Annals of Gastroenterological Surgery最新文献

{"title":"Short-Term Outcomes and Cost Drivers of Emergency Surgery for Acute Abdominal Disease in Super-Elderly Patients: A Study in the Japanese Tertiary Care Hospital","authors":"Yuta Kobayashi,&nbsp;Ryo Oikawa,&nbsp;Yumi Shibuya,&nbsp;Masakazu Tatsuno,&nbsp;Atsuya Kamiyama,&nbsp;Tsuyoshi Ozawa,&nbsp;Keiichiro Hara,&nbsp;Shojiro Hata,&nbsp;Hirokazu Yamaguchi","doi":"10.1002/ags3.70222","DOIUrl":"10.1002/ags3.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although emergency surgery for acute abdominal disease in super-elderly patients is often associated with high risk and substantial resource utilization, the relationship between short-term outcomes and inpatient medical costs remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 247 patients aged ≥ 85 years who underwent emergency surgery for acute abdominal disease were analyzed. Inpatient costs were assessed using total inpatient claim points and the fee-for-service component under Japan's diagnosis-based payment system. Multivariable analyses were performed to identify risk factors for postoperative complications, non-home discharge, and excess inpatient costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall complications occurred in 44.1% of patients, major complications in 19.4%, and 72.1% were discharged home. Mortality was predominantly observed in strangulated bowel obstruction, bowel perforation, and gastrointestinal ischemia or bleeding (8.1%). Multivariable analyses identified American Society of Anesthesiologists physical status (odds ratio [OR] 3.52, <i>p</i> &lt; 0.001) and operative time (OR 2.10, <i>p</i> &lt; 0.001) as independent risk factors for major complications, while age (OR 1.17, <i>p</i> &lt; 0.001), dementia (OR 2.34, <i>p</i> = 0.006), and major complications (OR 2.87, <i>p</i> = 0.005) were associated with non-home discharge. Total inpatient claim points were nearly doubled in patients with major complications (<i>p</i> &lt; 0.001), and residual cost analysis demonstrated disproportionately high inpatient costs among patients without major complications, independent of length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency abdominal surgery can be performed with acceptable short-term outcomes and high likelihood of discharge to home in carefully selected super-elderly patients. Inpatient costs among patients without major complications might be modifiable through optimization of perioperative management and resource utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1486-1495"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576751","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 Significance of PD-L1 and HLA Expression in Esophageal Squamous Cell Carcinoma in Response to Immunotherapy","authors":"Kosuke Kanemitsu,&nbsp;Yoshiyuki Tagayasu,&nbsp;Yoshihiro Komohara,&nbsp;Cheng Pan,&nbsp;Rin Yamada,&nbsp;Yukio Fujiwara,&nbsp;Kazuto Harada,&nbsp;Keisuke Kosumi,&nbsp;Yoshifumi Baba,&nbsp;Masaaki Iwatsuki","doi":"10.1002/ags3.70227","DOIUrl":"10.1002/ags3.70227","url":null,"abstract":"<p>Despite recent advances in multimodal therapy, esophageal squamous cell carcinoma (ESCC) remains a highly lethal malignancy. Although immune checkpoint inhibitors (ICIs) have improved clinical outcomes, predictive biomarkers are urgently needed. This study aimed to investigate immune-related features in tumor cells and the tumor microenvironment in pathological specimens from 45 patients with ESCC treated with ICIs for postoperative recurrence after curative resection. Immunohistochemistry and quantitative image analysis of CD3, CD8, FoxP3, CD163, PD-L1, HLA-A/B/C, and HLA-DR were conducted. High programmed death-ligand 1 (PD-L1) expression in tumor-associated macrophages (TAMs) and tumor cells was significantly associated with a favorable response. Infiltration of T cells, regulatory T cells, and TAMs was not associated with the clinical response, but increased T-cell infiltration was closely associated with high PD-L1 expression in TAMs. Downregulation of HLA-A/B/C and ectopic HLA-DR expression was seen in responders. High PD-L1 expression in TAMs was closely related to increased T-cell infiltration, and single-cell RNA-sequence analysis suggested a significant correlation with T-cell proliferation. Collectively, these findings indicate that not only PD-L1, but also HLA expression is useful for predicting the effectiveness of ICI therapy in patients with ESCC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1507-1517"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576919","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":"Pancreatic Atrophy: A Narrative Review and Surgical Interpretation","authors":"Rika Fujino,&nbsp;Ken-ichi Okada,&nbsp;Yohei Masugi,&nbsp;Eisuke Iwasaki,&nbsp;Masaki Mori","doi":"10.1002/ags3.70230","DOIUrl":"10.1002/ags3.70230","url":null,"abstract":"<p>Despite recent advances in multimodal management, pancreatic ductal adenocarcinoma remains a fatal malignancy. Early detection of indirect findings of pancreatic ductal adenocarcinoma is essential to improve treatment outcomes, drawing attention to pancreatic parenchymal atrophy. Pancreatic parenchymal atrophy, defined as the narrowing of the parenchyma below a line connecting the cephalic and caudal margins of the lesion on computed tomography, can predict early-stage pancreatic ductal adenocarcinoma and its intraductal extension. Computed tomography with three-directional imaging is the ideal initial modality for diagnosing pancreatic parenchymal atrophy. In patients with early pancreatic ductal adenocarcinoma, pancreatic parenchymal atrophy exhibits a significantly longer intraductal lateral tumor extension. Pancreatic parenchymal atrophy can be resected using an appropriate-margin pancreatectomy with a low risk of positive surgical margins. However, the appropriate surgical margin length for each case remains unclear. Carcinoma in situ may be present only within a focal pancreatic parenchymal atrophy region, and pancreatic duct changes may not be present. For such patients, a surgical strategy of limited pancreatectomy with a smaller surgical margin, combined with additional intraoperative resection based on frozen-section results, is acceptable. Although the relationship between carcinoma in situ and fatty replacement of the pancreatic parenchyma has been investigated, the underlying mechanism remains unclear.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 5","pages":"1419-1427"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576507","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":"CD86-Positive Mature Tertiary Lymphoid Structures Are Associated With CD8⁺ T-Cell Infiltration and Favorable Clinical Outcomes in Pancreatic Ductal Adenocarcinoma.","authors":"Takaomi Seki, Kenichiro Araki, Takehiko Yokobori, Hayato Ikota, Norio Kubo, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Yasuo Hosouchi, Hiroshi Saeki, Ken Shirabe","doi":"10.1002/ags3.70275","DOIUrl":"10.1002/ags3.70275","url":null,"abstract":"<p><strong>Aims: </strong>Although tertiary lymphoid structures (TLSs) contribute to antitumor immunity, the significance of CD86 expression within mature TLSs in pancreatic ductal adenocarcinoma (PDAC) remains unclear. This study evaluated CD86-positive mature TLSs as a marker of an immunologically active tumor microenvironment.</p><p><strong>Methods: </strong>We analyzed 128 treatment-naive patients with PDAC who underwent curative resection. TLSs were evaluated by hematoxylin and eosin staining and immunohistochemistry for CD4, CD8, CD20, CD21, CD23, and CD86. TLS maturation, CD86 expression, TLS density and diameter, intratumoral T-cell infiltration, and clinical outcomes were assessed. Multiplex immunofluorescence for CD8 and Granzyme B was performed in selected cases.</p><p><strong>Results: </strong>TLSs were identified in 124 patients. Among TLS-positive cases, 13, 21, and 90 were classified as immature, intermediate, and mature TLSs, respectively. Mature TLSs were associated with increased intratumoral CD8⁺ T-cell infiltration compared with TLS-absent cases (<i>p</i> = 0.027), whereas CD4⁺ T-cell infiltration did not differ significantly. CD86-positive mature TLSs were associated with higher intratumoral CD8⁺ T-cell infiltration (<i>p</i> = 0.002), greater TLS density, and larger TLS diameter than CD86-negative mature TLSs. Multiplex immunofluorescence confirmed that most CD86-positive cells co-expressed CD20. Exploratory CD8/Granzyme B analysis suggested a higher proportion of Granzyme B-expressing CD8⁺ T cells in CD86-positive mature TLSs. Patients with CD86-positive mature TLSs showed favorable clinical outcomes.</p><p><strong>Conclusion: </strong>CD86-positive mature TLSs may represent a pathological feature associated with an immunologically active tumor microenvironment in PDAC, as reflected by increased intratumoral CD8⁺ T-cell infiltration, a higher proportion of Granzyme B-expressing CD8⁺ T cells in the exploratory analysis, and favorable clinical outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872648","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":"Mac-2 Binding Protein Glycosylation Isomer (M2BPGi)-Based Risk Stratification Refined by Tumor Metabolic Activity in Hepatocellular Carcinoma.","authors":"Kojiro Shirabe, Junya Mita, Shinji Itoh, Takeo Toshima, Yoshiyuki Kitamura, Norifumi Iseda, Takuro Isoda, Kousei Ishigami, Tomoharu Yoshizumi","doi":"10.1002/ags3.70272","DOIUrl":"10.1002/ags3.70272","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the prognostic significance of preoperative Mac-2 binding protein glycosylation isomer (M2BPGi) and determine whether tumor metabolic activity provides additional risk stratification after hepatic resection for hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>We retrospectively analyzed 291 patients with HCC who underwent hepatic resection at a single Japanese institution between 2015 and 2023 and had available preoperative M2BPGi and 18F-fluorodeoxyglucose positron emission tomography/computed tomography data. Associations with clinicopathological features, recurrence-free survival (RFS), and overall survival (OS) were evaluated.</p><p><strong>Results: </strong>High M2BPGi was associated with impaired liver function and F3-F4 fibrosis but not with tumor-related features or tumor metabolic activity. In contrast, high tumor metabolic activity was associated with higher des-<i>γ</i>-carboxy prothrombin (DCP) levels, larger tumors, poor differentiation, microscopic vascular invasion, and intrahepatic metastasis. High M2BPGi and high tumor metabolic activity independently predicted worse RFS (hazard ratio [HR], 1.61; <i>p</i> = 0.0105 and HR, 1.94; <i>p</i> = 0.0023, respectively) and OS (HR, 2.03; <i>p</i> = 0.0042 and HR, 1.93; <i>p</i> = 0.0199, respectively). The dual-high group had the poorest RFS and OS (both <i>p</i> < 0.0001). In public data analysis, M2BPGi-related fibrosis and glycolysis-related signatures were positively correlated with a mechanistic target of rapamycin complex 1 (mTORC1)-related anabolic signature (<i>R</i> = 0.439 and <i>R</i> = 0.670, respectively; <i>p</i> < 0.0001), and a high mTORC1-related signature was associated with worse OS (<i>p</i> = 0.0074).</p><p><strong>Conclusions: </strong>Preoperative M2BPGi identifies fibrosis-related risk after HCC resection, whereas tumor metabolic activity further distinguishes patients with particularly poor outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872725","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":"Reduced-Port Laparoscopic Colectomy for Colorectal Cancer: The Comparison That Matters Now Is With Reduced-Access Robotic Surgery.","authors":"Mehmet Mahir Özmen, Cem Kaan Parsak, Tahsin Çolak","doi":"10.1002/ags3.70273","DOIUrl":"10.1002/ags3.70273","url":null,"abstract":"","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863206","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 Circumferential Resection Margin in Minimally Invasive Surgery for Locally Advanced Rectal Cancer: A Multicenter Prospective Study.","authors":"Atsushi Hamabe, Masaaki Ito, Shigeo Toda, Yusuke Suwa, Suguru Hasegawa, Masanori Kotake, Masafumi Inomata, Kazuki Ueda, Atsushi Ogura, Kiichi Sugimoto, Kei Kimura, Koki Otsuka, Tatsuki Noguchi, Koya Hida, Yasumitsu Hirano, Kazushige Kawai, Shigeru Yamagishi, Takeshi Naitoh, Ichiro Takemasa","doi":"10.1002/ags3.70268","DOIUrl":"10.1002/ags3.70268","url":null,"abstract":"<p><strong>Aim: </strong>Circumferential resection margin (CRM) status is a well-established prognostic factor in rectal cancer surgery; however, its long-term oncological relevance has not been prospectively validated in Japan, where upfront surgery has long been widely used. This study assessed the prognostic impact of CRM in patients with locally advanced rectal cancer treated with minimally invasive surgery.</p><p><strong>Methods: </strong>The PRODUCT trial was a multicenter, prospective, observational study conducted at 18 institutions in Japan. Patients aged ≥ 20 years with clinical stage II or III rectal adenocarcinoma located within 12 cm from the anal verge and scheduled for laparoscopic or robotic surgery were enrolled. CRM positivity was defined as a margin of ≤ 1 mm. Long-term outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression models.</p><p><strong>Results: </strong>Among 303 eligible patients, CRM positivity was observed in 26 (8.6%). The 3-year recurrence-free survival (RFS) rate was significantly lower in the CRM-positive group than in the CRM-negative group (61.5% vs. 82.3%; log-rank <i>p</i> = 0.003). CRM positivity was independently associated with worse RFS (hazard ratio, 2.35; 95% confidence interval, 1.17-4.71; <i>p</i> = 0.016). In patients with pT3-T4 tumors, recurrence rates were significantly higher in CRM-positive cases than in CRM-negative cases (47.6% vs. 21.2%; <i>p</i> = 0.013). CRM status was not significantly associated with overall survival or cumulative incidence of local recurrence (<i>p</i> = 0.057 and <i>p</i> = 0.706, respectively).</p><p><strong>Conclusions: </strong>CRM positivity is an adverse prognostic factor in Japanese patients with locally advanced rectal cancer undergoing MIS, underscoring the clinical importance of standardized CRM assessment.</p><p><strong>Trial registration: </strong>Clinical Trials Registry, Identification Number: UMIN00034365.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838908","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":"Achievement of the Ideal Outcome After Pancreatectomy for Pancreatic Ductal Adenocarcinoma Is Associated With Earlier Initiation and Higher Completion Rates of Adjuvant Chemotherapy and Improved Long-Term Survival.","authors":"Ryosuke Fukushima, Kenichiro Araki, Ryo Muranushi, Kouki Hoshino, Kei Hagiwara, Shunsuke Kawai, Mariko Tsukagoshi, Takamichi Igarashi, Norio Kubo, Ken Shirabe","doi":"10.1002/ags3.70270","DOIUrl":"10.1002/ags3.70270","url":null,"abstract":"<p><strong>Background: </strong>The Ideal Outcome is a composite quality indicator reflecting optimal postoperative course after pancreatic surgery. This study aimed to clarify the prognostic significance of achieving the Ideal Outcome and its influence on the initiation and completion of adjuvant chemotherapy.</p><p><strong>Methods: </strong>We retrospectively analyzed 187 patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma between 2016 and 2024. The Ideal Outcome was defined as absence of in-hospital mortality, severe complications, grade B or C postoperative pancreatic fistula, reoperation, prolonged hospitalization (> 75th percentile), or 30-day readmission. Associations with survival, timing and completion of adjuvant chemotherapy, and predictors of non-achievement of Ideal Outcome were assessed.</p><p><strong>Results: </strong>The Ideal Outcome was achieved in 56.7% of patients. Those who achieved it initiated adjuvant chemotherapy earlier and had significantly higher completion rates (64.2% vs. 43.2%; <i>p</i> = 0.004). In multivariate analysis, non-achievement of the Ideal Outcome (HR = 1.82, 95% CI: 1.21-2.73; <i>p</i> = 0.004), tumor size ≥ 30 mm, and no adjuvant chemotherapy were independent prognostic predictors of poor overall survival. Similarly, non-achievement of the Ideal Outcome (HR = 1.46, 95% CI: 1.14-2.35, <i>p</i> = 0.007), CA19-9 ≥ 150 U/mL, tumor size ≥ 30 mm, and no adjuvant chemotherapy administration were identified as independent prognostic predictors of poor recurrence-free survival. Age ≥ 80 years, cardiovascular disease, and soft pancreatic texture were independent predictors of not achieving the Ideal Outcome.</p><p><strong>Conclusions: </strong>Achievement of the Ideal Outcome was associated with earlier initiation and higher completion rates of adjuvant chemotherapy, as well as improved long-term survival after resection for pancreatic ductal adenocarcinoma.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838957","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":"One-Year Changes in Frailty Components After Curative Minimally Invasive Surgery for Colorectal Cancer in Older Patients.","authors":"Hajime Ushigome, Takuya Suzuki, Shunsuke Hayakawa, Akira Kato, Yushi Yamakawa, Kenta Saito, Hiroyuki Sagawa, Ryo Ogawa, Hiroki Takahashi, Shuji Takiguchi","doi":"10.1002/ags3.70269","DOIUrl":"10.1002/ags3.70269","url":null,"abstract":"<p><strong>Background: </strong>Frailty predicts outcomes after colorectal cancer surgery, but postoperative changes remain unclear. We previously reported improvement in FRAIL Scale-based frail/pre-frail status 1 year after curative minimally invasive surgery (MIS). This study examined the components underlying that improvement using the FRAIL Scale and Kihon Checklist (KCL).</p><p><strong>Methods: </strong>This secondary analysis included patients aged ≥ 70 years who underwent curative MIS for colorectal cancer and had preoperative and 1-year postoperative frailty assessments. Changes in FRAIL Scale and KCL indicators were evaluated using paired analyses.</p><p><strong>Results: </strong>Among 239 patients assessed preoperatively, 141 were included in the paired analysis. Among FRAIL Scale items, only the weight-loss criterion improved significantly (35.8% to 9.5%, <i>p</i> < 0.001). In the KCL, oral function risk improved, whereas physical function risk tended to worsen; houseboundness, cognitive decline, and depressive mood were unchanged. Patients whose FRAIL Scale weight-loss criterion resolved showed a modest 1.2-kg increase (<i>p</i> = 0.038), whereas mean body weight remained unchanged overall. In sensitivity analyses, the improvement in oral function risk persisted after excluding patients with preoperative bowel obstruction (<i>p</i> = 0.014). After excluding patients receiving oxaliplatin-containing adjuvant chemotherapy, physical function risk still tended to increase, and fear of falling remained significantly increased (<i>p</i> = 0.011).</p><p><strong>Conclusions: </strong>FRAIL Scale improvement was driven mainly by resolution of the weight-loss criterion, with modest weight gain and no clear overall body-weight recovery. KCL changes varied across domains and items, with improvement in some aspects but persistence or worsening in others, supporting a multidimensional interpretation of postoperative recovery in older patients.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817249","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":"AI-Assisted Recognition of Actual Ureteral and Pancreatic Injuries in Laparoscopic Colorectal Surgery: A Randomized Video Review Study.","authors":"Shunjin Ryu, Teppei Kamada, Kai Neki, Asuka Kuwashima, Yuta Imaizumi, Shunsuke Nakashima, Yasuhiro Takano, Yasunobu Kobayashi, Yasuhiro Takeda, Ken Eto","doi":"10.1002/ags3.70267","DOIUrl":"10.1002/ags3.70267","url":null,"abstract":"<p><strong>Aim: </strong>Artificial Intelligence (AI)-assisted anatomical recognition may help surgeons recognize intraoperative adverse events missed during surgery. We evaluated whether AI-enhanced videos improved recognition of ureteral and pancreatic injuries.</p><p><strong>Methods: </strong>In this two-institution randomized video-review study using historical laparoscopic colorectal surgery videos, 150 surgeons reviewed either EUREKA-generated AI-enhanced videos or unenhanced videos. Five videos were reviewed: three actual injury videos, including unrecognized injuries, and two clinically comparable no-injury control videos. The primary outcome was correct injured-organ recognition. Secondary outcomes included recognition within the predefined injury time-code window and correct no-adverse-event judgment.</p><p><strong>Results: </strong>Seventy-five surgeons were assigned to each group, with no significant baseline differences. AI-enhanced videos improved ureteral injury recognition in Video A (40.0% vs. 22.7%; <i>p</i> = 0.022) and Video C (50.7% vs. 28.0%; <i>p</i> < 0.01). Time-code window recognition was greater for Video A (20.0% vs. 5.3%; <i>p</i> < 0.01) and Video C (18.7% vs. 4.0%; <i>p</i> < 0.01). Pancreatic injury recognition in Video D did not differ overall (77.3% vs. 70.7%; <i>p</i> = 0.352) but was greater among surgeons without advanced laparoscopic certification (81.3% vs. 63.3%; <i>p</i> = 0.048). Correct no-adverse-event judgments did not differ between groups.</p><p><strong>Conclusion: </strong>AI-generated anatomical highlighting improved surgeons' recognition of actual ureteral injuries under controlled video-review conditions without increasing incorrect adverse-event judgments. These findings provide proof-of-concept evidence that AI-generated overlays may support timely recognition of clinically important intraoperative adverse events. Prospective intraoperative studies are needed to determine whether this recognition benefit facilitates earlier management, changes operative decision-making, reduces complications, or improves patient outcomes.</p><p><strong>Trial registration: </strong>UMIN-CTR; UMIN ID: UMIN000059439.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817294","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}