Annals of Gastroenterological Surgery最新文献

{"title":"Preoperative Total Iron-Binding Capacity Is a Potential Surrogate Marker of Long-Term Outcomes After Pancreatectomy for Pancreatic Cancer.","authors":"Taishi Yamane, Hiromitsu Hayashi, Hiroshi Sawayama, Takashi Matsumoto, Toru Takematsu, Takanobu Yamao, Yuki Kitano, Tatsunori Miyata, Hirohisa Okabe, Masaaki Iwatsuki","doi":"10.1002/ags3.70297","DOIUrl":"10.1002/ags3.70297","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to examine whether preoperative serum total iron-binding capacity (TIBC), which is directly proportional to transferrin level, correlates with long-term outcomes after pancreatectomy.</p><p><strong>Methods: </strong>Preoperative TIBC levels, calculated by summing serum iron and unsaturated iron binding capacity, were evaluated in 158 patients who underwent pancreatectomy for pancreatic cancer. We defined TIBC < 258 μg/dL calculated by receiver-operating characteristic (ROC) analysis as low TIBC. We evaluated the relationship between preoperative TIBC levels and long-term outcomes after pancreatectomy.</p><p><strong>Results: </strong>Low preoperative TIBC levels were correlated with lower body mass index, higher rate of preoperative chemotherapy, lower albumin, and higher amount of intraoperative blood loss compared to those in high TIBC levels (<i>p</i> = 0.041, 0.046, 0.0002, 0.0032, respectively). Patients with low preoperative TIBC levels had significantly poorer overall survival (OS) and recurrence-free survival (RFS) compared to that in high TIBC level in Kaplan-Meier analysis (<i>p</i> < 0.0001, <i>p</i> = 0.0031). Furthermore, these patients were significantly correlated with worse OS and RFS in univariate and multivariate analyses (OS; hazard ratio [HR] 6.22, 95% confidence interval [CI] 1.770-21.838, <i>p</i> = 0.0044/RFS; HR 3.24, 95% CI 1.012-13.206, <i>p</i> = 0.048).</p><p><strong>Conclusion: </strong>Preoperative low serum TIBC levels may be a <i>potential</i> surrogate marker of long-term survival after pancreatectomy for pancreatic cancer.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214976","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":"Short-Term Outcomes of Transanal Total Mesorectal Excision for Rectal Cancer: A Multicenter Propensity Score-Matched Analysis Comparing Patients With and Without Preoperative Neoadjuvant Therapy.","authors":"Takafumi Shima, Hiroki Hamamoto, Takeru Matsuda, Ichiro Takemasa, Keitaro Tanaka, Toshiki Mukai, Jun Watanabe, Sang-Woong Lee, Seiichiro Yamamoto, Takeshi Naitoh","doi":"10.1002/ags3.70298","DOIUrl":"https://doi.org/10.1002/ags3.70298","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the association between preoperative neoadjuvant therapy and short-term outcomes of transanal total mesorectal excision for rectal cancer.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent transanal total mesorectal excision at 26 Japanese institutions between 2012 and 2019. Patients who received neoadjuvant therapy were matched 1:1 with patients who did not. Perioperative, postoperative, and pathological outcomes were compared.</p><p><strong>Results: </strong>After matching, 294 patients (147 per group) were analyzed. Operative time was longer in the neoadjuvant therapy group than in the non-neoadjuvant therapy group (median, 510.0 vs. 382.0 min), with an adjusted mean difference of 129.25 min (95% CI, 87.90-170.59; <i>p</i> < 0.001). Clavien-Dindo grade ≥ III complications occurred in 18/147 patients (12.2%) without neoadjuvant therapy and 16/147 (10.9%) with neoadjuvant therapy (adjusted OR, 0.90; 95% CI, 0.44-1.85; <i>p</i> = 0.769). Full-cohort conventional and Firth logistic analyses and marginal standardization likewise did not identify a statistically significant association. Neoadjuvant therapy remained associated with longer operative time after adjustment for operative procedure, lateral pelvic lymph node dissection, and abdominal approach. Resection-margin involvement did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Neoadjuvant therapy was associated with longer operative time during transanal total mesorectal excision, whereas no statistically significant association with severe postoperative morbidity was detected. Sensitivity analyses likewise did not identify a statistically significant association, supporting the technical feasibility of transanal total mesorectal excision after neoadjuvant therapy in experienced centers.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190817","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 Implementation and Perioperative Outcomes of Robot-Assisted Pelvic Exenteration for Primary Rectal Cancer: A Multicenter Japanese Experience.","authors":"Shoma Yamamoto, Hiroyasu Kagawa, Yusuke Yatabe, Yusuke Kinugasa","doi":"10.1002/ags3.70296","DOIUrl":"10.1002/ags3.70296","url":null,"abstract":"<p><strong>Aim: </strong>Robot-assisted pelvic exenteration (RPE) has been introduced as a minimally invasive option for selected patients; however, its clinical implementation, patient selection, and perioperative outcomes for primary rectal cancer remain unclear. This study describes the use and outcomes of RPE in a multicenter Japanese cohort.</p><p><strong>Methods: </strong>This retrospective observational secondary analysis included patients who underwent pelvic exenteration (PE) for primary rectal cancer at 26 Japanese institutions between January 2012 and October 2022. Patient characteristics, surgical indications, temporal trends in operative approach, and perioperative outcomes were summarized descriptively. Propensity score-matched analyses were performed as supplementary exploratory analyses.</p><p><strong>Results: </strong>Among 135 patients, 43 (32%) underwent RPE, 57 (42%) underwent laparoscopic PE, and 35 (26%) underwent open PE. In the RPE cohort, median operative time was 690 min, median blood loss was 360 mL, and 13 patients (30%) received intraoperative transfusion. One patient (2%) required conversion to open surgery, and RM0 resection was achieved in 42 (98%). Clavien-Dindo Grade II or higher and Grade III or higher complications within 30 days occurred in 16 (37%) and seven (16%) patients, respectively. No patient underwent reoperation during hospitalization or died within 30 days. Grade III or higher morbidity between 31 and 90 days occurred in five patients (12%). Median hospital stay was 23 days.</p><p><strong>Conclusion: </strong>RPE was performed with acceptable perioperative outcomes in selected patients with primary rectal cancer. It may serve as a complementary approach at institutions with sufficient experience in PE, whereas open surgery remains essential for extensive or technically demanding disease.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134936","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 Results by the Prospectively Determined Clinical Staging for Locally Advanced Gastric Cancer: A Follow-Up Study of JCOG1302A.","authors":"Tsutomu Hayashi, Ryosuke Kato, Noriko Mitome, Rei Ogawa, Takeo Fukagawa, Hitoshi Katai, Souya Nunobe, Masanori Tokunaga, Etsuro Bando, Yuichi Ito, Takanobu Yamada, Takashi Nomura, Shigeto Makino, Takahiro Kinoshita, Hisashi Hara, Masaki Aizawa, Narikazu Boku, Yukinori Kurokawa, Masanori Terashima, Takaki Yoshikawa","doi":"10.1002/ags3.70293","DOIUrl":"10.1002/ags3.70293","url":null,"abstract":"<p><strong>Background: </strong>Long-term overall survival (OS) of gastric cancer stratified by the prospectively determined clinical stage remains unclear.</p><p><strong>Methods: </strong>This is an ancillary study of JCOG1302A, a prospective observational study that evaluated the accuracy of clinical diagnosis of gastric cancer with cT2/T3/T4, cN0/N1/N2/N3, and M0. The cT diagnosis was comprehensively determined by upper gastrointestinal endoscopy and upper abdominal contrast CT scan with 1 or 5 mm slice thickness. Lymph nodes with a minor axis greater than 8 mm or a major axis greater than 10 mm were defined as positive for metastasis. This follow-up study evaluated OS in eligible patients from JCOG1302A.</p><p><strong>Results: </strong>Among 1 260 patients enrolled in JCOG1302A between July 2013 and November 2014, survival data of 1 176 were analyzed. With a median follow-up of 6.0 years for 821 surviving patients, the 5 year-OS was 82.1% (95% CI, 77.3-85.9) in cT2 (<i>n</i> = 319), 72.7% (68.2-76.6) in cT3 (<i>n</i> = 450), 60.0% (54.9-64.7) in cT4a (<i>n</i> = 401), and 40.0% (5.2-75.3) in cT4b (<i>n</i> = 6), while that was 78.0% (74.2-81.2) in cN0 (<i>n</i> = 559), 70.6% (65.4-75.2) in cN1 (<i>n</i> = 350), 59.1% (52.5-65.1) in cN2 (<i>n</i> = 241), and 28.4% (12.7-46.5) in cN3 (<i>n</i> = 26). When combined with cT and cN, 5y-OS was 83.5% (77.8-87.8) in cT2N0 (<i>n</i> = 226), 77.2% (71.0-82.2) in cT3N0 (<i>n</i> = 232), 66.8% (56.3-75.2) in cT4aN0 (<i>n</i> = 100), 78.7% (68.6-85.8) in cT2N(+) (<i>n</i> = 93), 68.0% (61.1-73.8) in cT3N(+) (<i>n</i> = 218), and 57.7% (51.7-63.2) in cT4aN(+) (<i>n</i> = 301).</p><p><strong>Conclusion: </strong>Clinical T and N categories were associated with OS in locally advanced gastric cancer, providing prognostic information that may help identify higher-risk clinical subgroups.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103095","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":"Barbed Sutures Are Associated With a Lower Incidence of Incisional Hernia Compared With Continuous Non-Barbed Monofilament Sutures After Minimally Invasive Gastroenterological Surgery.","authors":"Shusaku Honma, Takashi Takashima, Tatsuhi Ushikubo, Kana Ishikawa, Takashi Kumode, Takahisa Suzuki, Teppei Murakami, Shinichi Hosokawa, Sanae Nakajima","doi":"10.1002/ags3.70294","DOIUrl":"https://doi.org/10.1002/ags3.70294","url":null,"abstract":"<p><strong>Aim: </strong>Although barbed sutures have been proposed to improve fascial closure, their superiority over conventional, continuous, slowly absorbable sutures remains unclear. Therefore, we compared the incidence of incisional hernia (IH), a common complication of minimally invasive gastroenterological surgery, after using the two suture types.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent elective minimally invasive gastroenterological surgery requiring a midline incision between 2021 and 2025. The patients were divided into barbed suture (ST) and continuous slowly absorbable monofilament suture (PC) groups. The primary outcome was the incidence of IH at 1 year, as assessed using computed tomography. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance the baseline characteristics.</p><p><strong>Results: </strong>A total of 255 patients were included in this study (142 and 113 in the PC and ST groups, respectively). IPTW adjustment balanced the baseline characteristics. The incidence of IH at 1 year was significantly lower in the ST group than that in the PC group. Weighted logistic regression demonstrated that barbed sutures were associated with a reduced risk of IH (odds ratio, 0.46; 95% confidence interval, 0.22-0.99; <i>p</i> = 0.047). Among the patients who developed IH, the defect size did not differ between the groups, although all symptomatic cases occurred in the PC group.</p><p><strong>Conclusions: </strong>Barbed sutures are associated with a lower incidence of IH than conventional continuous sutures after minimally invasive gastroenterological surgery. Therefore, in addition to suture selection, appropriate closure techniques and risk stratification may be important in preventing IH.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102970","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":"Small Intestinal Bacterial Overgrowth Following Gastrointestinal Cancer Surgery: Current Evidence and Future Perspectives.","authors":"Toru Aoyama, Haruhiko Cho, Takaki Yoshikawa","doi":"10.1002/ags3.70291","DOIUrl":"https://doi.org/10.1002/ags3.70291","url":null,"abstract":"<p><p>Small intestinal bacterial overgrowth (SIBO) has recently gained increasing attention as a potential cause of postoperative gastrointestinal symptoms following gastrointestinal cancer surgery. Surgical procedures can disrupt normal gastrointestinal physiology through anatomical reconstruction, impaired motility, reduced gastric acid secretion, vagal nerve injury, and alterations in the gut microbiota, thereby predisposing patients to bacterial overgrowth. Although positive breath tests for SIBO have frequently been reported after esophageal, gastric, and colorectal cancer surgery, the reported positivity rates vary widely because of differences in patient selection, surgical procedures, and diagnostic methods. Importantly, several studies evaluated selected symptomatic or referred patients; therefore, these rates should not necessarily be interpreted as the true prevalence of SIBO in the overall postoperative population. Breath testing is widely used because of its simplicity and non-invasive nature; however, altered gastrointestinal anatomy and accelerated postoperative transit may affect test specificity and potentially produce false-positive results. Evidence regarding treatment specifically in patients after gastrointestinal cancer surgery remains limited, and most data regarding rifaximin and other therapeutic approaches are extrapolated from general SIBO populations. This review summarizes the current evidence regarding the epidemiology, pathophysiology, diagnosis, and treatment of SIBO following gastrointestinal cancer surgery. We discuss future perspectives, including standardization of diagnostic criteria, optimization of breath testing, microbiome-based approaches, refinement of rifaximin therapy, and strategies for recurrence prevention. A better understanding of SIBO may improve the recognition and management of postoperative gastrointestinal symptoms and nutritional abnormalities; however, whether SIBO-directed management improves body composition, treatment tolerance, postoperative recovery, or long-term outcomes remains to be established.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103109","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":"Response to Letter to the Editor Regarding to \"More Liver Volume is Necessary for High Risk Living Donor Liver Transplantation Candidates\".","authors":"Kyohei Yugawa, Takeo Toshima, Shinji Itoh, Tomoharu Yoshizumi","doi":"10.1002/ags3.70290","DOIUrl":"10.1002/ags3.70290","url":null,"abstract":"","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079606","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":"Methodological Considerations in Evaluating Postoperative Infectious Complications and Long-Term Oncological Outcomes.","authors":"Hideki Endo, Hiroyuki Yamamoto","doi":"10.1002/ags3.70292","DOIUrl":"10.1002/ags3.70292","url":null,"abstract":"","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079596","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 Versus Open Total and Distal Gastrectomy After Chemotherapy for Gastric Cancer: A Nationwide Observational Study.","authors":"Nobuaki Hoshino, Shinya Hirakawa, Shiogeo Hisamori, Hisateru Tachimori, Yusuke Fujii, Koshi Kumagai, Hideki Ueno, Ken Shirabe, Kazutaka Obama","doi":"10.1002/ags3.70287","DOIUrl":"https://doi.org/10.1002/ags3.70287","url":null,"abstract":"<p><strong>Aim: </strong>Minimally invasive surgery (MIS) is increasingly used for gastric cancer surgery. MIS is expected to facilitate surgical precision because of its magnified view, and facilitating identification of anatomical dissection layers is expected to reduce postoperative complications. To our knowledge, there is no consensus on the most appropriate surgical approach for gastric cancer following chemotherapy.</p><p><strong>Methods: </strong>This nationwide, observational study used data from the National Clinical Database. Patients who underwent total gastrectomy (TG) or distal gastrectomy (DG) for gastric cancer after receiving chemotherapy between January 2014 and December 2022 were included. The incidence of overall complications of Clavien-Dindo (CD) grade ≥ 1 was set as the primary outcome, and the risk ratio (RR) was estimated using inverse probability of treatment weighting based on propensity scores and G-computation, comparing MIS and open surgery. The incidence of each complication was considered the secondary outcome.</p><p><strong>Results: </strong>Overall, 18 100 patients were included in this study (TG, 9481; DG, 8619). MIS was associated with a lower incidence of overall complications of CD grade ≥ 1 in both TG (RR 0.91, 95% confidence interval [CI] 0.85-0.98) and DG (RR 0.78, 95% CI 0.72-0.84). MIS was also significantly associated with a lower incidence of superficial incisional surgical site infection (SSI), deep incisional SSI, and pancreatic fistulas in both gastrectomy groups.</p><p><strong>Conclusions: </strong>MIS was associated with lower rates of overall postoperative complications of CD grade ≥ 1, and wound-related complications and pancreatic fistulas than open surgery in patients with gastric cancer who underwent TG and DG after chemotherapy.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103089","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":"The Geriatric Nutritional Risk Index Predicts Short- and Long-Term Outcomes in the Oldest-Old With Colorectal Cancer: A Multi-Institutional Analysis of 225 Nonagenarians.","authors":"Toshiaki Toshima, Fuminori Teraishi, Satoe Takanaga, Toshiharu Mitsuhashi, Ryo Inada, Tsuyoshi Ohtani, Ryosuke Yoshida, Naoto Hori, Kaoru Shigemitsu, Sumiharu Yamamoto, Tetsushi Kubota, Yuka Okano, Tetsuji Nobuhisa, Fumitaka Taniguchi, Wataru Ishikawa, Ryohei Shoji, Tatsuo Matsuda, Tatsuo Umeoka, Toshiyoshi Fujiwara","doi":"10.1002/ags3.70288","DOIUrl":"10.1002/ags3.70288","url":null,"abstract":"<p><strong>Aim: </strong>Surgical outcomes for colorectal cancer (CRC) in nonagenarians remain uncertain due to frailty, comorbidities, and malnutrition. The Geriatric Nutritional Risk Index (GNRI) is associated with surgical outcomes in older patients with CRC, but its prognostic value in nonagenarians is unclear. This study evaluated the GNRI's predictive value for short- and long-term surgical outcomes in this population.</p><p><strong>Methods: </strong>We retrospectively analyzed 225 nonagenarians undergoing surgical resection of CRC at 15 institutions between 2011 and 2022. Patients were stratified by GNRI-high/low status using two cutoffs: 98 (Cohort 1) and 86 (Cohort 2). Outcomes included postoperative complications, length of hospital stay, and overall survival (OS). Stabilized inverse-probability-of-treatment weighting (IPTW) was used to adjust for measured confounding.</p><p><strong>Results: </strong>The median age was 92 years (female, 64.9%; colon cancer, 79.6%). GNRI-high patients had higher body mass index and albumin levels. Complication rates did not differ between the groups. After adjustment, GNRI-high patients in Cohort 1 had a shorter expected hospital stay (ratio 0.70, 95% CI 0.51-0.96; <i>p</i> = 0.025) but no significant OS difference. In Cohort 2, GNRI-high patients had better OS (<i>p</i> < 0.01), confirmed by adjusted Cox models (HR 0.54, 95% CI 0.35-0.82; <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Preoperative GNRI was associated with hospital stay and OS in nonagenarians undergoing CRC surgery, although the OS association was significant only with the cohort-derived cutoff of 86, which requires external validation, and not with the literature-based cutoff of 98. The GNRI is a simple tool to stratify surgical risk and optimize perioperative nutritional status in this vulnerable population.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079574","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}