Annals of Gastroenterological Surgery最新文献

{"title":"Risk stratification of residual abscess after surgical treatment for gastroduodenal perforation","authors":"Kana Ishikawa,&nbsp;Siyuan Yao,&nbsp;Takashi Kumode,&nbsp;Keisuke Tanino,&nbsp;Yugo Matsui,&nbsp;Shusaku Honma,&nbsp;Shinichi Hosokawa,&nbsp;Teppei Murakami,&nbsp;Takatsugu Kan,&nbsp;Sanae Nakajima","doi":"10.1002/ags3.12877","DOIUrl":"https://doi.org/10.1002/ags3.12877","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Residual abscess is a major complication after emergency surgery for gastroduodenal (GD) perforation. However, there is little evidence regarding potential risk factors contributing to its development. Establishing a risk stratification strategy would be valuable for the entire management process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study analyzed 115 consecutive patients who underwent surgery for GD perforation between 2010 and 2023 at a secondary emergency care hospital. Patients were divided into two groups based on the presence or absence of residual abscesses. Potential risk factors for abscess formation were evaluated from various aspects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of residual abscesses was 19.1% (22 of 115). Multivariable analysis revealed that current use of nonsteroidal antiinflammatory drugs (odds ratio [OR] 3.76, <i>p</i> = 0.037), cancer chemotherapy (OR 13.56, <i>p</i> = 0.005), and preoperative renal dysfunction (OR 4.72, <i>p</i> = 0.018) were independent predictors. A potential scoring model could be created using these three parameters, and the number of risk factors correlated with the likelihood of developing a residual abscess (0 vs. 1 vs. ≥2; 6.2% vs. 29.4% vs. 50.0%, <i>p</i> &lt; 0.001). From a bacteriological point of view, the presence of <i>Enterococcus</i> in the ascites culture was closely related to its occurrence with 100% probability. Moreover, regarding early detection of this complication, C-reactive protein on postoperative d 5 had the highest predictive ability with an area under the curve of 0.818.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The risk of residual abscess formation after surgical treatment of GD perforation can be assessed utilizing both preoperative and postoperative information.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"263-270"},"PeriodicalIF":2.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12877","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535999","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 gastrectomy on efficacy and safety of second-line chemotherapy patients with advanced gastric cancer: Exploratory analysis of two randomized phase III trials","authors":"Kazuhiro Nishikawa,&nbsp;Wasaburo Koizumi,&nbsp;Akira Tsuburaya,&nbsp;Motoko Suzuki,&nbsp;Satoshi Morita,&nbsp;Kazumasa Fujitani,&nbsp;Yusuke Akamaru,&nbsp;Ken Shimada,&nbsp;Hisashi Hosaka,&nbsp;Ken Nishimura,&nbsp;Takaki Yoshikawa,&nbsp;Toshimasa Tsujinaka,&nbsp;Junichi Sakamoto","doi":"10.1002/ags3.12880","DOIUrl":"https://doi.org/10.1002/ags3.12880","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Second-line chemotherapy (SLC) improves survival in advanced gastric cancer (AGC). Although many patients receiving SLC have undergone gastrectomy, the impact of gastrectomy on SLC remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The objective was to evaluate the impact of gastrectomy on SLC for AGC. A total of 290 eligible patients registered in two randomized phase III trials evaluating SLC for patients with AGC was classified into the prior gastrectomy group (PGG; <i>n</i> = 187) or the no gastrectomy group (NGG; <i>n</i> = 103). We compared overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and safety between these two groups. Adjusted OS and adjusted PFS were estimated using inverse probability of treatment weighting (IPTW).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PGG had better performance status (<i>p</i> = 0.001), more prior platinum agent (<i>p</i> &lt; 0.001), and more frequent peritoneal metastasis (<i>p</i> = 0.006) than the NGG. The PGG had significantly better OS (13.8 vs. 9.3 mo; hazard ratio [HR]: 0.59; <i>p</i> &lt; 0.001) and PFS (4.7 vs. 2.8 mo; HR: 0.58; <i>p</i> &lt; 0.001) than the NGG. The PGG had significantly better adjusted OS (13.8 vs. 10.0 mo; IPTW HR: 0.66; <i>p</i> = 0.01) and adjusted PFS (4.3 vs. 3.2 mo; IPTW HR: 0.71; <i>p</i> = 0.027) than the NGG. No significant differences were observed in ORR and DCR. The incidence of Grade 3 or worse adverse events did not differ between the two groups except for a high incidence of anemia and diarrhea in the NGG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with previous gastrectomy are expected to have better survival outcomes when receiving second-line irinotecan (IRI)-based chemotherapy for AGC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"429-438"},"PeriodicalIF":2.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12880","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of autonomic nervous system resection extent on urinary dysfunction in robotic rectal cancer surgery","authors":"Sodai Arai,&nbsp;Hiroyasu Kagawa,&nbsp;Akio Shiomi,&nbsp;Yusuke Yamaoka,&nbsp;Shoichi Manabe,&nbsp;Chikara Maeda,&nbsp;Yusuke Tanaka,&nbsp;Shunsuke Kasai,&nbsp;Akifumi Notsu,&nbsp;Yusuke Kinugasa","doi":"10.1002/ags3.12878","DOIUrl":"https://doi.org/10.1002/ags3.12878","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We investigated whether autonomic nervous system resection during robotic rectal surgery contributes to urinary dysfunction and to what extent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients who underwent rectal surgery for primary rectal cancer between December 2011 and April 2021. We identified urinary dysfunction risk factors and examined the effect of autonomic nervous system resection extent on urinary dysfunction occurrence, with urinary dysfunction defined as a residual urine volume of &gt;50 mL. Urinary dysfunction with no improvement over 1 y was defined as permanent urinary dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1017 eligible patients, 78 (7.7%) required autonomic nervous system resection. Lateral lymph node dissection was performed in 357 patients (35.1%). Urinary dysfunction was observed in 102 patients (10.0%). We studied 32 (41.0%) of 78 patients who underwent autonomic nervous system resection and 82 (23.0%) of 357 patients who underwent lateral lymph node dissection presented with urinary dysfunction. Multivariate analysis revealed that lateral lymph node dissection and autonomic nervous system resection were significant predictors of urinary dysfunction. The urinary dysfunction incidence was notably higher in patients with autonomic nervous system unilateral total resection of at least one side than in those with bilateral preservation (65.4% vs. 28.8%, <i>p</i> &lt; 0.01), and permanent urinary dysfunction exclusively occurred in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In robotic surgery, autonomic nervous system resection and lateral lymph node dissection were independent risk factors for urinary dysfunction. Furthermore, the extent of autonomic nervous system resection may increase the risk of permanent urinary dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"476-485"},"PeriodicalIF":2.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12878","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950092","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":"Helicobacter pylori prevalence and its spontaneous eradication rate after distal or proximal gastrectomy for gastric cancer: A multicenter prospective cohort study","authors":"Takeshi Omori,&nbsp;Tsuyoshi Takahashi,&nbsp;Yukinori Kurokawa,&nbsp;Toru Masuzawa,&nbsp;Yusuke Akamaru,&nbsp;Masaaki Motoori,&nbsp;Takuro Saito,&nbsp;Kazuyoshi Yamamoto,&nbsp;Kazuhiro Nishikawa,&nbsp;Hiroshi Imamura,&nbsp;Atsushi Takeno,&nbsp;Ryohei Kawabata,&nbsp;Yoshiyuki Fujiwara,&nbsp;Hidetoshi Eguchi,&nbsp;Yuichiro Doki","doi":"10.1002/ags3.12860","DOIUrl":"https://doi.org/10.1002/ags3.12860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication is recommended in patients undergoing endoscopic resection for early gastric cancer to reduce recurrence. However, due to the possibility of spontaneous regression secondary to dynamic changes in the remnant stomach, the immediate eradication after gastrectomy for <i>H. pylori</i> carriers remains unclear. This study aimed to investigate the prevalence of <i>H. pylori</i> in Japanese patients with gastric cancer and the spontaneous eradication rate after distal or proximal gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter prospective cohort study was conducted at 22 institutions. Eligibility criteria was patients over 20 years planned to undergo R0 gastrectomy for gastric cancer. The primary endpoint was spontaneous eradication rate 1 year after distal or proximal gastrectomy. The prevalence of <i>H. pylori</i> infection before surgery and clinical features related to spontaneous eradication were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1247 patients were included in this study. The preoperative <i>H. pylori</i> status was positive in 756 patients and negative in 491. Seventy-nine of the negative patients had an eradication history, totaling 835 (67%) patients preoperatively infected with <i>H. pylori</i>. The infection status of 541 patients was examined 1 year postoperatively; 285 were negative, with a 52.7% spontaneous eradication rate. Spontaneous eradication was significantly higher in male and older patients (&gt;70 years); other factors, such as histological type, gastrectomy method and adjuvant chemotherapy presence, did not affect the rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As spontaneous <i>H. pylori</i> eradication occurred in more than half of the analyzed patients, retesting for <i>H. pylori</i>. should be considered before postoperative eradication therapy (UMIN000020280).</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"244-250"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534006","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 relevance of sarcopenia and tumor-infiltrating CD8+ T cells in patients with hepatocellular carcinoma","authors":"Shunsuke Doi,&nbsp;Satoshi Yasuda,&nbsp;Miu Miyashita,&nbsp;Minako Nagai,&nbsp;Kota Nakamura,&nbsp;Yasuko Matsuo,&nbsp;Taichi Terai,&nbsp;Yuichiro Kohara,&nbsp;Takeshi Sakata,&nbsp;Masayuki Sho","doi":"10.1002/ags3.12875","DOIUrl":"https://doi.org/10.1002/ags3.12875","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The relationship between sarcopenia, tumor-infiltrating lymphocytes (TILs), and long-term survival in patients with hepatocellular carcinoma (HCC) has not been investigated. We aimed to evaluate the prognostic relevance of sarcopenia and TILs in patients with HCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 351 patients with HCC following liver resection. Sarcopenia was defined based on the skeletal muscle index using computed tomography. Tumor-infiltrating CD4⁺ and CD8⁺ T cells, perforin, and granzyme B were examined in liver resection specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sarcopenia patients had a significantly lower lymphocyte count (<i>p</i> = 0.003), prognostic nutritional index (<i>p</i> = 0.017), and CD4⁺ and CD8⁺ T cell counts (<i>p</i> = 0.008 and <i>p</i> = 0.006, respectively). The overall survival (OS) and recurrence-free survival (RFS) rates of sarcopenia patients were significantly lower than non-sarcopenia patients (both <i>p</i> &lt; 0.001). Multivariate analysis revealed that sarcopenia and low CD8 levels were strong independent poor prognostic factors for OS and RFS (both <i>p</i> &lt; 0.001). Regardless of sarcopenia, patients with high CD8 levels had significantly better OS and RFS rates and increased expression of perforin and granzyme B. Particularly, sarcopenia patients with high CD8 levels had much better OS and RFS than those with low CD8 levels and were even comparable to non-sarcopenia patients with high CD8 levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sarcopenia and low CD8 levels are strong independent poor prognostic factors in patients with HCC. Furthermore, sarcopenia patients with high CD8 levels had favorable survival and activated local immunity, suggesting that tumor-infiltrating CD8⁺ T cells may play a functionally important role in sarcopenia patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"359-368"},"PeriodicalIF":2.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536033","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":"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}