Annals of Gastroenterological Surgery最新文献

{"title":"Prognostic factors of conversion surgery for stage IV gastric cancer: A multi-institutional retrospective analysis","authors":"Atsushi Takeno,&nbsp;Masaaki Motoori,&nbsp;Kentaro Kishi,&nbsp;Takeshi Omori,&nbsp;Motohiro Hirao,&nbsp;Toru Masuzawa,&nbsp;Kazumasa Fujitani,&nbsp;Kazuyoshi Yamamato,&nbsp;Yukinori Kurokawa,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.12778","DOIUrl":"10.1002/ags3.12778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conversion surgery (CS) is a highly anticipated strategy for stage IV advanced gastric cancer (AGC) with a good response to chemotherapy. However, prognostic factors limiting R0 resection remain unclear. In this multi-institutional study, we investigated the clinical outcomes of CS for stage IV AGC and the prognostic factors of CS-limiting R0 resection and analyzed them according to metastatic patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical data on 210 patients who underwent CS for stage IV AGC at six institutions between 2007 and 2017 were retrospectively retrieved. The patient background, preoperative treatment, operative outcomes, and survival times were recorded. Prognostic factors for overall and recurrence-free survival were investigated using univariate and multivariate analyses for patients who underwent R0 resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>R0 resection was achieved in 146 (70%) patients. The median survival time was 32 months, and the 3-year survival rate was 45%. Patients who achieved R0 resection had significantly longer survival than those with R1/2 resection (median survival time: 41.5 months vs. 20.7 months). Multivariate analysis identified pathological N positivity for overall and relapse-free survival and pathological T4 for relapse-free survival as significant independent poor prognostic factors of R0 resected patients. There was no significant difference in survival among the peritoneum, liver, and lymph node groups regarding the initial metastatic sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CS with R0 resection for patients with stage IV AGC can lead to longer survival. Patients with pathological T4 and pathological N positivity were eligible for intensive adjuvant therapy after CS with R0 resection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"431-442"},"PeriodicalIF":2.7,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491620","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":"The current multidisciplinary management of rectal cancer","authors":"Neal Bhutiani,&nbsp;Oliver Peacock,&nbsp;Abhineet Uppal,&nbsp;Y. Nancy You,&nbsp;Brian K. Bednarski,&nbsp;John M. Skibber,&nbsp;Craig Messick,&nbsp;Michael G. White,&nbsp;George J. Chang,&nbsp;Tsuyoshi Konishi","doi":"10.1002/ags3.12777","DOIUrl":"10.1002/ags3.12777","url":null,"abstract":"<p>Multidisciplinary management of rectal cancer has rapidly evolved over the last several years. This review describes recent data surrounding total neoadjuvant therapy, organ preservation, and management of lateral pelvic lymph nodes. It then presents our treatment algorithm for management of rectal cancer at The University of Texas MD Anderson Cancer Center in the context of this and other existing literature. As part of this discussion, the review describes how we tailor management based upon both patient and tumor-related factors in an effort to optimize patient outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"394-400"},"PeriodicalIF":2.7,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12777","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139592821","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":"Possible poor prognosis in younger-onset Crohn's disease-associated anorectal cancer: A subanalysis of the Nationwide Japanese study","authors":"Yoshiki Okita,&nbsp;Yuji Toiyama,&nbsp;Hiroki Ikeuchi,&nbsp;Motoi Uchino,&nbsp;Kitaro Futami,&nbsp;Kinya Okamoto,&nbsp;Tatsuki Noguchi,&nbsp;Kenichi Sugihara,&nbsp;Soichiro Ishihara,&nbsp;Yoichi Ajioka,&nbsp;from the Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum","doi":"10.1002/ags3.12773","DOIUrl":"10.1002/ags3.12773","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Crohn's disease (CD)-associated intestinal cancers are characterized by their high incidence, particularly at the anorectal site in the Japanese population. Accumulating evidence revealed that younger-onset sporadic colorectal cancer may exhibit unique biological features. To the best of our knowledge, few previous articles reported clinicopathological features in patients with CD-associated anorectal cancer (CDAAC). Therefore, we aimed to clarify the relationship between the younger onset of cancer and clinicopathological characteristics and prognosis, and the efficacy of cancer surveillance in patients with CDAAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CD patients who had been diagnosed with intestinal cancers from 1983 to 2020 were collected from 39 Japanese institutions in this study. Of 316 patients with CD-associated intestinal cancers, we analyzed 211 patients with CDAAC. We divided the patients into two groups according to the median age at cancer diagnosis (45 years old).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Younger-onset CDAAC (YO-CDAAC) patients were significantly more likely to have a poor outcome than those with older-onset CDAAC (OO-CDAAC) in terms of both disease-free survival (DFS) (<i>p</i> = 0.0014) and overall survival (OS) (<i>p</i> = 0.023). Multivariate analysis showed that age under 45 years old at diagnosis of cancer was one of the independent factors for poor DFS and OS (hazard ratios: 2.15, 95% confidence interval: 1.09–4.26, <i>p</i> = 0.028, hazard ratios: 1.95, 95% confidence interval: 1.05–3.60, <i>p</i> = 0.033, respectively). Patients detected via surveillance showed significantly better DFS and OS rates than symptomatic patients in YO-CDAAC (<i>p</i> = 0.012 and 0.0031, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>YO-CDAAC may have a poorer prognosis compared with OO-CDAAC. Surveillance could be important to improve cancer prognosis, especially in young CD patients with anorectal disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 4","pages":"620-630"},"PeriodicalIF":2.9,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12773","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140492893","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":"Exosomal circ_0032704 confers sorafenib resistance to hepatocellular carcinoma and contributes to cancer malignant progression by modulating the miR-514a-3p/PD-L1 pathway","authors":"Chengyun Dou,&nbsp;Hongbo Zhu,&nbsp;Xia Xie,&nbsp;Cuiqin Huang,&nbsp;Hui Tan,&nbsp;Chuangjie Cao","doi":"10.1002/ags3.12772","DOIUrl":"10.1002/ags3.12772","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to explore the role of circ_0032704 in sorafenib-resistant hepatocellular carcinoma (HCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The expression of circ_0032704, miR-514a-3p, and programmed death-ligand 1 (PD-L1) mRNA was detected by quantitative real-time PCR (qPCR). The expression of multidrug resistant-related proteins, migration/invasion-related proteins, exosome-related proteins, and PD-L1 protein was detected by western blot. Cell viability was detected by CCK-8 assay. Cell proliferation, migration, and invasion were assessed by EdU assay, wound healing assay, and transwell assay. The binding between miR-514a-3p and circ_0032704 or PD-L1 was verified by RIP assay, pull-down assay, and dual-luciferase reporter assay. Cell- or serum-derived exosomes were isolated and identified by TEM and NTA. Xenograft models were established to determine the effect of circ_0032704 on drug resistance in vivo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Circ_0032704 was overexpressed in sorafenib-resistant HCC tissues and cells. Circ_0032704 knockdown reduced sorafenib resistance in HCC cells and inhibited cell proliferation, migration, and invasion of sorafenib-resistant HCC cells, while these effects were reversed by PD-L1 overexpression. We found that circ_0032704 positively regulated PD-L1 expression via targeting miR-514a-3p. Exosomes with circ_0032704 inhibition reduced sorafenib resistance in HCC cells and inhibited cell proliferation, migration, and invasion of sorafenib-resistant HCC cells. Exosomes with circ_0032704 inhibition also inhibited tumor growth in vivo. The expression of circ_0032704 in exosomes was stable and possessed diagnostic value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Circ_0032704 enhanced sorafenib resistance in HCC and promoted the malignant development of sorafenib-resistant HCC. Circ_0032704 could be transported by exosomes, and exosomal circ_0032704 had diagnostic value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"507-520"},"PeriodicalIF":2.7,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603489","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 characteristics of new-onset diabetes after liver transplantation and outcomes","authors":"Shingo Shimada,&nbsp;Katsunori Miyake,&nbsp;Deepak Venkat,&nbsp;Humberto Gonzalez,&nbsp;Dilip Moonka,&nbsp;Atsushi Yoshida,&nbsp;Marwan Abouljoud,&nbsp;Shunji Nagai","doi":"10.1002/ags3.12775","DOIUrl":"10.1002/ags3.12775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to identify the characteristics of new-onset diabetes after liver transplantation (LT) (NODAT) and investigate its impacts on post-transplant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult LT patients between 2014 and 2020 who used tacrolimus as initial immunosuppression and survived 3 months at least were evaluated. Patients who developed NODAT within 3 months after LT were classified as NODAT group. Also, patients were further classified as history of diabetes before LT (PHDBT) and non-diabetes (ND) groups. Patient characteristics, post-LT outcomes, and cardiovascular and/or pulmonary complications were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 83, 225, and 263 patients were classified into NODAT, PHDBT, and ND groups. The proportion of cholestatic liver disease and rejection within 90 days were higher in NODAT group. Mean serum tacrolimus concentration trough level in the first week after LT was 7.12, 6.12, and 6.12 ng/mL (<i>p</i> &lt; 0.001). Duration of corticosteroids was significantly longer in NODAT compared to PHDBD or ND (416, 289, and 228 days, <i>p</i> &lt; 0.001). Three-year graft and patient survival were significantly worse in NODAT than ND (80.5% vs. 95.0%, <i>p</i> &lt; 0.001: 82.0% vs. 95.4%, <i>p</i> &lt; 0.001) but similar to PHDBT. Adjusted risks of 3-year graft loss and patient death using Cox regression analysis were significantly higher in NODAT compared to ND (adjusted hazard ratio [aHR] 3.41, <i>p</i> = 0.004; aHR 3.61, <i>p</i> = 0.004). Incidence rates of cardiovascular or pulmonary complications after LT in NODAT were significantly higher than ND but similar to PHDBT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher initial tacrolimus concentration and early rejection might be risk factors for NODAT. NODAT was associated with worse post-transplant outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"383-393"},"PeriodicalIF":2.7,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12775","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139524891","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":"What is the crux of successful living-donor liver transplantation for recipients aged 70 and beyond?","authors":"Takeo Toshima,&nbsp;Shinji Itoh,&nbsp;Yoshihiro Nagao,&nbsp;Shohei Yoshiya,&nbsp;Yuki Bekki,&nbsp;Takuma Izumi,&nbsp;Norifumi Iseda,&nbsp;Yuriko Tsutsui,&nbsp;Katsuya Toshida,&nbsp;Tomoharu Yoshizumi","doi":"10.1002/ags3.12769","DOIUrl":"10.1002/ags3.12769","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>There is limited evidence regarding the feasibility of living-donor liver transplantation (LDLT) for patients aged over 70. The aims of this study were to assess postoperative outcomes in elderly recipients and to ascertain the potential feasibility and acceptability of LDLT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from 762 recipients, including 26 in the elderly group (aged ≥70) and 736 in the younger group (aged &lt;70), and reviewed even by propensity score matching (PSM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed in the frequency of postoperative complications between the two groups. Additionally, both groups exhibited a comparable 30-day mortality rate after LDLT (3.9% in both) and similar hospital stays (36 days vs. 40 days). The 1-, 3-, and 5-year graft survival rates in the elderly group were 92.0%, which was comparable to those in the younger group (<i>p</i> = 0.517), as confirmed by PSM. Notably, all donors for elderly patients were the children of the recipients, with an average age of 41.6 years, and grafts from donors aged ≥50 years were not utilized, signifying the use of high-quality grafts. Our inclusion criterion for elderly recipients was strictly defined as an ECOG-PS score of 0–2, which played a pivotal role in achieving favorable postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LDLT can be performed safely for elderly patients aged 70 years or older, provided they have a preserved PS and receive high-quality grafts from younger donors, inevitably all children of elderly recipients. This approach yields acceptable long-term outcomes. Consequently, age alone should not serve as an absolute contraindication for LDLT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 4","pages":"668-680"},"PeriodicalIF":2.9,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139625215","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":"Surgery with minimal bleeding","authors":"Daisuke Ichikawa","doi":"10.1002/ags3.12774","DOIUrl":"https://doi.org/10.1002/ags3.12774","url":null,"abstract":"&lt;p&gt;Several clinical studies have been conducted to establish improved treatment options for patients with various cancers. There are, however, various aspects of better treatment, and it is important not only to provide better oncological outcomes but also to maintain the patient's quality of life after treatment.&lt;/p&gt;&lt;p&gt;In this issue, Toriumi et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported a supplemental analysis of the randomized controlled JCOG1001 trial, which primarily investigated the superiority of bursectomy over conventional omentectomy in patients with cT3-4 advanced gastric cancer. They examined the efficacy of an anti-adhesion membrane in preventing postoperative small-bowel obstruction (SBO) in patients undergoing open gastrectomy. SBO is a major complication in surgically treated patients with cancer and frequently affects them during long-term postoperative periods, even after complete healing. The authors demonstrated that the anti-adhesion membrane did not decrease the occurrence of SBO after surgery. Meanwhile, it was found that a large amount of blood loss was independently associated with SBO development in the multivariate analysis. Based on these findings, surgeons should strive to minimize intraoperative bleeding rather than rely on anti-adhesion membranes to prevent SBO.&lt;/p&gt;&lt;p&gt;Various reports and discussions have been published regarding the prognostic impact of intraoperative blood loss (IBL) and its effects on intra-abdominal adhesions. Several studies have demonstrated that IBL adversely affects the prognostic outcome of patients with various cancers, including gastric cancer, after curative resection. Although some studies have failed to identify this negative effect, various studies have set varying thresholds to analyze the clinical impact of IBL, which can potentially lead to varying interpretations. Comprehensive studies, such as meta-analyses and systematic reviews, have mostly concluded that large amount of IBL certainly has some negative prognostic effects.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Recently, randomized controlled trials have been considered the most important for elucidating the clinical significance of various medical interventions; however, it is ethically impossible to compare the clinical outcomes between large and small IBL groups. Therefore, supplemental and/or exploratory analyses of well-designed RCTs may be most appropriate for assessing the clinical significance of IBL. Misawa et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; analyzed the prognostic impact of IBL in the same cohort of JCOG1001 trial described above and clearly demonstrated that an intraoperative blood loss of ≥200 mL was an independent worse prognostic factor in patients after curative gastrectomy for cT3/4a gastric cancer.&lt;/p&gt;&lt;p&gt;Moreover, several studies have reported a relationship between IBL and the recurrence type. Kamei et al. (doi: 10.1007/s00268-009-9979-4.) reported that IBL is a critical risk factor for peritoneal recurrence, but not for nodal and hem","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 1","pages":"6-7"},"PeriodicalIF":2.7,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139494383","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":"The relationship between perioperative central venous oxygen saturation and postoperative complications in highly invasive gastroenterological surgery","authors":"Dai Miyazaki,&nbsp;Toshiaki Shichinohe,&nbsp;Yusuke Watanabe,&nbsp;Kimitaka Tanaka,&nbsp;Yoshitsugu Nakanishi,&nbsp;Toshimichi Asano,&nbsp;Yo Kurashima,&nbsp;Yuma Ebihara,&nbsp;Soichi Murakami,&nbsp;Satoshi Hirano","doi":"10.1002/ags3.12768","DOIUrl":"10.1002/ags3.12768","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after these surgeries is high, which affects the postoperative course and mortality. In patients who undergo these types of surgeries, continuous monitoring of the perioperative central venous oxygen saturation (ScvO₂) is possible via a central venous catheter. We aimed to investigate the relationship between continuously monitored perioperative ScvO₂ values and postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical records of 115 patients who underwent highly invasive gastroenterological surgeries and ScvO₂ monitoring from April 2012 to March 2014 were analyzed. Sixty patients met the inclusion criteria, and their ScvO₂ levels were continuously monitored perioperatively. The relationship between ScvO₂ levels and major postoperative complications, defined as Clavien–Dindo grade ≥ III, was examined using uni- and multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty patients developed major postoperative complications. The adequate cut-off value derived from receiver operating curves of the postoperative average ScvO₂ levels for predicting major complications was 75%. Multivariate analysis revealed that low average postoperative ScvO₂ levels (<i>p</i> = 0.016) and blood loss ≥ 1000 mL (<i>p</i> = 0.039) were significant predictors of major postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low perioperative ScvO₂ values were associated with an increased risk of major postoperative complications. Continuous ScvO₂ monitoring will help prevent postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 4","pages":"660-667"},"PeriodicalIF":2.9,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533500","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":"Presurgical mild anemia is a risk factor for severe postoperative complications of rectal cancer surgery: A Japanese nationwide retrospective cohort study","authors":"Takeshi Yamada,&nbsp;Hideki Endo,&nbsp;Hiroshi Hasegawa,&nbsp;Yoshihiro Kakeji,&nbsp;Hiroyuki Yamamoto,&nbsp;Hiroaki Miyata,&nbsp;Koki Otsuka,&nbsp;Akihisa Matsuda,&nbsp;Hiroshi Yoshida,&nbsp;Yuko Kitagawa","doi":"10.1002/ags3.12770","DOIUrl":"10.1002/ags3.12770","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anemia has negative effects on long-term outcomes of rectal cancer patients; however, its status as a risk factor for severe complications is disputed. Perioperative risks may differ based on the severity of pre-surgical anemia; nonetheless, no previous study has investigated these differences. This study identified risks of severe postoperative complications in rectal cancer patients based on severity of their pre-surgical anemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study enrolled patients who underwent low anterior resection for rectal cancer and were registered in the Japanese National Clinical Database (NCD) between 2017 and 2019. Anemia severity was categorized into three levels: mild, moderate, and severe. A logistic regression model was applied to calculate the risk-adjusted odds ratio (OR) of severe complications after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study analyzed a cohort of 51 765 rectal cancer patients who underwent low anterior resection. Results showed that severe complications occurred in 10.9% of patients and were significantly more frequent in patients with anemia (13.6%) than those with normal hemoglobin levels (9.2%). Risk-adjusted ORs of severe complications in the severe, moderate, and mild anemia groups versus the normal group for males were 1.19 (95% confidence interval [CI]: 0.89–1.58), 1.47 (1.34–1.62), and 1.21 (1.12–1.31), respectively. Those for females were 1.39 (0.90–2.15), 1.64 (1.37–1.97), and 1.36 (1.16–1.58), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>According to this large cohort study, pre-surgical anemia significantly increases the risk of severe postoperative complications in rectal cancer patients. Even mild anemia presents a significant risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"471-480"},"PeriodicalIF":2.7,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441187","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 significance of lymph node metastasis in pancreatic tail cancer: A multicenter retrospective study","authors":"Teijiro Hirashita,&nbsp;Naoki Ikenaga,&nbsp;Kohei Nakata,&nbsp;Masafumi Nakamura,&nbsp;Hiroshi Kurahara,&nbsp;Takao Ohtsuka,&nbsp;Takaaki Tatsuguchi,&nbsp;Kazuyoshi Nishihara,&nbsp;Hiromitsu Hayashi,&nbsp;Shigeki Nakagawa,&nbsp;Takao Ide,&nbsp;Hirokazu Noshiro,&nbsp;Tomohiko Adachi,&nbsp;Susumu Eguchi,&nbsp;Atsushi Miyoshi,&nbsp;Shiro Kohi,&nbsp;Atsushi Nanashima,&nbsp;Hiroaki Nagano,&nbsp;Mitsuhisa Takatsuki,&nbsp;Masafumi Inomata,&nbsp;Kyushu Study Group of Treatment for Pancreatobiliary Cancer","doi":"10.1002/ags3.12771","DOIUrl":"10.1002/ags3.12771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Distal pancreatectomy (DP) with lymph node (LN) dissection is the standard procedure for pancreatic ductal adenocarcinoma of the tail (Pt-PDAC). However, the optimal surgery including extent of LN dissection is still being debated. The present study investigated the incidence and prognostic impact of LN metastasis on patients suffering from Pt-PDAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and method</h3>\u0000 \u0000 <p>This multicenter, retrospective study involved 163 patients who underwent DP for resectable Pt-PDAC at 12 institutions between 2013 and 2017. The frequency of LN metastasis and the effect of LN dissection on Pt-PDAC prognosis were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were high incidences of metastases to the LNs along the splenic artery in the patients with Pt-PDAC (39%). The rate of metastases in the LNs along the common hepatic, left gastric, and celiac arteries were low, and the therapeutic index for these LNs was zero. In pancreatic tail cancer located more distally, there were no metastases to the LNs along the common hepatic artery. Multivariate analysis revealed that tumor size was the only independent factor related to recurrence-free survival (HR = 2.01, 95% CI = 1.33–3.05, <i>p</i> = 0.001). The level of pancreas division and LN dissection along the common hepatic artery did not affect the site of tumor recurrence or recurrence-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LN dissection along the hepatic artery for Pt-PDAC has little significance. Distal pancreatic transection may be acceptable in terms of oncological safety, but further examination of short-term outcomes and preservation of pancreatic function is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 4","pages":"681-690"},"PeriodicalIF":2.9,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443117","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}