Annals of Gastroenterological Surgery最新文献

{"title":"Risk Factors for Body Weight Loss After Gastrectomy for Gastric Cancer Analyzed From the JCOG1001 Phase III Trial","authors":"Takanobu Yamada,&nbsp;Yukinori Kurokawa,&nbsp;Junki Mizusawa,&nbsp;Kentaro Inoue,&nbsp;Yasuhiro Hasegawa,&nbsp;Kazuhisa Ehara,&nbsp;Naoki Hiki,&nbsp;Shusaku Tsutsui,&nbsp;Seiji Ito,&nbsp;Haruhiko Fukuda,&nbsp;Shuji Takiguchi,&nbsp;Yuichiro Doki,&nbsp;Narikazu Boku,&nbsp;Takaki Yoshikawa,&nbsp;Masanori Terashima,&nbsp;Takeshi Sano,&nbsp;Mitsuru Sasako","doi":"10.1002/ags3.70123","DOIUrl":"10.1002/ags3.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the factors associated with BWL after gastrectomy using data from the phase III trial (JCOG1001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This post hoc analysis included 728 patients from the JCOG1001. The percentage of BWL (%BWL) was defined as the proportion of decrease in body weight immediately before adjuvant chemotherapy initiation compared with that before surgery. Background, surgery, and postoperative data were compared between patients with and without a %BWL ≥ 10. The impact of each factor for a %BWL ≥ 10 was calculated using logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>%BWL ≥ 10 was observed in 258 (35.4%) patients. Male sex, preoperative body mass index (BMI) ≥ 25, total gastrectomy, operation time ≥ 238 min, intraoperative blood loss ≥ 285 mL, and postoperative complications were more frequent among patients with %BWL ≥ 10. Using multivariable analysis, a preoperative BMI ≥ 25 (odds ratio [OR] 1.870, 95% confidence interval [CI] 1.267–2.762, <i>p</i> &lt; 0.01), total gastrectomy (vs. distal) (OR 3.252, 95% CI 2.291–4.617, <i>p</i> &lt; 0.01), and grade 2–4 postoperative complications (vs. grade 0–1) (OR 3.229, 95% CI 2.192–4.756, <i>p</i> &lt; 0.01) were independent risk factors for a %BWL ≥ 10.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High preoperative BMI, total gastrectomy, and/or postoperative complications were risk factors for postoperative BWL ≥ 10% after gastrectomy for gastric cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The JCOG1001 was registered with UMIN-CTR, under the number UMIN000003688</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"452-459"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375579","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 Immunoscore in Pathological Stage III Differentiated Gastric Cancer: A Multicenter Cohort Study Including PD-L1/PD-L2 Expression Analysis","authors":"Yoshiro Yukawa,&nbsp;Takuro Saito,&nbsp;Yukinori Kurokawa,&nbsp;Yusuke Akamaru,&nbsp;Shinya Kidogami,&nbsp;Hiroshi Imamura,&nbsp;Kazumasa Fujitani,&nbsp;Jin Matsuyama,&nbsp;Kazuyoshi Yamamoto,&nbsp;Tsuyoshi Takahashi,&nbsp;Takahiro Matsui,&nbsp;Eiichi Morii,&nbsp;Hidetoshi Eguchi,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.70114","DOIUrl":"10.1002/ags3.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The clinical use of the tumor microenvironment as a biomarker remains difficult in gastric cancer (GC). This multicenter, retrospective cohort study assessed the prognostic ability of the Immunoscore (IS) and the expression of programmed death ligand 1 (PD-L1) or programmed death ligand 2 (PD-L2) to select GC patients at higher risk of recurrence who may therefore require more intensive perioperative treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 184 untreated pStage III GC patients who underwent radical gastrectomy at 13 institutions, IS (CD3+ and CD8+ lymphocytes) and PD-L1/2 expression were analyzed by immunohistochemistry using digital pathology HALO software. The associations between clinicopathological factors and prognosis were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Neither IS nor PD-L1/2 expression was a prognostic factor in the overall cohort. Subgroup analysis by histological type showed that in patients with differentiated-type GC, the high IS group had significantly better recurrence-free survival (RFS) (hazard ratio, 0.39; 95% confidence interval, 0.19–0.78; log-rank <i>p</i> = 0.006) and overall survival (OS) (hazard ratio, 0.39; 95% confidence interval, 0.19–0.82; log-rank <i>p</i> = 0.009) than the low IS group, whereas in undifferentiated-type cases, IS was not associated with RFS or OS. Cox multivariate analysis revealed that IS was an independent prognostic factor for RFS (<i>p</i> = 0.024) and OS (<i>p</i> = 0.017) only in differentiated-type cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Histological classification may be useful in assessing the tumor microenvironment in GC, and patients with differentiated-type pStage III with a low IS signature may be candidates for more intensive perioperative treatment due to their higher risk of recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"431-442"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376049","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":"Total Neoadjuvant Therapy for Rectal Cancer: Why Japan Says “Not Yet”","authors":"Kay Uehara,&nbsp;Akihisa Matsuda,&nbsp;Takeshi Yamada,&nbsp;Aitsariya Monkhonsupphawan,&nbsp;Hiroshi Yoshida","doi":"10.1002/ags3.70121","DOIUrl":"10.1002/ags3.70121","url":null,"abstract":"<p>Total neoadjuvant therapy (TNT) has rapidly gained global acceptance as a standard treatment for locally advanced rectal cancer (LARC). Supported by multiple phase III trials, TNT improves pathological complete response (pCR) rates, enhances systemic control, and expands opportunities for non-operative management (NOM). These advantages have led to its inclusion in major international guidelines as a core strategy for stage II/III rectal cancer. However, not all regions have embraced TNT. Japan's 2024 colorectal cancer treatment guidelines weakly recommend against the routine use of TNT or NOM—making it one of the few countries to diverge from the global trend. This stance does not reflect a rejection of evidence, but rather the realities of a healthcare system where rectal cancer is often treated in non-specialized institutions. Unlike consensus guidelines designed for subspecialists, the Japanese guidelines are tailored to general surgeons practicing in a wide range of settings, many of whom manage rectal cancer infrequently. This reflects a broader challenge of limited centralization within Japan's otherwise equitable healthcare system. TNT also presents unresolved concerns, including toxicity, uncertain survival benefit, and increased surgical complexity—issues particularly relevant in resource-diverse environments. This review examines the global evolution of TNT and Japan's restrained response, analyzing key trials, guideline positions, and barriers to implementation. Japan's approach reflects practical realities rather than opposition, emphasizing the need to tailor TNT to each country's healthcare setting. The future of TNT lies not in universal application, but in thoughtful integration that balances oncologic efficacy with local context and patient-centered care.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"305-314"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375835","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":"Postoperative Impact of Anti-Inflammatory Drug on Cancer Recurrence in Patients With Locally Advanced Gastric Cancer After Curative Gastrectomy: A Pilot Retrospective Study","authors":"Ryota Matsui,&nbsp;Manabu Ohashi,&nbsp;Motonari Ri,&nbsp;Rie Makuuchi,&nbsp;Masaru Hayami,&nbsp;Tomoyuki Irino,&nbsp;Takeshi Sano,&nbsp;Souya Nunobe","doi":"10.1002/ags3.70110","DOIUrl":"10.1002/ags3.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Elevated postoperative inflammation is associated with reduced recurrence-free survival (RFS) after gastrectomy in patients with gastric cancer, independent of postoperative complications. The effect of the administration of anti-inflammatory drugs immediately after gastrectomy on prolonging RFS in patients with gastric cancer has not been fully investigated. In this study, we aimed to investigate the effects of anti-inflammatory drugs on the long-term recurrence rates of gastric cancer after radical resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage II–III gastric cancer between May 2006 and March 2017. We performed propensity score matching using a logistic regression model to adjust for patient background, compared RFS, and used Cox proportional hazard regression to identify prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median duration of follow-up was 62 months. After matching, 591 patients were included in the untreated group, and 197 were included in the group treated with anti-inflammatory drugs. RFS was no significant difference in the two groups (5-year RFS: treated group, 73.2%; untreated group, 68.4%; <i>p</i> = 0.246), but peritoneal recurrence was significantly lower in the treated group (<i>p</i> = 0.028). Multivariate analyses showed that anti-inflammatory drugs were independent prognostic factors for recurrence-free survival (hazard ratio, 0.751; 95% confidence interval, 0.569–0.992; <i>p</i> = 0.044). In the subgroup analysis, using multivariate analysis for recurrence-free survival, anti-inflammatory drugs were more effective in patients with pStage III than in those with pStage II disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anti-inflammatory drug administration after radical resection may prolong recurrence-free survival in patients with pStage III gastric cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"414-423"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375989","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 Combined Resection of the Pancreas on Long-Term Survival in Gastric Cancer","authors":"Taku Hattori,&nbsp;Masanori Terashima,&nbsp;Yusuke Koseki,&nbsp;Kenichiro Furukawa,&nbsp;Keiichi Fujiya,&nbsp;Yutaka Tanizawa,&nbsp;Katsuhisa Ohgi,&nbsp;Teiichi Sugiura,&nbsp;Etsuro Bando","doi":"10.1002/ags3.70107","DOIUrl":"10.1002/ags3.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In patients with advanced gastric cancer invading adjacent organs, extended multivisceral resection is required to achieve R0 resection. However, the survival benefit of combined gastrectomy and pancreatic resection remains controversial. This study aimed to investigate the safety and efficacy of combined gastrectomy and pancreatectomy for gastric cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study retrospectively included 64 patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy with splenectomy (DP) for primary gastric cancer with invasion of the pancreas by the primary tumor, from lymph node metastasis or via duodenal invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PD was performed in 18 patients (28%) and DP in 46 (72%). Macroscopic invasion of the pancreas from the primary tumor was observed in 47 patients (73%), from lymph nodes in 13 (20%) and via duodenal invasion in four (6%). Pathological pancreatic invasion was observed in 27 patients (57%). Morbidity due to postoperative intra-abdominal infectious complications (PIICs) of Clavien–Dindo Grade III or higher was observed in 33 patients (52%). Multivariate analysis showed that duodenal invasion was an independent risk factor for PIICs (<i>p</i> = 0.039). Surgery resulted in R1 resection in 12 patients (18%). Multivariate analysis identified R1 resection (hazard ratio (HR): 5.315, <i>p</i> &lt; 0.001) and PIICs (HR: 2.067, <i>p</i> = 0.027) as independent prognostic factors for overall survival. Multivariate analysis of relapse-free survival identified PIICs as an independent prognostic factor (HR: 2.345, <i>p</i> = 0.036).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pancreatic resection is considered safe and effective in patients with pancreatic or duodenal invasion from gastric cancer when R0 resection is possible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"395-404"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376066","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":"Revising Fascial Anatomy With a Focus on the Fusion Fascia in Mesenteric Gastrointestinal Cancer Surgery","authors":"Hisashi Shinohara,&nbsp;Yasunori Kurahashi,&nbsp;Jun Watanabe,&nbsp;Yuichi Nagakawa,&nbsp;Tatsuro Nakamura,&nbsp;Eiichiro Nakao,&nbsp;Yudai Hojo,&nbsp;Shugo Kohno,&nbsp;Motoki Murakami,&nbsp;Yoshinori Ishida","doi":"10.1002/ags3.70117","DOIUrl":"10.1002/ags3.70117","url":null,"abstract":"<p>Recent advances in laparoscopic and robotic surgery have necessitated a critical re-evaluation of fascial anatomy relevant to mesenteric excision in gastrointestinal (GI) cancer surgery. Traditional models based on peritoneal fusion have often conflated mesothelial structures with fascia, resulting in conceptual imprecision regarding the fusion fascia (FF) and associated dissection planes. In this review, we integrate current surgical observations, histological evidence, and developmental anatomy to reformulate the anatomical conceptualization of connective tissue interfaces integral to mesenteric-based GI cancer surgery. Our synthesis indicates that Gerota's fascia, encompassing the anterior renal fascia, is an inherent anatomical structure rather than a surgical artifact thickened by dissection at the fusion plane. The subperitoneal fascia interweaves with Gerota's fascia but does not fold back into the mesentery at the base of the aorta. The FF is neither a dense connective tissue membrane nor a remnant of mesothelial fusion, but rather a loose connective tissue interface resulting from developmental remodeling of the digestive system. Dissection of the FF reveals a membranous covering on the deep surface of the mesentery, contributing to the formation of an intact resection package. Commonly used but poorly defined terms (e.g., “posterior pancreatic fascia”) are reinterpreted within this framework as surgically revealed manifestations of mesenteric dissection. This updated conceptual scheme offers a unified, anatomically grounded approach to mesenteric surgery that is consistent with intraoperative reality. It also underscores the need for surgical anatomy to evolve in response to modern techniques and for further refinement based on operative evidence.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"372-385"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375623","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 Hospital and Surgeon Volumes on Clinical Outcomes After Standard Surgery for Advanced Gastric Cancer: Supplementary Analysis of the Multicenter Randomized Phase III Trial JCOG1001","authors":"Motohiro Hirao,&nbsp;Yukinori Kurokawa,&nbsp;Riku Kajikawa,&nbsp;Junki Mizusawa,&nbsp;Kota Kawabata,&nbsp;Masanori Tokunaga,&nbsp;Kenji Kuroda,&nbsp;Shinichi Sakuramoto,&nbsp;Itaru Yasufuku,&nbsp;Hisayuki Matsushita,&nbsp;Shuji Takiguchi,&nbsp;Yuichiro Doki,&nbsp;Takaki Yoshikawa,&nbsp;Masanori Terashima,&nbsp;Stomach Cancer Study Group of Japan Clinical Oncology Group","doi":"10.1002/ags3.70115","DOIUrl":"10.1002/ags3.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Higher volumes of surgical procedures have been associated with better patient outcomes. However, few large-scale studies have evaluated interinstitutional variation to verify the generalization and standardization of gastric cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized phase III trial (JCOG1001) was conducted to compare standard and experimental surgeries for advanced gastric cancer. Of the 1204 patients with cT3–4b gastric adenocarcinoma enrolled in JCOG1001 between 2010 and 2015, this study only included hospitals that enrolled at least three patients and patients in the standard surgery arm in this analysis. Mixed-effects models were used to examine the short- and long-term outcome data for 595 patients from 47 institutes after adjusting for clinical backgrounds. Spearman's correlation coefficients were calculated for associations between the estimated outcomes and hospital or surgeon volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A degree of variation in the 5-year overall survival (OS) for standard gastric surgery in each hospital after adjusting for background was observed in the JCOG1001 patients (median, 81%; range, 61%–89%). For standard gastric surgery, a higher surgeon volume was significantly but weakly correlated with a higher proportion of patients with postoperative complications (<i>ρ</i> = 0.32, <i>p</i> = 0.0318). In addition, there were no correlations or trends in the number of dissected lymph nodes, operative time, blood loss volume, 5-year OS, and hospital or surgeon volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although there was some degree of interinstitutional variation in short- and long-term outcomes after standard gastric surgery, we found no correlation between long-term outcomes and hospital or surgeon volumes in JCOG1001.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"443-451"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376036","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":"Systematic Review and Meta-Analysis of Short- and Long-Term Outcomes Following Natural Orifice Specimen Extraction for Colon Cancer","authors":"Daichi Kitaguchi,&nbsp;Antonello Forgione,&nbsp;Mariano Giménez,&nbsp;Tatsuya Oda,&nbsp;Jacques Marescaux","doi":"10.1002/ags3.70096","DOIUrl":"10.1002/ags3.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Natural orifice specimen extraction (NOSE) in colon cancer surgery raises concerns about intra-abdominal infection, peritoneal seeding, and local recurrence due to possible tumor cell implantation. This systematic review and meta-analysis compares complete intracorporeal resection with NOSE versus conventional laparoscopic colon resection, focusing on short-term outcomes and long-term oncological safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A systematic literature search was conducted for English-language human studies published until April 2025. Meta-analyses were performed. They evaluated postoperative outcomes that included operative time, intraoperative blood loss, overall morbidity, severe morbidity, time to first flatus, and length of hospital stay. Oncological outcomes included local and overall recurrence rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15 studies met the inclusion criteria, comprising 3 randomized controlled trials and 12 retrospective studies, involving 1683 patients, 733 in the NOSE group and 950 in the conventional group. Pooled analyses demonstrated significantly reduced intraoperative blood loss, lower overall postoperative morbidity, and shorter time to first flatus and postoperative hospital stay in the NOSE group. However, operative time was significantly longer in the NOSE group. The average of median follow-up periods across studies was 38.9 months, and no significant differences were observed between the two groups in terms of oncological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study supports NOSE as a practical and effective surgical approach in selected patients with colon cancer. It offers significant benefits, including fewer postoperative complications and faster patient recovery, while maintaining oncological outcomes comparable to conventional techniques. NOSE should be considered in clinical practice, tailored to patient preferences and individual clinical factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"336-347"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375822","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":"Laparoscopic and Endoscopic Cooperative Surgery for Gastric Cancer as an Alternative Treatment in Elderly Patients: A Prospective Observational Study","authors":"Marie Washio,&nbsp;Keishi Yamashita,&nbsp;Takuya Wada,&nbsp;Mikiko Sakuraya,&nbsp;Hiroki Harada,&nbsp;Tadashi Higuchi,&nbsp;Koshi Kumagai,&nbsp;Yasushi Orihashi,&nbsp;Chika Kusano,&nbsp;Naoki Hiki","doi":"10.1002/ags3.70108","DOIUrl":"10.1002/ags3.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive procedure that preserves gastric function and reduces complications. Although widely applied for gastrointestinal stromal tumors, its role in gastric cancer remains uncertain. We prospectively evaluated LECS as an alternative for elderly gastric cancer patients who declined conventional gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center prospective study enrolled 20 patients aged 75–89 years with gastric cancer ≤ 5 cm. All patients underwent Inverted-LECS using the Crown method. The primary endpoint was surgery-related morbidity (Clavien–Dindo ≥ III). Secondary endpoints were operative outcomes, margin status, quality of life (QOL), and survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median age was 82 years, and 80% were cT1. No intraoperative complications or conversions occurred. Surgical morbidity ≥ Grade III was 0%. Delayed gastric emptying occurred in 25%, all Grade II. Resection margins were negative in 80%, including all pathologically early cancers. At 3 months, body weight and fat-free mass were preserved, physical function scores recovered to baseline, and mental function improved. Ninety-day mortality was 0%. With a median follow-up of 32 months, disease progression occurred in six patients, mainly with advanced disease or positive margins. One- and 3-year overall survival rates were 95% and 76.2%, and disease-specific survival 95% and 90%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LECS was technically safe and feasible for elderly gastric cancer patients ineligible for gastrectomy. However, because oncological curability cannot be assured in advanced gastric cancer or high-grade lymph node metastasis, careful selection and informed consent are essential. LECS may serve as a functional-preserving alternative to observation or palliative treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"405-413"},"PeriodicalIF":3.3,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376023","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 \"Laparoscopic and Endoscopic Cooperative Surgery for Gastric Cancer as an Alternative Treatment in Elderly Patients: A Prospective Observational Study\".","authors":"Marie Washio, Naoki Hiki","doi":"10.1002/ags3.70179","DOIUrl":"10.1002/ags3.70179","url":null,"abstract":"","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 2","pages":"627-628"},"PeriodicalIF":3.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375631","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}