Digestive Surgery最新文献

{"title":"Prognostic Impact of Inflammation-Based Scores for Extrahepatic Cholangiocarcinoma.","authors":"Riki Asakura,&nbsp;Hiroaki Yanagimoto,&nbsp;Tetsuo Ajiki,&nbsp;Daisuke Tsugawa,&nbsp;Takuya Mizumoto,&nbsp;Shinichi So,&nbsp;Takeshi Urade,&nbsp;Yoshihide Nanno,&nbsp;Kenji Fukushima,&nbsp;Hidetoshi Gon,&nbsp;Shohei Komatsu,&nbsp;Kaori Kuramitsu,&nbsp;Tadahiro Goto,&nbsp;Sadaki Asari,&nbsp;Masahiro Kido,&nbsp;Hirochika Toyama,&nbsp;Takumi Fukumoto","doi":"10.1159/000521969","DOIUrl":"https://doi.org/10.1159/000521969","url":null,"abstract":"<p><strong>Introduction: </strong>Although the relationship between systemic inflammatory responses and prognosis has been known in various cancers, it remains unclear which scores are most valuable for determining the prognosis of extrahepatic cholangiocarcinoma. We aimed to verify the usefulness of various inflammation-based scores as prognostic factors in patients with resected extrahepatic cholangiocarcinoma.</p><p><strong>Methods: </strong>We analyzed consecutive patients undergoing surgical resection for extrahepatic cholangiocarcinoma at our institution between January 2000 and December 2019. The usefulness of the following inflammation-based scores as prognostic factor was investigated: glasgow prognostic score (GPS), modified GPS, neutrophil-to-lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte-to-monocyte ratio, prognostic nutrition index, C-reactive protein to albumin ratio (CAR), controlling nutritional status (CONUT), and prognostic index.</p><p><strong>Results: </strong>A total of 169 patients were enrolled in this study. Of the nine scores, CAR and CONUT indicated prognostic value. Furthermore, multivariate analysis for overall survival revealed that high CAR (>0.23) was an independent prognostic factor (hazard ratio: 1.816, 95% confidence interval: 1.135-2.906, p = 0.0129), along with lymph node metastasis and curability. There was no difference in tumor staging and short-term outcomes between the low CAR (≤0.23) and high CAR groups.</p><p><strong>Conclusions: </strong>CAR was the most valuable prognostic score in patients with resected extrahepatic cholangiocarcinoma.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 2-3","pages":"65-74"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39927791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HBPD Table of Contents","authors":"","doi":"10.1159/000520691","DOIUrl":"https://doi.org/10.1159/000520691","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"38 1","pages":"379 - 384"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44842940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical Antegrade Modular Pancreatosplenectomy for Left-Sided Pancreatic Ductal Adenocarcinoma May Reduce the Local Recurrence Rate.","authors":"Sho Kiritani, Junichi Kaneko, Junichi Arita, Takeaki Ishizawa, Nobuhisa Akamatsu, Kiyoshi Hasegawa","doi":"10.1159/000524927","DOIUrl":"10.1159/000524927","url":null,"abstract":"<p><strong>Introduction: </strong>Although several clinical applications have reported the usefulness of the radical antegrade modular pancreatosplenectomy (RAMPS) procedure for left-sided pancreatic ductal adenocarcinoma, few studies have reported the advantages of RAMPS with respect to the local recurrence (LR) rate.</p><p><strong>Methods: </strong>As of 2018, 68 and 62 patients underwent RAMPS and standard retrograde pancreatosplenectomy (SRPS). The first recurrence and all subsequent recurrence sites observed on images during a follow-up period and/or chemotherapy. The clinical variables are collected retrospectively.</p><p><strong>Results: </strong>LR only was found in 5 patients in the RAMPS group (5/68, 7.3%) and in 15 patients in the SRPS group (15/62, 24.2%; p = 0.008) as the first recurrence site. Any chemotherapies were not a risk factor for the incidence of LR. The 5-year cumulative LR rate was significantly lower in patients in the RAMPS group compared with those in the SRPS group (23.6% vs. 49.6%; p = 0.019). The 5-year overall survival was 42.2% in the RAMPS group and 33.0% in the SRPS group (p = 0.251).</p><p><strong>Conclusion: </strong>The RAMPS procedure for left-sided pancreatic ductal adenocarcinoma may reduce the LR, cumulative LR rates.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 4","pages":"191-200"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique.","authors":"Kosei Takagi,&nbsp;Ryuichi Yoshida,&nbsp;Yuzo Umeda,&nbsp;Tomokazu Fuji,&nbsp;Kazuya Yasui,&nbsp;Takahito Yagi,&nbsp;Toshiyoshi Fujiwara","doi":"10.1159/000527249","DOIUrl":"https://doi.org/10.1159/000527249","url":null,"abstract":"<p><p>Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and the tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 4","pages":"137-140"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9121744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience.","authors":"Niccolò Surci,&nbsp;Claudio Bassi,&nbsp;Roberto Salvia,&nbsp;Giovanni Marchegiani,&nbsp;Luca Casetti,&nbsp;Giacomo Deiro,&nbsp;Christina Bergmann,&nbsp;Klaus Walenta,&nbsp;Dietmar Tamandl,&nbsp;Martin Schindl,&nbsp;Klaus Sahora,&nbsp;Jakob Mühlbacher","doi":"10.1159/000526263","DOIUrl":"https://doi.org/10.1159/000526263","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population.</p><p><strong>Materials and methods: </strong>Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain.</p><p><strong>Results: </strong>Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery.</p><p><strong>Discussion/conclusion: </strong>Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 4","pages":"169-175"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9909709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10744208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review.","authors":"Robert Memba,&nbsp;Olga Morató,&nbsp;Laia Estalella,&nbsp;Mihai C Pavel,&nbsp;Erik Llàcer-Millán,&nbsp;Mar Achalandabaso,&nbsp;Elisabet Julià,&nbsp;Erlinda Padilla,&nbsp;Carles Olona,&nbsp;Donal O'Connor,&nbsp;Rosa Jorba","doi":"10.1159/000521169","DOIUrl":"https://doi.org/10.1159/000521169","url":null,"abstract":"<p><strong>Introduction: </strong>Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention.</p><p><strong>Methods: </strong>Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296).</p><p><strong>Results: </strong>A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective.</p><p><strong>Conclusions: </strong>IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 1","pages":"6-16"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39789565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study.","authors":"Marco Milone,&nbsp;Sara Vertaldi,&nbsp;Marie Sophie Alfano,&nbsp;Antonino Agrusa,&nbsp;Gabriele Anania,&nbsp;Gian Luca Baiocchi,&nbsp;Pietro Paolo Bianchi,&nbsp;Alberto Biondi,&nbsp;Umberto Bracale,&nbsp;Salvatore Buscemi,&nbsp;Matteo Chiozza,&nbsp;Francesco Corcione,&nbsp;Domenico D'Ugo,&nbsp;Maurizio Degiuli,&nbsp;Giuseppe De Simone,&nbsp;Ugo Elmore,&nbsp;Federica Galli,&nbsp;Giuseppe Giuliani,&nbsp;Pietro Maida,&nbsp;Francesco Maione,&nbsp;Michele Manigrasso,&nbsp;Giampaolo Marte,&nbsp;Stefano Olmi,&nbsp;Stefano Rausei,&nbsp;Rossella Reddavid,&nbsp;Riccardo Rosati,&nbsp;Matteo Uccelli,&nbsp;Giovanni Domenico De Palma,&nbsp;Elisa Cassinotti,&nbsp;Luigi Boni","doi":"10.1159/000526348","DOIUrl":"https://doi.org/10.1159/000526348","url":null,"abstract":"<p><strong>Introduction: </strong>Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis.</p><p><strong>Methods: </strong>All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread.</p><p><strong>Results: </strong>Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029).</p><p><strong>Conclusions: </strong>Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 5-6","pages":"232-241"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9423304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Carcinoembryonic Antigen Doubling Time in Prognosis Prediction after Curative Resection of Locally Recurrent Rectal Cancer: A Retrospective Study.","authors":"Junichi Sakamoto,&nbsp;Heita Ozawa,&nbsp;Hiroki Nakanishi,&nbsp;Shin Fujita","doi":"10.1159/000520694","DOIUrl":"https://doi.org/10.1159/000520694","url":null,"abstract":"<p><strong>Introduction: </strong>Given that doubling time is an indicator of tumor growth, we assessed the usefulness of carcinoembryonic antigen doubling time (CEA-DT) in prognosis prediction after curative resection for locally recurrent rectal cancer.</p><p><strong>Methods: </strong>During January 1986-December 2016, 33 patients with locally recurrent rectal cancer who underwent curative resection at our hospital were retrospectively reviewed. The primary endpoint was the 3-year recurrence-free survival (RFS) rate. The Kaplan-Meier method was used to compare RFS rates and evaluate univariate and multivariate analyses for factors associated with oncologic outcomes, including CEA-DT. CEA-DT was classified into 2 groups: the short and long CEA-DT groups.</p><p><strong>Results: </strong>The 3-year overall survival and RFS rates were 62.6% and 42.4%, respectively. In multivariate analyses, CEA-DT was an independent risk factor for poor RFS. The 3-year RFS rate was significantly better in the long CEA-DT group than in the short CEA-DT group (58.8% vs. 25.0%, p = 0.0063).</p><p><strong>Conclusion: </strong>CEA-DT is a useful prognostic factor that can be assessed before surgery for locally recurrent rectal cancer. Long CEA-DT may indicate a favorable prognosis. Contrarily, short CEA-DT is associated with poor prognosis; therefore, further treatment intervention is necessary for patients with short CEA-DT.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 1","pages":"17-23"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39854504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement of Body Composition in Pancreatic Cancer: A Systematic Review, Meta-Analysis, and Recommendations for Future Study Design.","authors":"Oonagh M Griffin, Yasir Bashir, Donal O'Connor, Joseph Peakin, Jean McMahon, Sinead Noelle Duggan, Justin Geoghegan, Kevin C Conlon","doi":"10.1159/000524575","DOIUrl":"10.1159/000524575","url":null,"abstract":"<p><strong>Background/objectives: </strong>Sarcopenia in pancreatic cancer may increase the risk of chemotherapy-related toxicity and post-operative morbidity. This systematic review and meta-analysis aimed to quantify the prevalence of sarcopenia in early stage pancreatic cancer.</p><p><strong>Methods: </strong>Relevant studies were identified using Ovid Medline and Elsevier Embase. Pooled estimates of prevalence rates (percentages) and corresponding 95% confidence interval (CI) were computed using a random-effects model to allow for heterogeneity between studies.</p><p><strong>Results: </strong>The majority of the 33 studies (n = 5,593 patients) included in this meta-analysis utilized computed tomography (CT)-derived measures for body composition assessment in patients undergoing pancreatic resection. Reported prevalence of sarcopenia varied between 14 and 74%, and the pooled prevalence was 39% (95% CI: 38-40%) Heterogeneity was considerable, however, (I2 = 93%) and did not improve significantly when controlling for assessment method, and use of pre-defined cut-offs for sarcopenia, limiting potential to evaluate the true impact of sarcopenia.</p><p><strong>Conclusion: </strong>The ready availability of sequential CT offers a valuable opportunity for body composition assessment, but the quality of assessment and interpretation must improve before the impact of body composition on treatment-related outcomes and survival can be assessed. We suggest recommendations for the assessment of body composition for the design of future studies.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 4","pages":"141-152"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter to the Editor \"Re: Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery\".","authors":"Naru Kondo","doi":"10.1159/000527660","DOIUrl":"10.1159/000527660","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 5-6","pages":"274-275"},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10198394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}