exist in some sporadic gastric cancer patients and may profoundly affect tumor biological behavior, clinical prognosis, and treatment response. This article systematically reviews the latest research progress on BRCA1/2 mutations in sporadic gastric cancer, focusing on their incidence and molecular characteristics, their impact on patients' postoperative prognosis, and their potential value as novel biomarkers for guiding individualized therapy, thereby providing a theoretical basis for clinical risk stratification and tailored treatment strategies.

The Significance of Lymph Node Dissection in Patients with Early Epithelial Ovarian Cancer

AIM: This study aimed to investigate the impact of lymph node dissection on the prognosis of early epithelial ovarian cancer and to assess the factors associated with lymph node metastasis. METHODS: In this retrospective study, we collected and analyzed the demographic characteristics, clinical pathological data, and perioperative adverse events in newly diagnosed early epithelial ovarian cancer (EOC) patients, Federation International of Gynecology and Obstetrics (FIGO) stage IA–IIA. The patients underwent surgical treatment at the First, Second, and Third Affiliated Hospitals of Wenzhou Medical University in Zhejiang Province, China, between June 2012 and June 2022. The survival analysis was performed. RESULTS: We enrolled 284 patients in this study, including 246 stage I, 28 stage II, and 10 stage III patients after surgery. Among them, 42 patients did not undergo lymph node dissection, 113 underwent pelvic lymph node dissection only, and 129 underwent pelvic plus para-aortic lymph node dissection. Among the lymph node dissection group, only 8 patients had lymph node metastasis (8/242, 3.3%), including 6 with pelvic lymph node metastasis and 2 with pelvic plus para-aortic lymph node metastasis. The median follow-up duration was 63 months. The systematic lymph node dissection group significantly prolonged the median operation duration and increased intraoperative blood loss and postoperative complications (p < 0.05). Postoperative multivariate Cox regression analysis revealed FIGO stage III as an independent risk factor for Progression-Free-Survival (PFS) and Overall Survival (OS) (p < 0.05). Furthermore, the preoperative cancer antigen 125 (CA125) level was observed as an independent factor affecting lymph node metastasis. CONCLUSIONS: Systematic lymph node dissection showed minimal effect on the survival rate of patients with clinically apparent early epithelial ovarian cancer and increased the postoperative complications of patients.