Objective This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. MethodsA total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. ResultsOverall lymph node metastasis rate: 42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3% (41/123), intermediate lymph node (N2) was 10.6% (13/123), and central lymph node (N3) was 13.0% (16/123). Cecal cancer: ileocolic artery lymph node metastasis rate was 40.0% (10/25), right colic artery lymph node metastasis rate was 0 (0/6) and middle colic artery lymph node metastasis rate was 4.0% (1/25). Transverse colon cancer: ileocolic artery lymph node metastasis rate was 0 (0/18) and middle colic artery lymph node metastasis rate was 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) patient with hepatic flexure cancer showed metastasis. The metastasis rate was 2.2% (1/45). No ileal lymph node metastasis was observed. N3 metastasis rate: 9.3% (8/86) in well/moderately differentiated tumors vs 21.6% (8/37) in poorly differentiated tumors (χ2=2.63, P=0.105). No N3 lymph node metastasis occurred in T1 and T2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively (χ2=0.17, P=0.683). ConclusionsFor cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are high (more than 20%), respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.
Objective To develop and validate a nomogram based on Doppler ultrasound hemodynamics at 2 weeks post-surgery for predicting autogenous arteriovenous fistula (AVF) maturation failure. Methods Patients with end-stage renal disease who underwent first-time AVF surgery between March 2023 and September 2025 were selected. Patients were classified into the maturation group and maturation failure group according to AVF status at 6 weeks post-surgery. Predictive variables were screened using LASSO regression, and a nomogram was constructed via multivariable logistic regression. Model performance was evaluated using area under the curve (AUC), calibration curves, and decision curve analysis. Results A total of 260 patients were included. Among 260 patients, 94 (36.2%) experienced AVF maturation failure. Seven variables were selected by LASSO regression: female gender, diabetes, draining vein diameter, vascular access blood flow, pulsatility index, vein depth, and anastomotic stenosis. Multivariable logistic regression demonstrated that female gender, diabetes, smaller draining vein diameter, lower vascular access blood flow, and higher pulsatility index were independent predictors (P<0.05). The nomogram yielded an AUC of 0.924 [95%CI (0.893, 0.956)], with a bootstrap-corrected AUC of 0.912. The model showed good calibration (χ2=3.703, P=0.883) and clinical net benefit. Conclusion The established nomogram exhibits robust performance and can be integrated into the routine 2-week post-operative follow-up to facilitate early identification and individualized management of AVF maturation failure.