Annals of Gastroenterological Surgery最新文献

{"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}

{"title":"Acknowledgments","authors":"","doi":"10.1002/ags3.12899","DOIUrl":"10.1002/ags3.12899","url":null,"abstract":"<p>The publication of invaluable papers in <i>Annals of Gastroenterological Surgery</i> depends on the prompt, careful review of submitted manuscripts. We would like to thank the following experts for reviewing manuscripts submitted between December 1, 2023 and November 30, 2024.</p><p>Reviewer Full Name</p><p>Abe, Tatsuya</p><p>Abe, Yuta</p><p>Aizawa, Masaki</p><p>Ajiki, Tetsuo</p><p>Akahoshi, Keiichi</p><p>Akamatsu, Nobuhisa</p><p>Akita, Hirofumi</p><p>Akiyoshi, Takashi</p><p>Aoki, Takeshi</p><p>Aoki, Taku</p><p>Aoyama, Toru</p><p>Araki, Kenichiro</p><p>Arigami, Takaaki</p><p>Arita, Junichi</p><p>Baba, Kenji</p><p>Ban, Daisuke</p><p>Bekki, Yuki</p><p>Booka, Eisuke</p><p>Daiko, Hiroyuki</p><p>Ebata, Tomoki</p><p>Ebihara, Yuma</p><p>Eguchi, Hidetoshi</p><p>Etoh, Tsuyoshi</p><p>Fujimura, Takashi</p><p>Fujita, Fumihiko</p><p>Fujita, Takeo</p><p>Fukagawa, Takeo</p><p>Fukami, Yasuyuki</p><p>Fukushima, Ryoji</p><p>Ganeko, Riki</p><p>Hagi, Takaomi</p><p>Hamabe, Atsushi</p><p>Hanaoka, Marie</p><p>Harada, Kazuto</p><p>Harimoto, Norifumi</p><p>Haruki, Koichiro</p><p>Hasegawa, Kiyoshi</p><p>Hasegawa, Yasushi</p><p>Hashimoto, Daisuke</p><p>Hashimoto, Masashi</p><p>Hatano, Etsuro</p><p>Hayami, Shinya</p><p>Hayashi, Hiromitsu</p><p>Hibi, Taizo</p><p>Hida, Koya</p><p>Hidaka, Masaaki</p><p>Hijioka, Susumu</p><p>Hirano, Satoshi</p><p>Hirano, Yasumitsu</p><p>Hirashita, Teijiro</p><p>Hiyoshi, Yukiharu</p><p>Honda, Goro</p><p>Hosoda, Kei</p><p>Ichikawa, Nobuki</p><p>Iguchi, Tomohiro</p><p>Ikeda, Masataka</p><p>Ikeda, Satoshi</p><p>Ikeuchi, Hiroki</p><p>Ikoma, Hisashi</p><p>Imamura, Yu</p><p>Inaki, Noriyuki</p><p>Inoue, Mikihiro</p><p>Iseda, Norifumi</p><p>Ishido, Keinosuke</p><p>Ishihara, Soichiro</p><p>Ishizawa, Takeaki</p><p>Ishizuka, Mitsuru</p><p>Itatani, Yoshiro</p><p>Ito, Takashi</p><p>Itoh, Shinji</p><p>Iwatsuki, Masaaki</p><p>Jiang, Xingming</p><p>Kagawa, Hiroyasu</p><p>Kagawa, Yoshinori</p><p>Kaibori, Masaki</p><p>Kaido, Toshimi</p><p>Kajiwara, Yoshiki</p><p>Kanda, Mitsuro</p><p>Kanemitsu, Yukihide</p><p>Kasai, Shunsuke</p><p>Kato, Atsushi</p><p>Kato, Motohiko</p><p>Kato, Yutaro</p><p>Kawachi, Shigeyuki</p><p>Kawada, Kenji</p><p>Kawai, Kazushige</p><p>Kawai, Manabu</p><p>Kawamura, Junichiro</p><p>Kawazoe, Tetsuro</p><p>Kim, Dong-Sik</p><p>Kimura, Yasutoshi</p><p>Kimura, Yutaka</p><p>Kinami, Shinichi</p><p>Kinoshita, Takahiro</p><p>Kitagawa, Akihiro</p><p>Kitago, Minoru</p><p>Kitai, Toshiyuki</p><p>Kitayama, Joji</p><p>Kiyomatsu, Tomomichi</p><p>Kobayashi, Hirotoshi</p><p>Kobayashi, Minako</p><p>Kobayashi, Shogo</p><p>Kobayashi, Toshimichi</p><p>Koda, Keiji</p><p>Koike, Yuhki</p><p>Komatsu, Shuhei</p><p>Konishi, Hirotaka</p><p>Kosuga, Toshiyuki</p><p>Kosumi, Keisuke</p><p>Koyama, Fumikazu</p><p>Koyanagi, Kazuo</p><p>Kubo, Shoji</p><p>Kubota, Takeshi</p><p>Kumagai, Koshi</p><p>Kumagai, Youichi</p><p>Kunisaki, Chikara</p><p>Kuroda, Shinji</p><p>Lee, Sang-Woong</p><p>Makino, Isamu</p><p>Manabe, Tatsuya</p><p>Marubashi, Shigeru</p><p>Maruyama, Suguru</p><p>Mats","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"211-213"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930483","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":"Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer","authors":"Pengfei Wu,&nbsp;Kai Chen,&nbsp;Jin He","doi":"10.1002/ags3.12902","DOIUrl":"https://doi.org/10.1002/ags3.12902","url":null,"abstract":"<p>Pancreatic cancer is among the leading causes of gastrointestinal cancer-related death, with a dismal prognosis. Over 80% of pancreatic cancer patients present with advanced disease, making curative resection unfeasible. These patients are often presented with malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). In these cases, palliative management is aimed to alleviate symptoms, enhance quality of life, and facilitate subsequent chemotherapy. Currently, neoadjuvant chemotherapy is frequently used in both borderline resectable and resectable pancreatic cancer, necessitating effective biliary and gastrointestinal drainage in a growing number of patients. Traditionally, surgical bypass was the gold standard, performed via either a minimally invasive or open approach. However, notable progress has emerged in developing endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) stenting for MBO and endoscopic enteral stenting for GOO. While these procedures provide rapid symptom relief, they are associated with higher stent dysfunction rates and more frequent re-intervention needs. When ERCP fails, percutaneous transhepatic biliary drainage is a widely accepted alternative for MBO. Endoscopic ultrasound (EUS)-guided techniques, including EUS-guided biliary drainage and EUS-guided gastroenterostomy, have recently gained prominence. Emerging clinical data suggest that these methods may be superior, potentially becoming the preferred first-line palliative treatment for unresectable pancreatic cancer. This review will summarize the current evidence on managing MBO and GOO in patients with pancreatic cancer.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"218-225"},"PeriodicalIF":2.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533373","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":"Survival benefit of adjuvant therapy completion with early initiation for patients with pancreatic ductal adenocarcinoma","authors":"Kenjiro Okada,&nbsp;Kenichiro Uemura,&nbsp;Tatsuaki Sumiyoshi,&nbsp;Ryuta Shintakuya,&nbsp;Kenta Baba,&nbsp;Takumi Harada,&nbsp;Yasutaka Ishii,&nbsp;Shiro Oka,&nbsp;Yoshiaki Murakami,&nbsp;Shinya Takahashi","doi":"10.1002/ags3.12898","DOIUrl":"https://doi.org/10.1002/ags3.12898","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the prognostic effect of initiation timing and completion of adjuvant therapy in patients with pancreatic ductal adenocarcinoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical records of patients with pancreatic ductal adenocarcinoma who underwent radical pancreatectomy between 2006 and 2022 at Hiroshima University were retrospectively reviewed. Patient characteristics, perioperative outcomes, clinicopathological factors, and survival rates were analyzed. Adjuvant indications were for all patients who had a good postoperative status as early as possible. Early initiation was defined as adjuvant initiation within 4 weeks after surgery, and completion was defined as a total of 6 months of administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 444 (294, resectable; 150, borderline resectable or locally advanced) patients who received adjuvant therapy were enrolled in this study. The median time to adjuvant therapy initiation was 20 days. In total, 328 patients with early initiation had better overall survival than those with delayed initiation, and 409 patients with adjuvant completion had better survival rates than those with incompletion. Multivariate overall survival analysis demonstrated that early adjuvant therapy initiation and completion were independent prognostic factors for prolonged survival. In total, 310 adjuvant completions with early initiation resulted in a median survival period of 81.8 months. Multivariate analysis identified severe postoperative complication as an independent risk factor preventing adjuvant completion with early initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Adjuvant completion with early initiation may contribute to the improved survival of patients with pancreatic ductal adenocarcinoma. Preventing severe postoperative complications may facilitate adjuvant completion with early initiation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"785-793"},"PeriodicalIF":2.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12898","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520181","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":"Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato-biliary-pancreatic cancer","authors":"Norifumi Harimoto,&nbsp;Keishi Sugimachi,&nbsp;Tomohiro F. Nishijima,&nbsp;Tomino Takahiro,&nbsp;Tomonari Shimagaki,&nbsp;Yohei Mano,&nbsp;Emi Onishi,&nbsp;Masahiko Sugiyama,&nbsp;Yasue Kimura,&nbsp;Masaru Morita","doi":"10.1002/ags3.12897","DOIUrl":"https://doi.org/10.1002/ags3.12897","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Older adults with cancer are often at increased risk for postoperative complications following major surgeries. This study aimed to evaluate the combined role of frailty and sarcopenia in predicting postoperative complications in older adults with hepatobiliary and pancreatic cancer undergoing surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 107 Japanese patients who underwent comprehensive geriatric assessment (CGA) at the geriatric oncology service before cancer treatment decisions and subsequent curative surgery for hepatobiliary and pancreatic cancer. Frailty status was measured using the validated 10-item frailty index based on a CGA (FI-CGA-10) and categorized as fit, prefrail, or frail. Sarcopenia was assessed using bioelectrical impedance analysis and grip strength. The primary outcome was postoperative complications, defined as Clavien–Dindo grade ≥ III, within 1 month of surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the 107 patients was 79 (range, 75–89) years. Patients were categorized as fit (<i>n</i> = 36, 33.7%), prefrail (<i>n</i> = 57, 53.2%), or frail (<i>n</i> = 14, 13.1%). Of these, 21 patients (20%) were diagnosed with sarcopenia; 16 patients (15%) experienced postoperative complications. Patients classified as prefrail or frail had a higher incidence of postoperative complications compared with those classified as fit (19.7% vs. 5.6%, <i>p</i> = 0.08). Patients with both prefrail or frail and sarcopenia had a significantly higher risk of postoperative complications. This association remained significant in the multivariable model (OR 4.74; 95% CI, 1.10–20.29; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, patients classified as prefrail/frail and sarcopenic were at significantly higher risk for postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"587-594"},"PeriodicalIF":2.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950332","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":"Effect on short-term outcomes of the COVID-19 pandemic following laparoscopic distal gastrectomy and low anterior resection for gastric and rectal cancer: A retrospective study using the Japanese National Clinical Database, 2018–2022","authors":"Masafumi Inomata,&nbsp;Hideki Endo,&nbsp;Tomonori Akagi,&nbsp;Hidefumi Shiroshita,&nbsp;Shigeki Yamaguchi,&nbsp;Susumu Eguchi,&nbsp;Norihito Wada,&nbsp;Yukinori Kurokawa,&nbsp;Yosuke Seki,&nbsp;Yoshiharu Sakai,&nbsp;Hiroyuki Yamamoto,&nbsp;Yoshihiro Kakeji,&nbsp;Yuko Kitagawa,&nbsp;Akinobu Taketomi,&nbsp;Masaki Mori","doi":"10.1002/ags3.12901","DOIUrl":"https://doi.org/10.1002/ags3.12901","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We previously reported no change in surgical outcomes for laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR) early in the COVID-19 pandemic (2020), although the number of elective surgeries decreased. In 2021, COVID-19 spread further, with vaccination and other medical measures based on several medical societies' guidelines being initiated. Using the Japanese National Clinical Database (NCD), we added 2022 data to the 2018–2021 data to analyze the impacts of expansion of the COVID-19 infection and its spread on laparoscopic surgery (including robot-assisted surgery).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on patients who underwent LDG and LLAR for cancer were extracted from the NCD between 2018 and 2022. The numbers of LDG and LLAR were obtained, and morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), i.e. the ratio of the observed number of incidences to expected number of incidences calculated by the risk calculator previously developed by the NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The numbers of LDG and LLAR cases declined in 2020, the first pandemic year, and continued to decline in 2022 to the same level as 2021, but with no further decline and no recovery trend in the number of cases. Numbers of robot-assisted LDG and LLAR cases increased but at a rate lower than the prepandemic increase. Mortality and anastomotic leakage, two very important complications assessed in SMR, did not worsen during the pandemic compared to prepandemic levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Japan, laparoscopic surgery was safe and unaffected by the COVID-19 pandemic, even in 2022, when the epidemic spread.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"619-627"},"PeriodicalIF":2.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950527","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}