Annals of Gastroenterological Surgery最新文献

{"title":"Prognostic factors for patients with esophageal cancer who achieve pathological complete response in the primary tumor after upfront chemotherapy or chemoradiotherapy","authors":"Masaaki Motoori,&nbsp;Koji Tanaka,&nbsp;Hiroshi Miyata,&nbsp;Makoto Yamasaki,&nbsp;Osamu Shiraishi,&nbsp;Atsushi Takeno,&nbsp;Tomoki Makino,&nbsp;Keijiro Sugimura,&nbsp;Takushi Yasuda,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.12914","DOIUrl":"https://doi.org/10.1002/ags3.12914","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Upfront chemotherapy (uCT) or upfront chemoradiotherapy (uCRT) followed by surgery is generally accepted as the standard treatment for patients with locally advanced esophageal cancer. A substantial proportion of patients achieve a pathological complete response (pCR) of the primary tumor with upfront treatment. This retrospective study aimed to clarify the prognostic factors of patients with esophageal cancer who achieve pCR in the primary tumor after upfront treatment and whether the prognosis of patients with pCR who receive uCT differs from that of patients who receive uCRT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 121 patients who achieved pCR of the primary tumor after uCT and 40 patients after uCRT. Univariate and multivariate survival analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariate analysis of overall survival demonstrated that gender, upfront treatment, and pathological lymph node metastasis were independent prognostic factors (<i>p</i> = 0.0086, 0.011, and 0.031, respectively). Multivariate analysis of relapse-free survival demonstrated that gender, cM status, and pathological lymph node metastasis were independent prognostic factors (<i>p</i> = 0.033, 0.014, and 0.0010, respectively). Among patients without pathological lymph node metastasis, the uCT group showed significantly better both overall and relapse-free survival than the uCRT group (<i>p</i> = 0.014 and 0.037, respectively). Recurrence occurred in 24 patients in the uCT group and 9 in the uCRT group. All of local treatment (chemoradiotherapy and surgery) for recurrent lesions was performed in the uCT group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Male genders and pathological lymph node metastasis are independent poor prognostic factors in patients with esophageal cancer who receive upfront treatment followed by surgery and achieved pCR of the primary tumor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"678-686"},"PeriodicalIF":2.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520077","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":"The impact of delayed adjuvant chemotherapy on survival in gastric cancer patients with and without preoperative chemotherapy","authors":"Masataka Shimonosono,&nbsp;Takaaki Arigami,&nbsp;Daisuke Matsushita,&nbsp;Yusuke Tsuruda,&nbsp;Ken Sasaki,&nbsp;Kenji Baba,&nbsp;Takao Ohtsuka","doi":"10.1002/ags3.12911","DOIUrl":"https://doi.org/10.1002/ags3.12911","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Adjuvant chemotherapy (AC) is the standard treatment for patients with advanced gastric cancer (GC), yet the optimal timing for its initiation remains unclear. Besides, no studies have definitively established when AC should begin in patients receiving preoperative chemotherapy (PC). This study aimed to determine the optimal timing for initiating AC in patients with GC who underwent curative gastrectomy, either with or without PC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 446 patients who underwent curative gastrectomy were evaluated, including 140 who received AC: 72 without PC and 68 with PC. Patients were categorized into two groups based on when they began AC: the early initiation group (within 8 weeks post-surgery), and the late initiation group (8 weeks or later post-surgery).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the non-PC cohort, the 3-year relapse-free survival (RFS) rates were 71% in the early group versus 56% in the late group (<i>p</i> = 0.49), while the 3-year overall survival (OS) rates were 94% versus 73% (<i>p</i> = 0.003). Similar trends were observed in the PC cohort; the 3-year RFS rates were 59% versus 19% (<i>p</i> = 0.002), and the 3-year OS rates were 69% versus 48% (<i>p</i> = 0.02). Multivariate analysis identified pretherapeutic distant metastasis (<i>p</i> &lt; 0.001) and delayed AC initiation (≥8 weeks) (<i>p</i> = 0.001) as independent predictors of worse prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Delayed initiation of AC is associated with significantly poorer postoperative survival in patients with GC, irrespective of whether PC was administered. These findings emphasize the importance of timely AC initiation to improve long-term outcomes in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"668-677"},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12911","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520046","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 significance of six autoantibodies in esophageal squamous cell carcinoma: A prospective multi-institutional study","authors":"Fumiaki Shiratori,&nbsp;Naoto Fujiwara,&nbsp;Yasuaki Nakajima,&nbsp;Koji Otsuka,&nbsp;Masahiko Murakami,&nbsp;Satoru Matsuda,&nbsp;Hirofumi Kawakubo,&nbsp;Keita Takahashi,&nbsp;Yuichiro Tanishima,&nbsp;Daiji Oka,&nbsp;Shunichi Ito,&nbsp;Kosuke Narumiya,&nbsp;Osamu Aramaki,&nbsp;Tadatoshi Takayama,&nbsp;Takashi Suzuki,&nbsp;Satoshi Yajima,&nbsp;Hideaki Shimada","doi":"10.1002/ags3.12910","DOIUrl":"https://doi.org/10.1002/ags3.12910","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Serum autoantibodies have been reported to react with tumor-associated antigens in various cancers. This study evaluated the diagnostic and prognostic significance of six autoantibody panels in esophageal squamous cell carcinoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, 193 patients with esophageal squamous cell carcinoma and 78 healthy controls were enrolled. Serum antibodies were detected using originally developed enzyme-linked immunosorbent assays to detect autoantibodies against the following tumor antigens: c-myc, p62, RalA, p53, Sui1, and NY-ESO-1. The positive rates of the six-autoantibody panel were compared with those of SCC antigen (SCC-Ag). The prognostic significance of these autoantibodies was also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall positive rate was significantly higher in the six-autoantibody panel than in SCC-Ag (72% vs. 28%; <i>p</i> &lt; 0.01). The positive rates of the six-autoantibody panel were 71% in stage 0/I, 73% in stage II, and 71% in stage III. No clinicopathological factors were associated with autoantibodies. Although the difference was not significant, the overall survival of the autoantibody-positive group was worse than that of the autoantibody-negative group (<i>p</i> = 0.14).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The six-autoantibody panel was useful for detecting esophageal squamous cell carcinoma, particularly in stage 0/I; however, it showed limited prognostic significance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"658-667"},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520138","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":"Cost-effectiveness analysis of postoperative surveillance for stage IV colorectal cancer in Japan: An economic modeling study","authors":"Fumio Tsukamoto,&nbsp;Shunsuke Tsukamoto,&nbsp;Takeharu Kato,&nbsp;Hiroshi Nagata,&nbsp;Yasuyuki Takamizawa,&nbsp;Konosuke Moritani,&nbsp;Yusuke Kinugasa,&nbsp;Minoru Esaki,&nbsp;Yukihide Kanemitsu,&nbsp;Ataru Igarashi","doi":"10.1002/ags3.12906","DOIUrl":"https://doi.org/10.1002/ags3.12906","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal postoperative surveillance strategy after curative resection in patients with stage IV colorectal cancer remains unclear. The present study aimed to assess the cost-effectiveness of postoperative surveillance strategies recommended by the various academic societies for stage IV colorectal cancer after curative resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This economic evaluation used a Markov state-transition model to compare the cost-effectiveness of postoperative surveillance programs proposed in guidelines published by the American Society of Clinical Oncology, American Society of Colon and Rectal Surgeons, European Society for Medical Oncology, National Comprehensive Cancer Network, and Japanese Society for Cancer of the Colon and Rectum. Model parameters were extracted from our retrospective data for patients with colorectal cancer who had synchronous liver and/or lung metastases and underwent curative resection. Cost-effectiveness was assessed using an incremental cost-effectiveness ratio for quality-adjusted life years, with a maximum acceptable value of 5 000 000–6 000 000 JPY/33333–40 000 USD. Uncertainty in the model was assessed by probabilistic sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For patients with stage IV colorectal cancer after curative resection, the JSCCR-strategy was the most cost-effective, with an incremental cost-effectiveness ratio of 2 888 628 JPY/19256 USD compared with the next most cost-effective program. Probabilistic sensitivity analysis showed that the JSCCR-strategy was most likely to be selected as the most cost-effective (76.1%–77.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This modeling analysis found that the JSCCR-strategy was the most cost-effective strategy for stage IV colorectal cancer. Our findings suggest that intensive postoperative surveillance is acceptable for stage IV colorectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"730-738"},"PeriodicalIF":2.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519899","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":"Effectiveness of advanced dressings in preventing surgical site infections compared to that of standard dressings in gastrointestinal surgery: A systematic review and meta-analysis for guideline revision by the Japanese Society for Surgical Infection","authors":"Keita Kouzu,&nbsp;Hironori Tsujimoto,&nbsp;Seiichi Shinji,&nbsp;Hiroji Shinkawa,&nbsp;Koji Tamura,&nbsp;Yukio Sato,&nbsp;Koji Munakata,&nbsp;Yasunari Fukuda,&nbsp;Daisuke Koike,&nbsp;Hiromu Miyake,&nbsp;Yohei Hosoda,&nbsp;Motoi Uchino,&nbsp;Hiroki Ohge,&nbsp;Junzo Shimizu,&nbsp;Seiji Haji,&nbsp;Yasuhiko Mohri,&nbsp;Chizuru Yamashita,&nbsp;Yuichi Kitagawa,&nbsp;Motomu Kobayashi,&nbsp;Yuki Hanai,&nbsp;Hiroshi Nobuhara,&nbsp;Masahiro Yoshida,&nbsp;Toru Mizuguchi,&nbsp;Toshihiko Mayumi,&nbsp;Yuko Kitagawa","doi":"10.1002/ags3.12909","DOIUrl":"https://doi.org/10.1002/ags3.12909","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This is a systematic review and meta-analysis of the efficacy of wound coverage using advanced dressings specifically for the prevention of surgical site infections (SSI) in gastrointestinal surgery, as part of the update of the SSI prevention guidelines of the Japan Society for Surgical Infection (JSSI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>After searching CENTRAL, PubMed, and ICHUSHI-Web in July 2024, we included randomized controlled trials (RCTs) comparing advanced dressings and standard dressings for surgical wounds in gastrointestinal surgery (PROSPERO No. CRD42024569084). Three authors independently screened the RCTs. We assessed the risk of bias and certainty of the body of evidence for the extracted data. The primary outcome was superficial SSI, and the secondary outcomes were length of postoperative hospital stay, costs, and allergy. This study was partially supported by the JSSI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of seven RCTs and 927 patients were included. The use of advanced dressings significantly lowered the risk of SSI compared to that associated with standard dressings (risk ratio: 0.54, 95% confidence intervals: 0.34–0.88). The certainty of the evidence was rated as moderate. According to the subgroup analysis, advanced dressings reduced the risk of SSI in colorectal surgery. Advanced dressings did not reduce the length of postoperative hospital stay or costs compared to that of standard dressings. Allergies were reported in only one patient using silver-impregnated dressings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of advanced dressings for primary wounds in gastrointestinal surgery was associated with a significantly lower risk of SSI than that associated with standard dressings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"408-417"},"PeriodicalIF":2.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12909","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950173","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":"Late anastomotic complication after laparoscopic surgery for clinical stage I low rectal cancers located within 5 cm of the anal verge: Sub-analysis of the ultimate trial","authors":"Manabu Shimomura,&nbsp;Masanori Yoshimitsu,&nbsp;Yuichiro Tsukada,&nbsp;Hideki Ohdan,&nbsp;Jun Watanabe,&nbsp;Yosuke Fukunaga,&nbsp;Yasumitsu Hirano,&nbsp;Kazuhiro Sakamoto,&nbsp;Hiroki Hamamoto,&nbsp;Hisanaga Horie,&nbsp;Nobuhisa Matsuhashi,&nbsp;Yoshiaki Kuriu,&nbsp;Shuntaro Nagai,&nbsp;Madoka Hamada,&nbsp;Shinichi Yoshioka,&nbsp;Shinobu Ohnuma,&nbsp;Tamuro Hayama,&nbsp;Koki Otsuka,&nbsp;Yusuke Inoue,&nbsp;Kazuki Ueda,&nbsp;Yuji Toiyama,&nbsp;Satoshi Maruyama,&nbsp;Shigeki Yamaguchi,&nbsp;Keitaro Tanaka,&nbsp;Motoko Suzuki,&nbsp;Toshihiro Misumi,&nbsp;Takeshi Naitoh,&nbsp;Masahiko Watanabe,&nbsp;Masaaki Ito,&nbsp;Ultimate Trial Group","doi":"10.1002/ags3.12904","DOIUrl":"https://doi.org/10.1002/ags3.12904","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter-sparing surgery, the status of late anastomotic complications (post-30 days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70–1226 days). Only early AL (<i>p</i> = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (<i>p</i> = 0.004) and the presence of stenosis or fistula (<i>p</i> &lt; 0.0001) were independent risk factors.</p>\u0000 \u0000 <p>Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122–725 days). Intersphincteric resection (ISR) (<i>p</i> = 0.02) and splenic flexure takedown (<i>p</i> &lt; 0.0001) were independent risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"719-729"},"PeriodicalIF":2.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519637","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":"Possibility of incorrect evaluation of intraoperative blood loss during open and laparoscopic distal pancreatectomy","authors":"Keisuke Toya,&nbsp;Yoshito Tomimaru,&nbsp;Shogo Kobayashi,&nbsp;Kazuki Sasaki,&nbsp;Yoshifumi Iwagami,&nbsp;Daisaku Yamada,&nbsp;Takehiro Noda,&nbsp;Hidenori Takahashi,&nbsp;Yuichiro Doki,&nbsp;Hidetoshi Eguchi","doi":"10.1002/ags3.12888","DOIUrl":"https://doi.org/10.1002/ags3.12888","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Decreasing intraoperative blood loss is one reported advantage of laparoscopic surgery compared with open surgery. However, several reports indicate that blood loss during laparoscopic surgery may be underestimated. No studies have evaluated this possibility in laparoscopic distal pancreatectomy (LDP). Here we evaluated estimated blood loss (e-BL) compared to intraoperative blood loss (i-BL) during distal pancreatectomy (DP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 114 patients undergoing DP in our institution during the study period. We examined the relationship between i-BL and e-BL. Based on these results, we further investigated the relationship with LDP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The laparoscopic approach was used in a significantly higher percentage of patients in e-BL &gt; i-BL group compared to e-BL &lt; i-BL group (55.9% vs 10.9%, <i>p</i> &lt; 0.0001). Within the LDP group (<i>n</i> = 39), e-BL was significantly more than i-BL (388 ± 248 vs 127 ± 160 mL; <i>p</i> &lt; 0.0001). Within the open distal pancreatectomy (ODP) group (<i>n</i> = 75), e-BL was significantly less than i-BL (168 ± 324 vs 281 ± 209 mL; <i>p =</i> 0.0017). The e-BL &gt; i-BL trend in the LDP group was consistent, regardless of the indication for DP. In contrast, the finding of i-BL &gt; e-BL in the ODP group was limited to patients with pancreatic cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>During LDP, e-BL was significantly more than i-BL. During ODP, e-BL was significantly less than i-BL, only in patients with pancreatic cancer. These results suggested the possibility of i-BL underestimation during LDP, and overestimation during ODP in cases with pancreatic cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"569-577"},"PeriodicalIF":2.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949732","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 the characteristics and management of perforated peptic ulcer from 2011 to 2022: A multicenter and retrospective descriptive study","authors":"Hiromasa Hoshi,&nbsp;Akira Endo,&nbsp;Koji Ito,&nbsp;Tomohiro Akutsu,&nbsp;Hikaru Odera,&nbsp;Hideto Shiraki,&nbsp;Kei Ito,&nbsp;Takeshi Yokoyama,&nbsp;Yasukazu Narita,&nbsp;Taro Masuda,&nbsp;Akira Suekane,&nbsp;Koji Morishita","doi":"10.1002/ags3.12908","DOIUrl":"https://doi.org/10.1002/ags3.12908","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Although perforated peptic ulcer is common in Japan, few large-scale studies have assessed its management, including surgical procedures and outcomes. This study aimed to survey the characteristics, management, and outcomes of perforated peptic ulcer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter retrospective descriptive analysis was conducted across seven centers in Japan between 2011 and 2022. Perforated peptic ulcer was defined as gastric or duodenal ulcer perforation, excluding malignant or iatrogenic perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 703 patients with perforated peptic ulcer. The overall in-hospital mortality rate was 35/703 (5.0%). Conservative treatment was performed as an initial treatment in 217/703 (30.9%) patients, among whom 52 (24.0%) eventually underwent surgery. The median age (interquartile range) of patients who successfully completed the conservative treatment was 60 (46–71) years. A total of 538/703 (76.5%) patients underwent surgery. The gastrectomy percentage increased with the perforation diameter. The anastomotic leakage rate for gastrectomy was high in 10/66 (15.2%) patients. Laparoscopy was performed in 115/538 (21.4%) patients, among whom 23 (20.0%) were converted to open surgery. Patients who underwent laparoscopy had a perforation diameter ≤ 20 mm. The use of laparoscopy varied among facilities, ranging from 1.8% to 61.2%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The in-hospital mortality rate for perforated peptic ulcer in this study was 5.0%, and conservative treatment was safely performed even in elderly patients. As the perforation diameter increased, the rate of gastrectomy tended to rise, and the rate of anastomotic leakage in those patients was high. UMIN Clinical Trials Registry; UMIN000054391.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"464-475"},"PeriodicalIF":2.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950014","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":"Clinical impact of low fornix perfusion on devascularized whole stomach as a risk factor for anastomotic leakage after esophagectomy","authors":"Keita Takahashi,&nbsp;Masami Yuda,&nbsp;Yoshitaka Ishikawa,&nbsp;Takahiro Masuda,&nbsp;Takanori Kurogochi,&nbsp;Naoko Fukushima,&nbsp;Akira Matsumoto,&nbsp;Kazuto Tsuboi,&nbsp;Katsunori Nishikawa,&nbsp;Fumiaki Yano,&nbsp;Ken Eto","doi":"10.1002/ags3.12905","DOIUrl":"https://doi.org/10.1002/ags3.12905","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds</h3>\u0000 \u0000 <p>We previously reported poor vascularity of narrow gastric tube evaluated by thermography was associated with anastomotic leakage (AL) after esophagectomy. Meanwhile, the association between the fornix low perfusion on devascularized whole stomach (DWS) and the incidence of AL remains unclear. Therefore, this study aimed to clarify the impact of the fornix low perfusion on DWS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 238 patients who underwent Mckeown esophagectomy with gastric tube reconstruction between 2008 and 2021 were analyzed. Patients were divided into non-AL and AL groups and their clinical outcomes including vascular factors of DWS and gastric tube were compared. Additionally, the logistic regression analysis was conducted to detect the risk factors of AL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AL occurred in 31 patients (13.0%). Regarding vascular factors, avascular area temperature retain rate (Av-TRr) on DWS, right gastroepiploic artery length rate and anastomotic viability index (AVI) on gastric tube were significantly smaller in the AL group than in the non-AL group. In logistic regression model for AL, multivariate analysis showed that diabetes (Odds ratio [OR], 3.90; 95% confidence interval [CI], 1.32–11.60), hand-sewn anastomosis (OR, 4.42;95% CI, 1.05–18.60), Av-TRr on DWS&lt;0.91 (OR, 4.67; 95% CI, 2.00–10.90), and AVI&lt;0.64 (OR, 2.68; 95% CI, 1.12–6.39) were significant risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fornix low perfusion on DWS was a risk factor of AL as well as low AVI on gastric conduit. Additionally, fornix low perfusion on DWS was correlated with low AVI on gastric conduit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"226-234"},"PeriodicalIF":2.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12905","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535843","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 duration of antimicrobial prophylaxis in patients undergoing distal pancreatectomy: A multicenter cohort study","authors":"Kenjiro Okada,&nbsp;Kenichiro Uemura,&nbsp;Sohei Satoi,&nbsp;Tsutomu Fujii,&nbsp;Manabu Kawai,&nbsp;So Yamaki,&nbsp;Toru Watanabe,&nbsp;Hideki Motobayashi,&nbsp;Shinya Takahashi","doi":"10.1002/ags3.12903","DOIUrl":"https://doi.org/10.1002/ags3.12903","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antimicrobial prophylaxis is routinely administered in patients undergoing distal pancreatectomy, with cephalosporins being the most frequently used agents. However, there is limited evidence regarding optimal duration of antimicrobial prophylaxis. This study aimed to evaluate the optimal duration of antimicrobial prophylaxis in distal pancreatectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter cohort study was performed using a common database of patients who underwent distal pancreatectomy between April 2017 and March 2022 at four high-volume centers in Japan. Eligible patients were divided into two groups according to the duration of antimicrobial prophylaxis: intraoperative or up to 24 h after surgery and more than 24 h after surgery. Primary endpoint was the incidence of surgical site infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 496 patients were enrolled in this study, including 254 and 242 patients categorized into the intraoperative or up to 24-h and more than 24-h groups, respectively. Surgical site infections occurred in 129 patients (26%). The intraoperative or up to 24-h group had a significantly lower incidence of surgical site infection (19% vs. 33%, <i>p</i> &lt; 0.001) and infectious clinically relevant postoperative pancreatic fistula (8% vs. 17%, <i>p</i> = 0.002). There were no significant differences in severe surgical site infection rates between the groups. Multivariate logistic regression identified more than 24-h administration of antimicrobial prophylaxis as an independent risk factor for surgical site infections (<i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Prolonged administration of antimicrobial prophylaxis may not be effective in preventing surgical site infections after distal pancreatectomy compared to intraoperative or up to 24-h administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"794-803"},"PeriodicalIF":2.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12903","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519966","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}