Annals of Gastroenterological Surgery最新文献

{"title":"Nationwide Trends in Short-Term Outcomes After Low Anterior Resection for Rectal Cancer: A Pre- and Post-COVID-19 Analysis From the Japanese National Clinical Database, 2018–2023","authors":"Ryo Seishima,&nbsp;Hideki Endo,&nbsp;Hiromichi Maeda,&nbsp;Taizo Hibi,&nbsp;Masashi Takeuchi,&nbsp;Yusuke Takemura,&nbsp;Hiroyuki Yamamoto,&nbsp;Akinobu Taketomi,&nbsp;Yoshihiro Kakeji,&nbsp;Yasuyuki Seto,&nbsp;Hideki Ueno,&nbsp;Masaki Mori,&nbsp;Ken Shirabe,&nbsp;Yuko Kitagawa","doi":"10.1002/ags3.70031","DOIUrl":"https://doi.org/10.1002/ags3.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study evaluated the short-term outcomes of low anterior resection for rectal cancer in Japan before and after the COVID-19 pandemic, with a particular focus on the timing of its reclassification within Japan in May 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the Japanese National Clinical Database, we analyzed 109 754 low anterior resection cases between January 2018 and December 2023, categorized into pre-pandemic (February 2020 and earlier), pandemic (March 2020–April 2023), and post-pandemic (May 2023 onward) periods. Trends in the number of low anterior resection cases, postoperative intensive care unit utilization, and complications, including anastomotic leakage and pneumonia, were examined. Standardized morbidity ratios were used to adjust for risk and assess trends over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of low anterior resection cases declined during the pandemic but returned to pre-pandemic levels thereafter. The postoperative intensive care unit admission rates remained stable, with a slight increase post-pandemic. The incidence of major complications gradually declined from pre-pandemic to post-pandemic, with anastomotic leakage rates decreasing from 9.8% to 7.1% and the standardized morbidity ratio for anastomotic leakage decreasing from 1.0 to 0.8, reflecting improved outcomes. The number of robot-assisted surgeries significantly increased from 246 cases in March 2020 to 535 in May 2023, and their proportion among total surgeries also rose from 16.8% to 41.2%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite initial challenges, the healthcare system of Japan effectively managed rectal cancer surgeries during and after the pandemic. Robotic surgery became more widely adopted, and complication rates improved, demonstrating resilience and adaptability in surgical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1029-1035"},"PeriodicalIF":3.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013113","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 Update 2023/2024: Multidisciplinary Treatment for Invasive Intraductal Papillary Mucinous Carcinoma","authors":"Seiko Hirono","doi":"10.1002/ags3.70029","DOIUrl":"https://doi.org/10.1002/ags3.70029","url":null,"abstract":"<p>Invasive intraductal papillary mucinous carcinoma (IPMC) has a high malignant potential, with surgical resection being the only potentially curative treatment. However, even after surgical resection, recurrence occurs frequently and the prognosis is poor once recurrence develops. While retrospective studies aiming to achieve long-term survival in invasive IPMC patients have been reported, the rarity of invasive IPMC has resulted in small-scale datasets, leading to low levels of evidence. Consequently, the utility of adjuvant therapy after surgery, neoadjuvant therapy (NAT) before surgery, and treatments for postoperative recurrence in invasive IPMC remains unclear, with treatment strategies varying by institution—ranging from surgical resection alone to approaches based on conventional pancreatic cancer treatment. Recently, several large-scale multicenter studies on invasive IPMC have been reported. These studies suggested that while adjuvant therapy after surgery may not be beneficial for all invasive IPMC patients, it could potentially extend survival in cases with advanced-stage disease. Regarding NAT before surgery for invasive IPMC, the number of reported cases is extremely limited, and no definitive evidence has been established. For postoperative recurrence of invasive IPMC, some studies have indicated that administering treatment may prolong survival. Although these large-scale studies have gradually clarified certain characteristics of invasive IPMC, they are all retrospective in nature, resulting in a low level of evidence. To achieve long-term survival for invasive IPMC patients, large-scale prospective multicenter studies are needed in the future.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"643-649"},"PeriodicalIF":2.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520007","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":"Optimal Extent of Lymph Node Dissection for Non-Metastatic Colon Cancer by Tumor Location: Evaluation of the Therapeutic Value Index for Each Lymph Node Station","authors":"Akira Ouchi,&nbsp;Kozo Kataoka,&nbsp;Eiji Shinto,&nbsp;Takashi Akiyoshi,&nbsp;Takefumi Yoshida,&nbsp;Yasuyuki Takamizawa,&nbsp;Yukihide Kanemitsu,&nbsp;Hirotoshi Kobayashi,&nbsp;Yoichi Ajioka,&nbsp;the Lymph Nodes Committee of JSCCR","doi":"10.1002/ags3.70023","DOIUrl":"https://doi.org/10.1002/ags3.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine the optimal extent of lymph node dissection for non-metastatic colon cancer by tumor location based on the therapeutic value index (TVI) for each lymph node station.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with surgical stage I–III colon or rectosigmoid cancer in the Japanese Society for Cancer of the Colon and Rectum database who underwent curative resection between January 2003 and December 2014 were analyzed. The TVI was defined as the incidence of lymph node metastasis multiplied by 5-year overall survival and calculated for each nodal station stratified by tumor location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 33 231 patients were eligible for analysis. In cecal cancer, the TVI was 2.086 for nodal station #203, but only 0.000 for #213. In ascending colon cancer, the TVI was 1.080 for #203 and 0.644 for #213, but only 0.178 for #223. In transverse colon cancer, the TVI was 1.942 for #223, but only 0.066 for #213 and 0.159 for #203. In descending colon cancer, the TVI was 0.215 for #253. The TVI was 1.172 for #253 in sigmoid colon cancer and 1.155 for #253 in rectosigmoid cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Considering that a previous systematic review reported TVIs in the range of 0.295–0.576 for the para-aortic lymph nodes in patients with colorectal cancer, dissection of the main lymph nodes along the feeding artery has a therapeutic value in non-metastatic colon cancers. Meanwhile, the significance of #253 dissection for descending colon cancer requires further discussion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1008-1016"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007995","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":"International Comparison of Geriatric-Associated Variables in Major Gastroenterological Surgery Between National Clinical Database and American College of Surgeons National Surgical Quality Improvement Program","authors":"Yasuhide Kofunato,&nbsp;Xane Peters,&nbsp;Arata Takahashi,&nbsp;Mark E. Cohen,&nbsp;Hiraku Kumamaru,&nbsp;Mitsukazu Gotoh,&nbsp;Yoshihiro Kakeji,&nbsp;Yasuyuki Seto,&nbsp;Yuko Kitagawa,&nbsp;Ken Shirabe,&nbsp;Hideki Ueno,&nbsp;Hiroaki Miyata,&nbsp;Clifford Y. Ko,&nbsp;Shigeru Marubashi","doi":"10.1002/ags3.70021","DOIUrl":"https://doi.org/10.1002/ags3.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds</h3>\u0000 \u0000 <p>Incidence of malignant disease in older patients has been increasing. These geriatric patients have more comorbidities and frailty than younger patients, necessitating different approaches in evaluation and treatment. Geriatric surgery studies in Japan have followed those conducted in the US. The aims of this study were to compare trends in geriatric variables for patients who underwent gastroenterological surgeries between two countries, and to elucidate the characteristics of them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Geriatric variables and outcomes were analyzed via nationwide databases in both countries. Subjects were defined as patients with age ≥ 65 who underwent seven major gastroenterological surgeries for malignant disease. Basic statistical values were compared between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2703 patients in the National Clinical Database (NCD) and 1342 patients in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were included. Among preoperative comorbidities, dyspnea, hypertension, bleeding disorder, and emergency cases increased with age in both databases, while the rates of obesity and emergency cases were more frequent in NSQIP. Most postoperative complications were not significantly associated with age in either database. Geriatric-associated preoperative variables and outcomes varied with age in both countries. Cognitive variables (history of dementia, surrogate-signed consent, and delirium) were similar between the two databases. However, mobility elements (use of mobility aid, fall history, high fall risk, and new use of mobility aid) and postoperative functional dependency were more frequent in NSQIP than NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Geriatric-associated variables and outcomes changed similarly with age in both countries, while mobility and function were different between the two.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1093-1103"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013052","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":"Salvage esophagectomy for unresectable locally advanced esophageal squamous cell carcinoma: Significant or not?","authors":"Hiroshi Saeki,&nbsp;Makoto Sakai,&nbsp;Takayoshi Watanabe,&nbsp;Makoto Sohda,&nbsp;Ken Shirabe","doi":"10.1002/ags3.70013","DOIUrl":"https://doi.org/10.1002/ags3.70013","url":null,"abstract":"<p>We reviewed the current status and perspectives on salvage esophagectomy for initially unresectable locally advanced esophageal squamous cell carcinoma (ESCC) in the era of minimally invasive surgery and immunotherapy. Although the standard treatment for these patients is definitive chemoradiotherapy (CRT), the complete response rate to CRT alone remains unsatisfactory. Salvage esophagectomy, which is defined as surgery for residual or recurrent lesions after definitive CRT, is considered a curative treatment in clinical practice. No randomized trials have been conducted comparing salvage esophagectomy and non-surgical treatment in this cohort, because, in addition to the small number of eligible patients, constructing an appropriate study design may have been difficult. Therefore, in this review, the assessment of the current status was based on the results of several available retrospective studies. Most results from these studies show favorable results for salvage esophagectomy in this subject; however, whether it is a widely used treatment should be carefully evaluated because all these reports are limited to those from high-volume facilities for esophageal surgery. Appropriate patient selection and skilled surgical techniques are essential for successful salvage esophagectomy for initially unresectable locally advanced ESCC. To improve the short- and long-term outcomes of this surgery, advances in surgical techniques as well as further development of diagnostic capabilities, perioperative management, and multidisciplinary treatment are desirable.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"894-902"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013051","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 Approach Utilizing Linear Stapler for Midline Incisional Hernia: Stapler Repair Technique","authors":"Sho Ueda,&nbsp;Takuya Saito,&nbsp;Kohei Yasui,&nbsp;Kentaro Shinohara,&nbsp;Yasuyuki Fukami,&nbsp;Kenitiro Kaneko,&nbsp;Tsuyoshi Sano","doi":"10.1002/ags3.70026","DOIUrl":"https://doi.org/10.1002/ags3.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We successfully established the stapler repair technique (SRT), a straightforward laparoscopic Rives-Stoppa approach utilizing a linear stapler. This study retrospectively evaluated its short-term outcomes to determine its safety and efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The surgical outcomes of 87 patients who underwent laparoscopic median incisional hernia repair at our hospital were reviewed between August 2017 and May 2024. Patients were treated with intraperitoneal onlay mesh (IPOM), laparoscopic trans-abdominal retromuscular (TARM), or SRT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among these patients, 37 were treated with IPOM, 16 with TARM, and 34 with SRT, with no significant differences in patient characteristics. The median surgical time (range) was 96 min (50–211) for IPOM, 256 min (196–300) for TARM, and 112 min (60–289) for SRT, respectively. The median mesh areas (ranges) were 210 cm² (80–500) for IPOM, 500 cm² (270–780) for TARM, and 379 cm² (176–864) for SRT, respectively. The SRT group had significantly shorter operative times (<i>p</i> &lt; 0.001) and smaller mesh areas (<i>p</i> = 0.005) than the TARM group. Compared to the IPOM group, there was no significant difference in operative time in the SRT group (<i>p</i> = 0.444), but the mesh area was significantly larger (<i>p</i> &lt; 0.001). The SRT group had no significant intraoperative complications or conversions to open surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SRT offers a comparable operative time to IPOM and a significantly shorter time than TARM. Additionally, SRT can be performed extraperitoneally with no significant intraoperative complications or conversion to open surgery. These findings suggest that SRT is a safe and effective minimally invasive approach in median laparoscopic incisional hernia repair.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1086-1092"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013049","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 Bone Mineral Density Reduction During Neoadjuvant Chemotherapy (NAC) in Patients Undergoing NAC Followed by Esophagectomy for Esophageal Cancer","authors":"Kazuhide Sato,&nbsp;Keita Takahashi,&nbsp;Yoshitaka Ishikawa,&nbsp;Naoko Fukushima,&nbsp;Takahiro Masuda,&nbsp;Takanori Kurogochi,&nbsp;Masami Yuda,&nbsp;Akira Matsumoto,&nbsp;Kazuto Tsuboi,&nbsp;Yuichiro Tanishima,&nbsp;Fumiaki Yano,&nbsp;Ken Eto","doi":"10.1002/ags3.70025","DOIUrl":"https://doi.org/10.1002/ags3.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Our previous study suggested that low bone mineral density (BMD), known as osteopenia, was a poor prognostic factor in patients who underwent esophagectomy for esophageal cancer (EC).</p>\u0000 \u0000 <p>Meanwhile, the association between BMD reduction during neoadjuvant chemotherapy (NAC) and the worse prognosis remains unknown, although esophagectomy after NAC is the first option for the treatment of advanced esophageal squamous cell carcinoma (ESCC). Therefore, this study intended to investigate the prognostic impact of BMD reduction during NAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A total of 101 ESCC patients who underwent curative Mckeown esophagectomy after NAC between January 2008 and December 2019 were analyzed. BMD reduction (+) was defined as ≥ 6.8% of the BMD reduction rate during NAC. The patients were classified into the BMD reduction (+) group (<i>n</i> = 32) and the BMD reduction (−) group (<i>n</i> = 69) by measuring the BMD reduction during NAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall survival (OS) and relapse-free survival (RFS) in the BMD reduction (+) group were significantly worse than those in the BMD reduction (−) group (<i>p</i> &lt; 0.01). In multivariate analysis, BMD reduction was associated with worse OS (Hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.44–6.05) and RFS (HR, 2.29; 95% CI, 1.30–4.03). Moreover, low skeletal muscle index before NAC was an independent risk factor for BMD massive reduction (Odds ratio, 6.21; 95% CI, 2.10–18.30).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BMD reduction during NAC was considered to be an adverse prognostic factor for OS and RFS in patients underwent NAC followed by esophagectomy for ESCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"933-941"},"PeriodicalIF":3.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012754","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- and Long-Term Outcomes of Open, Laparoscopic, and Robot-Assisted Surgery for Rectal Cancer","authors":"Marie Hanaoka,&nbsp;Hiroyasu Kagawa,&nbsp;Ataru Igarashi,&nbsp;Hiroshi Yoshihara,&nbsp;Shinichi Yamauchi,&nbsp;Masanori Tokunaga,&nbsp;Lin Peng-Lin,&nbsp;Minkyung Shin,&nbsp;Yusuke Kinugasa","doi":"10.1002/ags3.70024","DOIUrl":"https://doi.org/10.1002/ags3.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robot-assisted surgery has short-term benefits in rectal cancer surgery; however, its long-term advantages remain unclear. This study compared short- and long-term outcomes of open, laparoscopic, and robot-assisted rectal cancer surgeries using large-scale, database-driven evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients (28 711) diagnosed with clinical stages I–III rectal cancer who underwent rectal resection and were registered in the Japanese Medical Data Vision Co. Ltd. database were included. Open rectal resection (ORR), laparoscopic rectal resection (LRR), and robot-assisted rectal resection (RARR) were identified. The primary outcomes were 5-year overall survival (OS) and relapse-free survival (RFS). Secondary outcomes included perioperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After applying overlap weight, the RARR, LRR, and ORR groups had 3635 (15.3%), 17 142 (72.3%), and 2935 (12.4%) patients, respectively. Among the cohort (mean age: 69.5 years), 64.9% were male, and 24.7%, 31.5%, and 43.8% had clinical stages I, II, and III, respectively. The RARR group demonstrated the lowest postoperative complication rate, 30- and 90-day mortality rates, and shortest hospital stay. The RARR group had the highest 5-year OS (95%) and RFS (93%) compared to LRR (OS: 89%, RFS: 86%) and ORR (OS: 81%, RFS: 77%; <i>p</i> &lt; 0.001). Multivariable analysis revealed that RARR was significantly associated with improved OS, whereas higher risks were observed for LRR (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.69–2.81) and ORR (HR: 3.96, 95% CI: 3.03–5.19).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The RARR group demonstrated superior short- and long-term outcomes than the LRR and ORR groups, indicating robot-assisted surgery as a potential new standard treatment for rectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1017-1028"},"PeriodicalIF":3.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012755","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":"Effect of Intraoperative Posture on Accurate Diagnostic Rate of Intraoperative Nerve Monitoring During Esophagectomy","authors":"Masami Yuda,&nbsp;Keita Takahashi,&nbsp;Yoshitaka Ishikawa,&nbsp;Takanori Kurogochi,&nbsp;Akira Matsumoto,&nbsp;Naoko Fukushima,&nbsp;Takahiro Masuda,&nbsp;Naoto Takahashi,&nbsp;Fumiaki Yano,&nbsp;Ken Eto","doi":"10.1002/ags3.70022","DOIUrl":"https://doi.org/10.1002/ags3.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The benefits of intraoperative nerve monitoring for identifying recurrent laryngeal nerves during esophageal cancer surgery have recently been reported. However, no standardized procedures have been established for the use of this system. This study aimed to identify factors affecting the diagnostic accuracy of intraoperative nerve monitoring for recurrent laryngeal nerve palsy and explore approaches to improve the precision and efficiency of intraoperative nerve monitoring in esophageal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 187 consecutive patients who underwent esophagectomy between 2011 and 2018, of whom 142 underwent intraoperative nerve monitoring. We evaluated factors affecting the diagnostic accuracy of intraoperative nerve monitoring for recurrent laryngeal nerve palsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall incidence of postoperative recurrent laryngeal nerve palsy was 22% (32/142). Univariate analysis identified the left lateral decubitus position (vs. prone position) and not using video laryngoscope during intubation as risk factors for discrepancies between intraoperative nerve monitoring findings and postoperative recurrent laryngeal nerve palsy diagnosis. Multivariate analysis confirmed that the left lateral decubitus position (odds ratio: 4.24; 95% confidence interval: 1.09–13.4, <i>p</i> = 0.019) and not using video laryngoscope during intubation (odds ratio: 9.51; 95% confidence interval: 2.94–15.9, <i>p</i> = 0.001) were independent risk factors for recurrent laryngeal nerve palsy diagnostic discrepancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Adequate contact between the intubation tube and vocal cord muscles is crucial for effective intraoperative nerve monitoring during esophagectomy. Additionally, the intraoperative posture significantly affects diagnostic outcomes and should be carefully considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"920-925"},"PeriodicalIF":3.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012757","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":"FIB-3 index as a novel age-independent predictor of liver fibrosis and prognosis in hepatocellular carcinoma patients undergoing hepatectomy","authors":"Yuki Imaoka,&nbsp;Masahiro Ohira,&nbsp;Tsuyoshi Kobayashi,&nbsp;Naruhiko Honmyo,&nbsp;Michinori Hamaoka,&nbsp;Takashi Onoe,&nbsp;Daisuke Takei,&nbsp;Koichi Oishi,&nbsp;Tomoyuki Abe,&nbsp;Toshihiro Nakayama,&nbsp;Miho Akabane,&nbsp;Kazunari Sasaki,&nbsp;Hideki Ohdan,&nbsp;Hiroshima Surgical study group of Clinical Oncology (HiSCO)","doi":"10.1002/ags3.70010","DOIUrl":"https://doi.org/10.1002/ags3.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver fibrosis is a key factor in the progression of chronic liver diseases, including viral hepatitis and metabolic dysfunction-associated steatotic liver disease. If untreated, fibrosis can progress to cirrhosis, increasing the risk of liver cancer or failure. This study evaluates the Fibrosis (FIB)-3 index, a novel marker free from age-related biases, for predicting liver fibrosis and 5-year outcomes in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 1013 patients who underwent liver resection were analyzed in this multi-institutional study. The predictive performance of the FIB-3 index was compared with the original FIB-4 index, which incorporates age into its calculation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The FIB-3 index demonstrated superior accuracy for advanced fibrosis (≥F3) in elderly patients. A higher FIB-3 index was an independent risk factor for recurrence-free survival in elderly patients, underscoring its utility in this population. Notably, the application of appropriate cutoff values allowed the FIB-3 index to facilitate effective risk stratification for 5-year overall survival and recurrence-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The FIB-3 index served as an effective alternative to the FIB-4 index in assessing liver fibrosis among aged patients, and it effectively stratified the likelihood of the 5-year outcomes when utilized in conjunction with a specific cut-off after initial hepatectomy for HCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1055-1065"},"PeriodicalIF":3.3,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012935","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}