Objectives To demonstrate the efficacy and safety of mini‐percutaneous nephrolithotomy, micro‐percutaneous nephrolithotomy, and flexible ureteroscopy for pediatric upper urinary tract calculi and to develop nomograms predicting surgical outcomes. Methods A prospectively managed database containing children who were diagnosed with upper urinary tract calculi and treated with mini‐percutaneous nephrolithotomy, micro‐percutaneous nephrolithotomy, and flexible ureteroscopy between June 2014 and April 2019 was analysed. Patient demographics, intraoperative data, stone characteristics, stone‐free rate, and complication rate were analysed and compared. Nomograms predicting the postoperative stone‐free rate and complication rate were established based on predictors, and internal validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. Results Forty‐three children underwent mini‐percutaneous nephrolithotomy on 56 sides in 47 operations, 30 children underwent micro‐percutaneous nephrolithotomy on 30 sides in 30 operations, and 275 children underwent flexible ureteroscopy on 320 sides in 288 operations. The stone‐free rates were 88.5% (282/320) for flexible ureteroscopy, 89.3% (50/56) for mini‐percutaneous nephrolithotomy, and 90.0% (27/30) for micro‐percutaneous nephrolithotomy (P = 0.94). And the complication rates were 19.8% (57/288), 36.2% (17/47), and 33.3% (10/30), respectively (P = 0.02). Nomograms based on stone characteristics, operation duration, and the physical condition of the child were shown to have good discrimination and calibration. The area under the curve of the models was 81% for stone‐free rate and 73% for complication rate. The calibration curves showed that the nomogram might underestimate the probability of stone‐free rate when the threshold was below 82% and might overestimate the risk of complication rate when the threshold was over 25%. The decision curves demonstrated that the Capital Medical University nomograms improved clinical risk prediction against threshold probabilities of stone‐free rate ≤20% and complication rate ≤10%. Conclusions Both the percutaneous nephrolithotomy and flexible ureteroscopy procedures could have acceptable stone‐free rates when treating pediatric stones. The Capital Medical University nomograms performed well in helping to predict stone‐free and complication rates.

To compare the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for pediatric kidney stones larger than 2 cm and to show the learning curves for the two procedures. Methods: A prospectively managed database containing pediatric patients with kidney stones larger than 2 cm from June 2014 to October 2019 was analyzed. The primary outcomes were the efficacy and safety of flexible ureteroscopy and mini-percutaneous nephrolithotomy. Data on patient demographics, treatment details, stone-free rate, and complication rate were collected and compared. Learning curves were generated to estimate the effect of the surgeon's experience on surgical outcomes. Results: The final analysis included 113 pediatric patients who underwent surgery for kidney stones on a total of 126 sides. The stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 80.9% (34/42) and 79.7% (67/84), respectively (P = 0.19). The complication rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy were 52.5% (21/40) and 27.4% (27/73), respectively (P = 0.01). When stone mass was considered, the stone-free rates for mini-percutaneous nephrolithotomy and flexible ureteroscopy for stones with a high mass (>5000 HU*cm 2 ) were 83.3% (20/24) and 55.5% (10/18), respectively (P = 0.04). The learning curves showed that the stone-free rates for both mini-percutaneous nephrolithotomy and flexible ureteroscopy increased with the accumulation of cases. A higher stone-free rate could be achieved after approximately 20 mini-percutaneous nephrolithotomy cases and after approximately 50 flexible ureteroscopy cases. Conclusions: Flexible ureteroscopy has an acceptable stone-free rate and a lower complication rate than mini-percutaneous nephrolithotomy when treating pediatric kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy is more applicable to stones with a high mass. The stone-free rates achieved after both mini-percutaneous nephrolithotomy and flexible ureteroscopy could be improved with number of cases accumulated.

BackgroundThe influence of additional surgery on the prognosis of early gastric cancer who underwent noncurative endoscopic resection was controversial. Different results were observed in different studies. Therefore, this meta-analysis was conducted to evaluate whether additional surgery could produce survival benefits for these patients.MethodsA systematic search was conducted in the PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure and Wanfang databases for relevant articles published until 31 March 2021 to investigate the differences in long-term results between the additional surgery group and the observation group. ResultsSixteen studies including 3877 patients were included in this meta-analysis. The results had shown that the surgery group were younger and more male, higher undifferentiated type, higher rate of SM2, lymphatic and vascular invasion, lower recurrence and metastasis than the observation group. Good survival benefits were observed in additional surgery group with obvious significant differences in the 5-year OS, 5-year DSS and 5-year DFS. Similar results were obtained in the subgroup analysis, such as elderly patients (aged ≥70 years) in 5-year OS. ConclusionThis meta-analysis illustrated that significant survival benefits, including 5-year OS, 5-year DSS and 5-year DFS, could be obtained with additional gastrectomy in patients with EGC after noncurative ER, and patients ≥70 years could also benefit from surgery.