Annals of Gastroenterological Surgery最新文献

{"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":"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}

{"title":"Regional and patient characteristic disparities in the outcomes of minimally invasive surgery for colorectal cancer in Japan","authors":"Atsushi Hamabe,&nbsp;Arata Takahashi,&nbsp;Hiraku Kumamaru,&nbsp;Hiroshi Hasegawa,&nbsp;Koki Otsuka,&nbsp;Yoshihiro Kakeji,&nbsp;Ken Shirabe,&nbsp;Masafumi Inomata,&nbsp;Yuko Kitagawa,&nbsp;Ichiro Takemasa","doi":"10.1002/ags3.70007","DOIUrl":"https://doi.org/10.1002/ags3.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The use of minimally invasive surgery, including laparoscopic and robotic surgery, for gastrointestinal cancer has been rapidly increasing. This study aimed to clarify whether differences in minimally invasive surgery outcomes are associated with regional and patient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 123 771 right hemicolectomy and 126 965 low anterior resection cases performed between 2013 and 2019 were selected from the National Clinical Database for analysis. Patients were stratified by regional and economic variables, and open and minimally invasive surgical outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In secondary medical regions characterized by urban settings and numerous designated cancer care hospitals, the observed 30-day mortality of low anterior resections was lower only in the minimally invasive surgery group. For right hemicolectomies in regions with many designated cancer care hospitals, the observed incidence of postoperative complications was also lower in the minimally invasive group. Residents of high-income areas undergoing low anterior resection had a lower frequency of 30-day reoperation regardless of the type of surgery and a lower 30-day mortality in the minimally invasive group. For both right hemicolectomy and low anterior resection, patients with longer travel distances had fewer postoperative complications and lower 30-day reoperation rates in the minimally invasive group than in the open surgery group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found regional and patient characteristic disparities in minimally invasive surgical outcomes; national policies should be implemented to address these inequities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"769-784"},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519823","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 hospital costs for robotic and open pancreatectomy incurred during the implementation of a robotic pancreatectomy program at a cancer center","authors":"Heather G. Lyu,&nbsp;Yuki Hirata,&nbsp;Pamela W. Lu,&nbsp;Jess E. Maxwell,&nbsp;Rebecca A. Snyder,&nbsp;Michael P. Kim,&nbsp;Hop Tran Cao,&nbsp;Ching-Wei D. Tzeng,&nbsp;Matthew H. G. Katz,&nbsp;Naruhiko Ikoma","doi":"10.1002/ags3.70017","DOIUrl":"https://doi.org/10.1002/ags3.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Costs associated with robotic pancreatectomy compared to those of open pancreatectomy are assumed to be high but are not well known, particularly during the initial implementation of the robot.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Patients who underwent pancreatectomy for any diagnosis from January 2017 to August 2021 were identified retrospectively. Total hospital cost was calculated using intraoperative, inpatient, and outpatient costs within 30 days of surgery. The ratio of the total cost of each pancreatectomy to the average cost of all operations at our center was used to represent cost without sharing proprietary financial data. Propensity score matching was performed to account for significant differences between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 679 patients who underwent pancreatectomies, 88 of which were robotic. After propensity score matching, the open cohort had 176 patients, and the robotic cohort remained at 88 patients. The median hospital length of stay was 2 days shorter for robotic than for open pancreatectomy (<i>p</i> &lt; 0.001). The total hospital cost was markedly lower in the robotic pancreatectomy cohort. The inpatient and outpatient costs for robotic pancreatectomy were considerably lower than those for open pancreatectomy despite substantially higher intraoperative costs for the former procedure. A scatter plot of total costs after the initial adoption of the robot showed a trend of decreasing costs over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, total hospital costs associated with robotic pancreatectomy were lower than those for open surgery, mainly driven by shorter length of stay. Our findings suggest that costs of robotic pancreatectomy may decrease further with increased surgeon experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1066-1074"},"PeriodicalIF":3.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012351","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}