Annals of Gastroenterological Surgery最新文献

{"title":"Biological Resectability in Colorectal Liver Metastases: A Nomogram-Based Continuous Risk Model to Define Borderline Disease.","authors":"Yuzo Umeda, Toshiharu Mitsuhashi, Tomokazu Fuji, Toru Kojima, Takeshi Koujima, Tatsuo Matsuda, Daisuke Satoh, Masaru Inagaki, Kosei Takagi, Toshiyoshi Fujiwara","doi":"10.1002/ags3.70278","DOIUrl":"10.1002/ags3.70278","url":null,"abstract":"<p><strong>Background: </strong>Resectability in colorectal liver metastases (CRLM) is traditionally defined by technical feasibility; however, a biologically based definition of borderline resectable disease has not been established. We evaluated the prognostic impact of <i>KRAS</i> mutation and developed a model for biological risk stratification.</p><p><strong>Methods: </strong>This multi-institutional retrospective study included 584 patients undergoing initial hepatectomy for CRLM. The impact of <i>KRAS</i> mutation was assessed according to primary tumor sidedness and tumor burden score (TBS). A nomogram predicting overall survival (OS) was constructed using independent prognostic factors and compared with established clinical risk scores.</p><p><strong>Results: </strong><i>KRAS</i> mutation was identified in 36.8% of patients and was associated with worse OS (median survival: 47.3 vs. 70.6 months, <i>p</i> = 0.0006) and recurrence-free survival. This adverse impact was observed in left-sided tumors but not in right-sided tumors. TBS stratified prognosis in <i>KRAS</i> wild-type but not in mutant cases, suggesting that tumor biology may outweigh morphology. A nomogram incorporating <i>KRAS</i> status, TBS, CA19-9, primary nodal status, and extrahepatic disease demonstrated improved discriminatory ability compared with conventional models and stratified recurrence patterns, including extrahepatic recurrence.</p><p><strong>Conclusions: </strong>The prognostic impact of <i>KRAS</i> mutation depends on tumor sidedness and is independent of tumor morphology. Our nomogram provides a continuous biological risk assessment and may facilitate biological risk stratification and support future refinement of the concept of biologically borderline resectable CRLM.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918313","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":"Workplace Harassment and Consideration of Leaving Surgical Practice: A Nationwide Survey by the Japanese Society of Gastroenterological Surgery.","authors":"Keisuke Kurimoto, Tsutomu Fujii, Yoshihiro Shirai, Atsuro Fujinaga, Masayuki Fukumoto, Sonoko Ishida, Koya Hida, Chie Tanaka, Tsunekazu Mizushima, Sachiyo Nomura, Ken Shirabe","doi":"10.1002/ags3.70274","DOIUrl":"10.1002/ags3.70274","url":null,"abstract":"<p><strong>Background: </strong>Workplace harassment in surgical settings is a critical issue affecting surgeon well-being, workforce sustainability, and patient safety. However, nationwide data focusing on gastroenterological surgeons remain limited.</p><p><strong>Objective: </strong>To assess prevalence and characteristics of workplace harassment among gastroenterological surgeons in Japan, examine its association with consideration of leaving surgical practice, and evaluate the need for institutional countermeasures by the Japanese Society of Gastroenterological Surgery (JSGS).</p><p><strong>Methods: </strong>A nationwide, cross-sectional, anonymous web-based survey was conducted among JSGS members between November 2024 and January 2025. The questionnaire assessed experiences and observations of five categories of harassment, power, sexual, maternity/paternity, academic, and surgery-related harassment during the preceding 10 years. Associations with consideration of leaving the profession and opinions on JSGS-led countermeasures were also evaluated.</p><p><strong>Results: </strong>A total of 1967 surgeons (response rate, 13.0%) participated. Overall, 66% reported experiencing at least one type of harassment, and 88% reported witnessing harassment in the workplace. Female surgeons reported higher exposure to all harassment types, particularly sexual harassment (55% vs. 8%) and maternity/paternity harassment (24% vs. 4%). Among those who experienced harassment, 56% reported having considered leaving their profession. More than 70% of respondents expressed the need for institutional countermeasures by the JSGS to address all types of harassment.</p><p><strong>Conclusion: </strong>Workplace harassment is highly prevalent among gastroenterological surgeons in Japan and is associated with consideration of leaving the profession. These findings suggest that harassment represents not only an interpersonal issue but also a structural challenge that may influence the long-term sustainability of the surgical workforce.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910870","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":"Correction to \"Preoperative Gemcitabine/Nab-Paclitaxel With Concurrent Radiation Therapy for Borderline Resectable Pancreatic Cancer: A Comparative Analysis With Preoperative Chemoradiation Therapy Using Gemcitabine Alone\".","authors":"","doi":"10.1002/ags3.70277","DOIUrl":"10.1002/ags3.70277","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1002/ags3.70191.].</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886234","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":"Recent Advances in Functional Liver Volumetry: Emphasis on 99mTc-GSA SPECT/CT Fusion Imaging","authors":"Toru Beppu,&nbsp;Toshiro Masuda,&nbsp;Yasunori Nagayama,&nbsp;Hidetoshi Nitta,&nbsp;Hiromitsu Hayashi","doi":"10.1002/ags3.70237","DOIUrl":"10.1002/ags3.70237","url":null,"abstract":"<p>Functional assessment of the future liver remnant (FLR) has become increasingly important for improving the safety of major hepatectomy. Conventional evaluation based on computed tomography (CT) volumetry estimates anatomical liver volume but does not fully reflect the functional capacity of the remnant liver, particularly in patients with underlying liver disease or those receiving preoperative therapy. In recent years, functional liver volumetry using technetium-99 m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy combined with single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging has emerged as a reliable method for quantitative assessment of regional liver function. This review summarizes recent advances in functional liver volumetry with particular focus on 99mTc-GSA SPECT/CT fusion imaging and its clinical applications in patients undergoing major hepatectomy. Functional imaging enables simultaneous evaluation of FLR volume and function and has demonstrated superior predictive value for post-hepatectomy liver failure compared with volumetric assessment alone. Functional imaging has also clarified important aspects of liver regeneration following portal vein embolization, hepatic vein embolization, and associating liver partition and portal vein ligation for staged hepatectomy, demonstrating that functional recovery often exceeds or precedes volumetric hypertrophy. Our studies using 99mTc-GSA SPECT/CT further demonstrated that functional liver regeneration after hepatectomy occurs earlier than volumetric regeneration and that factors such as liver fibrosis, chemotherapy exposure, and hepatic venous congestion influence regional functional recovery. Integration of functional volumetry into preoperative planning can improve risk stratification and optimize surgical decision-making.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1428-1440"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576617","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":"Relationship Between Hospital Volume and Outcomes of Minimally Invasive Esophagectomy for Esophageal Cancer: Analysis of the National Clinical Database in Japan","authors":"Soji Ozawa,&nbsp;Hiraku Kumamaru,&nbsp;Yuko Kitagawa,&nbsp;Kazuo Koyanagi,&nbsp;Junya Oguma,&nbsp;Harushi Udagawa,&nbsp;Hiroaki Miyata,&nbsp;Yasushi Toh,&nbsp;Hisahiro Matsubara","doi":"10.1002/ags3.70229","DOIUrl":"10.1002/ags3.70229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>While esophagectomy is a high-difficulty procedure, minimally invasive esophagectomy (MIE) requires even more advanced surgical skills, necessitating analysis of factors affecting surgical outcomes. This study examined the relationship between the postoperative mortality and complication rates of MIE and the annual hospital volume of esophagectomy to identify a threshold volume serving as a safety benchmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 22 712 patients registered in the National Clinical Database who underwent esophagectomy (MIE or open esophagectomy [OE]) at 1 037 hospitals in Japan between January 1, 2012, and December 31, 2015. Hospitals were stratified into five categories according to average annual volume of esophagectomies (MIE and OE). The primary outcome was operative mortality, and the secondary outcome was the incidence of postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 22 712 cases consisted of 9 739 cases (42.9%) of MIE and 12 973 cases (57.1%) of OE. Regarding MIE outcomes, the overall crude perioperative mortality and perioperative complication rates were 2.1% and 40.9%, respectively. Multivariable analysis performed using very-high-volume hospitals as reference revealed an odds ratio for mortality in very-low-volume hospitals of 2.70 (<i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The postoperative mortality rate in patients undergoing MIE was relatively low in hospitals with a higher annual average volume of esophagectomy cases. Mortality was significantly higher in hospitals performing five or fewer esophagectomies annually. However, residual confounding due to differences in baseline patient characteristics cannot be excluded, although key clinical factors were adjusted for. Therefore, careful attention must be paid to the surgical and perioperative management techniques when performing MIE, particularly in very-low-volume hospitals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1518-1526"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576832","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 Indication of D3 Lymph Node Dissection for Non-Metastatic Colon Cancers by Tumor Stages: Evaluation of 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;Hideki Ueno,&nbsp;the Lymph Nodes Committee of JSCCR","doi":"10.1002/ags3.70223","DOIUrl":"10.1002/ags3.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the therapeutic impact of D3 lymph node dissection for non-metastatic colon cancers, evaluating the therapeutic value index for each lymph node station according to surgical stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with surgical Stage I–III colon and rectosigmoid cancer who underwent curative resection between January 2003 and December 2014 were identified from the Japanese Society for Cancer of the Colon and Rectum database and analyzed. The therapeutic value index (TVI) was defined as the incidence of lymph node metastasis times 5-year overall survival and calculated for each nodal station stratified by tumor stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 21 914 patients, including 9583 patients with right-sided colon cancer and 12 331 with left-sided colon cancer, were eligible for analysis. In right-sided colon cancer, reflecting differences in tumor location and the presence of the right colic artery, variability in the TVIs was observed among stations #203 to #223. When the three stations were collectively considered as a single group of main lymph nodes, the combined TVIs for sT1Nany, sT2N0, sT2Nany, sT3-4 N0, and sT3-4Nany were 0.630, 0.493, 0.857, 0.849, and 2.274, respectively. For station #253 in left-sided colon cancers, the TVIs for sT1Nany, sT2N0, sT2Nany, sT3-4 N0, and sT3-4Nany were 0.120, 0.278, 0.634, 0.475, and 1.234, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Within a D3-treated cohort stratified by surgical stage, the TVI of the main lymph nodes for sT2N0 tumors remained low, approximating that of sT1Nany rather than sT2Nany or sT3-4 tumors. Further evaluation of the therapeutic impact of D3 lymphadenectomy for clinically node-negative T2 colon cancer is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1527-1537"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential Updates 2024–2025: Surgical Strategy for Esophageal Cancer Toward a New Paradigm in the Era of Immunotherapy and Personalization","authors":"Shuichiro Oya,&nbsp;Koichi Yagi,&nbsp;Yoshifumi Baba","doi":"10.1002/ags3.70197","DOIUrl":"10.1002/ags3.70197","url":null,"abstract":"<p>Esophageal cancer surgery is evolving from technical standardization to a paradigm of personalized, strategy-oriented care. Robotic-assisted techniques and enhanced perioperative protocols have improved safety, but the field is increasingly shaped by three forces: integration of immune checkpoint inhibitors (ICIs), population aging, and the rise of intelligent technologies such as artificial intelligence (AI) and extended reality. Adjuvant nivolumab after neoadjuvant chemoradiotherapy (nCRT) remains the standard for residual disease, while other regimens such as durvalumab or dual checkpoint blockade have not demonstrated consistent survival benefit. Neoadjuvant ICI strategies, particularly camrelizumab plus chemotherapy in esophageal squamous cell cancer (ESCC), achieve high pathological response rates without increasing surgical morbidity, and pooled analyses confirm their feasibility. Immune-related adverse events (irAEs) occur in approximately 20%–35% of patients but are usually manageable. Perioperative outcomes remain comparable to conventional regimens. Elderly and frail patients require individualized optimization. The integration of minimally invasive techniques, assessment of sarcopenia and nutritional risk, and adjustment of chemotherapy intensity have contributed to improved outcomes. Moreover, salvage surgery—once prohibitive—now offers meaningful long-term survival when performed in high-volume centers with specialized expertise. AI and machine learning are transforming risk stratification, intraoperative guidance, and surgical training. AI-assisted video analytics and VR/AR simulators enhance skill acquisition, credentialing, and standardization. Future progress will depend on multicenter validation, prospective registries, and integration of oncologic, physiologic, and technological variables. Ultimately, the future of esophageal cancer surgery will be defined not only by technical precision but also by the surgeon's ability to leverage data-driven innovation for personalized care.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1368-1381"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576876","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":"Pylorus-Preserving Gastrectomy for Gastric Cancer: Current Evidence and Future Directions","authors":"Sa-Hong Kim,&nbsp;Hyuk-Joon Lee","doi":"10.1002/ags3.70238","DOIUrl":"10.1002/ags3.70238","url":null,"abstract":"<p>Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for clinically T1N0M0 (cT1N0M0) early gastric cancer (EGC) located in the middle third of the stomach, at least 4 cm proximal from the pylorus. By preserving the peri-pyloric tissues, including the hepatic branch of the vagus nerve and the infrapyloric vessels, PPG maintains physiological pyloric function without compromising oncologic safety. Several randomized controlled trials (RCTs) have demonstrated the functional advantages of PPG. In particular, the Korean multicenter RCT (KLASS-04) reported a lower incidence of gallstone formation, bile reflux, and postoperative nutritional deficiencies. While PPG is technically demanding and associated with concerns regarding delayed gastric emptying (DGE), recent advances in minimally invasive surgery and intraoperative assessment tools, including augmented imaging technology using indocyanine green (ICG), have facilitated its safe implementation. Although PPG is currently indicated for cT1N0M0 EGC, emerging evidence suggests that patients pathologically confirmed as advanced disease postoperatively may still achieve favorable outcomes with standard adjuvant therapy without requiring additional surgery, suggesting potential oncological acceptability of PPG in carefully selected patients with advanced disease. The integration of robotic platforms and navigation-guided visualization with augmented imaging technology may further enhance oncologic safety and technical feasibility. This review aims to outline the current evidence and future directions of PPG, focusing on the feasibility of extending its application beyond its traditional indications.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1388-1403"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576627","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":"Diagnostic Accuracy of Size-Based Preoperative CT Assessment for Predicting Lymph Node Metastasis in Colon Cancer: A Systematic Review and Meta-Analysis","authors":"Yuji Takayama,&nbsp;Tomoya Shimizu,&nbsp;Jun Watanabe,&nbsp;Shimpei Ogawa,&nbsp;Yukihide Kanemitsu","doi":"10.1002/ags3.70218","DOIUrl":"10.1002/ags3.70218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate identification of preoperative lymph node metastasis is essential for planning colon cancer treatment. Computed tomography (CT) is widely used for staging, but its diagnostic performance based on size criteria alone remains unclear. This study aimed to evaluate the diagnostic accuracy of preoperative CT for detecting lymph node metastasis in colon cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted on June 12, 2025. Studies comparing preoperative CT with pathological evaluation and providing 2 × 2 contingency tables were included. Pooled sensitivity and specificity were calculated using a hierarchical summary receiver operating characteristic model and a bivariate random-effects model. Subgroup analyses were performed according to cancer location (colon only vs. colon plus rectal cancer) and diagnostic criteria (size alone vs. size plus morphology). Study quality was assessed using QUADAS-2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine studies involving 5634 patients were included. The pooled sensitivity and specificity of CT for detecting lymph node metastasis were 0.693 (95% CI: 0.636–0.744) and 0.660 (95% CI: 0.581–0.731), respectively, with an area under the curve of 0.727. Meta-regression showed no statistically significant differences in diagnostic performance between colon-only studies and those including rectal cancer (<i>p</i> = 0.561 and 0.316), or between size-only and morphologic criteria (<i>p</i> = 0.822 and 0.536).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CT using size criteria alone for preoperative lymph node staging in colon cancer demonstrated only moderate diagnostic performance. These findings indicate that relying on lymph node size as the primary determinant may be insufficient for reliable clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1450-1462"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-Analysis on the Efficacy and Safety of Salvage Esophagectomy for T4 Esophageal Squamous Cell Carcinoma","authors":"Makoto Sakai,&nbsp;Kengo Kuriyama,&nbsp;Kazue Nagai,&nbsp;Ken Shirabe,&nbsp;Hiroshi Saeki","doi":"10.1002/ags3.70233","DOIUrl":"10.1002/ags3.70233","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Salvage esophagectomy is associated with high morbidity and mortality rates. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of salvage esophagectomy for unresectable locally advanced (T4) esophageal squamous cell carcinoma (ESCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (the Academic Information Search Service of the National Institute of Information from Japan) for articles on salvage esophagectomy for T4 ESCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies (208 cases) were eligible for meta-analysis. The overall postoperative complications rate (Clavien–Dindo grade ≥ III) was 30% (95% CI: 23–38, <i>I</i>² = 0%); anastomotic leak rate was 18% (95% CI: 13–25, <i>I</i>² = 15%); pulmonary complication rate was 31% (95% CI: 20–42, <i>I</i>² = 63%); mortality rate was 7% (95% CI: 3–11, <i>I</i>² = 0%); and R0 resection rate was 72% (95% CI: 59–83, <i>I</i>² = 72%). A meta-analysis of survival was not performed due to heterogeneous reporting across studies. However, overall survival was reported to be higher in patients achieving R0 resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Salvage esophagectomy for cT4 ESCC is associated with significant morbidity, particularly a high anastomotic leak rate of 18%. The procedure should be reserved for carefully selected patients in whom R0 resection is highly feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1441-1449"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576777","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}