Journal of Gastrointestinal Surgery最新文献

{"title":"Prognostic Impact of the Advanced Lung Cancer Inflammation Index (ALI) in Patients Aged ≥80 Years Undergoing Gastrectomy for Gastric Cancer.","authors":"Yuta Marunaka, Hiroyuki Inoue, Takeshi Kubota, Toshiyuki Kosuga, Keiji Nishibeppu, Kazuya Takabatake, Atsushi Shiozaki","doi":"10.1016/j.gassur.2026.102610","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102610","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102610"},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024919","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":"Outcomes of Patients with ≥ 8mm Indeterminate Pulmonary Nodules at the Time of Liver Resection for Metastatic Colorectal Cancer.","authors":"H Catherine Wilbur, Heng-Chung Kung, Reena Suresh, Thanh Nguyen, Javad Azadi, Marco Dal Molin, Andrea Bafford, Katherine Bever, Dung Le, Ross Donehower, Daniel Laheru, Christopher Shubert, Kelly Lafaro, Eric S Christenson","doi":"10.1016/j.gassur.2026.102592","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102592","url":null,"abstract":"<p><strong>Background: </strong>The significance of indeterminate pulmonary nodules (IPNs) at the time of definitive surgical resection of colorectal liver metastases (CRLM) is not well understood. We examined how the presence of IPNs at the time of resection of liver metastases impacts clinical outcomes and identified predictive factors for the development of pulmonary metastases.</p><p><strong>Methods: </strong>Adult patients with CRLM who underwent curative intent liver resection between 1/2005 and 12/2022 were retrospectively identified and included if an IPN was present pre-operatively. Overall survival and time to pulmonary metastasis were analyzed using Kaplan-Meier; univariate/multivariate Cox regression identified predictive factors.</p><p><strong>Results: </strong>Of the 517 patients who underwent surgical resection of CRLM, 36 (7%) had IPNs. The median overall survival for patients with IPNs was 52.5 month compared to 62.7 months for those without IPNs (p = 0.0072). Of the 31 patients with IPNs with long-term follow-up, 13 (42%) developed pulmonary metastases from an IPN. No significant differences in baseline characteristics were observed between patients whose IPNs progressed to pulmonary metastasis. There were non-significant trends toward higher rates of left-sided primary tumors, metachronous presentation, bilobar and larger-volume hepatic disease (≥5cm), and spiculated pulmonary nodules in the cohort whose IPNs later progressed to pulmonary metastases.</p><p><strong>Conclusions: </strong>Patients with IPNs detected prior to CRLM resection had a shortened overall survival. However, presence of IPNs alone should not exclude patients from curative surgery, as outcomes remain excellent.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102592"},"PeriodicalIF":2.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990232","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":"Integrated Preoperative Diagnostic and Pathological Evaluation for Sentinel Node Navigation Surgery in Early Gastric Cancer: Early Experience from the FLECSS Trial.","authors":"Rui Xu, Zimeng Wang, Zhi Zheng, Danyang Yin, Yueyang Jian, Yu Zhao, Lei Niu, Jie Yin, Xiaoye Liu, Jun Cai, Xiujing Sun, Shengtao Zhu, Guangyong Chen, Peng Li, Jun Zhang, Zhongtao Zhang, Shutian Zhang","doi":"10.1016/j.gassur.2026.102585","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102585","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative diagnostic and pathological evaluation are essential for sentinel node navigation surgery (SNNS) in patients with early gastric cancer (EGC). This study developed and validated a standardized integrated preoperative diagnostic and pathological evaluation protocol to assess its feasibility and diagnostic concordance.</p><p><strong>Methods: </strong>This retrospective analysis included 60 consecutive patients with cT1N0M0 EGC from the prospectively collected Fluorescence-guided Laparoscopic-Endoscopic Cooperative Sentinel Lymph Node Navigation Surgery Strategy (FLECSS) trial database between February 2024 and December 2025. All patients underwent standardized multimodal preoperative assessment using white-light endoscopy, magnifying endoscopy with image-enhanced endoscopy, endoscopic ultrasonography, and contrast-enhanced computed tomography. Intraoperative sentinel basin nodes (SBNs) and basin nodes (BNs) underwent frozen-section examination, followed by serial postoperative pathological evaluation with hematoxylin-eosin and immunohistochemical staining. Residual adipose tissue within the SLB was systematically examined to identify occult basin nodes (OBNs). Diagnostic concordance between preoperative assessment, intraoperative pathology, and final postoperative pathology was evaluated.</p><p><strong>Results: </strong>All patients successfully underwent SLB identification. Preoperative assessment demonstrated excellent agreement with postoperative pathology for tumor size (ICC=0.904), excellent agreement for histological differentiation (Kappa=0.833; accuracy, 91.7%), and substantial agreement for invasion depth (Kappa=0.667; accuracy, 83.3%). Intraoperative evaluation identified a mean of 8.2 lymph nodes per patient, whereas postoperative serial examination increased the mean nodal yield to 14.5 by detecting an additional 6.3 OBNs per patient. Four patients (6.7%) had SBN metastases detected intraoperatively and underwent immediate conversion to radical gastrectomy with D2 lymphadenectomy; one patient harbored an additional non-sentinel lymph node micrometastasis. Complete concordance was observed between intraoperative frozen-section and definitive postoperative pathological findings.</p><p><strong>Conclusion: </strong>An integrated workflow combining multimodal preoperative assessment with standardized pathological evaluation of the SLB is feasible and demonstrated high diagnostic concordance in patients undergoing LECS-SNNS for EGC. Larger prospective multicenter studies with long-term follow-up are warranted to validate its oncological safety.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102585"},"PeriodicalIF":2.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944904","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":"Four Radical Bowel-Sparing Procedures for the Treatment of Small Bowel Tumors: A Retrospective Cohort Study From a Prospective Clinical Trial.","authors":"Dejan Ignjatovic, Teodor Vasic, Javier Armando Luzon, Bojan Vladimir Stimec","doi":"10.1016/j.gassur.2026.102586","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102586","url":null,"abstract":"<p><strong>Background: </strong>Bowel tumor surgery lacks standardized lymphadenectomy levels comparable to D1/D3 concepts in colorectal surgery. Wedge bowel resections compromise nodal staging, whereas extensive resection increases the risk of short bowel syndrome. Preoperative 3D-vascular reconstruction enables tailored lymphadenectomy while preserving bowel length.</p><p><strong>Purpose: </strong>To introduce and evaluate four radical bowel-sparing procedures for small bowel tumors, based on preoperative identification of tumor-feeding arteries and standardized D3-volume lymphadenectomy.</p><p><strong>Methods: </strong>Consecutive patients from the prospective trial \"Surgery with Extended Mesenterectomy for Small Bowel Tumors\" were analyzed. Patients underwent preoperative 3D vascular reconstruction to identify tumor-feeding arteries. Four procedures were defined by the tumor feeding vessel and tumor location: duodenojejunal resection, jejunal resection, ileal resection, and right colectomy/ileocaecal resection. Lymph node harvest, D3 positivity, bowel length, and short-term outcomes were analyzed.</p><p><strong>Results: </strong>Eighty-six patients were included. Tumor-feeding arteries were jejunal arteries in 15 patients, the terminal ileal artery in 50, and the ileocolic artery in 21. Duodenojejunal resection was performed in 5 patients, jejunal resection in 10, ileal resection in 34, ileocaecal resection in 6, and right colectomy in 31. Median specimen length was 31.5cm. Median lymph node harvest was 31, and median D3-lymph node harvest was 12. Positive nodes were found in 71 patients, with D3 positivity in 33. Vascular injuries occurred in 20 patients. 11 patients were reoperated. There was no 30- or 90-day mortality.</p><p><strong>Conclusions: </strong>Artery-based partitioning of the small bowel into four radical bowel-sparing procedures enables standardized D3-volume lymphadenectomy with comparable nodal yield, limited bowel resection, acceptable morbidity, and no short-term mortality.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102586"},"PeriodicalIF":2.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929793","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":"Tailored hybrid laparoscopic-endoscopic surgery for gastric subepithelial tumors: An algorithm-based comparative study with long-term outcomes.","authors":"Prasit Mahawongkajit, Worapong Anuponganan","doi":"10.1016/j.gassur.2026.102580","DOIUrl":"10.1016/j.gassur.2026.102580","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102580"},"PeriodicalIF":2.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919954","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":"Technical Performance and Clinical Utility of Indocyanine Green Thoracic Duct Lymphography During Esophagectomy: A Systematic Review and Meta-analysis.","authors":"Syed Nusrath, Devendra Ghanshyam Parikh, Rodolfo J Oviedo, Luigi Marano, Ajit Agarwal, Ashwin K R","doi":"10.1016/j.gassur.2026.102581","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102581","url":null,"abstract":"<p><strong>Background: </strong>Postoperative chylothorax is an uncommon but serious complication of esophagectomy, usually caused by thoracic duct injury. Indocyanine green (ICG) near-infrared fluorescence lymphography has been used to improve intraoperative identification of the thoracic duct. This systematic review and meta-analysis evaluated its technical performance, safety, and effect on postoperative chyle leak.</p><p><strong>Methods: </strong>Clinical studies of ICG-guided thoracic duct visualization during primary esophagectomy were included. The primary outcome was successful visualization of thoracic duct. Secondary outcomes included route-specific success, postoperative chyle leak, changes in operative management, and adverse events. Random-effects meta-analysis of proportions and risk ratios was performed. Risk of bias was assessed with ROBINS-I and the Joanna Briggs Institute checklist.</p><p><strong>Results: </strong>Sixteen studies were included. Thoracic duct visualization, a primary technical endpoint, was achieved in 656/702 patients (pooled rate 94.8%, 95% CI 87.6-97.9%; I² = 66.6%). Visualization was higher with intranodal than subcutaneous administration (98.2% vs 92.9%; subgroup p = 0.029). Across 16 cohorts, chyle leak occurred in 22/853 patients (2.58%). In five comparative studies, ICG did not significantly reduce chyle leak (RR 0.61, 95% CI 0.21-1.80; p = 0.277) or reintervention (RR 0.97, 95% CI 0.36-2.65; p = 0.94). No clinically significant adverse events occurred in 653 patients; comparative studies had serious risk of bias.</p><p><strong>Conclusions: </strong>ICG fluorescence lymphography provides highly reliable intraoperative visualization of the thoracic duct and appears safe. However, visualization represents a technical rather than patient-important clinical endpoint, and the available evidence does not demonstrate a reduction in postoperative chyle leak or reintervention. ICG should therefore be regarded as an anatomical-navigation tool whose clinical effectiveness remains to be established in adequately powered prospective comparative studies.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102581"},"PeriodicalIF":2.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905995","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":"Letter to Editor regarding: \"Development and validation of a machine-learning model for preoperative risk of gastric gastrointestinal stromal tumors\".","authors":"Srinivasa Naveen Kumar G, Vsk Reddy, Leela Kumari Balivada","doi":"10.1016/j.gassur.2026.102573","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102573","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102573"},"PeriodicalIF":2.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865390","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":"Effects of a whole-course individualized comprehensive nursing program on anastomotic leakage incidence and patient outcomes after esophageal cancer surgery","authors":"Li-Hua Yan,&nbsp;Yan Li,&nbsp;Min Zhang,&nbsp;Yu Lu,&nbsp;Li-Yun Ben,&nbsp;Yi-Ming Xu","doi":"10.1016/j.gassur.2026.102386","DOIUrl":"10.1016/j.gassur.2026.102386","url":null,"abstract":"<div><h3>Background</h3><div>To explore the effect of the whole individualized comprehensive nursing program on the incidence of anastomotic leakage and prognosis of patients after esophageal cancer surgery.</div></div><div><h3>Methods</h3><div>A total of 120 patients who planned to undergo radical resection of esophageal cancer between March 2022 and March 2025 were randomly divided into an experimental group (n = 60) and a control group (n = 60). The experimental group received whole-course individualized comprehensive nursing, including preoperative nutritional risk screening and intervention, precise management of basic diseases, psychological intervention, perioperative preparation under the concept of enhanced recovery after surgery, postoperative fistula targeted nursing, multichannel fine management, and complication prevention. The control group received routine nursing. The incidence of anastomotic leakage, healing time, hospitalization days, medical expenses, total incidence of postoperative complications, short form (SF)-36 quality of life score, and nursing satisfaction were compared between the 2 groups.</div></div><div><h3>Results</h3><div>The incidence of anastomotic leakage in the experimental group (3.33%) was significantly lower than that in the control group (11.67%). The healing time of fistula and length of hospital stay in the experimental group were shorter than those in the control group, and the medical cost was lower than that in the control group (<em>P</em> &lt;.05). The total incidence of postoperative complications in the experimental group (8.33%) was lower than that in the control group (20.00%), and the physical health general score, mental health general score, and nursing satisfaction score on the SF-36 scale at 1 month after operation were significantly higher than those in the control group (<em>P</em> &lt;.05).</div></div><div><h3>Conclusion</h3><div>The whole course individualized comprehensive nursing program can effectively reduce the incidence of anastomotic leakage after esophageal cancer surgery, reduce the risk of complications, and improve the quality of life of patients after surgery; this has important clinical application value.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 7","pages":"Article 102386"},"PeriodicalIF":2.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493893","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":"The impact of the microbiome on colorectal cancer recurrence after resection","authors":"Nicholas R. Suss,&nbsp;Bidisha Barat,&nbsp;Mohsen Rouhani Ravari,&nbsp;Benjamin D. Shogan","doi":"10.1016/j.gassur.2026.102360","DOIUrl":"10.1016/j.gassur.2026.102360","url":null,"abstract":"<div><div>Surgical resection of a colorectal adenocarcinoma remains a cornerstone in its treatment. However, despite proper patient selection and neoadjuvant and/or adjuvant chemotherapy/radiation, up to 30% of patients thought to be cured will develop a postoperative recurrence. Unfortunately, the outcomes in patients who develop a postoperative recurrence are poor and are associated with high morbidity and mortality. The gut microbiome has emerged to play a role in virtually all aspects of human health. In this manuscript, we critically examine the current literature implicating the gut microbiome’s role in the pathogenesis of postoperative recurrence after attempted curative resection. We discuss how microbes can drive a more advanced stage and explore how surgery itself can precipitate a gut microenvironment with tumorigenic bacteria and bacterial-derived metabolites that can drive postoperative tumor formation. Finally, we review evidence as to how the gut microbiome can be manipulated to improve oncological outcomes.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 7","pages":"Article 102360"},"PeriodicalIF":2.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132010","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":"Postsurgical circulating tumor DNA as a prognostic biomarker for relapse of resected pancreatic ductal adenocarcinoma","authors":"Matthew Z. Guo ,&nbsp;Apoorvaa S. Sachidanand ,&nbsp;Thanh Nguyen ,&nbsp;Sagar D. Patel ,&nbsp;William R. Burns ,&nbsp;Richard Burkhart ,&nbsp;Dung T. Le ,&nbsp;Kelly Lafaro ,&nbsp;Katherine M. Bever ,&nbsp;Michael J. Pishvaian ,&nbsp;Christopher Shubert ,&nbsp;Daniel Laheru ,&nbsp;Elizabeth Jaffee ,&nbsp;Eric S. Christenson ,&nbsp;Jin He","doi":"10.1016/j.gassur.2026.102359","DOIUrl":"10.1016/j.gassur.2026.102359","url":null,"abstract":"<div><h3>Background</h3><div>Circulating tumor DNA (ctDNA) has been used to diagnose and monitor response to therapy in the setting of advanced pancreatic ductal adenocarcinoma (PDAC), but its utility in the adjuvant setting to monitor for relapse after curative resection is less understood.</div></div><div><h3>Methods</h3><div>In this single-institution, retrospective study, we evaluated the use of ctDNA during the postoperative window (within 90 days from surgical resection and 30 days from the start of adjuvant therapy) and subsequent adjuvant/surveillance window (after the postoperative window) as prognostic biomarkers for relapse. We compared demographic and clinical characteristics among patients with radiographic disease relapse based on ctDNA positivity.</div></div><div><h3>Results</h3><div>We identified 51 patients with PDAC who underwent curative-intent surgical resection between 2013 and 2024 and completed postoperative ctDNA testing. Median follow-up was 635 days, and 28 patients (54.9%) experienced disease relapse. ctDNA during the postoperative window had a sensitivity of 35.7% and specificity of 88.9% for prognosticating disease relapse after resection, with a positive predictive value (PPV) of 79.6% and negative predictive value (NPV) of 53.2%. ctDNA during the adjuvant/surveillance window had a sensitivity of 62.5%, specificity of 95.5%, PPV of 94.4%, and NPV of 67.7%. Patients with disease relapse as liver metastases had the highest rate of ctNA positivity (n = 10 of 12; 83.3%), followed by resection bed recurrence (n = 4 of 7; 57.1%) and nonliver distant metastatic recurrence (n = 4 of 9; 44.4%).</div></div><div><h3>Conclusion</h3><div>Positive ctDNA is a strong prognostic factor for relapse after resection for PDAC; however, ctDNA testing lacks sensitivity to replace conventional surveillance testing in patients with resected PDAC.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102359"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125280","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}