Annals of Gastroenterological Surgery最新文献

{"title":"Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato-biliary-pancreatic cancer","authors":"Norifumi Harimoto,&nbsp;Keishi Sugimachi,&nbsp;Tomohiro F. Nishijima,&nbsp;Tomino Takahiro,&nbsp;Tomonari Shimagaki,&nbsp;Yohei Mano,&nbsp;Emi Onishi,&nbsp;Masahiko Sugiyama,&nbsp;Yasue Kimura,&nbsp;Masaru Morita","doi":"10.1002/ags3.12897","DOIUrl":"https://doi.org/10.1002/ags3.12897","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Older adults with cancer are often at increased risk for postoperative complications following major surgeries. This study aimed to evaluate the combined role of frailty and sarcopenia in predicting postoperative complications in older adults with hepatobiliary and pancreatic cancer undergoing surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 107 Japanese patients who underwent comprehensive geriatric assessment (CGA) at the geriatric oncology service before cancer treatment decisions and subsequent curative surgery for hepatobiliary and pancreatic cancer. Frailty status was measured using the validated 10-item frailty index based on a CGA (FI-CGA-10) and categorized as fit, prefrail, or frail. Sarcopenia was assessed using bioelectrical impedance analysis and grip strength. The primary outcome was postoperative complications, defined as Clavien–Dindo grade ≥ III, within 1 month of surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the 107 patients was 79 (range, 75–89) years. Patients were categorized as fit (<i>n</i> = 36, 33.7%), prefrail (<i>n</i> = 57, 53.2%), or frail (<i>n</i> = 14, 13.1%). Of these, 21 patients (20%) were diagnosed with sarcopenia; 16 patients (15%) experienced postoperative complications. Patients classified as prefrail or frail had a higher incidence of postoperative complications compared with those classified as fit (19.7% vs. 5.6%, <i>p</i> = 0.08). Patients with both prefrail or frail and sarcopenia had a significantly higher risk of postoperative complications. This association remained significant in the multivariable model (OR 4.74; 95% CI, 1.10–20.29; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, patients classified as prefrail/frail and sarcopenic were at significantly higher risk for postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"587-594"},"PeriodicalIF":2.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950332","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 on short-term outcomes of the COVID-19 pandemic following laparoscopic distal gastrectomy and low anterior resection for gastric and rectal cancer: A retrospective study using the Japanese National Clinical Database, 2018–2022","authors":"Masafumi Inomata,&nbsp;Hideki Endo,&nbsp;Tomonori Akagi,&nbsp;Hidefumi Shiroshita,&nbsp;Shigeki Yamaguchi,&nbsp;Susumu Eguchi,&nbsp;Norihito Wada,&nbsp;Yukinori Kurokawa,&nbsp;Yosuke Seki,&nbsp;Yoshiharu Sakai,&nbsp;Hiroyuki Yamamoto,&nbsp;Yoshihiro Kakeji,&nbsp;Yuko Kitagawa,&nbsp;Akinobu Taketomi,&nbsp;Masaki Mori","doi":"10.1002/ags3.12901","DOIUrl":"https://doi.org/10.1002/ags3.12901","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We previously reported no change in surgical outcomes for laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR) early in the COVID-19 pandemic (2020), although the number of elective surgeries decreased. In 2021, COVID-19 spread further, with vaccination and other medical measures based on several medical societies' guidelines being initiated. Using the Japanese National Clinical Database (NCD), we added 2022 data to the 2018–2021 data to analyze the impacts of expansion of the COVID-19 infection and its spread on laparoscopic surgery (including robot-assisted surgery).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on patients who underwent LDG and LLAR for cancer were extracted from the NCD between 2018 and 2022. The numbers of LDG and LLAR were obtained, and morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), i.e. the ratio of the observed number of incidences to expected number of incidences calculated by the risk calculator previously developed by the NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The numbers of LDG and LLAR cases declined in 2020, the first pandemic year, and continued to decline in 2022 to the same level as 2021, but with no further decline and no recovery trend in the number of cases. Numbers of robot-assisted LDG and LLAR cases increased but at a rate lower than the prepandemic increase. Mortality and anastomotic leakage, two very important complications assessed in SMR, did not worsen during the pandemic compared to prepandemic levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Japan, laparoscopic surgery was safe and unaffected by the COVID-19 pandemic, even in 2022, when the epidemic spread.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"619-627"},"PeriodicalIF":2.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950527","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":"Impacts of COVID-19 pandemic on short-term outcomes of low anterior resection performed in hospitals with different surgical volumes","authors":"Hiromichi Maeda,&nbsp;Hideki Endo,&nbsp;Ryo Seishima,&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/ags3.12900","DOIUrl":"https://doi.org/10.1002/ags3.12900","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the impact of the coronavirus disease (COVID-19) pandemic on short-term outcomes of low anterior resection (LAR) across hospitals classified by surgical volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of patients who underwent elective LAR for rectal cancer between 2018 and 2022 were obtained from the National Clinical Database of Japan. Hospitals were categorized into high-, medium-, and low-volume groups. Each group was constituted to represent approximately one-third of all surgeries performed between 2018 and 2019. The standardized morbidity/mortality ratios (SMRs) of Clavien–Dindo grade ≥3 (CD ≥ 3) complications were the primary endpoint. The secondary endpoints included anastomotic leakage, pneumonia, and surgical mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study analyzed 91 800 cases of elective LAR, with 10.5% experiencing CD ≥ 3 complications, 8.8% anastomotic leakage, 0.9% pneumonia, and 0.5% surgical mortality. Despite COVID-19, SMRs of CD ≥ 3 complications decreased from 2018 to 2022 across all groups. However, increases in the rates and SMRs of CD ≥ 3 complications were observed in low-volume hospitals around mid-2020, followed by a decline. Anastomotic leakage showed similar trends. The rates and SMRs of pneumonia and surgical mortality remained unchanged. Notably, anastomotic leakage rates were 7.6%, 8.9%, and 10.0% in high-, medium-, and low-volume hospitals, respectively, indicating superior outcomes in high-volume hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early COVID-19 waves may have disproportionately affected low-volume hospitals. However, the decline in SMRs of CD ≥ 3 complications from 2018 to 2022 across all three groups suggests the robustness and resilience of surgical services for rectal cancer in Japan. The potential disparity in short-term outcomes among hospitals is a new concern.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"608-618"},"PeriodicalIF":2.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950547","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":"Treatment outcomes of hepatectomy and systemic chemotherapy based on oncological resectability criteria for hepatocellular carcinoma","authors":"Shohei Komatsu,&nbsp;Yoshihiko Yano,&nbsp;Nobuaki Ishihara,&nbsp;Masahiro Kido,&nbsp;Hidetoshi Gon,&nbsp;Kenji Fukushima,&nbsp;Takeshi Urade,&nbsp;Hiroaki Yanagimoto,&nbsp;Hirochika Toyama,&nbsp;Takumi Fukumoto","doi":"10.1002/ags3.12893","DOIUrl":"https://doi.org/10.1002/ags3.12893","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The oncological resectability criteria for hepatocellular carcinoma (HCC) have recently been established (R/BR1/BR2), and validating the outcomes is an urgent issue. This study aimed to analyze the outcomes of hepatectomy and systemic chemotherapy based on the oncological resectability criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 931 patients in the hepatectomy group and 273 in the systemic chemotherapy group who received atezolizumab/bevacizumab, lenvatinib, or durvalumab plus tremelimumab were recruited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median survival times (MST) in the hepatectomy group were R, 107.2 mo; BR1, 44.4 mo; and BR2, 18.4 mo (<i>p</i> &lt; 0.0001). The MSTs in the systemic chemotherapy group were R, 16.3 mo; BR1, 24.5 mo; and BR2, 16.1 mo (<i>p</i> = 0.3598). A comparison of survival of patients in the BR2 category revealed no significant difference between the two groups for those with modified albumin-bilirubin grade 1 + 2a (<i>p</i> = 0.7343) and grade 2b + 3 (<i>p</i> = 0.6589). The BR2 definition comprised three tumor factors, and the MST of patients with only one BR2-defining factor tended to be better in the hepatectomy group than in the systemic chemotherapy group (22.9 vs 20.2 mo, <i>p</i> = 0.0977). Meanwhile, the MST tended to be better in the systemic chemotherapy group than in the hepatectomy group (16.5 vs 12.6 mo) for those with two to three BR2-defining factors, although the difference was insignificant (<i>p</i> = 0.4252).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The oncological resectability criteria for HCC effectively stratified the prognosis after hepatectomy. Treatment outcomes of hepatectomy in patients with two to three BR2-defining factors are limited, suggesting the need for multidisciplinary treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"235-243"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533425","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 hepatospleno volume ratio on postoperative chronic liver failure after major hepatectomy for perihilar cholangiocarcinoma","authors":"Atsushi Takahashi,&nbsp;Yoshihiro Ono,&nbsp;Kosuke Kobayashi,&nbsp;Atsushi Oba,&nbsp;Takafumi Sato,&nbsp;Hiromichi Ito,&nbsp;Yosuke Inoue,&nbsp;Akio Saiura,&nbsp;Yu Takahashi","doi":"10.1002/ags3.12895","DOIUrl":"https://doi.org/10.1002/ags3.12895","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The incidence of postoperative chronic liver failure (PCLF) after major hepatectomy for perihilar cholangiocarcinoma is relatively low, but it warrants careful attention. This study aimed to analyze the risk factors for PCLF, with a specific focus on the correlation with postoperative changes in liver and spleen volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 172 patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2006 and 2021 were included in the study. PCLF is defined as the presence of liver failure, such as ascites, esophageal varices, encephalopathy, and jaundice at 3 mo postoperatively. Risk factors, including chronological changes in liver volume, spleen volume, and hepatospleno volume ratio for PCLF, were evaluated by univariate and multivariate analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PCLF occurred in 8 of the 172 patients. On univariate analysis, multiple factors including preoperative prealbumin levels, indocyanine green retention test, and future remnant liver volume were identified as risk factors for PCLF. On multivariate analysis, the hepatospleno volume ratio (<i>p</i> = 0.033) and prealbumin level (<i>p</i> = 0.015) 3 mo after surgery were significantly associated with PCLF. The cutoff value for the hepatospleno volume ratio was 3.0 (area under the curve [AUC]: 0.881, sensitivity: 91.7%, specificity: 66.7%) and that for prealbumin level was 10 mg/dL (AUC: 0.894, sensitivity: 83.3%, specificity: 88.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hepatospleno volume ratio &lt;3.0 and prealbumin level &lt;10 mg/dL 3 mo after surgery were identified as risk factors for PCLF, implying the importance of postoperative nutritional guidance to preserve the remnant liver function for patients with these risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"578-586"},"PeriodicalIF":2.9,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949815","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":"Diagnosis of necrotic and non-necrotic small bowel strangulation: The importance of intestinal congestion","authors":"Takeshi Yamada,&nbsp;Yuto Aoki,&nbsp;Akihisa Matsuda,&nbsp;Yasuyuki Yokoyama,&nbsp;Goro Takahashi,&nbsp;Takuma Iwai,&nbsp;Seiichi Shinji,&nbsp;Hiromichi Sonoda,&nbsp;Kay Uehara,&nbsp;Hiroshi Yoshida","doi":"10.1002/ags3.12894","DOIUrl":"https://doi.org/10.1002/ags3.12894","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the prevalence of laparoscopic techniques in abdominal surgeries today, bowel obstruction remains a potentially serious complication. Small bowel strangulation (SBS), in particular, is a critical condition that can lead to patient mortality. However, the prognosis for SBS is favorable if surgery is performed before the onset of necrosis. Non-necrotic SBS is a reversible condition in which blood flow can be restored by relieving the strangulation. The purpose of this study was to identify sensitive and specific contrast-enhanced computed tomography (CT) findings that are useful for diagnosis of both non-necrotic and necrotic SBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients diagnosed with SBS and simple bowel obstruction (SBO) who underwent contrast-enhanced CT followed by surgery from 2006 to 2023. Two gastrointestinal surgeons independently assessed the images retrospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty SBO and 141 SBS patients were included. Eighty-seven had non-necrotic SBS and 54 had necrotic SBS. Mesenteric edema was most frequently observed in both necrotic and non-necrotic SBS cases followed by abnormal bowel wall thickening. These two findings were observed significantly less frequently in SBO. Bowel hypo-enhancement is identified in only about half of the non-necrotic SBS cases, and it was detected at significantly higher rates in necrotic SBS compared to non-necrotic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mesenteric edema and abnormal bowel wall thickening are sensitive and specific signs of both non-necrotic and necrotic SBS. These two findings indicate mesenteric and bowel congestion. Detecting intestinal congestion can lead to an accurate diagnosis of SBS, particularly in case of non-necrotic SBS, where bowel hypo-enhancement may sometimes be absent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"538-545"},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for postoperative complications in laparoscopic and robot-assisted surgery for octogenarians with colorectal cancer: A multicenter retrospective study","authors":"Takehito Yamamoto,&nbsp;Koya Hida,&nbsp;Kentaro Goto,&nbsp;Meiki Fukuda,&nbsp;Susumu Inamoto,&nbsp;Hiroki Hashida,&nbsp;Ryo Matsusue,&nbsp;Ryo Takahashi,&nbsp;Rei Mizuno,&nbsp;Hiroaki Terajima,&nbsp;Kazutaka Obama","doi":"10.1002/ags3.12874","DOIUrl":"https://doi.org/10.1002/ags3.12874","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Minimally invasive surgery for colorectal cancer is increasing globally. However, the safety in older patients have not been thoroughly examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with colorectal cancer who underwent laparoscopic or robot-assisted surgery at Kyoto University Hospital and 18 affiliated institutions in Japan that participated in the Kyoto Colorectal Surgery Group between 2018 and 2023 were enrolled. Focusing on patients ≥80 y, we investigated the risk factors for postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 7303 patients were enrolled in this study. The mean age was 71 ± 11 y, with 1665 patients (22.8%) ≥80 y old. Older patients (≥80 y) had significantly higher ASA and ECOG-PS scores and more comorbidities including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, heart disease, and cerebrovascular disease than patients ≤79 y old (all <i>p</i> &lt; 0.05). In the older group, postoperative complications (Clavien–Dindo grade ≥II) occurred in 210 patients (12.6%). After adjusting for covariates using the multivariable logistic regression model, rectal cancer (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.30–2.60, <i>p</i> = 0.001), operation time ≥300 min (OR: 1.52, 95% CI: 1.07–2.16, <i>p</i> = 0.020), and blood loss ≥100 mL (OR: 2.19, 95% CI: 1.80–3.24, <i>p</i> &lt; 0.001) were associated with the occurrence of complications, whereas their comorbidities showed no association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In minimally invasive colorectal cancer surgery for older patients (≥80 y old), prioritizing shorter operation time and blood loss control is crucial, especially for patients with rectal cancer because of their high risk of complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"319-328"},"PeriodicalIF":2.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533376","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":"Effects of an increase in emergency cases with difficulties in transport to hospital during the COVID-19 pandemic on postoperative short-term outcomes of colorectal perforation: A study based on the National Clinical Database","authors":"Shimpei Ogawa,&nbsp;Hideki Endo,&nbsp;Masahiro Yoshida,&nbsp;Tomomitsu Tsuru,&nbsp;Michio Itabashi,&nbsp;Hiroyuki Yamamoto,&nbsp;Yoshihiro Kakeji,&nbsp;Hideki Ueno,&nbsp;Ken Shirabe,&nbsp;Taizo Hibi,&nbsp;Akinobu Taketomi,&nbsp;Norihiko Ikeda,&nbsp;Masaki Mori","doi":"10.1002/ags3.12887","DOIUrl":"https://doi.org/10.1002/ags3.12887","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>During the COVID-19 pandemic, there were delays in transport of emergency cases to hospital by ambulance due to increased difficulties in obtaining hospital acceptance. The aim of this study was to examine if this had a negative effect on postoperative short-term outcomes in patients with colorectal perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Clinical Database (NCD) includes &gt;95% of surgical cases in Japan. Postoperative 30-day mortality, surgical mortality, and postoperative complications (Clavien–Dindo grade ≥3) were examined in 17 770 cases of colorectal perforation registered from 2019 to 2022 in the NCD. These outcomes were compared for cases with new COVID-19 infection and emergency cases with difficulties in transport to hospital. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) did not contain 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Postoperative 30-day mortality occurred in 1826 cases (10.3%), surgical mortality in 2382 cases (13.4%), and postoperative complications in 5276 cases (29.7%). Significantly higher SMRs were found for 30-day mortality in November 2020 (1.44 [95% CI: 1.07–1.89]) and February 2021 (1.54 [95% CI: 1.14–2.03]), and for postoperative complications in June 2020 (1.27 [95% CI: 1.07–1.50]). In 2022, there were marked increases in new COVID-19 cases and in emergency cases with difficulties in transport to hospital, but no month had a significantly high SMR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency cases with difficulties in transport markedly increased during the COVID-19 pandemic but had little effect on short-term outcomes of colorectal perforation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"505-517"},"PeriodicalIF":2.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950243","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":"Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery","authors":"Yoshikuni Kawaguchi,&nbsp;Kenta Murotani,&nbsp;Nahoki Hayashi,&nbsp;Satoru Kamoshita","doi":"10.1002/ags3.12892","DOIUrl":"https://doi.org/10.1002/ags3.12892","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The study aimed to clarify how nutrition was managed in patients based on surgical site during the first 7 d after gastroenterological cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A Japanese medical claims database was used to identify patients who had gastroenterological cancer surgery from 2011 to 2022. Patients were divided into groups based on the surgical sites, and postoperative feeding routes and timing of initiation of oral intake for groups were assessed. For the subset of patients fasting postoperatively for ≥7 d, the proportion of patients prescribed target doses of energy (20 kcal/kg) and amino acids (0.8 g/kg) on postoperative d 7 were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surgical sites of 360 296 study patients were: esophagus, 14 784; stomach, 103 339; colon/rectum, 194 049; liver, 19 277; gallbladder/bile duct, 8279; pancreas, 20 568. The median postoperative day of oral intake initiation was: esophagus, seven; stomach and pancreas, four; colon/rectum and gallbladder/bile duct, three; liver, two. The proportions of fasting patients prescribed target doses of energy and amino acids on postoperative d 7 were: esophagus, 42.6% and 34.4%; stomach, 21.8% and 28.0%; colon/rectum, 20.9% and 29.1%; liver, 21.2% and 22.5%; gallbladder/bile duct, 31.0% and 33.4%; pancreas, 28.2% and 37.8%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Oral intake after gastroenterological cancer surgery was started earliest in patients undergoing liver surgery and latest in patients undergoing esophageal surgery. Target parenteral energy and amino acid doses were prescribed to less than half of fasting patients. Education is needed to promote early initiation of oral intake and the use of guidelines-based parenteral nutrition dosing in patients after gastroenterological cancer surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"595-607"},"PeriodicalIF":2.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12892","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950244","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":"Analysis of surgical volume and short-term outcomes for upper gastrointestinal cancer post-COVID-19: Evidence from a nationwide Japanese database","authors":"Masashi Takeuchi,&nbsp;Hideki Endo,&nbsp;Taizo Hibi,&nbsp;Ryo Seishima,&nbsp;Yusuke Takemura,&nbsp;Hiroyuki Yamamoto,&nbsp;Hiromichi Maeda,&nbsp;Akinobu Taketomi,&nbsp;Yoshihiro Kakeji,&nbsp;Yasuyuki Seto,&nbsp;Hideki Ueno,&nbsp;Masaki Mori,&nbsp;Ken Shirabe,&nbsp;Yuko Kitagawa","doi":"10.1002/ags3.12891","DOIUrl":"https://doi.org/10.1002/ags3.12891","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Previous studies indicated that short-term outcomes for gastroenterological surgeries did not worsen during the COVID-19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre- and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD-established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Esophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study analyzed changes in surgical volume and short-term outcomes for upper gastrointestinal cancer in the post-COVID-19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"448-455"},"PeriodicalIF":2.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950551","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}