Annals of Gastroenterological Surgery最新文献

{"title":"Tele-proctoring for minimally invasive surgery across Japan: An initial step toward a new approach to improving the disparity of surgical care and supporting surgical education","authors":"Ichiro Takemasa,&nbsp;Koichi Okuya,&nbsp;Kenji Okita,&nbsp;Emi Akizuki,&nbsp;Masaaki Miyo,&nbsp;Masayuki Ishii,&nbsp;Ryo Miura,&nbsp;Momoko Ichihara,&nbsp;Korai Takahiro,&nbsp;Eiji Oki,&nbsp;Mitsuhisa Takatsuki,&nbsp;Susumu Eguchi,&nbsp;Daisuke Ichikawa,&nbsp;Yuko Kitagawa,&nbsp;Yoshiharu Sakai,&nbsp;Masaki Mori","doi":"10.1002/ags3.12750","DOIUrl":"10.1002/ags3.12750","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study was to verify the clinical feasibility of tele-proctoring using our ultra-low latency communication system with shared internet access.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Connections between two multiple remote locations at various distances were established through the TELEPRO® tele-proctoring system. The server records the latency between the two locations for tele-proctoring using the annotations. Questionnaires were administered to the surgeons, assistants, and medical staff. Respondents rated the quickness and quality of communication in terms of latency and disturbances in the audio, video, and usefulness of the live telestrations with annotation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven hospitals tele-proctored with Sapporo Medical University between January 2021 and September 2022. The median latency of annotation between the two locations ranged from 24.5 to 48.5 ms. No major technological problems occurred, such as streaming interruption, loss of video or audio, poor resolution. The video encoding time was 10 ms, and its decoding time was 0.8 ms. The total latency positively correlated with the distance between two locations (<i>R</i> = 0.55, <i>p</i> &lt; 0.01). The quality of communication regarding latency, disturbance, and surgical education with intraoperative annotative instructions showed similar trends, with perfectly fine being the most common response. No significant differences in surgical quality, educational effect, or social impact were observed between the latency ≥30 and &lt;30 ms groups for whether the size of latency affects surgical education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The feasibility of the tele-proctoring system is expected to be a sustainable approach to help education for young surgeons and surgical supports in rural areas, thereby reducing disparities in health care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"356-364"},"PeriodicalIF":2.7,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12750","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139253415","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":"Blood flow ratio in the gastric conduit measured by laser Doppler flowmetry: A predictor of anastomotic leakage after esophagectomy","authors":"Hirotaka Ishida,&nbsp;Toshiaki Fukutomi,&nbsp;Yusuke Taniyama,&nbsp;Chiaki Sato,&nbsp;Hiroshi Okamoto,&nbsp;Yohei Ozawa,&nbsp;Yu Onodera,&nbsp;Ken Koseki,&nbsp;Michiaki Unno,&nbsp;Takashi Kamei","doi":"10.1002/ags3.12754","DOIUrl":"10.1002/ags3.12754","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anastomotic leakage after esophagectomy is a common complication. Laser Doppler flowmetry (LDF) can quantitatively evaluate the blood flow in the gastric conduit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 326 patients who underwent thoracoscopic/robot-assisted esophagectomy followed by gastric conduit reconstruction and end-to-side anastomosis were enrolled. We divided the gastric conduit into zones I (dominated by the right gastroepiploic vessels), II (dominated by the left gastroepiploic vessels), and III (perfused with short gastric vessels). Before pulling up the gastric conduit to the neck, LDF values were measured at the pylorus, the border between zones I and II (zone I/II), the border between zones II and III (zone II/III), and the gastric conduit tip (tip). The blood flow ratio was calculated as the LDF value divided by the LDF value at the pylorus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Anastomotic leakage developed in 32 of 326 patients. Leakage was significantly associated with the blood flow ratio at the tip (<i>p</i> &lt; 0.001), but not at zone I/II, zone II/III, and the anastomotic site. The receiver-operating characteristic curve analysis identified an anastomotic leakage cutoff ratio of 0.41 (at the tip). A multivariate Cox analysis showed that a blood flow ratio &lt;0.41 at the tip was an independent risk factor for anastomotic leakage (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anastomotic leakage after esophagectomy was significantly associated with the blood flow ratio at the tip of the gastric conduit. Preservation of the blood supply to the tip via the gastric wall might contribute to a decreased incidence of anastomotic leakage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"234-242"},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139255150","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":"Serum NY-ESO-1 and p53 antibodies as useful tumor markers in gastric cancer","authors":"Junji Kawada,&nbsp;Takuro Saito,&nbsp;Yukinori Kurokawa,&nbsp;Ryohei Kawabata,&nbsp;Atsushi Takeno,&nbsp;Tomohira Takeoka,&nbsp;Yohei Nose,&nbsp;Hisashi Wada,&nbsp;Hidetoshi Eguchi,&nbsp;Yuichiro Doki,&nbsp;Osaka University Clinical Research Group for Gastroenterological Study","doi":"10.1002/ags3.12757","DOIUrl":"10.1002/ags3.12757","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The NY-ESO-1 antigen is highly immunogenic and often spontaneously induces an immune response in patients with cancer. We conducted a large-scale multicenter cohort study to investigate the utility of serum NY-ESO-1 and p53 antibodies as predictive markers for the postoperative recurrence of gastric cancer. Here, we examined the usefulness of pre-treatment NY-ESO-1 and p53 antibodies as tumor markers for the diagnosis of gastric cancer in combination with carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 1031 patients with cT3-4 gastric cancer were enrolled in the study. NY-ESO-1 and p53 antibodies were assessed prior to treatment. The positivity of NY-ESO-1 and p53 antibodies, CEA, and CA19-9 was evaluated before treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Serum NY-ESO-1 and p53 antibodies were positive in 12.6% and 18.1% of the patients, respectively. Positive NY-ESO-1 antibody response was correlated with male gender, higher cStage, and upper tumor location. However, a positive p53 antibody response was not associated with tumor factors. The combination of NY-ESO-1 or p53 antibody response with CEA and CA19-9, or the 4-factors, was positive in 45.1%, 49.6%, and 53.8% of patients, respectively. Moreover, the 4-factor combination was able to detect &gt;60% of cStage III-IV diseases, which was 14% higher than that with the combination of CEA and CA19-9.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of NY-ESO-1 and p53 antibody responses to CEA and CA19-9 increases the diagnostic accuracy of gastric cancer. Serum NY-ESO-1 and p53 antibodies may be useful tumor markers for gastric cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"243-250"},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12757","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139257967","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 thoracic shape on the surgical outcomes of laparoscopic-assisted living donor hepatectomy","authors":"Kosuke Tanaka,&nbsp;Satoshi Ogiso,&nbsp;Tomoaki Yoh,&nbsp;Ahmed Hussein Abdelhafez,&nbsp;Yuki Masano,&nbsp;Shinya Okumura,&nbsp;Shoichi Kageyama,&nbsp;Takashi Ito,&nbsp;Koichiro Hata,&nbsp;Etsuro Hatano","doi":"10.1002/ags3.12755","DOIUrl":"10.1002/ags3.12755","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although laparoscopic-assisted donor hepatectomy (LADH) has become the definitive procedure for harvesting living donor livers, its surgical outcomes in association with donor body shape have not been elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The impact of donor factors, including thoracic shape, on LADH outcomes was retrospectively investigated. Thoracic anthropometric data were examined in all LADHs with a left/right graft between 2013 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 210 LADHs, consisting of 106 left- and 104 right-lobe donors with similar blood loss and similar operation time. Males have greater thoracic depth and greater thoracic width compared with females, respectively. Thoracic depth was associated with graft weight (<i>p</i> &lt; 0.001), blood loss (<i>p</i> &lt; 0.001), and operation time (<i>p</i> &lt; 0.001). On multivariate analyses, blood loss &gt;500 mL and operation time &gt;8 h were associated with graft weight in the left-lobe donors, and blood loss &gt;500 mL was associated with thoracic depth in the right-lobe donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The greater thoracic depth is associated with massive blood loss in right-lobe donors. Anthropometric parameters might be helpful for estimating LADH outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"490-497"},"PeriodicalIF":2.7,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12755","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262467","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 and management of primary retroperitoneal sarcoma: A literature review","authors":"Yukinori Yamagata,&nbsp;Motokiyo Komiyama,&nbsp;Shintaro Iwata","doi":"10.1002/ags3.12756","DOIUrl":"10.1002/ags3.12756","url":null,"abstract":"<p>Retroperitoneal sarcoma (RPS) is a rare tumor classified into many histological types. It is also often detected only after it has grown to a considerable size and requires extensive resection of the surrounding organs, making it difficult to offer optimal patient-tailored management. Evidence supporting specific treatment modalities for RPS is insufficient, owing to its rarity. The Japanese clinical practice guidelines for RPS were published in December 2021, with the aim of accumulating existing evidence and indicating the optimal practice for RPS. These guidelines provide important clinical questions (CQs) concerning the diagnosis and treatment of RPS. This review, with a particular focus on primary RPS, attempts to introduce clinical problems in the diagnosis and treatment of RPS and to assess those problems along with the CQs in the guidelines. According to these guidelines, although chemotherapy and radiotherapy are expected to have therapeutic effects, the level of evidence to support these treatments is not very high at present. Accordingly, complete resection of the tumor is the first and only option for managing primary RPS. However, as with other tumors, the demand for multidisciplinary treatment for RPS is increasing. These guidelines will undoubtedly represent a milestone in clinical practice in relation to RPS in the future, and further evidence is expected to be accumulated based on the CQs that have been proposed.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 1","pages":"21-29"},"PeriodicalIF":2.7,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267681","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":"Oligo-like liver metastasis: A novel prognostic indicator to improve survival in pancreatic cancer","authors":"Ryo Saito,&nbsp;Daisuke Ban,&nbsp;Takahiro Mizui,&nbsp;Takeshi Takamoto,&nbsp;Satoshi Nara,&nbsp;Minoru Esaki,&nbsp;Kazuaki Shimada","doi":"10.1002/ags3.12753","DOIUrl":"10.1002/ags3.12753","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Whether surgical intervention for patients with oligometastatic recurrence can improve their post-recurrent prognosis is unclear. In this study, we introduce a novel concept of oligometastasis in post-surgical pancreatic ductal adenocarcinoma (PDAC) patients with hepatic recurrence, which we call “oligo-like liver metastasis (OLLM).” Patients with OLLM have better post-recurrence prognosis and could therefore be eligible for surgical intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 121 PDAC patients who underwent radical resection, and who had an initial and single-organ metastasis to the liver, were analyzed. Independent prognostic factors for overall survival after recurrence (OSAR) were examined, and patients with all of these factors were defined as OLLM. The clinicopathological features and post-recurrent prognosis of OLLM patients were evaluated. In addition, a detailed analysis using the oligo-score, which was based on the prognostic factors, was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prognostic analysis revealed that short recurrence-free interval (RFI) (&lt;6 months), short stable disease interval (SDI) (≤3 months), and four or more recurrent tumors were independent poor prognostic factors. OLLM patients were defined as those with all three conditions: long RFI (≥6 months), long SDI (&gt;3 months), and three or less recurrent tumors. OLLM patients had a significantly better prognosis for OSAR than non-OLLM patients (HR = 0.272, <i>p</i> &lt; 0.001). Further analysis demonstrated that the OSAR of patients could be stratified using the oligo-score, which was calculated based on the prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We recommend that OLLM should be used to predict which patients are most likely to experience better post-recurrent prognosis after surgery with curative intent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"481-489"},"PeriodicalIF":2.7,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352097","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":"Surgical education through integration of robotic telesurgical technology and AI","authors":"Kenichi Hakamada","doi":"10.1002/ags3.12751","DOIUrl":"10.1002/ags3.12751","url":null,"abstract":"&lt;p&gt;Robotic surgery technology is now fusing with ICT (information and communications technology) and AI (artificial intelligence) to bring about new changes in surgical education.&lt;/p&gt;&lt;p&gt;In robotic surgery, images of the surgical field are converted into digital signals by a 3D high-definition camera and transmitted to the surgeon's viewer, and surgical operations are digitally converted into 3D coordinate axis information and acceleration information, which are transmitted to the robotic arm and accurately reproduced as forceps manipulations. Therefore, robotic surgery can be described as a digitization technology for surgery.&lt;/p&gt;&lt;p&gt;Robotic surgery enables surgery without motion restrictions under detailed images deep inside the body, and the number of surgeries, especially in the field of gastrointestinal surgery, is increasing due to expectations for precision. In this volume, McCarron et al. report that they started a robotic HPB program in 2008, performed 100% of Whipple procedures by 2020, and over 1600 complex hepatobiliary surgeries by robotic surgery to date. Unfortunately, at this time, there is still little evidence of a clinical long-term outcome advantage of robotic surgery over laparoscopic surgery, but the digitization technology of surgery offers two major enhancements besides precision.&lt;/p&gt;&lt;p&gt;The first is telesurgery integrated with ICT. Robotic surgery began to be developed in the 1970s for use in outer space and on the battlefield. Later, as military technology was converted to civilian use, development progressed as surgical robots for general medical use. In 2001, the world's first cholecystectomy was performed by connecting New York and Strasbourg, France via a dedicated line, followed by 22 cases of abdominal surgery in Canada. All these early attempts were reportedly successful, but unacceptably long transmission delay times, high communication costs, inadequate communication security, and even the discontinuation of surgical robotics led to a setback in the development of telesurgery technology. However, recent advances in ICT, the development of high-speed communication networks, and the development of new telesurgery-compatible robots have led to a re-evaluation of telerobotic surgery.&lt;/p&gt;&lt;p&gt;In Japan, following the legal establishment of telesurgery in 2019, the Japan Surgical Society has established a project team to conduct research on the social implementation of telesurgery. It was found that the transmission delay, which is the biggest barrier in implementing telesurgery, does not affect surgical operations as long as it is less than 100 ms.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In 15 telesurgery experiments conducted using commercial lines by September 2023, the communication delay between two sites 100–700 km apart was 4–25 ms round-trip, and the total delay time, including the video information processing time, was about 50 ms.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; In these remote surgical environments, we have performed several porcine","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"7 6","pages":"846-847"},"PeriodicalIF":2.7,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using extracorporeal membrane oxygenation in donations after cardiac death or brain death: A single-center experience and long-term outcome","authors":"Chia-En Hsieh,&nbsp;Ya-Lan Hsu,&nbsp;Yao-Li Chen,&nbsp;Hsin-Rou Liang,&nbsp;Kuo-Hua Lin,&nbsp;Wen-Yuan Chen,&nbsp;Hsiu-Man Wu,&nbsp;Sin-Bao Hunang,&nbsp;Yu-Ju Hung","doi":"10.1002/ags3.12749","DOIUrl":"10.1002/ags3.12749","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The use of extended criteria donors is a routine practice that sometimes involves extracorporeal membrane oxygenation (ECMO) in donations after cardiac death or brain death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective study in a single center from January 2006 to December 2019. The study included 90 deceased donor liver transplants. The patients were divided into three groups: the donation after brain death (DBD) group (<i>n</i> = 58, 64.4%), the DBD with ECMO group (<i>n</i> = 11, 12.2%) and the donation after cardiac death (DCD) with ECMO group (<i>n</i> = 21, 23.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no significant differences between the DBD with ECMO group and the DBD group. When comparing the DCD with ECMO group and the DBD group, there were statistically significant differences for total warm ischemia time (<i>p</i> &lt; 0.001), total cold ischemia time (<i>p</i> = 0.023), and split liver transplantation (<i>p</i> &lt; 0.001), and there was significantly poor recovery in regard to total bilirubin level (<i>p</i> = 0.027) for the DCD with ECMO group by repeated measures ANOVA. The 5-year survival rates of the DBD, DBD with ECMO, and DCD with ECMO groups were 78.1%, 90.9%, and 75.6%, respectively. The survival rate was not significantly different when comparing the DBD group to either the DBD with ECMO group (<i>p</i> = 0.435) or the DCD with ECMO group (<i>p</i> = 0.310).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using ECMO in donations after cardiac death or brain death is a good technology, and it contributed to 35.6% of the liver graft pool.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"312-320"},"PeriodicalIF":2.7,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12749","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462783","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":"Requirements for hospitals in Japan to have low operative mortality and failure-to-rescue rates","authors":"Itaru Endo,&nbsp;Arata Takahashi,&nbsp;Hisateru Tachimori,&nbsp;Hiroaki Miyata,&nbsp;Yuki Homma,&nbsp;Takafumi Kumamoto,&nbsp;Ryusei Matsuyama,&nbsp;Yoshihiro Kakeji,&nbsp;Yuko Kitagawa,&nbsp;Yasuyuki Seto","doi":"10.1002/ags3.12745","DOIUrl":"10.1002/ags3.12745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We explored institutional factors in Japan associated with lower operative mortality and failure-to-rescue (FTR) rates for eight major gastrointestinal procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 22-item online questionnaire was sent to 2119 institutional departments (IDs) to examine the association between institutional factors and operative mortality and FTR rates. IDs were classified according to the number of annual surgeries, board certification status, and locality. In addition, the top 20% and bottom 20% of IDs were identified based on FTR rates and matched with the results of the questionnaire survey. Factors associated with operative mortality were selected by multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1083 IDs that responded to the questionnaire, 568 (213 382 patients) were included in the analysis. Operative morbidity, operative mortality, and FTR rates in the top 20% and bottom 20% of IDs were 13.1% and 8.4% (<i>p</i> &lt; 0.001), 0.52% and 4.3% (<i>p</i> &lt; 0.001), and 4.0% and 51.2% (<i>p</i> &lt; 0.001), respectively. Based on the patients' background characteristics, the top 20% of IDs handled more advanced cases. No significant difference in locality was seen between better or worse hospital FTR rates, but fewer esophagectomies, hepatectomies, and pancreatoduodenectomies were performed in depopulated areas. Six items were found to be associated with operative mortality by multivariate logistic analysis. Only 50 (8.8%) IDs met all five factors related to better FTR rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present findings indicate that several hospital factors surrounding surgical treatment, characterized by abundant human resources, are closely related to better postoperative recovery from severe complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"342-355"},"PeriodicalIF":2.7,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136113993","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 a robotic system on intra-abdominal infectious complications after minimally invasive gastrectomy in patients with gastric cancer: A propensity score matching analysis regarding visceral obesity","authors":"Naoshi Kubo,&nbsp;Katsunobu Sakurai,&nbsp;Tsuyoshi Hasegawa,&nbsp;Yutaka Tamamori,&nbsp;Yasuhito Iseki,&nbsp;Takafumi Nishii,&nbsp;Sadatoshi Shimizu,&nbsp;Toru Inue,&nbsp;Yukio Nishiguchi,&nbsp;Kiyoshi Maeda","doi":"10.1002/ags3.12748","DOIUrl":"10.1002/ags3.12748","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The efficacy of robotic gastrectomy (RG) on postoperative complications in patients with gastric cancer (GC) is unclear in terms of the volume of intra-abdominal fat tissue.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We enrolled 403 patients with GC who had minimally invasive surgery between January 2015 and July 2022. During this time, 197 RG and 206 laparoscopic gastrectomies (LG) were performed on the study participants. According to the computed tomography scan, patients were defined as having or not having visceral obesity based on the visceral fatty area (VFA). In each high and low VFA group, we compared short-term outcomes between the RG group and LG group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PS matching for patients with high VFA, the two groups were well matched, with 71 cases in both the RG and LG groups. The median surgical time in the RG group was significantly longer (420 vs. 365 min, <i>p</i> &lt; 0.001). However, the RG group had a significantly lower rate of severe intra-abdominal infectious complications (IAIC), such as anastomotic leakage, pancreatic fistula, and intra-abdominal abscess (1.4% vs. 15.4%, <i>p</i> = 0.004). However, among the 77 patients with low VFA values, we found no significant difference in the rate of severe IAIC between the two groups (1.1% in the RG group vs. 2.6% in the LG group, <i>p</i> = 1.00).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RG may be a viable alternative to LG because of the lower postoperative IAIC for patients with visceral obesity and GC. However, RG may not benefit non-obese patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"221-233"},"PeriodicalIF":2.7,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136064043","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}