Annals of Gastroenterological Surgery最新文献

{"title":"Inter-prefectural and urban–rural regional disparities in rectal cancer and rectal resections: A Japanese nationwide population-based cohort study from 2014 to 2019","authors":"Masamitsu Kido,&nbsp;Tomohiro Arita,&nbsp;Katsutoshi Shoda,&nbsp;Hiroki Shimizu,&nbsp;Jun Kiuchi,&nbsp;Kenji Nanishi,&nbsp;Luying Yan,&nbsp;Eigo Otsuji","doi":"10.1002/ags3.12865","DOIUrl":"https://doi.org/10.1002/ags3.12865","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This observational study aimed to elucidate the regional disparities in rectal cancer (RC) and rectal resections (RRs) across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The annual incidence of RC, and number of all RRs and board-certified surgeons by the Japan Society for Endoscopic Surgery were examined by prefecture in Japan from 2014 to 2019. The surgical approaches were broken down by open and laparoscopic. Disparities in 47 prefectures and urban–rural disparities were evaluated using the Gini coefficient and unpaired <i>t</i>-test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The annual national average incidence of RC was 50 127 and the number of all RRs was 39 903. Gini coefficients for RC, and laparoscopic and all RRs were &lt;0.2, indicating low inequality. There was no significant difference between urban and rural prefectures in the number of RRs, despite a significantly higher incidence of RC in rural prefectures and a significantly higher number of board-certified surgeons in urban prefectures (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RC and laparoscopic and all RRs exhibited minimal inter-prefectural disparities. The urban–rural analysis revealed significant differences in the incidence/number of RC and board-certified surgeons between urban and rural prefectures, despite minor differences in RRs regardless of approach. This pattern suggests a potential migration of surgical services from rural to urban areas. This preliminary study is expected to contribute to a basic epidemiological database for RC and RRs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"281-287"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534007","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":"Lavage cytology diagnosed by immunostaining may be a poor prognostic factor in pathological stage III colorectal cancer","authors":"Akitoshi Nankaku,&nbsp;Yusuke Yamaoka,&nbsp;Akio Shiomi,&nbsp;Hiroyasu Kagawa,&nbsp;Shoichi Manabe,&nbsp;Takuma Oishi,&nbsp;Kiyoshi Tone,&nbsp;Akifumi Notsu,&nbsp;Yusuke Kinugasa","doi":"10.1002/ags3.12863","DOIUrl":"https://doi.org/10.1002/ags3.12863","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To clarify the prognostic impact of positive lavage cytology diagnosed by immunostaining on long-term outcomes following curative resection for pathological stage III colorectal cancer (CRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We retrospectively investigated patients who underwent radical resection and intraoperative lavage cytology (LCY) simultaneously for pathological stage III primary CRC between 2005 and 2017. All LCY specimens were evaluated by Papanicolaou staining and immunostaining for carcinoembryonic antigen and Ber-EP4. Only Class V diagnosed by either staining method was defined as positive LCY, and patients were classified into two groups: a positive lavage cytology (LCY+) group; and a negative lavage cytology (LCY−) group. Overall survival (OS) and relapse-free survival (RFS) were compared between groups. Multivariate analysis was performed to identify clinicopathological factors affecting OS and RFS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 708 patients with pathological stage III CRC, 30 patients (4.2%) showed positive LCY. OS and RFS were significantly lower in the LCY(+) group than in the LCY(−) group. Five-y OS rates in the LCY(+) and LCY(−) groups were 58.7% and 91.0%, respectively, and 5-y RFS rates were 28.8% and 76.6%, respectively. Multivariate analysis revealed that positive LCY was independently associated with lower OS and RFS. In the LCY(+) group, the proportion of patients with negative Papanicolaou staining but positive immunostaining was 20.0% (6 of 30). No significant differences in OS and RFS were evident between those patients and patients with positive results for both Papanicolaou staining and immunostaining.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Positive LCY as diagnosed by immunostaining may represent a poor prognostic factor for pathological stage III CRC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"271-280"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534009","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":"y-shaped side overlap esophagogastrostomy in proximal gastrectomy","authors":"Yukinori Kurokawa,&nbsp;Takuro Saito,&nbsp;Kazuyoshi Yamamoto,&nbsp;Tsuyoshi Takahashi,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.12859","DOIUrl":"10.1002/ags3.12859","url":null,"abstract":"<p>Several reconstruction methods are used in proximal gastrectomy. Esophagogastrostomy is the simplest and most physiological. The challenge in esophagogastrostomy is preventing reflux esophagitis. Various techniques have been developed to reduce reflux of gastric juice. Taking advantage of the usefulness of the recently reported modified side overlap with fundoplication by Yamashita (mSOFY) method, we developed a y-shaped mSOFY method that is simpler and has potential for a greater anti-reflux effect. Unlike the original mSOFY method, the pseudo-fornix does not go behind the esophagus and the axes of the esophagus and residual stomach are shifted by approximately 60° to form a “y” shape. In addition, fixation of the residual stomach and both sides of the esophagus and crus of the diaphragm is performed at the end of the procedure. We performed 12 cases of laparoscopic or robotic proximal gastrectomy with y-shaped mSOFY esophagogastric anastomosis located below the crus of the diaphragm for gastric or esophagogastric junction adenocarcinoma between August 2021 and March 2023. The median operative time and blood loss were 260 min and 5 mL, respectively. No postoperative complications of Clavien–Dindo classification grade II or higher occurred. No stenoses requiring balloon dilation occurred within 1 year after surgery, but endoscopy at 1 year after surgery revealed two cases (17%) of reflux esophagitis of Los Angeles grade B or higher. In conclusion, this y-shaped side overlap esophagogastrostomy method could be one of the recommended esophagogastrostomy procedures in proximal gastrectomy.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"205-210"},"PeriodicalIF":2.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930576","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":"Robotic esophagectomy with function-preserving radical mediastinal lymphadenectomy for esophageal cancer","authors":"Raja Kalayarasan,&nbsp;Pothugunta Sai Krishna","doi":"10.1002/ags3.12862","DOIUrl":"10.1002/ags3.12862","url":null,"abstract":"<p>Radical lymphadenectomy is the critical component of surgery for esophageal cancer. However, lymphadenectomy significantly contributes to postoperative morbidity, particularly in terms of pulmonary complications following esophagectomy. Function-preserving mediastinal lymphadenectomy seeks to balance the procedure's necessary radicality and optimal functional outcomes. This approach emphasizes the preservation of the thoracic duct, tracheobronchial vascularity, and the pulmonary and recurrent laryngeal branches of the vagus nerve. Preservation of the thoracic duct is facilitated by indocyanine green fluorescence. Compared to the conventional technique of thoracic duct identification using anatomical landmarks, indocyanine green fluorescence lymphangiography offers real-time feedback, making it particularly advantageous in cases with complex anatomy or when the thoracic duct is challenging to visualize using conventional methods. Preservation of pulmonary branches of the right vagus during subcarinal lymphadenectomy and left recurrent laryngeal nerve during left paratracheal node dissection are technically challenging. The description of two types of left recurrent laryngeal nerve node dissection and technical tips for nerve function preservation are outlined in this review. Intraoperative neuromonitoring is a useful adjunct for nerve-sparing mediastinal lymphadenectomy. As ischemia to the respiratory tract impairs respiratory protective mechanisms, preservation of the tracheobronchial blood supply is critical. Preoperative imaging to detect bronchial artery anatomical variations and intraoperative assessment of perfusion using laser doppler flowmetry and indocyanine green fluorescence angiography are useful strategies to minimize tracheobronchial ischemia. Function-preserving mediastinal lymphadenectomy has the potential to improve short- and long-term outcomes after esophagectomy for esophageal cancer.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"12-23"},"PeriodicalIF":2.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930545","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":"Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome","authors":"Koji Kubota,&nbsp;Akira Shimizu,&nbsp;Tsuyoshi Notake,&nbsp;Satoshi Nakamura,&nbsp;Yuji Soejima","doi":"10.1002/ags3.12858","DOIUrl":"10.1002/ags3.12858","url":null,"abstract":"<p>Median arcuate ligament syndrome (MALS) is a rare condition characterized by nonspecific symptoms, such as abdominal pain, nausea, and vomiting. Furthermore, the development and rupture of pancreaticoduodenal artery aneurysms pose a potentially fatal risk. Median arcuate ligament release (MALR) is useful in the treatment of MALS, with most procedures performed laparoscopically. However, detailed descriptions of laparoscopic MALR (lap-MALR) procedures are rare. In this study, we performed lap-MALR via an anterior approach with dissection of the right lateral wall of the celiac artery (CA). For optimal visualization of the right side of the CA, the right branch of the inferior phrenic artery was divided. We believe that this procedure allows the MAL to be released within a sufficient surgical field and without excess or deficiency. Here, we present the details of six patients who underwent lap-MALR for varying indications; three for pancreaticoduodenal artery aneurysms due to CA obstruction (unruptured, <i>n</i> = 1; ruptured, <i>n</i> = 2), two cases prior to hepato-biliary-pancreatic surgery, and one symptomatic case. In all cases, lap-MALR was performed as described above, and the CA stenosis was successfully released. Our case series demonstrates the safety and reliability of our lap-MALR procedure in the treatment of MALS-related disorders, including pancreaticoduodenal artery aneurysms associated with CA compression.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"1137-1143"},"PeriodicalIF":2.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580797","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":"Robotic right-sided colon cancer surgery: Dissecting the outermost layer of the autonomic nerve along the superior mesenteric artery","authors":"Dai Shida,&nbsp;Yuka Ahiko,&nbsp;Naoki Sakuyama,&nbsp;Satoko Monma,&nbsp;Shigehiro Kojima","doi":"10.1002/ags3.12861","DOIUrl":"10.1002/ags3.12861","url":null,"abstract":"<p>In right-sided colon cancer surgery, lymph node dissection around the superior mesenteric artery is necessary but technically challenging. Here we introduce the concept of “outermost layer-oriented robotic surgery” to improve the safety, efficacy, and reproducibility of superior mesenteric artery nodal dissection. In this procedure, the thin, loose connective tissue layer between the autonomic nerve sheath of the superior mesenteric artery and adipose tissue bearing lymph nodes, termed “the outermost layer of the autonomic nerve,” is dissected. The procedure exposes the outermost layer of the nerve plexus covering the surface of the superior mesenteric artery with a width of approximately 1 cm, enabling direct visualization of the anatomy of the main arteries and, if they exist, jejunal veins which cross the superior mesenteric artery ventrally. This allows for sufficient dissection of main lymph nodes at the roots of the ileocolic artery, right colic artery, and middle colic artery and minimizes the risk of unforeseen bleeding. Thirty-nine patients underwent robotic right hemicolectomy with this procedure. No intraoperative complications were observed. The median number of dissected lymph nodes was 50, including 16 main lymph nodes. The median operative time was 284 min, blood loss was 50 mL, and the median postoperative hospital stay was 8 days. Postoperative complications included two cases of Clavien–Dindo classification grade II, with no cases of grade III or higher. Chylous leakage as well as intractable diarrhea were not observed in any case. These findings demonstrate that the procedure can achieve safe and reliable lymph node clearance.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"199-204"},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930547","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":"Digestive tract reconstruction after laparoscopic proximal gastrectomy: Double tract reconstruction or double flap technique?","authors":"Lindi Cai,&nbsp;Guanglin Qiu,&nbsp;Mengke Zhu,&nbsp;Shangning Han,&nbsp;Pengwei Zhao,&nbsp;Panxing Wang,&nbsp;Xiaowen Li,&nbsp;Xinhua Liao,&nbsp;Xiangming Che,&nbsp;Lin Fan","doi":"10.1002/ags3.12857","DOIUrl":"10.1002/ags3.12857","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The reconstruction methods after proximal gastrectomy (PG) are varied but not standardized. This study was performed to evaluate the short-term clinical outcomes between double tract reconstruction (DTR) and double flap technique (DFT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed and collected data of patients who underwent DTR and DFT after laparoscopic proximal gastrectomy (LPG), respectively, between January 2020 and March 2023. Propensity score matching (PSM) was used to balance the baseline data of the two groups, then we compared their short-term clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 72 patients (48 and 24 patients in the DTR and DFT groups, respectively) were included. The anastomosis time was significantly longer in the DFT group than that in the DTR group (70.1 vs. 52.7 min, <i>p</i> &lt; 0.001). DFT was associated with shorter times of gas-passing, start of diet, and postoperative length of hospital stay (<i>p</i> &lt; 0.001). There were no significant differences between the two groups in terms of early and late postoperative complications (<i>p</i> = 0.710, <i>p</i> = 1.000, respectively). DFT was superior to DTR in maintaining body weight (<i>p</i> &lt; 0.001), total protein (<i>p</i> = 0.011) and albumin levels (<i>p</i> = 0.018). As for QOL, DTR showed better results in the meal-related distress subscale (<i>p</i> &lt; 0.001). However, DFT was superior to DTR in terms of reducing diarrhea, constipation, and dumping related symptoms (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Double flap technique emerged as a superior alternative to DTR in terms of facilitating early postoperative recovery, sustaining nutritional status, and improving QOL. DFT could potentially be the preferred reconstruction method following laparoscopic proximal gastrectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"98-108"},"PeriodicalIF":2.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930505","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":"Intraluminal washout in rectal and sigmoid colon cancer surgeries with double-stapling technique anastomosis: A single-institution prospective study","authors":"Shinji Furuya,&nbsp;Kensuke Shiraishi,&nbsp;Hiroki Shimizu,&nbsp;Koichi Takiguchi,&nbsp;Makoto Sudo,&nbsp;Akaike Hidenori,&nbsp;Yoshihiko Kawaguchi,&nbsp;Hidetake Amemiya,&nbsp;Tetsuo Kondo,&nbsp;Daisuke Ichikawa","doi":"10.1002/ags3.12851","DOIUrl":"10.1002/ags3.12851","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to determine the necessity of intraluminal washout through cytological assessment to prevent implantation of exfoliated cancer cells (ECCs) in patients with rectal and sigmoid cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 140 patients with either sigmoid or rectal cancer who underwent anastomosis surgery using a double-stapling technique. An intraluminal washout sample was collected before and after irrigation with 1000, 1500, or 2000 mL of physiological saline or distilled water. Cytological assessments were conducted using the Papanicolaou classification system, where classes IV and V indicated positive cytological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Initially, 46.4% of the patients (65 out of 140) had positive ECCs. Patients with cancer cells had a significantly shorter distal free margin (DM) from the tumor (<i>p</i> &lt; 0.001). The length of the DM was significantly associated with the tumor distance from the anal verge (<i>p</i> &lt; 0.001). After irrigation with 2000 mL, ECCs were found in only 7.3% of patients. Logistic regression analysis showed that DM (≤50 mm) and tumor size (≥50 mm) were independent risk factors for positive ECCs after intraluminal washout, regardless of the type of irrigation solution used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with sigmoid colon cancer, adequate preoperative bowel preparation, a long DM, and a small tumor size, a 1000 mL intraluminal washout may be sufficient. By contrast, in patients with rectal cancer with a short DM and a large tumor size, a ≥2000 mL intraluminal washout is required. The different types of irrigation solution did not affect the ECCs. Large randomized controlled trials are required to confirm these results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"137-144"},"PeriodicalIF":2.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy: A propensity score-matched study via a nationwide database","authors":"Tatsuto Nishigori,&nbsp;Hiraku Kumamaru,&nbsp;Kazutaka Obama,&nbsp;Koichi Suda,&nbsp;Shigeru Tsunoda,&nbsp;Yukie Yoda,&nbsp;Makoto Hikage,&nbsp;Susumu Shibasaki,&nbsp;Tsuyoshi Tanaka,&nbsp;Masanori Terashima,&nbsp;Yoshihiro Kakeji,&nbsp;Masafumi Inomata,&nbsp;Yuko Kitagawa,&nbsp;Hiroaki Miyata,&nbsp;Yoshiharu Sakai,&nbsp;Hirokazu Noshiro,&nbsp;Ichiro Uyama","doi":"10.1002/ags3.12854","DOIUrl":"10.1002/ags3.12854","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The advantages of robot-assisted minimally invasive esophagectomy (RA-MIE) over conventional minimally invasive esophagectomy (C-MIE) are unknown. This nationwide large-scale study aimed to compare surgical outcomes between RA-MIE and C-MIE using rigorous propensity score methods, including detailed covariates and relevant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This Japanese nationwide retrospective cohort study included RA-MIE or C-MIE for esophageal malignant tumors performed between October 2018 and December 2019 and registered in the Japanese National Clinical Database. The primary outcome measure was postoperative complications classified as Clavien–Dindo Grade IIIa or higher. Propensity score matching was performed to create a balanced covariate distribution between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching, 1092 patients were selected. The RA-MIE group had a significantly longer operation time and greater blood loss than the C-MIE group (565 vs. 477 min and 120 vs. 90 mL). Furthermore, the R0 resection rate was lower in the RA-MIE group than in the C-MIE group (95.1% vs. 97.8%). The RA-MIE and C-MIE groups had no differences regarding overall complications ≥ Grade IIIa (22.0% vs. 20.3%, <i>p</i> = 0.52), 30-day mortality rates (0.4% vs. 0.5%), and operative mortality rates (0.7% vs. 0.7%). Deep SSI was less frequent (2.7% vs. 6.0%) and pulmonary embolism was more frequent (2.4% vs. 0.5%) in the RA-MIE group than in the C-MIE group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the initial phase of implementation, RA-MIE and C-MIE demonstrated comparable morbidity rates when performed by skilled board-certified endoscopic surgeons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"109-118"},"PeriodicalIF":2.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930573","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":"Comparison of surgical outcomes and postoperative nutritional parameters between subtotal and proximal gastrectomy in patients with proximal early gastric cancer","authors":"Wataru Soneda,&nbsp;Masanori Terashima,&nbsp;Yusuke Koseki,&nbsp;Kenichiro Furukawa,&nbsp;Keiichi Fujiya,&nbsp;Yutaka Tanizawa,&nbsp;Hiroya Takeuchi,&nbsp;Etsuro Bando","doi":"10.1002/ags3.12856","DOIUrl":"10.1002/ags3.12856","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In this study, we evaluated the difference in short-term outcomes and postoperative nutritional status between subtotal gastrectomy (sTG) and proximal gastrectomy (PG) to determine the optimal surgical treatment for early gastric cancer in the upper third of the stomach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent laparoscopic or robotic sTG or PG at the Shizuoka Cancer Center in Shizuoka between January 2014 and December 2020 were enrolled in this retrospective study. Patient characteristics, surgical outcomes, endoscopic findings, and postoperative nutritional changes, including blood tests, body weight, psoas muscle, and subcutaneous and visceral adipose tissue, were measured and compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 110 patients were enrolled, including 42 in the sTG group and 68 in the PG group. Albumin and hemoglobin levels were comparable between the two groups. Changes in body weight and psoas mass index measured over 36 months postoperatively were favorable in the sTG group compared with the PG group (<i>p</i> = 0.005 and <i>p</i> = 0.002, respectively). There were no significant differences in subcutaneous or visceral adipose tissue between the two groups (<i>p</i> = 0.331 and 0.845, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>sTG is the preferred function-preserving gastrectomy procedure for early gastric cancer in the upper third of the stomach because it is associated with less postoperative body weight loss and psoas mass index loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"89-97"},"PeriodicalIF":2.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930502","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}