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":"Significance of Intraoperative Lavage Cytology in Perihilar Cholangiocarcinoma","authors":"Kentaro Miyake,&nbsp;Ryusei Matsuyama,&nbsp;Yusuke Nakazaki,&nbsp;Kota Sahara,&nbsp;Tomoaki Takahashi,&nbsp;Yutaro Kikuchi,&nbsp;Yasuhiro Yabushita,&nbsp;Yu Sawada,&nbsp;Yuki Homma,&nbsp;Itaru Endo","doi":"10.1002/ags3.70044","DOIUrl":"https://doi.org/10.1002/ags3.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Perihilar cholangiocarcinoma (PHC) has a poor prognosis, with frequent early metastatic recurrence after curative resection. Peritoneal metastasis (PM) is particularly difficult to diagnose and predict. While intraoperative lavage cytology (CY) is a standard method to detect PM, its utility remains unclear in PHC. In this study, we investigated the significance of CY in PHC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively examined the relationship between CY status and clinicopathological factors in 285 PHC patients and underwent CY for resection between January 1993 and December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>32/285 (11.2%) cases were CY positive. We excluded 61 cases of expiratory laparotomy due to distant metastasis or local extension and nine cases with postoperative hospital mortality. 215 cases were divided into CY positive group (CY+, <i>n</i> = 12) and CY negative group (CY−, <i>n</i> = 203). PM recurrence was higher in the CY+ group (33.3%) than in the CY− group (13.3%), though not statistically significant (<i>p</i> = 0.087). Median recurrence-free survival was 21.7 months (CY+) versus 30.6 months (CY−) (<i>p</i> = 0.357), and early recurrence (&lt; 6 months) occurred in 16.7% versus 10.3% (<i>p</i> = 0.552). The median survival time was 42.8 months (CY+) and 44.1 months (CY−), with no significant difference (<i>p</i> = 0.678).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CY status was not strongly associated with PM or predictive of PM recurrence. Surgical resection may be justified in CY+ cases, as no statistically significant difference in prognosis was observed; however, these findings are exploratory and require validation in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1281-1288"},"PeriodicalIF":3.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436391","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":"Significance of Neoadjuvant S-1-Based Chemotherapy for Older Patients With Locally Advanced Gastric Cancer","authors":"Kota Kawabata,&nbsp;Takuro Saito,&nbsp;Yukinori Kurokawa,&nbsp;Kazuyoshi Yamamoto,&nbsp;Tsuyoshi Takahashi,&nbsp;Koji Tanaka,&nbsp;Tomoki Makino,&nbsp;Kiyokazu Nakajima,&nbsp;Hidetoshi Eguchi,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.70049","DOIUrl":"https://doi.org/10.1002/ags3.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Neoadjuvant chemotherapy (NAC) has been extensively developed for locally advanced gastric cancer (GC). In Asia, S-1-based regimens, such as docetaxel, oxaliplatin, and S-1 (DOS) and S-1 and oxaliplatin (SOX), are expected to become the standard of care. However, the data on the significance of NAC for older patients with advanced GC remains scarce. Therefore, this study aimed to evaluate the feasibility and efficacy of NAC in older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the data from patients with cStage II–III locally advanced GC who underwent radical surgery at our institution between 2015 and 2021. This study included three groups: 56 patients with NAC and age &lt; 75 years (NAC-Young group), 20 with NAC and age ≥ 75 years (NAC-Older group), and 46 without NAC and age ≥ 75 years (OP-Older group). Patient backgrounds, adverse events of NAC, and prognoses were compared among the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the NAC-Young group, the NAC-Older group was more likely to receive the SOX regimen and reduced initial doses, but there was no significant difference in the incidence of adverse events of NAC and prognosis. Compared to the OP-Older group, overall survival and cancer-specific survival tended to be better in the NAC-Older group at cStage III. Moreover, for patients with cStage III and ECOG-PS 0, cancer-specific survival was significantly better in the NAC-Older group compared to the OP-Older group (<i>p</i> = 0.030).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NAC with S-1-based regimens is a feasible and effective treatment option for older patients with GC with advanced-stage disease and good overall condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1163-1173"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436462","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":"Surgery for Older Cancer Patients: Cross-Organ Review and Good Practice Statement by the Japanese Geriatric Oncology Guideline Committee","authors":"Chie Tanaka,&nbsp;Takashi Ofuchi,&nbsp;Kiichiro Ninomiya,&nbsp;Daisuke Inoue,&nbsp;Ken Sugimoto,&nbsp;Keiko Murofushi,&nbsp;Toru Okuyama,&nbsp;Shigeaki Watanuki,&nbsp;Chiyo Imamura,&nbsp;Daisuke Sakai,&nbsp;Naomi Sakurai,&nbsp;Kiyotaka Watanabe,&nbsp;Kazuo Tamura,&nbsp;Toshiaki Saeki,&nbsp;Hiroshi Ishiguro","doi":"10.1002/ags3.70048","DOIUrl":"https://doi.org/10.1002/ags3.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although the number of older people is increasing, there is a lack of evidence and insufficient consensus regarding postoperative complications and survival in older cancer patients. In this study, we conducted a literature search and systematic review focusing on the outcomes after surgery for older cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Literature focusing on surgical treatment for older cancer patients was extracted from Japanese clinical practice guidelines for gastric cancer, lung cancer, colorectal cancer, liver cancer, and gynecological cancers (uterine body, uterine cervix, ovary, and external genitalia and vagina). Outcomes were reviewed, and committee members determined the strength of evidence on a four-point scale (A to D), with A being the highest and D being the lowest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Older cancer patients tend to have a higher incidence of postoperative complications and postoperative syndromes, and their expected survival is generally shorter compared to non-older patients. When extensive surgeries such as para-aortic lymph node dissection and/or resection with other organs are performed for older cancer patients, the postoperative mortality rates tend to increase compared to non-older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgical treatments for older cancer patients tend to result in higher morbidity even when the patients are in good health status. Nevertheless, there is still a possibility that a certain fraction of the patients achieve treatment outcomes comparable to those of non-older patients. Therefore, surgical indication and procedure for older cancer patients should be carefully determined based on surgical invasiveness and patient tolerability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1128-1136"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436463","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":"Prognostic Impact of Hepatectomy Versus Radiofrequency Ablation for Non-Small Hepatocellular Carcinoma (2–3 cm): A Case-Matched Study","authors":"Yuki Kitano,&nbsp;Hiromitsu Hayashi,&nbsp;Takumi Tanizaki,&nbsp;Yoshiyuki Tagayasu,&nbsp;Takashi Matsumoto,&nbsp;Rumi Itoyama,&nbsp;Shigeki Nakagawa,&nbsp;Hirohisa Okabe,&nbsp;Masaaki Iwatsuki","doi":"10.1002/ags3.70046","DOIUrl":"https://doi.org/10.1002/ags3.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While the surgery versus radiofrequency ablation (RFA) (SURF) trial demonstrated no significant difference in long-term outcomes between hepatectomy and RFA for patients with small hepatocellular carcinomas (HCCs) (≤ 3 cm and less than three nodules), uncertainty persists regarding the potential risk of local recurrence and inferior overall survival (OS) associated with RFA for HCCs with a diameter ≥ 2 cm when compared to hepatectomy. This study aimed to elucidate the prognostic outcomes of hepatectomy versus RFA for treating primary HCC of 2–3 cm and less than three nodules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 398 patients with primary HCC measuring 2–3 cm and having less than three nodules. Propensity score matching (PSM) was employed to balance the hepatectomy (<i>n</i> = 281) and RFA (<i>n</i> = 117) cohorts, resulting in 101 matched pairs. OS and recurrence-free survival (RFS) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Before PSM, hepatectomy showed better RFS (hazard ratio [HR] = 0.57, <i>p</i> &lt; 0.001) and OS (HR = 0.74, <i>p</i> = 0.005) than RFA. After PSM, hepatectomy retained a trend of improved outcomes (RFS: HR = 0.72, <i>p</i> = 0.051, OS: HR = 0.63, <i>p</i> = 0.08), and the local recurrence rate (3.0 vs. 22.8%, <i>p</i> &lt; 0.001) in hepatectomy were significantly lower than RFA. In the subgroup analysis, hepatectomy showed significantly better OS than RFA in the cohort with alpha-fetoprotein (AFP) ≥ 20 ng/mL (HR = 0.40, <i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For patients with primary HCC measuring 2–3 cm and having less than three nodules, hepatectomy may offer superior prognostic benefits, particularly in those with elevated AFP levels. These findings emphasize the importance of individualized treatment decisions based on tumor size and AFP levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1303-1311"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436461","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 Evaluation of the NCD Risk Calculator for Open Pancreaticoduodenectomy in Elderly Patients: A Validation Study","authors":"Nana Kimura,&nbsp;Ayaka Itoh,&nbsp;Ayano Sakai,&nbsp;Katsuhisa Hirano,&nbsp;Kenta Yagi,&nbsp;Naoya Takeda,&nbsp;Kazuto Shibuya,&nbsp;Isaku Yoshioka,&nbsp;Kenta Murotani,&nbsp;Tsutomu Fujii","doi":"10.1002/ags3.70045","DOIUrl":"https://doi.org/10.1002/ags3.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is no clear indication for surgery in pancreaticoduodenectomy (PD) for the elderly patients. The aim of this study was to use real-world data to investigate the usefulness of preoperative risk assessment with the risk calculator available in the National Clinical Database (NCD) in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 311 patients aged ≥ 65 years who underwent PD was performed. In addition to background factors, preoperative predicted incidence rates calculated with the risk calculator, as well as visceral fat analysis items, were analyzed. Patients with (1) serious postoperative complications, (2) a decline in postoperative activities of daily living (ADL), or (3) discharge to a place other than home were defined as having a poor postoperative course. All patients were randomly assigned to the training cohort (<i>n</i> = 209) or validation cohort (<i>n</i> = 102).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Comparisons of patient characteristics revealed no differences between the training and validation cohorts. In the training cohort, multivariate analysis revealed that “Predicted incidence of postoperative ADL decline” of ≥ 44.8% (OR 4.68; <i>p</i> = 0.031) and “Predicted incidence of Clavien–Dindo grade IV or higher” of ≥ 9.2% (OR 5.92; <i>p</i> = 0.025) among those calculated with the risk calculator were independent predictors of a poor postoperative course. Among patients with 2, 1, and none of these factors, 100%, 47.4%, and 15.7%, respectively, had a poor postoperative course.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A “Predicted incidence of postoperative ADL decline” and “Predicted incidence of Clavien–Dindo grade IV or higher” in the NCD risk calculator were useful predictors of a poor postoperative course after PD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1289-1302"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436453","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":"Long-Term Nutritional Benefits of Laparoscopic Pancreatoduodenectomy Over Open Surgery","authors":"Koki Kurahashi,&nbsp;Takayuki Anazawa,&nbsp;Kei Yamane,&nbsp;Kazuyuki Nagai,&nbsp;Satoshi Ishida,&nbsp;Satoshi Ogiso,&nbsp;Yoichiro Uchida,&nbsp;Takashi Ito,&nbsp;Takamichi Ishii,&nbsp;Etsuro Hatano","doi":"10.1002/ags3.70038","DOIUrl":"https://doi.org/10.1002/ags3.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Pancreatoduodenectomy (PD) is a highly invasive surgical procedure associated with postoperative malnutrition. Laparoscopic pancreatoduodenectomy (LPD) is a minimally invasive alternative, but its long-term effects on nutritional outcomes remain unclear. This study aimed to compare long-term nutritional outcomes between LPD and open PD (OPD) and to identify factors influencing postoperative nutritional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 65 patients who underwent PD. Nutritional indicators, including the psoas muscle index (PMI), prognostic nutritional index, and liver-to-spleen ratio, were assessed at 3, 6, and 12 months postoperatively. Multivariate analysis was performed to determine factors affecting nutritional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The LPD group (<i>n</i> = 36) demonstrated better PMI preservation at 12 months compared with the OPD group (<i>n</i> = 29) (<i>p</i> = 0.002), with significantly lower fatty liver incidence (3.7% vs. 22.7%, <i>p</i> = 0.038) and higher prognostic nutritional index values at 3 months (<i>p</i> = 0.029). LPD was identified as an independent factor for improved PMI (<i>p</i> = 0.020). Additionally, LPD was associated with reduced blood loss and shorter hospital stays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LPD improves long-term nutritional outcomes by preserving muscle mass and reducing metabolic disruptions, thus supporting its role in enhancing postoperative recovery and quality of life. Further prospective studies are warranted to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1263-1272"},"PeriodicalIF":3.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436253","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":"External Validation of an Automated Surgical Step Recognition Model for Robotic Distal Gastrectomy (RDG) Using a Multicenter Dataset","authors":"James S. Strong,&nbsp;Masahiro Yura,&nbsp;Masashi Takeuchi,&nbsp;Hirofumi Kawakubo,&nbsp;Tasuku Furube,&nbsp;Yusuke Maeda,&nbsp;Satoru Matsuda,&nbsp;Takahiro Kinoshita,&nbsp;Yuko Kitagawa","doi":"10.1002/ags3.70042","DOIUrl":"https://doi.org/10.1002/ags3.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Innovations in artificial intelligence (AI) are revolutionizing surgical practices, enhancing the analysis and outcomes of complex procedures. Recent advances in AI-based computer vision have enabled our team to develop a novel artificial intelligence model that can recognize defined steps of robotic distal gastrectomy (RDG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study assessed 130 robotic surgical videos from two institutions, 69 and 61 videos, respectively. The AI model used TeCNO, a multi-stage temporal convolutional network, and was trained using annotated videos with surgical steps defined by qualified surgeons. RDG step recognition predicted by the model was assessed using accuracy, precision, recall, and F-value metrics, and statistical analysis was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three data sets were established to train and test the model. AI trained on single institution training sets performs moderately well at predicting RDG surgical steps with accuracies ranging from 56% to 63%, whereas AI trained on the multi-institutional data yielded a step recognition accuracy of 86%. These results were confirmed with <i>F</i>-scores and precision tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We demonstrated that an AI step recognition model for RDG can predict surgical steps in an external video dataset with moderate accuracy. Furthermore, we conclude that training an AI model on a multi-institutional dataset significantly increases its step recognition capabilities. These results confirm that our model can be utilized by external institutions, and that a diverse training set of RDG procedures from multiple institutions is valuable to developing an AI model with precise step recognition capabilities in new institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1155-1162"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436317","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":"Essential Updates 2023/2024: Recent Advances of Multimodal Approach in Patients for Gastric Cancer","authors":"Katsutoshi Shoda,&nbsp;Yoshihiko Kawaguchi,&nbsp;Suguru Maruyama,&nbsp;Daisuke Ichikawa","doi":"10.1002/ags3.70041","DOIUrl":"https://doi.org/10.1002/ags3.70041","url":null,"abstract":"<p>Gastric cancer remains a major global health burden, especially in East Asia. Recent years have brought significant advances in multimodal management, including surgery, perioperative chemotherapy, immunotherapy, and supportive care. This review summarizes key updates from 2023 to 2024, focusing on surgical innovations, perioperative systemic therapy, treatment strategies for stage IV disease, and nutritional interventions. In early and locally advanced disease, laparoscopic and robotic gastrectomy have become widely accepted in Asia, supported by large, randomized trials such as JCOG0912 and KLASS-02. Perioperative chemotherapy has become a global standard, with the FLOT regimen leading in the West and SOX, XELOX, or DOS emerging in Asia. Immunotherapy is increasingly incorporated into perioperative settings, with trials like KEYNOTE-585 and NEONIPIGA suggesting potential benefit in selected patients. For stage IV gastric cancer, systemic chemotherapy remains the mainstay, but conversion surgery and treatment of oligometastasis have shown promising results in selected cases. Trials such as JCOG1704 and AIO-FLOT5 are investigating optimal strategies. Perioperative nutrition has also gained attention, with oral nutritional supplements, ERAS protocols, and digital tools like continuous glucose monitoring (CGM) and AI-driven platforms enhancing outcomes. Looking ahead, integration of molecular biomarkers (e.g., HER2, PD-L1, MSI, ctDNA), precise staging, and multidisciplinary collaboration will be essential for personalized treatment. Ongoing trials and international cooperation are expected to further refine evidence-based approaches to gastric cancer care.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1119-1127"},"PeriodicalIF":3.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436427","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}