Annals of Gastroenterological Surgery最新文献

{"title":"New National Network of Experts (Japan Pelvic Exenteration Network: J-PEN) Formed in a Bid to Improve Outcomes of Pelvic Exenteration in Japan","authors":"Hideaki Yano,&nbsp;Alex Mirnezami,&nbsp;Masataka Ikeda,&nbsp;Kay Uehara,&nbsp;Shuichiro Matoba,&nbsp;Yuichiro Tsukada,&nbsp;Toshiki Mukai,&nbsp;Kei Kimura,&nbsp;Yudai Fukui,&nbsp;Naoyuki Toyota","doi":"10.1002/ags3.70050","DOIUrl":"https://doi.org/10.1002/ags3.70050","url":null,"abstract":"<p>Pelvic exenteration (PE) is a radical and extreme surgical procedure for <i>en bloc</i> removal of pelvic organs and tissues contiguously involved by cancer. PE has long been the mainstay, and often the only option to potentially provide cure, or long term control, in the management of patients with locally advanced and recurrent abdomino-pelvic malignancies. The concept focusses on attaining an R0 cancer resection margin (most commonly defined as ≥ 1 mm), by surgically removing margin-involved or margin-threatened organs and structures, as this is consistently demonstrated as the most important predictor of outcome [<span>1</span>]. Naturally, however, such radicality comes with significant risks of complications; of loss of function and quality of life; as well as substantial healthcare resource utilisation and health economic impact. Consequently, the deployment of PE as a surgical solution has in the past been correctly cautious, but at times also overly pessimistic, informed by historically poor outcomes.</p><p>In more recent times, the PE landscape has undergone a paradigm shift. Incremental developments in multiple disciplines have helped pave the way for substantially improved outcomes in carefully selected patients. These include but are not limited to advances in diagnostic radiology; oncology; anaesthesia and peri-operative medicine; intensive care; surgical devices and techniques; understanding of the pelvic anatomy; management and control of haemorrhage; reconstructive options; and interventional radiology [<span>2</span>]. As a result, the field of PE has evolved, with broadening indications and applications, and greater radicality, manifested by the fact that pelvic bones are increasingly resected as one of the most outermost tissues in a margin of concern, and reflecting the “higher and wider” approaches achievable [<span>3</span>].</p><p>The increasing application of PE has also emphasised some of the glaring unmet needs in the field. Examples of these are highlighted below but are not exhaustive. A lack of standardisation and differing protocols in MRI imaging techniques is one such unmet need. Poorly designed multidisciplinary team (MDT) models for the discussion of some of the most complex and heavily pre-treated patients an MDT may receive is another such unmet need. A further concern has been in the use of surgical terminology. Contemporary PE represents an umbrella term that in the modern era encompasses a diversity of resections, and to date a confusing array of terminology has been used to describe the different surgical interventions possible. Pathological handling of specimens, for example the method of specimen orientation and marking, the number of sections taken, and management of specimens with bone, is a further area of unmet need requiring a standardisation of reporting and minimum pathological datasets. Nevertheless to date no formal international system has been described. Importantly, as a result of the lack","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"880-882"},"PeriodicalIF":3.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Stage Treatment for Adult Large Patent Ductus Venosus","authors":"Shohei Kudo,&nbsp;Shiro Onozawa,&nbsp;Ryosuke Miyauchi,&nbsp;Ryota Matsuki,&nbsp;Yoshihiro Sakamoto","doi":"10.1002/ags3.70043","DOIUrl":"https://doi.org/10.1002/ags3.70043","url":null,"abstract":"<p>Patent ductus venosus is a congenital portosystemic shunt that may cause progressive portal hypertension, hepatic encephalopathy, and focal nodular hyperplasia of the liver. Embolization of the Arantius' duct is the first choice of treatment in infants and children. However, it carries the risk of coil migration into the systemic circulation in adult patients with larger Arantius ducts. Additionally, the primary closure of the Arantius' duct may result in acute portal hypertension. Herein, we present a two-stage treatment for adult patent large ductus venosus (Arantius' duct). A 23-year-old female patient with hypoalbuminemia showed a patent large Arantius' duct (diameter = 45 mm), intrahepatic portal venous hypoplasia, and multiple hepatic nodules with dynamic computed tomography (CT). Preoperative angiography showed the absence of the intrahepatic portal vein, and tentative occlusion of the Arantius' duct increased the portal pressure from 9 to 15 mmHg with visualization of only a few portal branches. Therefore, we conducted a two-stage treatment for the Arantius' duct. In the first stage, we used an open approach to perform angioplasty of the Arantius' duct to reduce the size from 45 to 8 mm in diameter, which gradually increased the intrahepatic portal blood flow in the follow-up CT scan. The second-stage embolization of the Arantius' duct was performed using an interventional procedure via the internal jugular vein 4 months after the first stage. The patient's recovery was uneventful, and post-treatment CT showed increased intrahepatic portal flow. Serum albumin value increased from 2.7 to 3.7 g/dL 2 weeks post-treatment.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1104-1108"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Economic Insights Into Surgery for Colonic Diverticular Perforation: A Long-Term Observational Cohort Study","authors":"Minoru Fujita,&nbsp;Noriaki Manabe,&nbsp;Munenori Takaoka,&nbsp;Masaharu Higashida,&nbsp;Hideo Matsumoto,&nbsp;Atsushi Urakami,&nbsp;Tomoki Yamatsuji,&nbsp;Tomio Ueno,&nbsp;Jiro Hata,&nbsp;Ken Haruma,&nbsp;Collaborators","doi":"10.1002/ags3.70033","DOIUrl":"https://doi.org/10.1002/ags3.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The clinical characteristics of colonic diverticular perforation are poorly understood. We aimed to clarify the clinical characteristics of colonic diverticular perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent surgery for colonic diverticular perforation from 2011 to 2021 were retrospectively evaluated. The patients were divided into right- and left-sided colon cohorts according to their perforation location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1129 patients with gastrointestinal perforation, 138 had colonic diverticular perforation. The sigmoid colon was the most common perforation site. The patients were categorized into right-sided (20 patients) and left-sided (118 patients) colon cohorts. The number of patients with colonic diverticular perforation increased with age, as did the proportion of left-sided perforations. The left-sided cohort had significantly higher mean age, hemoglobin, and serum albumin levels than the right-sided cohort. The blood urea nitrogen and serum creatinine levels were significantly lower in the right-sided cohort. The proportion of patients with colostomy, the proportion of patients with postoperative complications, and the length of intensive care unit stay during hospitalization were significantly longer in the left-sided cohort. The left-sided cohort also had a considerably longer mean hospital stay and higher mean hospitalization costs than the right-sided colon cohort. An age of ≥ 75 years tended to be associated with a prolonged hospital stay and high hospitalization costs in the left-sided colon cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The patients' conditions, length of hospital stay, and hospitalization costs were significantly worse in the left- than right-sided colon cohort. The clinical characteristics differed according to the location of the diverticular perforation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1036-1046"},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Super Subtotal Gastrectomy: A Novel Reconstruction Concept for Upper Gastric Cancer That Preserves the Fornix","authors":"Kohei Fujita,&nbsp;Hiroyuki Sagawa,&nbsp;Sunao Ito,&nbsp;Ryo Ogawa,&nbsp;Shuji Takiguchi","doi":"10.1002/ags3.70030","DOIUrl":"https://doi.org/10.1002/ags3.70030","url":null,"abstract":"<p>The incidence of upper-third gastric cancer is rising, necessitating proximal gastrectomy or total gastrectomy in most patients. However, surgical removal of the fornix, a major site for ghrelin secretion, often results in reduced appetite and weight loss post-surgery. To address this issue, we devised a resection approach aimed at preserving ghrelin secretory sites. Here, we introduce a novel technique for treating upper-third gastric cancer near the esophagogastric junction: super subtotal gastrectomy (SSTG). During distal gastrectomy assisted by robotics, lymph node dissection was performed. Endoscopic confirmation of the tumor site guided the design of the gastrectomy line. Using a linear stapler, the stomach was dissected from the greater curvature fold to the angle of His. The specimen was then extracted through a precise incision from the angle of His to the right side of the esophagus, partially resecting the esophagogastric junction. Suturing of the open lumens of the esophagus and stomach was performed to repair the remaining stomach. Closure of the diaphragmatic crus prevented esophageal hiatal hernia. Reconstruction was achieved through Roux-en-Y reconstruction. SSTG offers the advantage of maintaining an oral margin beyond the esophageal junction while preserving the fornix. In the SSTG group, the median operative time was 333 min (range: 257–354), with a blood loss of 79.5 mL (range: 20–141). No serious intraoperative complications were observed. Our proposed SSTG technique enables the preservation of the fornix even in cases of upper-third gastric cancer located closer to the esophagogastric junction than was previously possible.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"870-875"},"PeriodicalIF":2.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma","authors":"Yuichi Goto,&nbsp;Yutaro Mihara,&nbsp;Takashi Niizeki,&nbsp;Hisamune Sakai,&nbsp;Sachiko Ogasawara,&nbsp;Jun Akiba,&nbsp;Hirohisa Yano,&nbsp;Takumi Kawaguchi,&nbsp;Fumihiko Fujita,&nbsp;Toru Hisaka","doi":"10.1002/ags3.70034","DOIUrl":"https://doi.org/10.1002/ags3.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (<i>p</i> = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1075-1085"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A history of gastrectomy is a risk factor for choledocholithiasis in patients undergoing cholecystectomy: A single center retrospective study","authors":"Yuki Matsui,&nbsp;Daisuke Hashimoto,&nbsp;So Yamaki,&nbsp;Kazuki Matsumura,&nbsp;Hidetaka Miyazaki,&nbsp;Yuji Ikeda,&nbsp;Denys Tsybulskyi,&nbsp;Thanh Sang Nguyen,&nbsp;Sohei Satoi","doi":"10.1002/ags3.70008","DOIUrl":"https://doi.org/10.1002/ags3.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The incidence of cholelithiasis after gastrectomy is higher than that in the general population; however, the incidence and risk factors for choledocholithiasis have not been well reported. We aimed to assess the association between a history of gastrectomy and choledocholithiasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 3025 patients who underwent cholecystectomy with or without choledocholithotomy between January 2006 and December 2020 at Kansai Medical University, Japan were included in this study. Patients were divided into a gastrectomy group with a history of gastrectomy (173 patients, 5.7%) and a control group having no history of gastrectomy (2852 patients, 94.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of choledocholithiasis was 61.8% and 22.2% in the gastrectomy and control groups, respectively, with a significantly higher incidence in the gastrectomy group (<i>p</i> &lt; 0.0001). Multivariate analysis showed that age, sex, history of gastrectomy, and previous surgery except gastrectomy were risk factors for the development of choledocholithiasis, with a history of gastrectomy being the strongest risk factor (Odds Ratio 3.78, 95% Confidence Interval 2.71–5.27). The incidence values of choledocholithiasis in the Billroth I, Billroth II, and Roux-en-Y methods were 44.7%, 70.6%, and 69.7%, respectively, and were significantly lower in the Billroth I group than in the Roux-en-Y group (<i>p</i> = 0.009). The median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux-en-Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gastrectomy is a known risk factor for choledocholithiasis. Concomitant cholecystectomy during gastrectomy may be indicated in older men.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1047-1054"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Facility Size on Perioperative Outcomes in Minimally Invasive Esophagectomy for 14 152 Patients With Esophageal Cancer Based on the Japanese National Clinical Database: A Multicenter Cohort Study","authors":"Taro Oshikiri,&nbsp;Hisateru Tachimori,&nbsp;Hiroaki Miyata,&nbsp;Yoshihiro Kakeji,&nbsp;Ken Shirabe","doi":"10.1002/ags3.70027","DOIUrl":"https://doi.org/10.1002/ags3.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conventional minimally invasive esophagectomy (C-MIE) is the mainstay for locally advanced esophageal cancer. However, the relationship among facility size, risk-adjusted mortality and morbidity in C-MIE remains unclear. This study aims to clarify whether C-MIE should be consolidated into high-volume centers in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Risk models for perioperative mortality and morbidity were created using the Japanese National Clinical Database (NCD) data. NCD data registered between January 2016 and December 2020, including 14 152 C-MIE records. The developed risk models were used to estimate the ratio of expected to observed events (perioperative deaths or complications) (O/E ratio) for each facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Regarding the risk model performances, the C-indices of the perioperative mortality risk prediction models were 0.793. The O/E ratio and 95% confidence interval (CI) for perioperative mortality were facility size &lt; 10 MIEs/year, O/E ratio: 1.368 and 95% CI: 1.140–1.597; facility size 10–29 MIEs/year, O/E ratio: 0.886 and 95% CI: 0.644–1.127; and facility size ≥ 30 MIEs/year, O/E ratio: 0. 61 and 95% CI: 0.342–0.892. Conversely, there were no significant differences in morbidity rate by facility size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of perioperative mortality from C-MIE was lower in hospitals with larger facilities than those with smaller facilities; therefore, consolidating patients for C-MIE in high-volume hospitals is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"942-951"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive genetic analysis of poorly differentiated gastric cancer in young females","authors":"Nobuhiro Nakazawa,&nbsp;Takehiko Yokobori,&nbsp;Yohei Morishita,&nbsp;Akinobu Echigo,&nbsp;Reika Kawabata-Iwakawa,&nbsp;Akiharu Kimura,&nbsp;Akihiko Sano,&nbsp;Makoto Sakai,&nbsp;Ken Shirabe,&nbsp;Hiroshi Saeki","doi":"10.1002/ags3.70020","DOIUrl":"https://doi.org/10.1002/ags3.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The reasons behind the high prevalence of poorly differentiated gastric cancer in young females remain unclear. Therefore, this study aimed to conduct a comprehensive genetic analysis to investigate the factors responsible for the high prevalence of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 299 patients who underwent gastric cancer surgery at the Gunma University Hospital between April 2015 and December 2020. Among them, we selected cases of poorly differentiated gastric cancer in females, differentiated gastric cancer in females, and poorly differentiated gastric cancer in males, aged 30–50 years. Three eligible cases of each condition were found and included in the study. RNA was isolated from dissected formalin-fixed, paraffin-embedded tissue samples, followed by RNA sequencing. The results were analyzed using ingenuity pathway analysis to elucidate the mechanisms contributing to the high incidence of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Dexamethasone, β-estradiol, and interleukin-1β were identified as significant upstream regulators associated with poorly differentiated gastric cancer in young females. The downstream target genes of β-estradiol included male germ cell-associated kinase, growth differentiation factor 6, endothelin 2, and collagen type XI alpha 1 chain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our detailed RNA-seq analysis revealed that the female sex hormone, β-estradiol, plays a role in the development of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"926-932"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Outcomes of Esophageal Squamous Cell Carcinoma Patients Who Underwent Salvage Esophagectomy: A Literature Review and Results From Two High-Volume Centers","authors":"Kotaro Sugawara,&nbsp;Koichi Yagi,&nbsp;Takashi Fukuda,&nbsp;Shoh Yajima,&nbsp;Daiji Oka,&nbsp;Yoshiyuki Miwa,&nbsp;Shuichiro Oya,&nbsp;Asami Okamoto,&nbsp;Raito Asaoka,&nbsp;Yoshifumi Baba","doi":"10.1002/ags3.70028","DOIUrl":"https://doi.org/10.1002/ags3.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to investigate survival outcomes, the efficacy of lymph node (LN) dissection, and recurrence patterns in patients who underwent salvage surgery (SALV) for esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 69 patients with clinical stage I–IV thoracic ESCC who underwent SALV. Recurrence patterns and the distribution of LN metastases were analyzed according to the primary tumor location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 90-day mortality rate was 2.9%, and the 3-year overall survival (OS) rate of the 69 patients was 47.1%. OS curves were significantly stratified by the presence of abdominal LN metastases (<i>p</i> = 0.007). Among six patients whose clinically positive LNs were not dissected because their swelling disappeared after dCRT (cN+/CRT-cN0 cases), two (33.3%) developed locoregional recurrence. In contrast, among 25 patients whose clinically positive LNs were dissected regardless of CRT-cN status, the incidence of locoregional recurrence alone was 4.0%. Patients with lower thoracic (Lt) tumors had a higher incidence of distant metastases than those with middle (Mt) or upper thoracic (Ut) tumors (61.5% vs. 36.8%/33.3%). Mediastinal LN metastases were rare (7.7%) in Lt tumors, whereas LN metastases were widely distributed within the regional zones in Mt/Ut tumors. Patients with Lt tumors and pathological LN metastases had extremely poor OS (3-year OS: 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Abdominal LN metastases had a negative impact on survival in ESCC patients who underwent SALV. Clinically positive LNs should be dissected, provided it is technically feasible. The tumor location might influence the distribution and prognostic impact of pathological LN metastases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"952-963"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Kyphosis and Postoperative Gastroesophageal Reflux After Proximal Gastrectomy","authors":"Takaomi Ozawa,&nbsp;Suguru Maruyama,&nbsp;Katsutoshi Shoda,&nbsp;Yoshihiko Kawaguchi,&nbsp;Ryo Saito,&nbsp;Kensuke Shiraishi,&nbsp;Shinji Furuya,&nbsp;Hidetake Amemiya,&nbsp;Hiromichi Kawaida,&nbsp;Daisuke Ichikawa","doi":"10.1002/ags3.70032","DOIUrl":"https://doi.org/10.1002/ags3.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The prevalence of kyphosis is increasing with increasing life expectancy. One of the most notable gastrointestinal complications is gastroesophageal reflux disease (GERD) in patients with kyphosis. In this study, we investigated the association between kyphosis and the incidence of postoperative GERD in patients who underwent proximal gastrectomy (PG), a procedure with a particularly high risk of GERD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 54 consecutive patients who underwent PG between 2009 and 2023 met the inclusion criteria. The thoracic/lumbar angle ratio (T/L ratio) derived from sagittal computed tomography was performed to preoperatively assess kyphosis, defined as a T/L ratio ≥ 1.25.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients (27.8%) had kyphosis. Overall, postoperative GERD occurred in seven patients (13.0%). Preoperative albumin levels were significantly lower in the Kyphosis group than in the Normal group (<i>p</i> = 0.03), whereas other clinical characteristics showed no significant differences between the two groups. The incidence of postoperative GERD was significantly higher in the Kyphosis group than in the Normal group (33.3% vs. 5.1%, <i>p</i> = 0.01). Postoperative reflux symptoms also were more frequently observed in the Kyphosis group than in the Normal group (60.0% vs. 16.0%, <i>p</i> = 0.13). Kyphosis was one of the independent predictive factors for postoperative GERD (Odds ratio, 18.7; 95% confidence interval, 1.46–240; <i>p</i> = 0.02) in the multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Kyphosis was significantly associated with the occurrence of postoperative GERD in patients who underwent PG. Alternative preventive measures may be considered when patients with kyphosis undergo PG.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"964-970"},"PeriodicalIF":3.3,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}