Journal of Gastrointestinal Surgery最新文献

{"title":"A single-center retrospective study of conversion surgery in stage IV gastric cancer: association with immune checkpoint inhibitor-based chemotherapy","authors":"Yuki Ushimaru,&nbsp;Takeshi Omori,&nbsp;Kazuyoshi Yamamoto,&nbsp;Kei Yamamoto,&nbsp;Yasunori Masuike,&nbsp;Yoshitomo Yanagimoto,&nbsp;Norihiro Matsuura,&nbsp;Takahito Sugase,&nbsp;Takashi Kanemura,&nbsp;Ryota Mori,&nbsp;Masatoshi Kitakaze,&nbsp;Masahiko Kubo,&nbsp;Yasunari Fukuda,&nbsp;Hisateru Komatsu,&nbsp;Masaaki Miyo,&nbsp;Toshinori Sueda,&nbsp;Yoshinori Kagawa,&nbsp;Kunihito Gotoh,&nbsp;Shogo Kobayashi,&nbsp;Hiroshi Miyata","doi":"10.1016/j.gassur.2025.102301","DOIUrl":"10.1016/j.gassur.2025.102301","url":null,"abstract":"<div><h3>Background</h3><div>Stage IV gastric cancer remains challenging to treat despite recent advances in systemic therapy. Among patients with favorable responses to chemotherapy, conversion surgery aiming for R0 resection has shown promise in improving survival. Immune checkpoint inhibitors (ICIs) have become a key component of systemic treatment, but their prognostic impact in the setting of conversion surgery remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 98 patients with gastric cancer who received platinum-based doublet chemotherapy followed by minimally invasive surgery. Patients were stratified into ICI (n = 41) and non-ICI groups (n = 57). Perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox regression models.</div></div><div><h3>Results</h3><div>The median operative time was 345 min, and the median blood loss was 5 mL. R0 resection was achieved in 79.6% of cases, and the median hospital stay was 7 days. Clavien–Dindo grade ≥ II complications occurred in 12.2% of patients. ICI-treated patients had significantly longer PFS (hazard ratio [HR], 0.418; <em>P</em> =.0008) and OS (HR, 0.437; <em>P</em> =.024). R0 resection was independently associated with improved PFS (HR, 0.179; <em>P</em> &lt;.0001) and OS (HR, 0.231; <em>P</em> &lt;.0001). Multivariate analysis identified pathological N status, R0 resection, and ICI use as independent predictors of PFS.</div></div><div><h3>Conclusion</h3><div>Among patients who underwent conversion surgery in this real-world cohort, those treated with ICI-based chemotherapy demonstrated more favorable long-term outcomes than those treated with chemotherapy alone. Although our findings do not demonstrate a causal relationship of ICI therapy on resectability, they suggest that ICI-based chemotherapy may be associated with improved survival in appropriately selected patients with human epidermal growth factor receptor 2–negative stage IV gastric cancer. Prospective studies are warranted to clarify optimal indications and perioperative strategies for integrating ICI-based regimens into conversion treatment.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102301"},"PeriodicalIF":2.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804680","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}

{"title":"The efficacy of immunotherapy in the treatment of tyrosine kinase inhibitor-refractory gastrointestinal stromal tumors: a systematic review and meta-analysis","authors":"YuLong Zhang ,&nbsp;XianHao Xiao ,&nbsp;JiaYing Tan,&nbsp;Liang Shan,&nbsp;He Song","doi":"10.1016/j.gassur.2025.102307","DOIUrl":"10.1016/j.gassur.2025.102307","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The advent of tyrosine kinase inhibitors (TKIs), such as imatinib, has significantly improved clinical outcomes in patients with GISTs by delaying metastasis and prolonging survival. However, most patients eventually develop resistance to TKIs, limiting long-term disease control. Immunotherapy has demonstrated durable responses in various solid tumors and has emerged as a potential treatment strategy for TKI-refractory GISTs. This study aimed to systematically evaluate the efficacy and safety of immunotherapy in patients with advanced or recurrent GIST, particularly those who have failed previous TKI therapy, to inform future clinical decision-making and research directions.</div></div><div><h3>Methods</h3><div>A systematic literature search of PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted for studies published before June 23, 2025. The inclusion criteria focused on immunotherapy interventions in patients with histologically confirmed GIST. Study selection, data extraction, and risk of bias assessments were performed independently by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Joanna Briggs Institute checklist was used for quality appraisal. Random-effects models were used to pool estimates of clinical benefit rate (CBR), objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Generalized linear mixed models (GLMM) were used to account for cohorts with extreme values. This review protocol was registered with the International Registry of Systematic Reviews (registration number: CRD42024496866).</div></div><div><h3>Results</h3><div>A total of 9 studies involving 169 patients were included. The pooled CBR was 41.69% (95% CI, 26.99%–58.03%), and the ORR was 16.49% (95% CI, 6.25%–36.91%), both with moderate to high heterogeneity. GLMM adjustments, which incorporated additional extreme value cohorts, yielded a corrected CBR of 46.39% (95% CI, 28.85%–64.88%) and ORR of 13.23% (95% CI, 4.21%–34.56%). The pooled median PFS across 7 cohorts was 6.11 months (95% CI, 2.63–9.59), and the OS, which was calculated using 2 models, ranged from 15.53 to 17.01 months, depending on the data imputation strategy.</div></div><div><h3>Conclusion</h3><div>This meta-analysis suggests that immunotherapy provides modest yet clinically meaningful efficacy in patients with advanced or treatment-refractory GIST. Despite considerable heterogeneity among studies, the observed trends in response and survival outcomes support immunotherapy as a viable treatment option. Further large-scale, biomarker-driven clinical trials are warranted to validate these findings and guide personalized therapeutic strategies.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 3","pages":"Article 102307"},"PeriodicalIF":2.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800569","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}

{"title":"Dysphagia megalatriensis as differential diagnosis of recurrence in a long-term survivor of gastric cancer: an uncommon cause of dysphagia beyond the alimentary tract","authors":"Enrique Biel ,&nbsp;Juan Sánchez-Parrilla ,&nbsp;Manuel Pera","doi":"10.1016/j.gassur.2025.102305","DOIUrl":"10.1016/j.gassur.2025.102305","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102305"},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781039","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}

{"title":"Preoperative endoscopy in revisional bariatric surgery: who should hold the scope?","authors":"Sergio Carandina ,&nbsp;Salvatore Avallone ,&nbsp;Viola Zulian ,&nbsp;Francesco Angrisani ,&nbsp;Luigi Angrisani ,&nbsp;Antonio Iannelli","doi":"10.1016/j.gassur.2025.102303","DOIUrl":"10.1016/j.gassur.2025.102303","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative esophagogastroduodenoscopy (EGD) is a key component of revisional bariatric surgery workup. However, the completeness and surgical relevance of reports may vary depending on whether the examination is performed by a gastroenterologist or a bariatric surgeon. This study aimed to compare the diagnostic completeness and surgical relevance of preoperative EGD reports performed by gastroenterologists with that performed by bariatric surgeons in candidates for revisional bariatric surgery.</div></div><div><h3>Methods</h3><div>This was a retrospective study that reviewed 88 patients who underwent revisional bariatric surgery after sleeve gastrectomy (SG) or gastric bypass (GB) between January 2024 and April 2025 in 2 bariatric centers in France. Patients were divided into 2 groups: group G (endoscopy by gastroenterologists [n = 44]) and group S (endoscopy by bariatric surgeons [n = 44]). Each report was evaluated using a standardized checklist of surgery-relevant items. The primary endpoint was the Completeness Index (CoI; percentage of mandatory items documented). The secondary endpoints included use of objective measurements, classification of sleeve dilation, documentation of bile reflux, and structured reporting.</div></div><div><h3>Results</h3><div>In the SG subgroup (n = 48), reports by surgeons achieved higher CI scores than those of gastroenterologists (93.5% ± 10.3% vs 69.6% ± 10.6%, respectively; <em>P</em> &lt;.0001). Sleeve dilation classification and bile reflux were consistently documented by surgeons but rarely by gastroenterologists. In the GB subgroup (n = 40), surgeon-performed reports also showed greater completeness than gastroenterologist-performed reports (88.7% ± 11.4% vs 41.2% ± 9.1%, respectively; <em>P</em> &lt;.0001), with more frequent documentation of pouch size, anastomosis diameter, and configuration. Both groups described anatomical landmarks, such as the esophagogastric junction, comparably.</div></div><div><h3>Conclusion</h3><div>Surgeon-performed EGD provides more complete, surgery-oriented information than gastroenterologist-performed examinations, particularly regarding sleeve morphology, pouch size, and anastomotic configuration. Structured reporting and collaboration are essential for optimizing preoperative evaluation in revisional bariatric surgery.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102303"},"PeriodicalIF":2.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774904","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}

{"title":"The Shouldice renaissance: revisiting tissue repair in the era of mesh-based technique","authors":"Vipul D. Yagnik ,&nbsp;Prema Ram Choudhary ,&nbsp;Pankaj Garg","doi":"10.1016/j.gassur.2025.102304","DOIUrl":"10.1016/j.gassur.2025.102304","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102304"},"PeriodicalIF":2.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751585","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}

{"title":"Robotic right hemihepatectomy for perihilar cholangiocarcinoma (with video)","authors":"Marcel Autran Machado,&nbsp;Bruno H. Mattos,&nbsp;Murillo Lobo Filho,&nbsp;Fábio Makdissi","doi":"10.1016/j.gassur.2025.102302","DOIUrl":"10.1016/j.gassur.2025.102302","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102302"},"PeriodicalIF":2.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743016","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}

{"title":"Impact of Medicaid expansion on treatment and outcomes in patients undergoing surgery for common colorectal conditions","authors":"Mayin Lin ,&nbsp;John C. Hsieh ,&nbsp;Miya C. Yoshida ,&nbsp;Julie S. Hong ,&nbsp;Christopher M. Foglia ,&nbsp;Steven Y. Chao","doi":"10.1016/j.gassur.2025.102300","DOIUrl":"10.1016/j.gassur.2025.102300","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102300"},"PeriodicalIF":2.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742953","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}

{"title":"Predictors for operative intervention in adult patients with foreign body ingestion","authors":"Shea Gallagher ,&nbsp;Cameron Ghafil ,&nbsp;Li Ding ,&nbsp;Yu-Tung Wu ,&nbsp;Edward Compton ,&nbsp;Shivani Sundaram ,&nbsp;Philip Paulson ,&nbsp;Morgan Schellenberg ,&nbsp;James Buxbaum ,&nbsp;Matthew Martin ,&nbsp;Kenji Inaba ,&nbsp;Kazuhide Matsushima","doi":"10.1016/j.gassur.2025.102297","DOIUrl":"10.1016/j.gassur.2025.102297","url":null,"abstract":"<div><h3>Background</h3><div>The management of foreign body ingestion (FBI) in the adult population varies widely given the lack of evidence-based guidelines. This study aimed to identify risk factors associated with the need for operative intervention in these cases.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study between July 2015 and January 2021. All adult patients (age ≥18 years) presenting after FBI were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was used to identify foreign body (FB) characteristics associated with operative interventions.</div></div><div><h3>Results</h3><div>A total of 303 patient encounters were included. Ingested FBs were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Notably, 40% underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%) and colonoscopy (4.6%). Twelve patients (4.0%) underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median FB lengths than patients without these complications (11.5 vs 3.0 cm; <em>P</em> &lt;.001). On multivariate regression analysis, FB length was significantly associated with the need for operative intervention (odds ratio [OR], 1.67 for each centimeter increment; <em>P</em> &lt;.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR, 0.20; <em>P</em> =.04).</div></div><div><h3>Conclusion</h3><div>Adult patients who present after FBI can often be managed conservatively. The length of ingested objects seems to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk FBs should be considered when feasible.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102297"},"PeriodicalIF":2.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742972","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}

{"title":"Invited commentary on “Minimally invasive surgery in hepatocellular carcinoma: evolving trade-offs of patient selection and recurrence risk”","authors":"Abu Bakar Hafeez Bhatti","doi":"10.1016/j.gassur.2025.102299","DOIUrl":"10.1016/j.gassur.2025.102299","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102299"},"PeriodicalIF":2.4,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743049","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}

{"title":"Artificial intelligence-driven 3-dimensional simulation system for enhanced preoperative planning in gastric cancer surgery: a retrospective validation study.","authors":"Sachiko Kaida, Yoko Murakami, Yuto Masaki, Yuki Suzuki, Yukihiro Nagatani, Yoshito Otake, Yoshinobu Sato, Shoji Kido, Yoshiyuki Watanabe, Masaji Tani","doi":"10.1016/j.gassur.2025.102295","DOIUrl":"10.1016/j.gassur.2025.102295","url":null,"abstract":"<p><strong>Background: </strong>Few studies have developed artificial intelligence (AI) systems for the automatic recognition of the anatomy of the stomach, a dynamic organ capable of expansion and contraction. This study aimed to create a 3-dimensional (3D) simulation to assist gastric cancer surgery by combining AI models to visualize the positional relationships among the stomach, surrounding organs, and blood vessels.</p><p><strong>Methods: </strong>A deep learning-based model was developed using an AI system to segment abdominal organs and detect blood vessels, including midartery-level structures, from contrast-enhanced computed tomography (CT) images. Surgical structures, including the stomach, pancreas, and arteries, were extracted using a blood vessel detection model. Of note, 2 surgeons and 2 radiologists evaluated 51 3D images for structural detection confidence using a 5-point scale and compared them to standard CT images.</p><p><strong>Results: </strong>A retrospective analysis of 51 cases of preoperative patients with gastric cancer demonstrated that AI-generated images provided clear visualization of the spatial relationships between blood vessels and organs. Structures, including the left hepatic-left gastric artery, common duct and its branches, and the short gastric artery distinct from the splenic artery, were clearly identified. These findings were useful for surgical planning. The reliability score for detecting blood vessels was significantly higher (P <.05) for the AI images than for the CT images, with good agreement among the evaluators.</p><p><strong>Conclusion: </strong>Automatic organ recognition systems are promising, valuable tools for gastric cancer surgery, improving preoperative planning and potentially reducing operative time and complications.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102295"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723959","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}