Patients with recurrent hepatocellular carcinoma after liver resection can often receive curative treatment, including repeat hepatic resection and local ablative therapy. However, recurrence typically becomes increasingly aggressive during the clinical course, characterized by cycles of recurrence and repeated treatment, ultimately resulting in noncurative patterns.
Methods
Noncurative recurrence was defined as the presence of ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions. First, this study investigated the incidence of noncurative recurrence and survival after noncurative recurrence. Subsequently, this study examined survival after the initial recurrence in patients with curative and noncurative recurrences and compared them. Finally, this study investigated whether the time to noncurative recurrence serves as a surrogate for overall survival (OS) in 266 patients who underwent initial curative hepatectomy.
Results
The 3-year cumulative incidences of noncurative recurrence were 15.6%, 6.0%, and 11.0% for ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions, respectively. The median postrecurrence survival estimates after these noncurative recurrences were 21, 17, and 8 months, respectively (P =.006). When analyzed exclusively in patients developing initial recurrence, the 3-year postrecurrence survival rates were 68.3% and 27.8% for patients with curative and noncurative recurrences, respectively (P =.003). The 3-year survival rate without noncurative recurrences was 71.9%, and the recurrence-free survival (RFS) and OS rates were 49.2% and 87.9%, respectively. The concordance index with OS was higher for time to noncurative recurrence than for RFS (0.88 vs 0.67, respectively).
Conclusion
Our findings suggest that the time to noncurative recurrence is a more suitable surrogate for OS than RFS.
{"title":"The time to noncurative recurrence after liver resection as an appropriate surrogate measure for overall survival in patients with hepatocellular carcinoma","authors":"Yoshinori Takeda , Hiroshi Imamura , Katsuhiro Sano , Hirofumi Ichida , Ryuji Yoshioka , Yoshihiro Mise , Yutaka Matsuyama , Akio Saiura","doi":"10.1016/j.gassur.2025.101989","DOIUrl":"10.1016/j.gassur.2025.101989","url":null,"abstract":"<div><h3>Background</h3><div>Patients with recurrent hepatocellular carcinoma after liver resection can often receive curative treatment, including repeat hepatic resection and local ablative therapy. However, recurrence typically becomes increasingly aggressive during the clinical course, characterized by cycles of recurrence and repeated treatment, ultimately resulting in noncurative patterns.</div></div><div><h3>Methods</h3><div>Noncurative recurrence was defined as the presence of ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions. First, this study investigated the incidence of noncurative recurrence and survival after noncurative recurrence. Subsequently, this study examined survival after the initial recurrence in patients with curative and noncurative recurrences and compared them. Finally, this study investigated whether the time to noncurative recurrence serves as a surrogate for overall survival (OS) in 266 patients who underwent initial curative hepatectomy.</div></div><div><h3>Results</h3><div>The 3-year cumulative incidences of noncurative recurrence were 15.6%, 6.0%, and 11.0% for ≥4 liver nodules, macroscopic vascular invasion, and extrahepatic lesions, respectively. The median postrecurrence survival estimates after these noncurative recurrences were 21, 17, and 8 months, respectively (<em>P</em> =.006). When analyzed exclusively in patients developing initial recurrence, the 3-year postrecurrence survival rates were 68.3% and 27.8% for patients with curative and noncurative recurrences, respectively (<em>P</em> =.003). The 3-year survival rate without noncurative recurrences was 71.9%, and the recurrence-free survival (RFS) and OS rates were 49.2% and 87.9%, respectively. The concordance index with OS was higher for time to noncurative recurrence than for RFS (0.88 vs 0.67, respectively).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the time to noncurative recurrence is a more suitable surrogate for OS than RFS.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101989"},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Long-term data on the prognosis of patients who survive >5 years following gastrectomy for gastric cancer (GC) remain scarce. This study aimed to investigate sequential changes in conditional survival (CS) in these patients.
Methods: Of 1,129 patients with stage I-III GC who underwent R0 gastrectomy, the causes of death were assessed, and sequential changes in conditional overall survival (cOS), disease-specific survival (cDSS), and non-disease-specific survival (cNDSS) were calculated and compared. In a subgroup of 709 patients who survived >5 years, the associations between cOS, cDSS, cNDSS, and clinicopathological factors were analyzed.
Results: Over a median follow-up of 63 months, 203 (18.0%) patients died from GC, and 131 (11.6%) died from non-GC causes. The 5-year cDSS consistently increased over the 10 years following gastrectomy in stages II and III. For stage II, cDSS and cNDSS intersected at 7 years post-gastrectomy, whereas for stage III, these measures crossed at 8 years. In the 709 5-year survivors, multivariate analysis identified disease stage as significantly associated with cOS and cDSS. Moreover, age ≥75, male sex, and preoperative comorbidities were associated with lower cNDSS.
Conclusion: Surveillance for GC relapse was critical during the first 7 and 8 years post-gastrectomy for stages II and III, respectively. Conversely, surveillance for second primary cancers and benign diseases became relatively more important after 0, 7, and 8 years post-gastrectomy for stages I, II, and III, respectively. In 5-year survivors, age ≥75, male sex, and preoperative comorbidities were associated with mortality unrelated to GC.
{"title":"Sequential changes in conditional survival of patients undergoing curative gastrectomy for gastric cancer.","authors":"Hiromitsu Imataki, Hideo Miyake, Hidemasa Nagai, Yuichiro Yoshioka, Junichi Takamizawa, Norihiro Yuasa","doi":"10.1016/j.gassur.2025.101987","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101987","url":null,"abstract":"<p><strong>Background: </strong>Long-term data on the prognosis of patients who survive >5 years following gastrectomy for gastric cancer (GC) remain scarce. This study aimed to investigate sequential changes in conditional survival (CS) in these patients.</p><p><strong>Methods: </strong>Of 1,129 patients with stage I-III GC who underwent R0 gastrectomy, the causes of death were assessed, and sequential changes in conditional overall survival (cOS), disease-specific survival (cDSS), and non-disease-specific survival (cNDSS) were calculated and compared. In a subgroup of 709 patients who survived >5 years, the associations between cOS, cDSS, cNDSS, and clinicopathological factors were analyzed.</p><p><strong>Results: </strong>Over a median follow-up of 63 months, 203 (18.0%) patients died from GC, and 131 (11.6%) died from non-GC causes. The 5-year cDSS consistently increased over the 10 years following gastrectomy in stages II and III. For stage II, cDSS and cNDSS intersected at 7 years post-gastrectomy, whereas for stage III, these measures crossed at 8 years. In the 709 5-year survivors, multivariate analysis identified disease stage as significantly associated with cOS and cDSS. Moreover, age ≥75, male sex, and preoperative comorbidities were associated with lower cNDSS.</p><p><strong>Conclusion: </strong>Surveillance for GC relapse was critical during the first 7 and 8 years post-gastrectomy for stages II and III, respectively. Conversely, surveillance for second primary cancers and benign diseases became relatively more important after 0, 7, and 8 years post-gastrectomy for stages I, II, and III, respectively. In 5-year survivors, age ≥75, male sex, and preoperative comorbidities were associated with mortality unrelated to GC.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101987"},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.gassur.2025.101991
Zili Zhang, Jixuan Wu, Lei Zhang
{"title":"Letter to the Editor on \"Thrombosis and anticoagulation after portal vein reconstruction during pancreatic surgery: a systematic review\".","authors":"Zili Zhang, Jixuan Wu, Lei Zhang","doi":"10.1016/j.gassur.2025.101991","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101991","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101991"},"PeriodicalIF":2.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.gassur.2025.101992
Ze-Qin Wang, Han-Kun Hao, Jun Hong
{"title":"A novel method for intracorporeal end-to-end colorectal anastomosis using a linear stapler.","authors":"Ze-Qin Wang, Han-Kun Hao, Jun Hong","doi":"10.1016/j.gassur.2025.101992","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101992","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101992"},"PeriodicalIF":2.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Upregulation of nuclear export protein exportin-1 (coded by gene XPO1) has been previously demonstrated in multiple cancer subtypes, contributing to pharmacotherapy resistance and increased recurrence rates. This study aimed to explore the effect of non–gain-of-function (GOF) XPO1 alterations in patients with colorectal cancer (CRC).
Methods
Patients with colon/rectal/colorectal adenocarcinoma were identified from the Memorial Sloan Kettering Clinicogenomic, Harmonized Oncologic Real-World Dataset using cBioPortal. A subpopulation with alterations in XPO1 was identified. Patients with known amplifications and GOF E571K and R749Q alterations were excluded, as were patients with in situ and stage IV disease. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards analyses, adjusted for patient age and disease stage.
Results
Among 5543 patients with CRC, 83 (1.5%) had alterations in the XPO1 locus, and 5460 patients (98.5%) did not. Of patients with XPO1 alteration, 66 (79.5%) had non-GOF alterations, and 17 (21.5%) had GOF point mutations or amplifications. Patients with non-GOF XPO1 alteration had a mortality hazard ratio of 0.601 (95% CI, 0.463–0.805; P =.011). When adjusted for patient age and disease stage, XPO1 co-alteration was associated with improved overall survival (OS) in patients with alterations in TP53, APC, FBXW7, SMAD4, and BRAF genes (all P <.01).
Conclusion
XPO1 alterations were associated with improved OS in patients with CRC. Associated survival benefits persisted when co-alterations were present, particularly in co-alterations with intranuclear tumor suppressor proteins.
{"title":"Association of non–gain-of-function alterations in exportin-1 with improved overall survival in colorectal cancer","authors":"Hunter Stecko , Diamantis Tsilimigras , Sidharth Iyer , Jad Daw , Hua Zhu , Emily Huang , Matthew Kalady , Timothy M. Pawlik","doi":"10.1016/j.gassur.2025.101990","DOIUrl":"10.1016/j.gassur.2025.101990","url":null,"abstract":"<div><h3>Background</h3><div>Upregulation of nuclear export protein exportin-1 (coded by gene <em>XPO1</em>) has been previously demonstrated in multiple cancer subtypes, contributing to pharmacotherapy resistance and increased recurrence rates. This study aimed to explore the effect of non–gain-of-function (GOF) <em>XPO1</em> alterations in patients with colorectal cancer (CRC).</div></div><div><h3>Methods</h3><div>Patients with colon/rectal/colorectal adenocarcinoma were identified from the Memorial Sloan Kettering Clinicogenomic, Harmonized Oncologic Real-World Dataset using cBioPortal. A subpopulation with alterations in <em>XPO1</em> was identified. Patients with known amplifications and GOF E571K and R749Q alterations were excluded, as were patients with <em>in situ</em> and stage IV disease. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards analyses, adjusted for patient age and disease stage.</div></div><div><h3>Results</h3><div>Among 5543 patients with CRC, 83 (1.5%) had alterations in the <em>XPO1</em> locus, and 5460 patients (98.5%) did not. Of patients with <em>XPO1</em> alteration, 66 (79.5%) had non-GOF alterations, and 17 (21.5%) had GOF point mutations or amplifications. Patients with non-GOF <em>XPO1</em> alteration had a mortality hazard ratio of 0.601 (95% CI, 0.463–0.805; <em>P</em> =.011). When adjusted for patient age and disease stage, <em>XPO1</em> co-alteration was associated with improved overall survival (OS) in patients with alterations in <em>TP53, APC, FBXW7, SMAD4,</em> and <em>BRAF</em> genes (all <em>P</em> <.01).</div></div><div><h3>Conclusion</h3><div><em>XPO1</em> alterations were associated with improved OS in patients with CRC. Associated survival benefits persisted when co-alterations were present, particularly in co-alterations with intranuclear tumor suppressor proteins.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101990"},"PeriodicalIF":2.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.gassur.2025.101984
Miho Akabane , Jun Kawashima , Abdullah Altaf , Selamawit Woldesenbet , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik
Background
The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection.
Methods
Patients undergoing curative-intent HCC resection (2000–2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS).
Results
Among 759 patients, the median ALBI score was −2.78 (−3.02 to −2.48), and the median GGT was 55.0 U/L (31.0–93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112–1.950]; P =.007) and GGT (HR, 1.007 [1.004–1.010]; P <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015–1.090]; P =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005–2.161]; P =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58–0.72]), outperforming the ALBI score (0.62 [0.56–0.69]) and GGT (0.65 [0.58–0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; P <.001).
Conclusion
ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival.
{"title":"Development and validation of the albumin-bilirubin gamma-glutamyl transferase score for enhanced prognostic accuracy after hepatocellular carcinoma resection","authors":"Miho Akabane , Jun Kawashima , Abdullah Altaf , Selamawit Woldesenbet , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik","doi":"10.1016/j.gassur.2025.101984","DOIUrl":"10.1016/j.gassur.2025.101984","url":null,"abstract":"<div><h3>Background</h3><div>The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection.</div></div><div><h3>Methods</h3><div>Patients undergoing curative-intent HCC resection (2000–2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS).</div></div><div><h3>Results</h3><div>Among 759 patients, the median ALBI score was −2.78 (−3.02 to −2.48), and the median GGT was 55.0 U/L (31.0–93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112–1.950]; <em>P</em> =.007) and GGT (HR, 1.007 [1.004–1.010]; <em>P</em> <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015–1.090]; <em>P</em> =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005–2.161]; <em>P</em> =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58–0.72]), outperforming the ALBI score (0.62 [0.56–0.69]) and GGT (0.65 [0.58–0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; <em>P</em> <.001).</div></div><div><h3>Conclusion</h3><div>ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101984"},"PeriodicalIF":2.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1016/j.gassur.2025.101983
Antonio Mazzeo, Valentino Fiscon, Giuseppe Portale
{"title":"LAPAROSCOPIC SIDE-TO-SIDE DUODENODUODENOSTOMY FOR INCOMPLETE ANNULAR PANCREAS CAUSING GASTRIC OUTLET OBSTRUCTION IN A 21-YEAR-OLD PATIENT.","authors":"Antonio Mazzeo, Valentino Fiscon, Giuseppe Portale","doi":"10.1016/j.gassur.2025.101983","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101983","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101983"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101888
Arianna Vittori , Giovanni Capovilla , Renato Salvador , Matteo Santangelo , Luca Provenzano , Loredana Nicoletti , Andrea Costantini , Francesca Forattini , Matteo Pittacolo , Lucia Moletta , Edoardo V. Savarino , Michele Valmasoni
Background
Most existing literature studies reported that laparoscopic fundoplication (LF) is safe in the setting of ineffective or weak peristalsis. However, the effect of the wrap on esophageal motility is still debated. This study aimed to assess how a functioning and effective fundoplication could affect esophageal motility in patients with gastroesophageal reflux disease (GERD).
Methods
This study analyzed prospectively collected data on patients who underwent laparoscopic Nissen (LN) fundoplication or laparoscopic Toupet (LT) fundoplication for GERD at our department between 2010 and 2022. Demographic and clinical characteristics were recorded. Patients were evaluated using the Gastroesophageal Reflux Disease Questionnaire (GerdQ), barium swallow, endoscopy, high-resolution manometry (HRM), and 24-hour pH impedance (multichannel intraluminal impedance and pH monitoring [MII-pH]) before and after surgery. HRM was reviewed by 2 experts, following the criteria of the Chicago Classification (version 4.0). LF failure was objectively defined in case of abnormal postoperative MII-pH according to the Lyon 2.0 criteria with/without an abnormal GerdQ.
Results
During the study period, 124 patients with GERD (89 males and 35 females) were recruited. Of note, 58 patients underwent LN fundoplication, and 66 patients underwent LT fundoplication. All procedures were completed laparoscopically, and the 90-day postoperative mortality was nil. At the postoperative MII-pH, good outcome was recorded in 103 patients, and failure was recorded in 21 patients. There was a significant association between a successful LF and the normalization of esophageal motility (P < .05).
Conclusion
Our data confirmed that LF is an effective treatment in patients with GERD, regardless of esophageal motility status. Moreover, our results indicate that LF could determine a normalization of motility abnormalities in patients with GERD.
{"title":"Laparoscopic fundoplication improves esophageal motility in patients with gastroesophageal reflux disease: a high-volume single-center controlled study in the era of high-resolution manometry and 24-hour pH impedance","authors":"Arianna Vittori , Giovanni Capovilla , Renato Salvador , Matteo Santangelo , Luca Provenzano , Loredana Nicoletti , Andrea Costantini , Francesca Forattini , Matteo Pittacolo , Lucia Moletta , Edoardo V. Savarino , Michele Valmasoni","doi":"10.1016/j.gassur.2024.101888","DOIUrl":"10.1016/j.gassur.2024.101888","url":null,"abstract":"<div><h3>Background</h3><div>Most existing literature studies reported that laparoscopic fundoplication (LF) is safe in the setting of ineffective or weak peristalsis. However, the effect of the wrap on esophageal motility is still debated. This study aimed to assess how a functioning and effective fundoplication could affect esophageal motility in patients with gastroesophageal reflux disease (GERD).</div></div><div><h3>Methods</h3><div>This study analyzed prospectively collected data on patients who underwent laparoscopic Nissen (LN) fundoplication or laparoscopic Toupet (LT) fundoplication for GERD at our department between 2010 and 2022. Demographic and clinical characteristics were recorded. Patients were evaluated using the Gastroesophageal Reflux Disease Questionnaire (GerdQ), barium swallow, endoscopy, high-resolution manometry (HRM), and 24-hour pH impedance (multichannel intraluminal impedance and pH monitoring [MII-pH]) before and after surgery. HRM was reviewed by 2 experts, following the criteria of the Chicago Classification (version 4.0). LF failure was objectively defined in case of abnormal postoperative MII-pH according to the Lyon 2.0 criteria with/without an abnormal GerdQ.</div></div><div><h3>Results</h3><div>During the study period, 124 patients with GERD (89 males and 35 females) were recruited. Of note, 58 patients underwent LN fundoplication, and 66 patients underwent LT fundoplication. All procedures were completed laparoscopically, and the 90-day postoperative mortality was nil. At the postoperative MII-pH, good outcome was recorded in 103 patients, and failure was recorded in 21 patients. There was a significant association between a successful LF and the normalization of esophageal motility (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>Our data confirmed that LF is an effective treatment in patients with GERD, regardless of esophageal motility status. Moreover, our results indicate that LF could determine a normalization of motility abnormalities in patients with GERD.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101888"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented.
Methods
A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (c) and phase angle (φ), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF.
Results
CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower c (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50−37.75] days) than the no-CR-POPF group. The MRE parameters, c and φ, were moderately correlated with pancreas stiffness (eta2 for φ = 0.189 and eta2 for c = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher c were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for c, 0.041 [95% CI, 0.002–0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022–0.768]). The area under the curve (AUC) of the predictive model based on c and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test P = .028 and P = .002, respectively.
Conclusion
The MRE parameters were associated with pancreatic stiffness, and c was an independent predictor of CR-POPF after pancreatoduodenectomy.
{"title":"Prediction of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy based on multifrequency magnetic resonance elastography","authors":"Yu-Qing Zhong , Xiao-Xu Zhu , Xi-Tai Huang , Yan-Ji Luo , Chen-song Huang , Qiong-cong Xu , Xiao-Yu Yin","doi":"10.1016/j.gassur.2024.101886","DOIUrl":"10.1016/j.gassur.2024.101886","url":null,"abstract":"<div><h3>Background</h3><div>Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented.</div></div><div><h3>Methods</h3><div>A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (<em>c</em>) and phase angle (<em>φ</em>), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF.</div></div><div><h3>Results</h3><div>CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower <em>c</em> (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50−37.75] days) than the no-CR-POPF group. The MRE parameters, <em>c</em> and <em>φ</em>, were moderately correlated with pancreas stiffness (eta<sup>2</sup> for <em>φ</em> = 0.189 and eta<sup>2</sup> for <em>c</em> = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher <em>c</em> were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for <em>c</em>, 0.041 [95% CI, 0.002–0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022–0.768]). The area under the curve (AUC) of the predictive model based on <em>c</em> and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test <em>P</em> = .028 and <em>P</em> = .002, respectively.</div></div><div><h3>Conclusion</h3><div>The MRE parameters were associated with pancreatic stiffness, and <em>c</em> was an independent predictor of CR-POPF after pancreatoduodenectomy.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101886"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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