Annals of Gastroenterological Surgery最新文献

{"title":"Safety and Feasibility of Laparoscopic and Endoscopic Cooperative Surgery With Endoscopic Submucosal Dissection for Large Superficial Non-Ampullary Duodenal Epithelial Tumors","authors":"Masaru Hayami,&nbsp;Shoichi Yoshimizu,&nbsp;Naoki Miyazaki,&nbsp;Shintaro Yamamoto,&nbsp;Hiroyuki Yamamoto,&nbsp;Motonari Ri,&nbsp;Rie Makuuchi,&nbsp;Tomoyuki Irino,&nbsp;Manabu Takamatsu,&nbsp;Souya Nunobe","doi":"10.1002/ags3.70124","DOIUrl":"10.1002/ags3.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection (ESD) for large superficial non-ampullary duodenal epithelial tumors (SNADETs) poses substantial technical challenges, primarily because of a heightened risk of adverse events (AEs). Laparoscopic and endoscopic cooperative surgery (D-LECS) was introduced to address these risks, with recent advancements extending its application to larger tumors, including those on the pancreatic side of the duodenum. This study evaluated the safety and feasibility of D-LECS combined with ESD and seromuscular reinforcement for large SNADETs (≥ 30 mm).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included patients diagnosed with SNADETs who underwent D-LECS with ESD from October 2013 to October 2023. The primary outcome was the incidence of AEs graded Clavien–Dindo II or higher. Secondary outcomes included delayed perforation, delayed bleeding, delayed gastric emptying, stenosis, intra-abdominal fluid collection, and rates of <i>en-bloc</i> and R0 resection. Analyses focused on outcomes by tumor size and location, particularly pancreatic-side lesions requiring duodenal dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients were analyzed: 19 with tumors ≥ 30 mm, 31 with tumors &lt; 30 mm, and 21 requiring pancreatic-side dissection. Primary AE incidence was 6.5% (95% CI: 1.8–20.7) for tumors &lt; 30 mm, 5.3% (95% CI: 0.9–24.6) for tumors ≥ 30 mm, 6.9% (95% CI: 1.9–22.0) without pancreatic-side dissection, and 4.8% (95% CI: 0.8–22.7) with pancreatic-side dissection. Secondary outcomes indicated no increased risk from tumor size or pancreatic-side dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>D-LECS with ESD and seromuscular reinforcement represents a safe and feasible strategy for large SNADETs, including pancreatic-side lesions, with minimal AE rates, supporting its broader application.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"460-469"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375604","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":"Exercise and Nutrition Prehabilitation Program During Preoperative Chemotherapy Followed by Esophagectomy in Older Patients With Esophageal Cancer: A Randomized Clinical Trial","authors":"Keijiro Sugimura,&nbsp;Takashi Kanemura,&nbsp;Tomohira Takeoka,&nbsp;Takahito Sugase,&nbsp;Norihiro Matsuura,&nbsp;Kazuyoshi Yamamoto,&nbsp;Masahiko Yano,&nbsp;Hiroshi Miyata","doi":"10.1002/ags3.70127","DOIUrl":"10.1002/ags3.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We conducted a single-center randomized prospective phase 2 trial to investigate whether exercise alone or prehabilitation intervention, including exercise and nutrition, is effective in increasing skeletal muscle mass during neoadjuvant chemotherapy for elderly esophageal cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥ 60 years scheduled for preoperative chemotherapy followed by esophagectomy were randomized into three groups: Group A (no intervention), Group B (exercise-only), and Group C (exercise plus nutritional intervention). Interventions occurred before treatment and surgery. The primary outcome was changes in skeletal muscle mass during chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 99 patients enrolled, 88 were analyzed: 31 in Group A, 26 in Group B, and 31 in Group C. The skeletal muscle mass decreased by 1.1% in Group A, increased by 0.9% in Group B, and increased by 1.7% in Group C. The change in skeletal muscle mass in Group C was significantly higher than that in Group A (<i>p</i> = 0.013). The change in skeletal muscle mass in Group B tended to be higher than Group A, but the difference did not reach significance (<i>p</i> = 0.140) Group C showed a greater increase in body weight, skeletal muscle mass index, and gait speed than Group A (<i>p</i> = 0.014, <i>p</i> = 0.044, and <i>p</i> = 0.031, respectively). In Group B, skeletal muscle mass and skeletal muscle index tended to increase, but did not reach statistical significance compared to Group A (<i>p</i> = 0.140, <i>p</i> = 0.096).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prehabilitation, including nutrition and exercise, is effective in increasing skeletal muscle mass during neoadjuvant chemotherapy for older patients with esophageal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Japan Registry of Clinical Trials: jRCT s051190016</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"470-482"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375981","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":"Risk Factors for Anastomotic Stricture and Obstructive Symptoms Following Double-Flap Technique Reconstruction After Proximal Gastrectomy","authors":"Shinji Kuroda,&nbsp;Yoshihiko Kakiuchi,&nbsp;Satoru Kikuchi,&nbsp;Hajime Kashima,&nbsp;Nobuhiko Kanaya,&nbsp;Shunya Hanzawa,&nbsp;Kenjiro Kumano,&nbsp;Masahiko Nishizaki,&nbsp;Shunsuke Kagawa,&nbsp;Toshiyoshi Fujiwara","doi":"10.1002/ags3.70130","DOIUrl":"10.1002/ags3.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The double-flap technique (DFT) is a widely used esophagogastrostomy method after proximal gastrectomy (PG) due to its strong anti-reflux mechanism. However, anastomotic stricture remains a major concern, leading to obstructive symptoms and impaired postoperative quality of life (QOL). This study aimed to identify risk factors for anastomotic stricture and obstructive symptoms after PG with DFT reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study analyzed 77 patients who underwent DFT reconstruction between 2014 and 2022. The impact of technical factors, including suturing methods and mucosal detachment, was evaluated. In addition, intraluminal pressure analysis was performed using ex vivo pig stomach models to assess sites contributing to obstructive symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Anastomotic stricture requiring balloon dilatation occurred in 10 patients (13%), with mucosal detachment of the esophagus identified as an independent risk factor (odds ratio [OR]: 48, 95% confidence interval [CI]: 4.47–515, <i>p</i> = 0.001). Thermal damage during esophageal transection was a potential risk factor for mucosal detachment (OR: 6.63, 95% CI: 1.00–44.1, <i>p</i> = 0.051). Moderate or severe obstructive symptoms 1 month after surgery were reported by 59% of patients, with continuous suturing for esophago-stomach fixation (E-S fixation) increasing the risk (OR: 4.50, 95% CI: 0.98–20.7, <i>p</i> = 0.054). Intraluminal pressure analysis confirmed that continuous suturing at the E-S fixation site significantly increased pressure compared with interrupted suturing (<i>p</i> = 0.028).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preventing mucosal detachment by minimizing thermal damage can reduce anastomotic stricture. Further, interrupted suturing at the E-S fixation site may reduce obstructive symptoms. These findings provide insights into optimizing DFT reconstruction to improve postoperative outcomes and patient QOL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"483-491"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375628","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":"Time-Dependent Recovery of Gastric Emptying After Gastrectomy: A 12-Month Longitudinal Study Using a 13C-Acetate Breath Test With a Semi-Solid Meal","authors":"Sachiko Kaida,&nbsp;Katsushi Takebayashi,&nbsp;Mika Kurihara,&nbsp;Reiko Otake,&nbsp;Haruki Mori,&nbsp;Hiromitsu Maehira,&nbsp;Toru Miyake,&nbsp;Shigeki Bamba,&nbsp;Masaji Tani","doi":"10.1002/ags3.70106","DOIUrl":"10.1002/ags3.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Gastric emptying dysfunction is a major concern after gastrectomy for gastric cancer; however, its long-term course and relationship with surgical procedures remain unclear. This study aimed to evaluate gastric emptying function longitudinally over 12 months postoperatively using the ¹³C-acetate breath test with a semi-solid meal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort of 95 patients who underwent curative gastrectomy for gastric cancer between April 2021 and July 2024 was assessed. A novel semi-solid test meal, integrated with a ¹³C-acetate breath test, was used to evaluate patients' gastric emptying function. Gastric emptying half-time (T1/2) was measured preoperatively and at 1, 6, and 12 months postoperatively. Patients were stratified according to surgical procedure and reconstruction method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median T1/2 was 42.0 min preoperatively, delayed to 45.9 min at 1 month, and then significantly decreased to 23.4 min at 6 months and 18.7 min at 12 months postoperatively. In distal gastrectomy with Billroth I or Roux-en-Y reconstruction, T1/2 was prolonged at 1 month but improved markedly at 6 and 12 months. In contrast, proximal gastrectomy with modified side-overlap esophagogastrostomy and total gastrectomy showed consistently rapid gastric emptying at all time points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gastric emptying function after gastrectomy demonstrated dynamic, time-dependent changes, with an initial postoperative delay followed by significant acceleration within the first year. The pattern and degree of change differ depending on the surgical procedure and reconstruction method. These findings highlight the importance of individualized, and time-adapted nutritional management after surgery in patients with gastric cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"386-394"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375811","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":"Minimally Invasive Esophagectomy for Esophageal Cancer: Current Evidence and Future Perspectives","authors":"Hirotaka Konishi,&nbsp;Hiroyuki Inoue,&nbsp;Hitoshi Fujiwara,&nbsp;Atsushi Shiozaki","doi":"10.1002/ags3.70112","DOIUrl":"10.1002/ags3.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Esophageal cancer is a highly aggressive malignancy with regional variations in histological subtypes. Adenocarcinoma predominates in Western countries, whereas squamous cell carcinoma is more common in Asia. Despite advances in multimodal therapy, esophagectomy remains the cornerstone of curative treatment, and the development of various minimally invasive esophagectomies (MIE) has been promoted to reduce invasiveness and complications. The status of the MIE has been outlined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature review was conducted using PubMed/MEDLINE to identify relevant studies on MIE published up to June 2025. The search focused on thoracoscopic, robot-assisted, and mediastinoscopic approaches, with an emphasis on randomized trials and high-quality comparative studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thoracoscopic MIE, especially in the prone position, demonstrated reduced pulmonary complications and shorter recovery times than open surgery, as supported by randomized trials such as TIME, MIRO, and MONET. Robot-assisted MIE (RAMIE) further enhances lymph node dissection and improves preservation of the recurrent laryngeal nerve, as demonstrated in trials such as REVATE and RAMIE. Mediastinoscopic esophagectomy via the transcervical and transhiatal approaches is emerging as a promising alternative for high-risk patients, offering favorable perioperative outcomes with reduced pulmonary complications. Further evaluation is required to determine the efficacy of lymph node dissection and the risk of recurrent laryngeal nerve damage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MIE, including the thoracoscopic, robot-assisted, and mediastinoscopic approaches, is evolving into an effective and less invasive alternative to open surgery. Future research should focus on conducting standardized, multicenter trials to establish optimal surgical strategies based on tumor characteristics and patient-specific factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"363-371"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376002","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 GLIM-Defined Malnutrition and Postoperative Outcomes After Curative Resection in Patients With Gastroenterological Cancer: Update Systematic Review and Meta-Analysis","authors":"Ryota Matsui,&nbsp;Jun Watanabe,&nbsp;Kazuma Rifu,&nbsp;Souya Nunobe,&nbsp;Noriyuki Inaki","doi":"10.1002/ags3.70173","DOIUrl":"10.1002/ags3.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In cancer patients, malnutrition worsens postoperative outcomes, with increased complications and poor prognosis. We aimed to update the impact of malnutrition, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria, on postoperative outcomes in patients with gastroenterological cancer after curative resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified observational studies published from inception to April 2, 2025. A systematic review and random-effects meta-analysis were performed on studies including adult patients (age &gt; 18 years) with gastroenterological cancer who received surgical treatment and had nutritional status assessments based on GLIM criteria. The primary outcomes were overall survival (OS) and overall postoperative complications, which were defined as events with a Clavien–Dindo (CD) grade ≥ II that occurred within 30 days after surgery. Hazard ratios and relative risk ratios for OS and postoperative complications, respectively, with 95% confidence intervals were pooled. The protocol has been published in PROSPERO (CRD42023434267).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five studies (28 reports comprising 10 942 patients) were included in the qualitative and quantitative syntheses. Compared with the absence of malnutrition, GLIM-defined malnutrition probably worsens OS (hazard ratio: 1.88, 95% concordance interval: 1.62–2.18, certainty of the evidence: low) and increases postoperative complications (relative risk ratio: 1.57, 95% concordance interval: 1.34–1.84, certainty of the evidence: low). The risk of bias in each study was moderate or high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GLIM-defined malnutrition probably worsens OS and increases the risk of postoperative complications in patients with gastroenterological cancer after surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"348-362"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376041","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":"Current Status of Multidisciplinary Treatment Strategies for Hepatocellular Carcinoma in the Era of Advanced Systemic Therapies","authors":"Keiichi Akahoshi,&nbsp;Shun Kaneko,&nbsp;Shinji Tanaka,&nbsp;Minoru Tanabe,&nbsp;Daisuke Ban","doi":"10.1002/ags3.70153","DOIUrl":"10.1002/ags3.70153","url":null,"abstract":"<p>The therapeutic landscape of hepatocellular carcinoma (HCC) has been transformed by recent advancements in systemic therapies, particularly with the introduction of immune checkpoint inhibitors, expanding treatment options beyond conventional locoregional approaches. This review provides an overview of evidence accumulated from recent Phase III trials of first-line regimens and key second-line agents and examines how these advances enable multidisciplinary treatment strategies and timely transition to curative local treatments. We highlight prospective and retrospective data on systemic therapy administered in combination with or in sequence with locoregional treatment modalities, including TACE-based combinations and “conversion” concepts leading to resection. A central focus is the oncological resectability criteria proposed by the Japan Liver Cancer Association and the Japanese Society of Hepato-Biliary-Pancreatic Surgery, which provide an objective framework to assess surgical indications under contemporary systemic therapy. Validation studies have consistently demonstrated robust prognostic stratification across resectable (R), borderline resectable 1 (BR1), and borderline resectable 2 (BR2) categories. Evidence for application of the oncological resectability criteria in treatment decision-making is still insufficient. Thus, future prospective studies and real-world registries aligned with the resectability framework are essential for defining the optimal timing, sequencing, and candidacy for surgery to ultimately enable provision of individualized, evidence-based care for patients with advanced HCC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"325-335"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376018","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":"Impact of Circular Stapler Size on Short-Term Outcomes and Long-Term Quality of Life After McKeown Esophagectomy","authors":"Suguru Maruyama,&nbsp;Katsutoshi Shoda,&nbsp;Yoshihiko Kawaguchi,&nbsp;Ryo Saito,&nbsp;Wataru Izumo,&nbsp;Kensuke Shiraishi,&nbsp;Shinji Furuya,&nbsp;Hidetake Amemiya,&nbsp;Hiromichi Kawaida,&nbsp;Daisuke Ichikawa","doi":"10.1002/ags3.70111","DOIUrl":"10.1002/ags3.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The circular stapling technique (CST) is reported to be a simple and time-efficient method; however, it is associated with a high incidence of anastomotic stenosis for McKeown esophagectomy. Meanwhile, the impact of circular stapler size remains controversial. We aimed to investigate the impact of circular stapler size on both short-term outcomes and long-term quality of life (QOL) after McKeown esophagectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 63 consecutive patients who underwent McKeown esophagectomy for esophageal cancer between 2019 and 2022 were eligible. We examined the association between circular stapler size and short-term outcomes and long-term QOL using the PGSAS-37.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>35 (55.6%) patients underwent anastomosis with a 21 mm stapler, whereas 28 (44.4%) patients used a 23 mm stapler. No significant differences were observed between the groups. The incidence of anastomotic leakage did not differ significantly between the groups (5.7% vs. 7.1%, <i>p</i> = 1.00) Also, the incidence of anastomotic stenosis did not differ between the groups (25.7% vs. 21.4%, <i>p</i> = 0.77). However, in QOL assessment, the meal-related subscale (SS) score in the 21 mm group was significantly worse than in the 23 mm group (<i>p</i> = 0.02). Regarding the details the meal-related SS score, the feeling of dysphagia was significantly worse in the 21 mm group (<i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short-term outcomes did not differ between patients who underwent anastomosis with a 21 mm stapler and those with a 23 mm stapler, however QOL, particularly the feeling of dysphagia, was worse in patients who used a 21 mm stapler compared to those who used a 23 mm stapler.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"424-430"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376063","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":"Thirty Years of Mentoring by “Bob Chan” of Young Japanese Surgeons to Become Scientists: An Adventure of Love","authors":"Robert M. Hoffman,&nbsp;Kentaro Miyake,&nbsp;Itaru Endo","doi":"10.1002/ags3.70120","DOIUrl":"10.1002/ags3.70120","url":null,"abstract":"<p>Over the past three decades, we have mentored a generation of young Japanese surgeons, guiding them to become internationally recognized surgeon-scientists. Through a unique collaboration between Japanese academic institutions and our laboratories at AntiCancer Inc. and the University of California, San Diego (UCSD), these trainees engaged in immersive translational research. They mastered advanced imaging and therapeutic tools including fluorescent-protein technology, patient-derived orthotopic xenograft (PDOX) models, the FUCCI cell-cycle imaging system, tumor-targeting <i>Salmonella typhimurium</i> A1-R (A1-R), and recombinant methioninase (rMETase) to treat the methionine addiction of cancer. These technologies enabled real-time visualization of cancer biology in vivo, accurate modeling of tumor behavior, and the development of strategies to target quiescent, treatment-resistant cancer cells. FUCCI imaging revealed that most solid cancer cells within tumors exist in non-cycling states, which are largely unaffected by conventional therapies. Our team explored methods to decoy these cells into vulnerable phases of the cell cycle. PDOX models provided a clinically-relevant platform to evaluate such strategies, while A1-R and rMETase offered novel therapeutic avenues by exploiting cancer-specific vulnerabilities. The present review highlights the scientific advances achieved through this collaboration, but also the human story of mentorship, cultural exchange, and the formation of a lasting international academic network and permanent friendship. Many of our mentees now lead research laboratories and academic departments across Japan, continuing the cycle of innovation and global partnership. We reflect on this journey as a successful model for training surgeon-scientists and advancing precision cancer therapy through visualization, imagination, and mentorship.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"315-324"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375825","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":"Conversion Therapy for cT4b and M1 Esophageal Squamous Cell Carcinoma: A Comprehensive Systematic Review","authors":"Eisuke Booka,&nbsp;Hiroya Takeuchi","doi":"10.1002/ags3.70104","DOIUrl":"10.1002/ags3.70104","url":null,"abstract":"<p>Conversion therapy, defined as curative-intent surgery or chemoradiotherapy after induction therapy, is gaining attention in patients with initially unresectable esophageal squamous cell carcinoma due to adjacent organ invasion (cT4b) or distant metastasis (M1). This systematic review aimed to assess survival outcomes, treatment strategies, and the evolving role of immune checkpoint inhibitors in this context. PubMed, Embase, and the Cochrane Library were comprehensively searched to identify studies published between 2010 and 2025 that reported conversion therapy outcomes in patients with esophageal squamous cell carcinoma with cT4b or M1. This review included 15 studies. A 2019 systematic review established the foundation for current practice in cT4b. Subsequent retrospective and prospective studies have reported 5-year overall survival rates of up to 51.6% in patients undergoing salvage or conversion surgery, with no residual tumor (R0) resection rates reaching 98.9% in extended procedures. The ongoing JCOG1510 phase III trial is expected to clarify the optimal strategy. Selected patients undergoing conversion surgery for M1 after induction therapy achieved a 5-year overall survival of 31.7%, with an R0 resection rate of 87%. Survival was not significantly associated with the metastatic site or treatment modality, highlighting the importance of treatment response and multidisciplinary decision-making. The incorporation of immune checkpoint inhibitors into induction regimens expands the pool of candidates eligible for curative-intent local therapy. Conversion therapy may provide durable survival in carefully selected patients, and further prospective studies are warranted to refine patient selection and establish standardized treatment algorithms.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"294-304"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375986","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}