Annals of Gastroenterological Surgery最新文献

{"title":"Intraoperative redosing of antibiotics for prevention of surgical site infections: A systematic review and meta-analysis","authors":"Yuki Hanai,&nbsp;Jun Hirai,&nbsp;Masahiro Kobayashi,&nbsp;Kazuhiro Matsuo,&nbsp;Keita Kouzu,&nbsp;Hiroji Shinkawa,&nbsp;Seiichi Shinji,&nbsp;Motomu Kobayashi,&nbsp;Yuichi Kitagawa,&nbsp;Chizuru Yamashita,&nbsp;Yasuhiko Mohri,&nbsp;Hiroshi Nobuhara,&nbsp;Katsunori Suzuki,&nbsp;Junzo Shimizu,&nbsp;Motoi Uchino,&nbsp;Seiji Haji,&nbsp;Masahiro Yoshida,&nbsp;Toru Mizuguchi,&nbsp;Toshihiko Mayumi,&nbsp;Yuko Kitagawa,&nbsp;Hiroki Ohge","doi":"10.1002/ags3.12866","DOIUrl":"https://doi.org/10.1002/ags3.12866","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Appropriate antibiotic prophylaxis is essential for preventing surgical site infections (SSI); however, the clinical benefit of intraoperative redosing remains unclear and controversial owing to insufficient reliable evidence. Therefore, we performed a systematic review and meta-analysis to assess the effectiveness of prophylactic antibiotic redosing in lengthy surgical procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched the PubMed, Cochrane Library, Web of Science, and Ichushi-Web databases for articles published until 31 December, 2023. We compared the incidence of SSI between patients receiving and not receiving intraoperative redosing of antibiotics in surgeries lasting ≥3 h. Subgroup analyses were conducted across study characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random effects model. The risk of bias was assessed using the ROBINS-I.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, seven observational studies involving 4,671 patients were included. Intraoperative antibiotic redosing significantly reduced the risk of SSI compared with non-redosing (OR = 0.65, 95% CI = 0.45–0.94, <i>p</i> = 0.02). Subgroup analyses showed that intraoperative redosing decreased SSI risk in studies with a minimum 4-h operative time, no postoperative antibiotic continuation, and a moderate risk of bias. However, the statistical heterogeneity of the analyses was high among the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative redosing with prophylactic antibiotics during lengthy surgeries may be associated with a lower risk of SSI than non-redosing. Therefore, we recommend intraoperative redosing for surgeries lasting beyond 3–4 h to reduce the risk of infection. Further research is required to clarify the optimal redosing interval, which should be prioritized in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"369-378"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535729","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":"Annual report on National Clinical Database 2021 for gastroenterological surgery in Japan","authors":"Sunao Ito,&nbsp;Arata Takahashi,&nbsp;Hideki Ueno,&nbsp;Shuji Takiguchi,&nbsp;Yoshiki Kajiwara,&nbsp;Yoshihiro Kakeji,&nbsp;Susumu Eguchi,&nbsp;Takanori Goi,&nbsp;Akio Saiura,&nbsp;Akira Sasaki,&nbsp;Hiroya Takeuchi,&nbsp;Chie Tanaka,&nbsp;Masaji Hashimoto,&nbsp;Naoki Hiki,&nbsp;Akihiko Horiguchi,&nbsp;Satoru Matsuda,&nbsp;Tsunekazu Mizushima,&nbsp;Hiroyuki Yamamoto,&nbsp;Yuko Kitagawa,&nbsp;Ken Shirabe","doi":"10.1002/ags3.12868","DOIUrl":"10.1002/ags3.12868","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The Japanese National Clinical Database, which covers more than 95% of the surgeries performed in Japan, is the largest nationwide database. This is the 2021 annual report of the Gastroenterological Section of the National Clinical Database, which aims to present the short-term outcomes of cases registered in 2021 and discuss significant changes and insights into gastroenterological surgeries observed over the decade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the data of patients registered in the National Clinical Database between 2012 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 5 788 093 cases, including 597 780 cases in 2021, were extracted from the National Clinical Database. The number of surgeries resumed its original trend after a uniform decrease due to the coronavirus disease 2019 pandemic. The patient population continues to age, and the proportion of female patients is steadily increasing. The trend of surgeries being conducted in certified institutions with the involvement of board-certified surgeons is consistently rising. Moreover, the increasing trend of endoscopic surgery rate is still maintained. Although operative mortality is declining, the trend of increasing postoperative complications continues. Surgery on the esophagus, liver, and pancreas has shown substantial improvements in operative mortality, with a high participation rate of board-certified surgeons. Surgical procedures with a high incidence of emergency surgeries are characterized by low participation rates of board-certified surgeons, increased morbidity rates, and worse mortality outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This overview of surgical patients in Japan, obtained using data extracted from the National Clinical Database, may serve as a critical cornerstone for the future development of gastroenterological surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"32-59"},"PeriodicalIF":2.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930485","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":"Upfront surgery, neoadjuvant chemoradiotherapy, or neoadjuvant chemotherapy for rectal cancer with lateral lymph node metastasis: A multicenter MRI and lateral lymph node dissection study","authors":"Takuya Miura,&nbsp;Kazushige Kawai,&nbsp;Hiromasa Fujita,&nbsp;Shinsuke Kazama,&nbsp;Hideki Ueno,&nbsp;Yusuke Kinugasa,&nbsp;Kazuhiro Sakamoto,&nbsp;Hirotoshi Kobayashi,&nbsp;Kenichi Hakamada,&nbsp;Yoichi Ajioka","doi":"10.1002/ags3.12873","DOIUrl":"https://doi.org/10.1002/ags3.12873","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The purpose was to clarify the oncological outcomes of rectal cancer (RC) with lateral lymph node metastasis (LLNM) on high-resolution MRI (HRMRI), considering preoperative treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred and twelve patients, from 13 hospitals, diagnosed with RC with lateral lymph node dissection (LLND), between 2017 and 2019, were prospectively registered. LLNM was defined as a short-axis size ≥5 mm. Ultimately, this study included 102 patients. Upfront surgery (Upfront), chemoradiotherapy (CRT), and neoadjuvant chemotherapy (NAC) were performed at each institution's discretion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-six (64.7%) had mesorectal fascia (MRF) involvement, 35 (34.3%) had extramural venous invasion, and 33 (32.4%) had bilateral LLNMs. A positive radial margin (RM1) was observed in nine patients (8.8%), and 35 (34.3%) had pathological LLNM (pLLNM). Overall, 3-year relapse-free survival (3yRFS) and local recurrence-free survival (3yLRFS) were 69.6% and 92.9%. Upfront 3yRFS (<i>N</i> = 54), CRT (<i>N</i> = 23) and NAC (<i>N</i> = 25) constituted 62.9%, 82.6%, and 72.0%; 3yLRFS was 92.4%, 100%, and 88.0%. RM1 and pLLNM were significantly associated with LRFS (RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%; pLLNM negative vs. positive, 97.0% vs. 84.7%). 3yRFS Upfront non-MRF (<i>N</i> = 21), post CRT non-MRF (<i>N</i> = 15), and post NAC non-MRF (<i>N</i> = 14) were 61.9%, 86.7%, and 100%; 3yLRFS was 90.2%, 100%, and 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Good local control of Upfront LLND for RC with LLNM was shown, but multidisciplinary treatments were required. CRT followed by surgery was preferable for RC with LLNM, but a radiation-sparing strategy is promising for post NAC non-MRF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"309-318"},"PeriodicalIF":2.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12873","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533528","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":"Comparative retrospective study on surgical outcomes of hand-sewn anastomosis versus stapling anastomosis for colectomy using a nationwide inpatient database in Japan with propensity score matching","authors":"Shota Ebinuma,&nbsp;Susumu Kunisawa,&nbsp;Kiyohide Fushimi,&nbsp;Nobuki Ichikawa,&nbsp;Tadashi Yoshida,&nbsp;Shigenori Homma,&nbsp;Akinobu Taketomi,&nbsp;Yuichi Imanaka","doi":"10.1002/ags3.12870","DOIUrl":"https://doi.org/10.1002/ags3.12870","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intestinal anastomosis is performed by two main methods: hand-sewn anastomosis (HA) and stapling anastomosis (SA). Studies on anastomosis are still being reported and are an ongoing area of interest. The aim of this study was to evaluate the characteristics of each by comparing them with description and statistical analysis using a nationwide inpatient database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected data for colon cancer patients who underwent colectomy between April 2014 and March 2022 using the Diagnosis Procedure Combination (DPC) database. In the descriptive analysis, we described the background of the study population and the number of each method. In the statistical analysis, we used propensity score matching to achieve balanced covariates and showed the results of the comparative study using risk ratios and risk differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 232 155 cases were selected (HA group: 40 764; SA group: 191 391). SA was performed more frequently than HA during the study period, with the proportion of SA increasing over the last few years (~80% in 2015 and 85% in 2021). We obtained 40 760 pairs through propensity score matching. The comparison of postoperative events varied by outcome (reoperation: 517 [1.27%] vs 380 [0.93%]; risk ratio [RR]: 1.36 [95% confidence interval [CI], 1.19 to 1.55], endoscopic intestinal hemostasis: 17 [0.04%] vs 80 [0.20%]; RR: 0.21 [95% CI, 0.13 to 0.36]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SA is becoming more common in colectomy. The risk of reoperation could be higher in the HA group, while the risk of postoperative endoscopic intestinal hemostasis could be higher in the SA group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"379-388"},"PeriodicalIF":2.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535850","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":"Efficacy of lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery for rectal cancer","authors":"Hidekazu Takahashi,&nbsp;Kazuhiro Saso,&nbsp;Masayuki Ohue,&nbsp;Shingo Noura,&nbsp;Tsukasa Tanida,&nbsp;Takamichi Komori,&nbsp;Mitsuyoshi Tei,&nbsp;Yoshinori Kagawa,&nbsp;Shunji Morita,&nbsp;Shu Okamura,&nbsp;Masakazu Miyake,&nbsp;Norikatsu Miyoshi,&nbsp;Mamoru Uemura,&nbsp;Makoto Fujii,&nbsp;Yuko Ohno,&nbsp;Hirofumi Yamamoto,&nbsp;Kohei Murata,&nbsp;Yuichiro Doki,&nbsp;Hidetoshi Eguchi,&nbsp;Clinical Study Group of Osaka University, Colorectal Cancer Treatment Group (CSGOCG)","doi":"10.1002/ags3.12869","DOIUrl":"https://doi.org/10.1002/ags3.12869","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We investigated how Japanese D3 dissection with left colic artery (LCA) preservation affects anastomotic leakage after anterior resection with anastomosis for rectal cancer, based on the leak rate. The correlation between LCA preservation, survival, and cancer recurrence after resection was also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary and Background Data</h3>\u0000 \u0000 <p>It remains unclear how LCA preservation affects the anastomotic leak rate and oncological outcomes after resection remains unclear. Some reports suggested that anastomotic leakage increases local recurrence and decreases cancer-specific survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we enrolled and analyzed 457 patients who underwent radical resection of rectal cancer in the period October 2011 through December 2016. The attending surgeon decided preoperatively and registered whether to preserve the LCA. This trial was registered under the UMIN-CTR Identifier UMIN000006160.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>D3 with LCA preservation was successfully completed in 218 (89.3%) of the 244 patients registered in this group, whereas D3 without LCA preservation was successfully completed in all 213 patients registered in this group. After propensity score matching, the anastomotic leakage rate was 7.86% (11/140) after D3 with LCA preservation and 7.14% (10/140) after D3 without LCA preservation. The overall survival rates were 90.1% and 89.3%, and the recurrence-free survival rates were 77.6% and 77.3%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that LCA preservation has no effect on the incidence of anastomotic leakage after rectal resection with anastomosis using DST and that oncological outcomes may not be affected.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"298-308"},"PeriodicalIF":2.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535851","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":"Efficacy of the U-shaped flap technique in preventing reflux after minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer","authors":"Takeshi Omori,&nbsp;Hisashi Hara,&nbsp;Yoshitomo Yanagimoto,&nbsp;Naoki Shinno,&nbsp;Yasunori Masuike,&nbsp;Takashi Kanemura,&nbsp;Hiroshi Wada,&nbsp;Masayoshi Yasui,&nbsp;Masayuki Ohue,&nbsp;Hiroshi Miyata","doi":"10.1002/ags3.12864","DOIUrl":"https://doi.org/10.1002/ags3.12864","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preventing gastroesophageal reflux after proximal gastrectomy for proximal gastric and esophagogastric junction cancer remains challenging due to the lack of standardized reconstructive techniques. The double flap technique (DFT) in valvuloplastic esophagogastrostomy prevents reflux esophagitis but is less effective in esophagogastric junction cancer because of negative pressure on the inferior mediastinum. We developed the U-shaped flap technique (UFT) to enhance the anti-reflux efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzed data from patients who underwent minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer between August 2014 and May 2022, using a prospectively maintained database. We compared DFT and UFT for short- and long-term outcomes, focusing on gastroesophageal reflux, using one-to-one propensity score matching to control for patient-related variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 217 eligible patients, 205 (100 in DFT, 105 in UFT) completed a 1-year follow-up. After propensity score matching, we selected 42 pairs of patients who underwent DFT and UFT. UFT had significantly shorter operative time (<i>p</i> = 0.044), similar blood loss, and similar morbidity. The UFT group had significantly fewer reflux symptoms (0% vs. 14.3%, <i>p</i> = 0.0011) and endoscopic Los Angeles grade B or higher reflux esophagitis (0% vs. 14.3%, <i>p</i> = 0.0011) than the DFT group. In lower mediastinal reconstructions for esophagogastric junction cancer, UFT showed a reduced incidence of reflux esophagitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study indicates that the U-shaped flap technique (UFT) offered significant advantages in reducing postoperative reflux symptoms and endoscopic esophagitis, in a cohort of patients with proximal gastric and esophagogastric junction cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"251-262"},"PeriodicalIF":2.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533541","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":"Endoscopic ultrasound-guided tissue acquisition allows a reliable proliferation assessment of small (≤20 mm) pancreatic neuroendocrine tumors","authors":"Yoshihide Nanno,&nbsp;Hirochika Toyama,&nbsp;Kazuyuki Nagai,&nbsp;Dongha Lee,&nbsp;Yuichiro Uchida,&nbsp;Jun Ishida,&nbsp;Takeshi Takahara,&nbsp;Ippei Matsumoto,&nbsp;Etsuro Hatano,&nbsp;Takumi Fukumoto","doi":"10.1002/ags3.12871","DOIUrl":"https://doi.org/10.1002/ags3.12871","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Evidence regarding the reliability of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for assessing histological proliferation and WHO grading of small (≤20 mm) pancreatic neuroendocrine tumors (PanNETs) is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multicenter retrospective study, we analyzed data from 122 patients with small PanNETs who underwent EUS-TA followed by surgical resection between 2006 and 2022. We compared the histopathological proliferation assessment and WHO grading between preoperative EUS-TA and surgical definitive specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 122 patients with small PanNETs (80% with surgical definitive WHO grade G1 and 20% with G2), EUS-TA histology identified neuroendocrine tumors in 101 (83%) patients and provided WHO grading in 85 (70%) patients. Histopathological WHO grading for EUS-TA was concordant with surgical definitive grading in 86% (73/85) of cases, overstaged in 4% (3/85), and understaged in 11% (9/85). Moderate, severe, and fatal adverse events associated with EUS-TA, as classified by the lexicon, were not reported in this cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-TA is a reliable method for assessing histopathological proliferation and WHO grading of small PanNETs. However, grading discordance may occur, and a risk–benefit evaluation on a per-patient basis is recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"339-346"},"PeriodicalIF":2.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12871","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535726","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 preoperative anemia and perioperative transfusion on short-term outcomes in colorectal cancer surgery: The role of iron supplementation","authors":"Junpei Takashima,&nbsp;Hirotoshi Kobayashi,&nbsp;Ayaka Koizumi,&nbsp;Fumi Shigehara,&nbsp;Kenji Yamazaki,&nbsp;Daisuke Fujimoto,&nbsp;Fumihiko Miura","doi":"10.1002/ags3.12867","DOIUrl":"https://doi.org/10.1002/ags3.12867","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Colorectal cancer is a common malignancy, and many patients with colorectal cancer experience preoperative anemia. Anemia and transfusions negatively impact short-term surgical outcomes. Management of anemia, including iron supplementation, has not been extensively studied in Japanese patients. Thus, the impact of anemia and blood transfusions on short-term surgical outcomes in colorectal cancer patients and the effectiveness of oral iron supplementation with ferrous citrate were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of patients with colorectal cancer (≥18 y) who underwent elective surgery from April 2015 to March 2023 was conducted. Patients with benign tumors, malignant lymphoma, emergency surgeries, or nonresectable lesions were excluded from the study. Hemoglobin levels were assessed at consultation, admission, the day after surgery, and discharge. Patients were categorized by anemia severity and divided into iron supplementation and no supplementation groups. Outcomes, including transfusions and postoperative complications, were compared with univariate and multivariate analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of postoperative anemia in the 545 enrolled patients increased significantly from 52.8% at admission to 78.7% the day after surgery (<i>p</i> &lt; 0.001). Severe anemia immediately before surgery was an independent risk factor for postoperative complications (odds ratio [OR] = 9.24, <i>p</i> &lt; 0.001). Iron supplementation significantly improved hemoglobin levels and reduced transfusions and complications. The median duration of iron supplementation was 30 d, suggesting a positive influence on outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Severe anemia immediately before surgery is an independent risk factor for postoperative complications. Iron supplementation with ferrous citrate improves short-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"288-297"},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536001","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":"Inter-prefectural and urban–rural regional disparities in rectal cancer and rectal resections: A Japanese nationwide population-based cohort study from 2014 to 2019","authors":"Masamitsu Kido,&nbsp;Tomohiro Arita,&nbsp;Katsutoshi Shoda,&nbsp;Hiroki Shimizu,&nbsp;Jun Kiuchi,&nbsp;Kenji Nanishi,&nbsp;Luying Yan,&nbsp;Eigo Otsuji","doi":"10.1002/ags3.12865","DOIUrl":"https://doi.org/10.1002/ags3.12865","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This observational study aimed to elucidate the regional disparities in rectal cancer (RC) and rectal resections (RRs) across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The annual incidence of RC, and number of all RRs and board-certified surgeons by the Japan Society for Endoscopic Surgery were examined by prefecture in Japan from 2014 to 2019. The surgical approaches were broken down by open and laparoscopic. Disparities in 47 prefectures and urban–rural disparities were evaluated using the Gini coefficient and unpaired <i>t</i>-test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The annual national average incidence of RC was 50 127 and the number of all RRs was 39 903. Gini coefficients for RC, and laparoscopic and all RRs were &lt;0.2, indicating low inequality. There was no significant difference between urban and rural prefectures in the number of RRs, despite a significantly higher incidence of RC in rural prefectures and a significantly higher number of board-certified surgeons in urban prefectures (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RC and laparoscopic and all RRs exhibited minimal inter-prefectural disparities. The urban–rural analysis revealed significant differences in the incidence/number of RC and board-certified surgeons between urban and rural prefectures, despite minor differences in RRs regardless of approach. This pattern suggests a potential migration of surgical services from rural to urban areas. This preliminary study is expected to contribute to a basic epidemiological database for RC and RRs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"281-287"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534007","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":"Lavage cytology diagnosed by immunostaining may be a poor prognostic factor in pathological stage III colorectal cancer","authors":"Akitoshi Nankaku,&nbsp;Yusuke Yamaoka,&nbsp;Akio Shiomi,&nbsp;Hiroyasu Kagawa,&nbsp;Shoichi Manabe,&nbsp;Takuma Oishi,&nbsp;Kiyoshi Tone,&nbsp;Akifumi Notsu,&nbsp;Yusuke Kinugasa","doi":"10.1002/ags3.12863","DOIUrl":"https://doi.org/10.1002/ags3.12863","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To clarify the prognostic impact of positive lavage cytology diagnosed by immunostaining on long-term outcomes following curative resection for pathological stage III colorectal cancer (CRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We retrospectively investigated patients who underwent radical resection and intraoperative lavage cytology (LCY) simultaneously for pathological stage III primary CRC between 2005 and 2017. All LCY specimens were evaluated by Papanicolaou staining and immunostaining for carcinoembryonic antigen and Ber-EP4. Only Class V diagnosed by either staining method was defined as positive LCY, and patients were classified into two groups: a positive lavage cytology (LCY+) group; and a negative lavage cytology (LCY−) group. Overall survival (OS) and relapse-free survival (RFS) were compared between groups. Multivariate analysis was performed to identify clinicopathological factors affecting OS and RFS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 708 patients with pathological stage III CRC, 30 patients (4.2%) showed positive LCY. OS and RFS were significantly lower in the LCY(+) group than in the LCY(−) group. Five-y OS rates in the LCY(+) and LCY(−) groups were 58.7% and 91.0%, respectively, and 5-y RFS rates were 28.8% and 76.6%, respectively. Multivariate analysis revealed that positive LCY was independently associated with lower OS and RFS. In the LCY(+) group, the proportion of patients with negative Papanicolaou staining but positive immunostaining was 20.0% (6 of 30). No significant differences in OS and RFS were evident between those patients and patients with positive results for both Papanicolaou staining and immunostaining.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Positive LCY as diagnosed by immunostaining may represent a poor prognostic factor for pathological stage III CRC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"271-280"},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534009","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}