Annals of Gastroenterological Surgery最新文献

{"title":"Current Status and Future Perspectives of Robotic Surgery for Esophagogastric Cancer in Asia.","authors":"Jia Jun Ang, Jimmy Bok Yan So","doi":"10.1002/ags3.70266","DOIUrl":"https://doi.org/10.1002/ags3.70266","url":null,"abstract":"<p><p>Robotic-assisted surgery (RAS) has moved from an experimental adjunct to an increasingly established component of gastrointestinal (GI) oncological practice in parts of Asia, a region that carries a disproportionately high burden of gastric and esophageal cancer. Asian surgeons have been among the earliest and most prolific contributors to the clinical evidence base for robotic gastrectomy and robot-assisted minimally invasive esophagectomy. This narrative review synthesizes evidence from randomized trials (including the ROBOT, RAMIE, and REVATE trials, and the ongoing MONA LISA [JCOG1907] study), multicenter prospective and propensity-matched cohort studies, and recent meta-analyses to critically appraise the efficacy, safety, cost, and future trajectory of RAS in Asia. Across multiple Korean, Japanese, and Chinese series, RG and RAMIE are associated with reduced short-term morbidity, improved lymph node retrieval in technically demanding anatomic regions, and lower rates of recurrent laryngeal nerve injury compared with conventional laparoscopic or thoracoscopic approaches; however, much of the evidence on long-term oncological outcomes remains retrospective or derived from propensity-score analyses rather than mature randomized data, and results across studies are not always concordant. We argue that robotic surgery in Asia is best understood as passing through three overlapping transitions: technical and oncological validation, economic and educational democratization, and digital and telesurgical integration, each of which carries distinct and unresolved questions. We conclude that while RAS has demonstrably reshaped upper GI surgical practice in high-volume Asian centers, its designation as a definitive regional standard of care should await longer-term randomized outcomes, standardized credentialing, and more equitable deployment across the region.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787335","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":"Preoperative FIB-4 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma.","authors":"Masanori Nakamura, Yukiyasu Okamura, Osamu Aramaki, Nao Yoshida, Yusuke Mitsuka, Hayato Abe, Shunsuke Yamagishi, Yasuhiro Okumura, Kyongsun Pak, Shinobu Masuda","doi":"10.1002/ags3.70263","DOIUrl":"https://doi.org/10.1002/ags3.70263","url":null,"abstract":"<p><strong>Background: </strong>Liver fibrosis influences tolerance to surgical stress, dictating postoperative complication risks after hepatectomy for hepatocellular carcinoma (HCC). While conventional systems assess hepatic function, they may not fully capture structural fibrosis. This study evaluated the whether preoperative Fibrosis-4 (FIB-4) index is associated with severe complications and \"endogenous organ failure\" (EOF: systemic decompensation unaccompanied by localized surgical-site complications).</p><p><strong>Methods: </strong>This retrospective study analyzed 1778 HCC patients undergoing hepatectomy between 2001 and 2020. A restricted cubic spline (RCS) model identified the optimal preoperative FIB-4 cutoff for predicting major complications (Clavien-Dindo [C-D] Grade ≥ IIIa). Following stratification by this cutoff, intergroup comparisons and multivariable logistic regression analyses were performed to identify independent predictors of major and severe (C-D Grade ≥ IIIb) complications.</p><p><strong>Results: </strong>RCS analysis suggested a FIB-4 threshold of 5.0 for an increased trend in complication risk. The High FIB-4 index group (≥ 5.0, <i>n</i> = 385) showed a higher frequency of severe complications (7.0% vs. 3.4%) and EOF (3.1% vs. 0.4%) compared to the Low FIB-4 index group (< 5.0, <i>n</i> = 1393). Among patients developing life-threatening complications (C-D Grade ≥ IV), 92.3% of the High FIB-4 index group presented with EOF. In multivariable analyses, FIB-4 ≥ 5.0 was consistently and independently associated with both major and severe complications.</p><p><strong>Conclusion: </strong>A preoperative FIB-4 ≥ 5.0 was associated with an increased incidence of severe complications, particularly EOF, after hepatectomy. This simple index could serve as a clinical indicator of systemic vulnerability, enhancing surgical risk stratification beyond traditional functional markers.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757279","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":"Interaction Between Operator and Assistant Certification Is Associated With Local Recurrence After Laparoscopic Rectal Cancer Surgery: An Ancillary Analysis of the EnSSURE Study.","authors":"Yusuke Sakimura, Hiroyuki Bando, Koya Hida, Tatsunari Fukuoka, Tohru Funakoshi, Fuminori Teraishi, Kay Uehara, Yuji Inoue, Nobuaki Suzuki, Nobuki Ichikawa, Hiroaki Iijima, Akinobu Taketomi, Yoshiharu Sakai, Takeshi Naitoh, Ichiro Takemasa","doi":"10.1002/ags3.70265","DOIUrl":"10.1002/ags3.70265","url":null,"abstract":"<p><strong>Background: </strong>Local recurrence (LR) after laparoscopic rectal cancer surgery remains a major clinical concern. While surgical expertise is important, the impact of combined operator and assistant certification on local recurrence remains unclear.</p><p><strong>Methods: </strong>This retrospective multicenter study analyzed 2825 patients with stage II-III rectal cancer who underwent laparoscopic resection in the EnSSURE cohort. The primary endpoint was the 3-year cumulative incidence of LR, treating death and distant metastasis as competing events. The primary analysis used a Fine-Gray model including an interaction term between operator and assistant certification based on the Endoscopic Surgical Skill Qualification System. Secondary analyses included a four-group Fine-Gray analysis (qualified operator and assistant [QQ], qualified operator only [QN], qualified assistant only [NQ], and neither qualified [NN]). A cause-specific Cox model was used for sensitivity analysis.</p><p><strong>Results: </strong>During a median follow-up of 55 months, LR occurred in 125 patients (4.4%). A significant interaction between operator and assistant certification was observed (subdistribution hazard ratio [sHR] 0.43, 95% confidence interval [CI] 0.20-0.95; <i>p</i> = 0.038), whereas neither was independently associated with LR. In the four-group analysis, the risk of LR was significantly higher in the QN, NQ, and NN groups compared with the QQ group (QN: sHR 2.37; NQ: sHR 2.12; NN: sHR 2.18). Results were consistent in sensitivity analyses.</p><p><strong>Conclusions: </strong>A significant interaction between operator and assistant certification was associated with a lower risk of LR, suggesting that surgical outcomes may depend on team composition rather than individual qualifications alone.</p><p><strong>Trial registration: </strong>UMIN Clinical Trials Registry System: UMIN000040645 (June 3, 2020).</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727808","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 Aortic Calcification Volume Predicts Postoperative Complications in Nonpancreatic Cancer Patients Undergoing Pancreaticoduodenectomy\".","authors":"","doi":"10.1002/ags3.70262","DOIUrl":"10.1002/ags3.70262","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1002/ags3.70132.].</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705251","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":"Impact of Postoperative Infectious Complications on Long-Term Survival After Curative Resection for Colorectal Cancer: A Multicenter Study in the Minimally Invasive Era.","authors":"Takehito Yamamoto, Ryosuke Mizuno, Yoshiro Itatani, Tetsuya Shiota, Masahiro Yamada, Tadayoshi Yamaura, Mami Yoshitomi, Kazutaka Obama","doi":"10.1002/ags3.70261","DOIUrl":"10.1002/ags3.70261","url":null,"abstract":"<p><strong>Aim: </strong>Previous studies have reported that postoperative infectious complications (PICs) worsen long-term outcomes after colorectal cancer surgery; however, most were conducted before widespread adoption of minimally invasive surgery. We evaluated the association between PICs and long-term oncological outcomes after curative colorectal cancer resection.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study enrolled patients who underwent curative resection for colorectal adenocarcinoma between 2017 and 2021 at 19 hospitals in Japan. PICs were defined as Clavien-Dindo grade≥II infectious complications within 30 days after surgery. Multivariable Cox regression and propensity score matching (1:4) were used to evaluate associations with overall survival (OS) and relapse-free survival (RFS).</p><p><strong>Results: </strong>Among 5377 patients, 90.6% underwent laparoscopic or robot-assisted surgery, and PICs occurred in 500 (9.3%). In multivariable Cox proportional hazards analysis, PICs were independently associated with worse OS (HR 1.32, 95% CI 1.01-1.72; <i>p</i> = 0.040) and RFS (HR 1.26, 95% CI 1.04-1.54; <i>p</i> = 0.020). After propensity score matching (500 vs. 1931 patients), PICs remained significantly associated with poorer OS and RFS. Patients with PICs had a higher rate of distant recurrence (5-year rate, 19.1% vs. 15.2%; HR 1.33, 95% CI 1.02-1.72; <i>p</i> = 0.03), whereas locoregional recurrence did not differ significantly.</p><p><strong>Conclusion: </strong>PICs are associated with impaired long-term survival after curative colorectal cancer surgery, even in the modern minimally invasive era. Preventing postoperative infections is important to improve perioperative recovery and long-term oncological outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705203","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":"Impact of Histopathological Response on Outcomes After Surgical Resection Following Carbon-Ion Radiotherapy for Pancreatic Cancer With Arterial Involvement.","authors":"Kenichiro Araki, Norio Kubo, Yuhei Miyasaka, Hayato Ikota, Ryo Muranushi, Mariko Tsukagoshi, Takamichi Igarashi, Masahiko Okamoto, Tatsuya Ohno, Ken Shirabe","doi":"10.1002/ags3.70259","DOIUrl":"10.1002/ags3.70259","url":null,"abstract":"<p><strong>Aim: </strong>Carbon-ion radiotherapy (CIRT) provides superior dose distribution and higher biological effectiveness than conventional X-ray radiotherapy and has emerged as a promising component of multidisciplinary treatment for advanced pancreatic ductal adenocarcinoma (PDAC). However, evidence regarding surgical resection after CIRT remains limited. In this study, we aimed to evaluate the feasibility, histopathological therapeutic response, and oncological outcomes of pancreatic resection after CIRT-based multimodal treatment.</p><p><strong>Methods: </strong>We retrospectively analyzed 12 patients with borderline resectable pancreatic cancer with arterial involvement (BR-A) or unresectable locally advanced PDAC (UR-LA), who underwent surgical resection following CIRT at our institution between January 2016 and June 2025. The surgical outcomes, perioperative morbidity, pathological therapeutic responses, and survival outcomes were assessed.</p><p><strong>Results: </strong>Surgical resection after CIRT was feasible in all patients. The procedures included pancreaticoduodenectomy (<i>n</i> = 5), distal pancreatectomy (<i>n</i> = 2), and distal pancreatectomy with celiac axis resection (<i>n</i> = 5). R0 resection was achieved in 11 patients (92%) and no pathological lymph node metastasis was identified. A marked histopathological response (Evans Grades III-IV) was observed in 83% of patients. No local recurrences were observed in the CIRT irradiation field. The 3-year progression-free survival and overall survival (OS) rates calculated from treatment initiation were 74.1% and 79.5%, respectively, whereas the corresponding 3-year recurrence-free survival and OS rates calculated from surgical resection were 47.6% and 50.8%, respectively.</p><p><strong>Conclusions: </strong>Surgical resection following CIRT-based multimodal treatment is feasible and safe, achieving a favorable histopathological response and durable local control in selected patients with PDAC with arterial involvement.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668344","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 2024-2026: Advances in Colorectal Cancer Surgery.","authors":"Hiroyasu Kagawa, Yusuke Kinugasa","doi":"10.1002/ags3.70260","DOIUrl":"10.1002/ags3.70260","url":null,"abstract":"<p><p>Surgical innovation in colorectal cancer is increasingly judged not by technical feasibility alone, but by whether it improves oncological outcomes, preserves function, reduces morbidity, or makes difficult procedures more reproducible. This structured narrative review examines major surgical studies published from January 2024 through July 2026, while retaining earlier landmark reports when needed to interpret safety and implementation. The strongest recent randomized evidence concerns robot-assisted rectal cancer surgery. In the REAL trial, robotic surgery improved 3-year locoregional control, disease-free survival, and early functional recovery compared with laparoscopy in middle and low rectal cancer, although overall survival did not differ and generalizability beyond experienced Chinese centers remains uncertain. For transanal total mesorectal excision, noninferiority in the TaLaR trial must be interpreted in light of its -10% margin, the experience of participating centers, and early reports of multifocal local recurrence during implementation. Individual trials of indocyanine green fluorescence angiography have yielded mixed results; however, a 2026 meta-analysis of nine randomized trials found lower leakage rates overall and after left-sided and rectal resections, but not after right-sided colectomy, supporting procedure-specific use. Robotic colectomy is feasible but has not clearly surpassed mature laparoscopy. Intracorporeal anastomosis is associated with faster recovery and greater flexibility in extraction-site selection and may reduce extraction-site hernia, whereas long-term oncological equivalence has not yet been established. Across these fields, benefit appears context-specific and closely linked to case selection, surgeon experience, technical standardization, and structured audit.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652893","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":"Carcinoembryonic Antigen Messenger RNA in Pelvic Lavage Fluid Predicts Local Recurrence After Curative-Intent Resection of Rectal Cancer.","authors":"Hiroyuki Asai, Yushi Yamakawa, Kazuyoshi Shiga, Shuhei Uehara, Akira Kato, Takuya Suzuki, Hajime Ushigome, Hiroki Takahashi, Yoichi Matsuo, Shuji Takiguchi","doi":"10.1002/ags3.70257","DOIUrl":"10.1002/ags3.70257","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether pelvic lavage carcinoembryonic antigen (CEA) mRNA is associated with local recurrence after curative-intent resection for rectal cancer and whether it provides additional prognostic information beyond circumferential resection margin (CRM) status.</p><p><strong>Methods: </strong>We retrospectively analyzed 178 patients who underwent curative-intent resection for primary rectal cancer. Pelvic lavage fluid was collected intraoperatively before enterotomy, and CEA mRNA levels were quantified using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). CEA mRNA positivity was defined as ≥ 0.26, and CRM positivity as ≤ 1 mm. Local recurrence was evaluated using Kaplan-Meier analysis and Cox proportional hazards modeling.</p><p><strong>Results: </strong>During a median follow-up of 59.1 months, local recurrence occurred in 8 patients (4.5%). CEA mRNA was positive in 7 patients (3.9%), and CRM was positive in 11 patients (6.2%). Local recurrence rates were 36.4% (4/11) in CRM-positive patients and 42.9% (3/7) in CEA mRNA-positive patients. All patients who tested positive for both markers (3/3) developed local recurrence, whereas the rate was only 2.5% (4/163) among those who tested negative for both markers. In multivariable analysis, CRM positivity (HR 11.09, 95% CI 2.06-59.68, <i>p</i> = 0.005) and CEA mRNA positivity (HR 5.99, 95% CI 1.06-33.81, <i>p</i> = 0.043) remained associated with local recurrence.</p><p><strong>Conclusions: </strong>Pelvic lavage CEA mRNA levels were associated with local recurrence beyond CRM status and may improve risk stratification. Further validation in larger multicenter cohorts is warranted.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13426386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652906","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":"Age-Dependent Prognostic Significance of Preoperative Transthyretin After Curative Resection for Stage I-III Colorectal Cancer.","authors":"Ayane Kawata, Yuji Miyamoto, Hiro Nakamura, Takahiko Akiyama, Kota Arima, Katsuhiro Ogawa, Yukiharu Hiyoshi, Masaaki Iwatsuki","doi":"10.1002/ags3.70258","DOIUrl":"10.1002/ags3.70258","url":null,"abstract":"<p><strong>Background: </strong>Preoperative malnutrition and systemic inflammation are established determinants of adverse outcomes in colorectal cancer (CRC). Transthyretin (TTR), a rapid-turnover hepatic protein, reflects both nutritional and inflammatory status; however, its clinical utility may be influenced by age- and sex-related variability. This study evaluated the prognostic significance of preoperative TTR in patients undergoing curative resection for stage I-III CRC.</p><p><strong>Methods: </strong>A retrospective cohort of 536 patients who underwent curative resection for stage I-III CRC between 2014 and 2024 at a single institution was analyzed. Sex-specific TTR cutoffs were derived using survival classification and regression tree analysis (20.9 mg/dL for men; 16.95 mg/dL for women), and patients were stratified into low- and high-TTR groups. The primary endpoint was recurrence-free survival (RFS). Survival outcomes were assessed using Kaplan-Meier analysis, multivariable Cox proportional hazards modeling, and age-stratified analyses.</p><p><strong>Results: </strong>Preoperative TTR levels were lower in women and demonstrated a progressive decline with increasing age. Patients with low TTR exhibited significantly inferior RFS compared with those with high TTR (log-rank <i>p</i> < 0.0001). In multivariable analysis, low preoperative TTR remained an independent predictor of worse RFS (HR 2.407, 95% CI 1.625-3.566; <i>p</i> < 0.001). Age-stratified analyses demonstrated that the prognostic impact of low TTR was most pronounced in younger patients and progressively attenuated with advancing age.</p><p><strong>Conclusions: </strong>Preoperative TTR represents an independent prognostic biomarker following curative resection for stage I-III CRC. Its prognostic utility is age-dependent, with greatest relevance in younger patients, supporting interpretation within an age- and sex-specific framework.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652851","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":"Radical Resection of the Third Portion of the Duodenum for Secondary Aortoduodenal Fistula.","authors":"Koji Kubota, Akira Shimizu, Tsuyoshi Notake, Tatsuichiro Seto, Yuji Soejima","doi":"10.1002/ags3.70255","DOIUrl":"10.1002/ags3.70255","url":null,"abstract":"<p><p>Secondary aortoduodenal fistula (sADF) is a rare but life-threatening complication following abdominal aortic aneurysm repair. Its management requires multidisciplinary collaboration; however, even gastrointestinal surgeons-who play a pivotal role in duodenal resection and reconstruction-often lack sufficient experience with this condition. Therefore, a clear understanding of sADF is essential for gastrointestinal surgeons. We retrospectively analyzed 16 sADF patients who underwent combined vascular and gastrointestinal reconstruction at Shinshu University Hospital between September 2018 and December 2025. We describe our step-by-step approach to radical resection of the third portion of the duodenum performed in collaboration with cardiovascular surgeons. The procedure includes complete division of the Treitz ligament, mobilization of the fourth portion from the uncinate process, preservation of the papilla of Vater, en bloc resection of the involved segment, and duodenojejunostomy. The greater omentum is mobilized through a retrocolonic route to facilitate secure graft coverage following vascular reconstruction. Postoperative course, complications, and survival rates were evaluated. The median age was 75 years (range: 67-83 years). The median operation time was 651 min (range 481-1477 min), and the median blood loss was 3050 mL (range 850-15 000 mL). Severe postoperative complications (Clavien-Dindo classification grade IIIa or higher) occurred in 10 patients (63%), and the 90-day mortality rate was 21%. The 1-year overall survival rate was 57%. Careful multidisciplinary coordination and precise gastrointestinal surgical technique are essential for achieving safe and durable management of this complex condition.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618176","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}