Annals of Gastroenterological Surgery最新文献

{"title":"Prediction of Long-Term Prognosis in Patients With Hepatocellular Carcinoma Using the National Clinical Database Risk Calculator.","authors":"Mariko Tsukagoshi, Kenichiro Araki, Norio Kubo, Takamichi Igarashi, Shunsuke Kawai, Kei Hagiwara, Kouki Hoshino, Ryo Muranushi, Ken Shirabe","doi":"10.1002/ags3.70256","DOIUrl":"10.1002/ags3.70256","url":null,"abstract":"<p><strong>Aim: </strong>To determine the value of the National Clinical Database (NCD) risk calculator for predicting surgical outcomes and long-term prognosis in patients undergoing resection for hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>We retrospectively analyzed data from 210 patients with HCC who underwent initial hepatic resection between January 2016 and December 2022. We calculated predicted incidence of surgery-related mortality (predicted mortality rate) using the NCD risk calculator. We assessed the relationship between predicted mortality rate and clinicopathological factors, including their relationship with long-term prognosis.</p><p><strong>Results: </strong>A predicted mortality rate of ≥ 3% significantly correlated with worse recurrence-free survival and overall survival (OS), with a high-risk group showing increased blood loss, longer hospital stays, and higher severe complication rates. Multivariate analysis identified predicted mortality rate of ≥ 3% as an independent prognostic indicator for poor OS, alongside male sex and microvascular invasion.</p><p><strong>Conclusion: </strong>The NCD risk calculator showed potential to predict not only short-term outcomes but also long-term prognosis in patients with HCC undergoing resection. The NCD risk calculator may be a valuable complementary tool for decision-making about liver resection in patients with HCC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13402846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598066","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":"Return-To-Work and Working Status After Surgery for Gastric and Esophageal Cancer: A Prospective Observational Study.","authors":"Kentaro Goto, Shigeo Hisamori, Kohei Ueno, Hiroyasu Abe, Ryosuke Okamura, Hisahiro Hosogi, Yoshito Yamashita, Dai Manaka, Hiroaki Hata, Tatsuto Nishigori, Sanae Nakajima, Michihiro Yamamoto, Koichi Kinoshita, Shintaro Okumura, Masazumi Sakaguchi, Shigeru Tsunoda, Yu Sakagami, Koya Hida, Kazutaka Obama","doi":"10.1002/ags3.70251","DOIUrl":"10.1002/ags3.70251","url":null,"abstract":"<p><strong>Aim: </strong>As survival after gastric and esophageal cancer continues to improve, sustained work participation has become an important survivorship outcome. We aimed to evaluate return-to-work (RTW) rates 18 months after curative-intent surgery for gastric and esophageal cancers and to identify clinical and socioeconomic factors associated with delayed or failed RTW.</p><p><strong>Methods: </strong>This multicenter, longitudinal, prospective cohort study evaluated working-age Japanese patients undergoing curative-intent surgery for gastric or esophageal cancer. Working status was assessed preoperatively and at 6, 12, and 18 months postoperatively. The primary outcome was working status at 18 months. Secondary outcomes included time to first RTW, and factors associated with non-working and delayed RTW. Exploratory analyses evaluated 6-month patient-reported outcomes (QLQ-C30) and postoperative weight loss.</p><p><strong>Results: </strong>Among 158 eligible patients, 124 (78.5%) were working at 18 months. Older age (≥ 65 years) and pathological stage≥ III were associated with non-working at 18 months, whereas sedentary work and self-employment were associated with a lower risk of non-working. Postoperative appetite loss, financial difficulties (QLQ-C30), and ≥ 10% body weight loss at 6 months were associated with non-working status. Median time to first RTW was 30 and 70 days for gastric and esophageal cancers, respectively. Esophageal cancer and advanced stage were consistently associated with delayed RTW, with weaker evidence for associations with female sex and preoperative retirement.</p><p><strong>Conclusions: </strong>Approximately 80% of patients were working at 18 months after surgery. Postoperative nutritional impairment and symptom burden were associated with long-term work participation and may help identify patients at risk of not working after surgery.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13402095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598044","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 Minimally Invasive Colectomy Between Intra- Versus Extra-Corporeal Anastomosis Technique (COMMIT Study): Short-Term Analysis.","authors":"Takuya Takami, Takehito Yamamoto, Yoshiro Itatani, Ryosuke Mizuno, Kae Okoshi, Yasunori Deguchi, Keiji Nagata, Tomoaki Okada, Rei Mizuno, Kazutaka Obama","doi":"10.1002/ags3.70252","DOIUrl":"10.1002/ags3.70252","url":null,"abstract":"<p><strong>Aim: </strong>To compare the operative and short-term outcomes between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in minimally invasive colectomy.</p><p><strong>Methods: </strong>This multicenter cohort study used data from the Kyoto Colorectal Surgery Study Group database. Patients who underwent minimally invasive colectomy between 2018 and 2025 were included. Primary outcome was the incidence of intraoperative blood loss ≥ 200 mL. Secondary outcomes included continuous intraoperative blood loss, the incidence of intraoperative blood loss ≥ 100 and ≥ 300 mL, intraoperative blood transfusion, operative time, resection margins, harvested lymph node yield, and postoperative complications. Propensity score matching was performed to balance baseline characteristics.</p><p><strong>Results: </strong>Of 3213 eligible patients, 928 and 2285 underwent IA and EA, respectively. After the propensity score matching, 650 matched pairs were identified. The incidence of intraoperative blood loss ≥ 200 mL was significantly lower in the IA group than that in the EA group (2.5% vs. 4.9%; risk difference, -2.46%; 95% confidence interval, -4.65% to -0.43%), whereas continuous intraoperative blood loss was comparable. Although operative time was generally longer for IA, subgroup analysis demonstrated significant effect modification according to surgical approach, with operative time tending to favor IA. The incidence of adequate resection margins tended to be higher in IA, although the difference was not statistically significant. Harvested lymph nodes and postoperative complications were generally comparable.</p><p><strong>Conclusion: </strong>IA was associated with a lower incidence of intraoperative blood loss ≥ 200 mL during minimally invasive colectomy. These findings indicate that IA may reduce the occurrence of relatively high blood loss events.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13402651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598077","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":"Redefining the Role of Splenectomy in Scirrhous Gastric Cancer: Toward a Selective Multimodal Strategy.","authors":"Tsutomu Hayashi, Takaki Yoshikawa","doi":"10.1002/ags3.70254","DOIUrl":"10.1002/ags3.70254","url":null,"abstract":"<p><p>Scirrhous gastric cancer, characterized by diffuse infiltration and a high propensity for peritoneal dissemination, remains one of the most aggressive subtypes of gastric cancer. Despite a relatively high incidence of splenic hilar lymph node (No. 10) metastasis, the oncologic benefit of splenectomy remains controversial, while its association with increased postoperative morbidity is well established. Recent advances in systemic therapy, including immune checkpoint inhibitors and molecular-targeted agents, have shifted the treatment paradigm toward improved systemic disease control. In parallel, minimally invasive surgical approaches, particularly spleen-preserving splenic hilar lymph node dissection, have emerged as feasible alternatives to conventional splenectomy. However, in scirrhous gastric cancer, disease-specific features such as diffuse infiltration, marked fibrosis, and difficulty in intraoperative assessment continue to pose significant challenges. Furthermore, the optimal extent of lymphadenectomy, especially following neoadjuvant therapy, remains undefined. Taken together, splenectomy should no longer be regarded as a routine component of surgical management for scirrhous gastric cancer, but rather as a selective procedure tailored to individual tumor characteristics and treatment context. Future studies integrating systemic therapy, surgical safety, and oncologic adequacy are required to establish evidence-based strategies for this challenging disease.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590293","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 \"Intratumoral <i>Fusobacterium nucleatum</i> Drives Cancer-Associated Fibroblasts Enrichment and Immune Exclusion in Esophageal Squamous Cell Carcinoma\".","authors":"","doi":"10.1002/ags3.70253","DOIUrl":"10.1002/ags3.70253","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1002/ags3.70116.].</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576896","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 Healthcare Utilization and Costs After Emergency Department Encounters for Uncomplicated Appendicitis: A Statewide Observational Study.","authors":"Andrew C Meltzer, Michael Makutonin, Taylor Gorak, Aditya Loganathan, Jack A Meltzer, Avi Dor","doi":"10.1002/ags3.70248","DOIUrl":"10.1002/ags3.70248","url":null,"abstract":"<p><strong>Objective: </strong>Non-operative management with antibiotics has emerged as an alternative to appendectomy for uncomplicated appendicitis. This study compared one-year healthcare costs and utilization outcomes after operative versus non-operative management of uncomplicated appendicitis using statewide administrative data.</p><p><strong>Methods: </strong>We conducted a statewide observational study using linked Healthcare Cost and Utilization Project (HCUP) databases from Maryland (2016-2021) including emergency department, inpatient, and ambulatory surgery encounters. Adults with uncomplicated appendicitis, identified by ICD-10 codes and excluding complicated cases, were analyzed. Operative management was defined as appendectomy during the index hospitalization, non-operative management as initial treatment without appendectomy. The primary outcome was total healthcare cost within one year of the index visit. Secondary outcomes included emergency department revisits, hospital readmissions, and cumulative hospital length of stay. Inverse probability of treatment weighting based on propensity scores was used to balance covariates, and generalized linear models estimated adjusted outcomes.</p><p><strong>Results: </strong>Among 15 754 patients, 14 056 (89.2%) underwent appendectomy and 1698 (10.8%) received non-operative management. Adjusted mean one-year costs were significantly lower for appendectomy ($6241) than for non-operative management ($8187). Operative management was also associated with fewer emergency department revisits (0.69 vs. 1.00 per patient), fewer readmissions (0.11 vs. 0.34 per patient), and shorter total hospital stays (3.84 vs. 5.87 days) (all <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Initial appendectomy for uncomplicated appendicitis was associated with lower one-year healthcare costs, fewer emergency department revisits, and fewer readmissions compared with non-operative management. These findings suggest that early surgery may reduce long-term healthcare utilization.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576323","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":"Current Status and Challenges of Imaging-Based Diagnosis of Lymph Node Metastasis in Colon Cancer: The Lymph Node Committee of the Japanese Society for Cancer of the Colon and Rectum.","authors":"Shimpei Ogawa, Yuji Takayama, Yasuyuki Takamizawa, Yukihide Kanemitsu, Hideki Ueno","doi":"10.1002/ags3.70250","DOIUrl":"10.1002/ags3.70250","url":null,"abstract":"<p><strong>Background: </strong>Accurate pre-treatment evaluation of lymph node metastasis (LNM) in colon cancer is important for determining an optimal treatment strategy. This diagnosis is mainly performed using the size of lymph nodes visualized on CT, although morphological diagnosis is also used.</p><p><strong>Results: </strong>Meta-analyses of CT for diagnosis of LNM in colon cancer indicate unsatisfactory results, with pooled sensitivities of 71% and 74%, and pooled specificities of 67% and 54%. Our recent report also showed only moderate diagnostic performance, with pooled sensitivity of 66.7%, pooled specificity of 72.4%, and an AUC of the HSROC of 0.741. This is because strict positive criteria based on the size and morphology of visualized lymph nodes are difficult to establish, and currently there are limitations to determining treatment strategies based on imaging diagnosis. Diagnostic accuracy can be improved by setting individualized diagnostic criteria according to the purpose, considering underlying clinicopathological factors, and combining multiple metastasis-related factors. New diagnostic methods such as dual-energy CT and radiomics have also been explored. Unlike traditional diagnoses based on imaging findings, these methods quantify and evaluate parameters, and radiomics, in particular, allows detailed evaluation by quantifying high-dimensional features that are not visible.</p><p><strong>Conclusion: </strong>Further studies are required to improve diagnostic capabilities that will enable optimal treatment strategies for LNM in colon cancer.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576904","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":"Artificial Intelligence-Based Surgical Phase Analysis Enables Objective Assessment of Surgeon Skill in Robotic Distal Gastrectomy: A Multicenter Study.","authors":"Masaru Komatsu, Daichi Kitaguchi, Yoichi Ninomiya, Yuya Takabe, Mitsumasa Yoshida, Masahiro Yura, Nobuyoshi Takeshita, Takahiro Kinoshita, Masaaki Ito","doi":"10.1002/ags3.70249","DOIUrl":"10.1002/ags3.70249","url":null,"abstract":"<p><strong>Aim: </strong>Artificial intelligence (AI)-based surgical video analysis can automate time-consuming manual assessments and enable objective characterization of surgical workflows. We aimed to construct a large, multicenter, fully annotated dataset of robotic distal gastrectomy (RDG) videos and evaluate the feasibility and performance of an AI model for surgical phase recognition. We further explored whether AI-derived phase-specific metrics could characterize phase-level performance differences according to surgeon experience.</p><p><strong>Methods: </strong>We developed an image classification model to automatically identify surgical phases in RDG videos. Experienced gastric surgeons annotated nine predefined surgical phases on a frame-by-frame basis (1 fps). Model performance was assessed using accuracy, precision, recall, and F1-score. In an exploratory analysis, the duration of each AI-predicted surgical phase was quantified and compared according to each surgeon's robotic case volume.</p><p><strong>Results: </strong>We analyzed 137 RDG videos collected from 15 institutions. The nine-phase recognition model achieved an overall accuracy of 87.0%. Among the surgical phases, the AI-predicted duration of right-sided greater curvature lymphadenectomy was shorter for surgeons with higher robotic case volume than those with lower volume (3789 vs. 2547 frames, <i>p</i> < 0.01), indicating phase-specific differences in operative performance.</p><p><strong>Conclusions: </strong>The proposed AI model demonstrated robust performance in multicenter surgical phase recognition. AI-based surgical phase analysis enabled objective characterization of phase-specific operative profiles according to surgeon experience. These findings support the feasibility of surgical phase analysis as an exploratory framework for performance profiling and educational support in robotic gastrectomy. However, generalizability may be limited owing to institutional overlap between the training and validation datasets.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576754","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":"Very Long-Term Outcomes of Laparoscopic Adjustable Gastric Banding in a Japanese Cohort: A Single-Center 15-Year Follow-Up Study.","authors":"Yuichi Endo, Hiroomi Takayama, Wataru Miyoshino, Shun Nakamura, Yuiko Nagasawa, Masahiro Kawamura, Yoko Kawano, Takashi Masuda, Teijiro Hirashita, Yoshinori Ozeki, Takayuki Masaki, Hirotaka Shibata, Masafumi Inomata","doi":"10.1002/ags3.70244","DOIUrl":"10.1002/ags3.70244","url":null,"abstract":"<p><strong>Background: </strong>The long-term clinical role of laparoscopic adjustable gastric banding (LAGB) remains uncertain in the contemporary era of metabolic surgery, and very long-term outcome data from Asian populations are limited. This study evaluated very long-term outcomes of LAGB in a Japanese cohort, focusing on weight change, metabolic comorbidities, and reoperations.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients who underwent LAGB between 2005 and 2010 at a single institution. Changes in body weight, metabolic comorbidities, and reoperation were assessed for up to 15 years. Weight outcomes were evaluated using percent total weight loss (%TWL) and percent excess weight loss (%EWL).</p><p><strong>Results: </strong>A total of 28 patients were included. Mean %EWL was 49% at 1 year, 62% at 5 years, 64% at 10 years, and 59% at 15 years, indicating sustained long-term weight reduction despite partial weight regain. Early improvements in metabolic comorbidities were observed; however, recurrence of diabetes mellitus, hypertension, and dyslipidemia increased after 5-10 years, whereas hepatic comorbidities remained relatively stable. Reoperation was required in 7 of 28 patients (25%), mainly because of device-related complications or insufficient weight loss.</p><p><strong>Conclusion: </strong>This study provides very long-term outcome data of LAGB in an Asian cohort. Although LAGB achieved sustained weight reduction in selected patients, metabolic improvements showed limited long-term durability and a substantial proportion of patients required reoperation. These findings highlight the limitations of a purely restrictive and device-dependent bariatric procedure in the contemporary era of metabolic surgery.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1655-1662"},"PeriodicalIF":3.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576894","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 Metastasis Timing in Metastatic Gastrointestinal Stromal Tumors: A Multicenter Retrospective Cohort Study.","authors":"Kunihiko Kawai, Tsuyoshi Takahashi, Ryugo Teranishi, Shinsuke Sato, Yukinori Kurokawa, Toshirou Nishida, Seiichi Hirota, Jyunya Fujita, Yuichiro Doki, Toshimasa Tsujinaka","doi":"10.1002/ags3.70245","DOIUrl":"10.1002/ags3.70245","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal stromal tumors (GISTs) commonly metastasize to the liver and peritoneum. Metastases may be detected synchronously at the time of initial diagnosis or develop metachronously after curative-intent resection. Nonetheless, the prognostic significance of metastasis timing in advanced GIST remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 147 patients with metastatic GIST treated at multiple institutions between 2003 and 2012. The patients were categorized into synchronous (<i>n</i> = 51) and metachronous (<i>n</i> = 96) groups. Clinicopathological characteristics and overall survival (OS) were compared using Kaplan-Meier analysis and Cox proportional hazards models. Among patients with metachronous disease, the outcomes were further evaluated according to the recurrence interval.</p><p><strong>Results: </strong>The median OS was significantly shorter in the synchronous group (6.7 years) than in the metachronous group (12.8 years; <i>p</i> = 0.001). Metastasis timing remained an independent prognostic factor in multivariable analysis (hazard ratio 2.36, 95% confidence interval 1.39-4.00; <i>p</i> = 0.001). Among patients with metachronous metastasis, early recurrence within 2 years after surgery was associated with significantly inferior survival compared to late recurrence.</p><p><strong>Conclusion: </strong>Metastasis timing was associated with survival in patients with metastatic GIST. Both synchronous presentation and early metachronous recurrence were associated with poorer outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1663-1672"},"PeriodicalIF":3.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576576","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}