Surgery Today最新文献

Purpose: We evaluated the long-term outcomes of children undergoing thoracotomy lung resection for congenital lung malformations in terms of lung function, complications, and health-related quality of life (HRQOL).

Methods: We retrospectively reviewed 27 children who underwent thoracotomy at Osaka University Hospital (1992-2017) with at least five years of follow-up and postoperative lung function testing after six years of age. We compared the percent predicted vital capacity (%VC), percent predicted forced expiratory volume in 1 s (%FEV₁), and FEV₁ to FVC ratio (FEV₁/FVC) as indicators of the lung function. Longitudinal changes in the lung function, pulmonary and musculoskeletal morbidities, and HRQOL were assessed using the Pediatric Quality of Life Inventory.

Results: %VC and FEV₁/FVC remained within the normal range but were significantly lower than the controls; %FEV₁ was below the normal range. No significant longitudinal changes in the lung function were observed. Asthma‑like symptoms appeared in 37.0% of the patients and persisted beyond adolescence. Musculoskeletal morbidities occurred in 33.3% of the patients, with five pectus excavatum cases requiring correction. HRQOL did not differ from that of the healthy controls.

Conclusions: In our study, children undergoing thoracotomy lung resection for congenital lung malformations exhibited a significantly lower lung function than the healthy controls, and these impairments persisted over an extended follow-up period. Long-term complications and a reduced lung function were not reflected in the subjective HRQOL.

Purpose: Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection.

Methods: We retrospectively reviewed 272 patients (1990-2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (n = 8) and a hepatectomy alone group (DMpos-HA, n = 10).

Results: A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 > 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (n = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (p < 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, p = 0.396), although the difference was not statistically significant. Major complications (Clavien-Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (p = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups.

Conclusion: In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.

Purpose: To evaluate how surgeons' experience and qualifications in laparoscopic surgery influence safe implementation of robotic surgery.

Methods: We retrospectively reviewed 652 patients with colorectal cancer who underwent robotic surgery between 2016 and 2024 years. The patients were divided into two groups: those who underwent surgery performed by an expert surgeon (expert group, n = 571) and a non-expert surgeon (non-expert group, n = 81). Following propensity score matching (PSM) to minimize the possibility of any selection bias, 81 patients in each group were matched, and the clinical and perioperative features were compared between the two groups.

Results: The number of procedures performed by non-experts has gradually increased over time, and surgeons have become progressively younger. Before matching, the non-expert group had a higher American Society of Anesthesiologists physical status (expert vs. non-expert: 13.6% vs. 4.6%, p < 0.001) and included a higher proportion of colon tumors (36.4% vs. 54.3%, p = 0.002). However, after matching, no differences were observed between the groups. Furthermore, there were no significant differences in the operative time, blood loss, or postoperative complications.

Conclusions: Proctored robotic surgery is considered to be safe. However, when non-expert surgeons perform robotic surgery, expert supervision is desirable.

Introduction: As the global population ages, older patients undergo pancreatoduodenectomy (PD). This study aimed to evaluate the safety and postoperative outcomes of PD in patients > 85 years of age.

Methods: We reviewed 200 consecutive PDs and compared the postoperative outcomes in patients aged ≥ 85 years using propensity score matching (PSM).

Results: After PSM, no differences in the clinical characteristics were observed between the two cohorts (n = 16 each). Those aged ≥ 85 years had a significantly lower induction rate of adjuvant chemotherapy (p < 0.0001) and a higher rate of best supportive care selection at recurrence (BSC) (p = 0.033) than those aged < 85 years. There was no significant difference in the rate of non-cancer-related deaths (p = 0.18). Although there were no significant differences in the -free survival rates (p = 0.89), the overall survival rate of those ≥ 85 years was significantly worse (p = 0.023). The risk factors for death after surgery were tumor-related factors and BSC (p = 0.0012). An age ≥ 85 years was not a risk factor for major postoperative complications or death after surgery.

Conclusions: PD can be safely performed in patients aged ≥ 85 years without increasing postoperative complications and recurrences in the cases with appropriate patient selection.

Purpose: Long-term data on the risk factors for fistulizing disease (FD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis are limited. This study aimed to identify the predictors of FD after ileostomy closure and evaluate the impact of FD on pouch failure.

Methods: We reviewed 374 patients who underwent mucosal restorative proctocolectomy with handsewn IPAA between 2004 and 2022. Cox proportional hazards regression and log-rank tests were used to assess the FD-free survival and risk factors.

Results: After excluding 59 patients, 315 patients were analyzed. FD developed in 20 (6.3%) of these patients. Multivariate analysis showed that a monthly prednisolone (PSL) dose ≥ 450 mg before IPAA and chronic pouchitis were independent risk factors for FD (odds ratio [OR] 2.96, 95% CI: 1.15-7.64, p = 0.025; OR 3.85, 95% CI: 1.52-9.78, p = 0.0045). Patients with PSL ≥ 450 mg or chronic pouchitis had significantly poorer FD-free survival (p = 0.0004 and p = 0.0002, respectively). Pouch failure occurred more frequently in patients with FD than in those without FD (30.0% vs. 1.0%; p < 0.0001).

Conclusions: High steroid exposure before IPAA and chronic pouchitis were significant predictors of FD, which strongly increased the risk of pouch failure.