Surgery Today最新文献

Purpose: To examine the clinical impact of transanal total mesorectal excision (TaTME) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy (NACRT).

Methods: This retrospective study included 91 patients undergoing surgery for rectal cancer after NACRT between 2011 and 2022. Among them, 24, 22, and 45 patients underwent open (Open), conventional laparoscopic (Lap), and TaTME surgeries, respectively. We compared their clinical outcomes.

Results: Operative time, blood loss, transfusion, morbidity, and hospital stay were significantly lower in the TaTME group than in the Open or Lap groups. The multivariate regression analyses identified only the TaTME approach as a significant factor for reducing morbidity. Both 3 yrear relapse-free survival (RFS) and local recurrence-free survival (LRFS) were significantly better in the TaTME group than in the Open or Lap groups (3 yr RFS: 94.7%, 80.4%, and 66.7%, and 3 yr LRFS: 100%, 90.5%, and 82.2% for the TaTME, Lap, and Open groups, respectively). Multivariate analyses of potential risk factors for recurrence identified body mass index, combined resection, and pathological stage, but not the TaTME approach, as significant predictors of recurrence.

Conclusion: TaTME reduced morbidity significantly in patients with locally advanced rectal cancer undergoing NACRT, compared with open or laparoscopic surgery.

Purpose: Current diagnostic modalities for differentiating between benign and malignant cervical lymph nodes in patients with thyroid cancer are imprecise and time-consuming. The real-time intraoperative detection of malignancy in suspicious lesions could improve the medical management of these patients. This human study was undertaken to evaluate a precise, newly developed Electrical Lymph-Node Scanning (ELS) system to facilitate the effective treatment of cervical LNs in thyroid cancer patients.

Methods: Using the ELS, we examined a collective 109 radiologically suspicious lymph nodes from 36 patients after dissection and compared the ELS results with the histopathological findings.

Results: A total of 27 involved lymph nodes were correctly diagnosed, while 75 reactive or free lymph nodes were correctly identified as uninvolved lymph nodes by ELS (as 3 false negatives and 4 false positives) with total sensitivity and specificity of 90% and 94.9%, respectively. The corresponding negative and positive predictive values were 87.1% and 96.2%, respectively.

Conclusions: Results from this clinical study demonstrate the value of the ELS as a surgical assist adjunct for differentiating equivocal lesions during neck dissection surgery for patients with different types of thyroid cancer.

Synopsis: This study shows the utility of magnetic resonance imaging elastography as an independent predictor of the postoperative recurrence of hepatocellular carcinoma.

Purpose: Accurate assessment of postoperative recurrence risk is crucial for the perioperative management of patients undergoing surgical resection for hepatocellular carcinoma (HCC). Magnetic resonance imaging elastography (MRE) has emerged as a noninvasive tool for assessing liver fibrosis. This study evaluated whether MRE independently predicts HCC recurrence more effectively than well-known oncological factors, including pathological findings.

Methods: The subjects of this retrospective observational study were HCC patients who underwent preoperative MRE and hepatectomy between 2013 and 2023. Data collected included demographics, laboratory findings, imaging, pathology, operative details, and prognosis. Patients were followed up for at least 1 year after hepatectomy or until recurrence.

Results: Recurrence developed in 46 of 100 patients. Multivariable Cox regression analysis for overall recurrence identified MRE ≥ 3.7 kPa (hazard ratio [HR] 3.161, p = 0.021), the FIB-4 index (HR 3.176, p = 0.001), tumor size > 5 cm (HR 5.893, p < 0.001), invasive growth pattern (HR 2.375, p = 0.036), METAVIR F3-4 (HR 2.562, p = 0.046), and venous invasion (HR 10.622, p < 0.001) as risk factors. The recurrence-free rate at 1 year for patients with MRE ≥ 3.7 kPa was lower than for those with MRE < 3.7 kPa (72.0% vs. 92.0%, p = 0.017).

Conclusions: Preoperative MRE predicts postoperative HCC recurrence, underscoring its utility in risk stratification.

The C-Reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) index is an established immuno-nutritional scoring system. We screened relevant literature from the major databases up until May, 2024, and extracted the data for analysis. A total of 2829 gastric cancer (GC) patients from six studies were included in this meta-analysis, the results of which revealed that the CALLY index was an independent prognostic factor for OS and RFS in both univariate analyses and multivariate analyses, and that a high CALLY index was a favorable prognostic factor. Moreover, GC patients in the high CALLY index group seemed to have better 5-year OS and 5-year RFS than those in the low CALLY index group. There was a higher proportion of patients with T1 status in the high CALLY index group than in the low CALLY index group. However, the opposite results were found in the analyses of lymph node metastasis positivity, lymph-vascular invasion positivity, postoperative complications, differentiated histological type, anastomotic leakage, and adjuvant chemotherapy. The present meta-analysis concluded that the CALLY index was a simple and useful independent prognostic biomarker for GC patients after gastrectomy.

Purpose: Board certification by the Japanese Society of Pediatric Surgeons is awarded to pediatric surgeons with substantial surgical experience and academic achievement. However, to date, the surgical performance or outcomes of certified surgeons have not been reported. This study examined the relationship between board certification and surgical outcomes of central venous catheterization.

Methods: This retrospective single-center study was conducted between April 2017 and May 2024. Patients were classified based on whether their procedures were performed by board-certified or non-certified surgeons, and their backgrounds and surgical outcomes were compared. In addition, multivariate analysis was performed to identify the factors associated with prolonged operative time.

Results: This study included 112 procedures: 26 performed by board-certified surgeons and 86 performed by non-certified surgeons. There were no significant differences in the age, sex, weight, or primary diagnosis between the groups; however, surgery-associated complications were significantly more common in the non-certified surgeon group than in the board-certified surgeon group (15.1% vs. 0%, P = 0.036). In addition, factors independently associated with a prolonged operative time included weight < 10 kg, left-sided approach, implantable port device use, and < 7 years of postgraduate experience for the surgeon.

Conclusion: Board certification was associated with a significant reduction in surgery-associated complications during central venous catheterization.

Purpose: In Japan, immunohistochemistry for mismatch repair (MMR) proteins targeted at stage II and III colorectal cancers (CRCs) has been covered by national insurance since October, 2022. This study aimed to clarify the long-term outcomes of patients with stage II and III CRCs receiving postoperative adjuvant chemotherapy based on their MMR status.

Methods: The outcomes of 640 patients who underwent radical surgery for stage II and III CRCs were analyzed retrospectively.

Results: Deficient MMR (dMMR) was diagnosed in 41 (13.3%) patients with stage II and 28 (9.1%) patients with stage III CRC. The overall survival and recurrence rates were not significantly different between the patients with stage II and those with stage III CRC. The risk factors for recurrence among those with stage II CRC were tumors on the left side, T4 disease, and the presence of BRAF wild type. The recurrence rates were lower in the stage II CRC patients with sporadic dMMR than in those with suspected Lynch syndrome (LS). The first site of recurrence was more frequently the peritoneum or distant lymph node in patients with dMMR.

Conclusions: Stage II CRC patients with sporadic dMMR were found to have a very good prognosis. On the other hand, peritoneal dissemination or distant lymph node metastasis tended to develop in patients with dMMR.

Purpose: To investigate the role of ¹⁸F-fluorodeoxy glucose-positron emission tomography/computed tomography (FDG-PET/CT) to assess pathological response and prognosis after induction therapy in patients with thymic carcinoma.

Methods: The subjects of this retrospective study were 18 patients with thymic carcinoma who underwent FDG-PET, before and after induction therapy. We measured the maximum standardized uptake value (SUVmax) of the tumor and analyzed the correlation between the change in SUVmax and pathological response or recurrence.

Results: Induction therapy led to a reduction in both the tumor size and SUVmax in most patients. A strong correlation (Pearson coefficient = 0.90, p < 0.0001) was observed between the changes in tumor size and SUVmax. Although the SUVmax and tumor size showed no association with the pathological response, an SUVmax change > 50% predicted lower recurrence rates (p = 0.03).

Conclusion: Changes in the SUVmax following induction therapy may serve as a valuable predictor of recurrence in patients with thymic carcinoma. This finding highlights the potential of FDG-PET as a tool for patient monitoring and prognostication of this rare subset of carcinomas. Further studies are warranted to validate these results and standardize the FDG-PET protocols for optimal clinical use.

Purpose: Abdominal aortic calcification (AAC), an indicator of systemic arteriosclerosis, is associated with short- and long-term outcomes in malignancies. We investigated the prognostic impact of AAC in patients who underwent hepatectomy for intrahepatic cholangiocarcinoma (IHCC).

Methods: The study cohort comprised 46 patients who underwent hepatectomy for IHCC between January 2008 and September 2020. The AAC volume measured by preoperative computed tomography was used to construct a model of the calcified segment from the renal artery to the common iliac artery bifurcation. We investigated the relationship between AAC and the long-term outcomes. The AAC volume cutoff value was calculated from a receiver-operating characteristic curve based on the three-year survival.

Results: According to our cutoff AAC volume of 3,700 mm³, 11 patients (24%) had high AAC volumes. The high-AAC group was significantly older than the low-AAC group (73 vs. 62 years old, p < 0.01). A multivariate analysis of the cancer-specific survival showed that a high serum carbohydrate antigen 19-9 concentration (hazard ratio [HR] 5.57, p = 0.01), high AAC volume (HR 3.03, p = 0.04), and [high?] T3 or T4 levels (HR 9.05, p < 0.01) were independently associated with a poor prognosis.

Conclusion: AAC is a useful predictor of the oncological prognosis in patients undergoing hepatectomy for IHCC.

Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92-97% for simple fistulas versus 40-95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50-60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.

Purpose: Infectious complications, particularly post-transplant sepsis, have a critical impact on postoperative outcomes. This study examined the effects of perioperative synbiotic treatment on postoperative outcomes in patients receiving early enteral nutrition.

Methods: We reviewed 210 living-donor liver transplantation procedures and retrospectively analyzed the postoperative outcomes with and without perioperative synbiotic treatment (live lactic acid bacteria, bifidobacteria, and oligosaccharides) 5 days before and after living-donor liver transplantation.

Results: The synbiotic group (n = 34) had significantly fewer male donors (38.2% vs. 61.9%, p = 0.011) and a higher proportion of ABO-incompatible grafts (52.9% vs. 25.6%, p = 0.021) than the non-synbiotic group (n = 176). The incidence of sepsis was significantly lower in the synbiotic group than in the non-synbiotic group (0% vs. 7.4%, p = 0.029), with a lower incidence rate of sepsis due to bacteremia with intestinal bacteria (0% vs. 4.6%, p = 0.089). There were no significant differences in the proportions of acute rejection, small-for-size graft syndrome, or postoperative liver function between the two groups. Furthermore, there was no significant difference in the graft survival rates after LDLT between two groups. (p = 0.24).

Conclusion: Perioperative synbiotic treatment prevents post-transplant sepsis, even with early enteral nutrition.