Surgery Today最新文献

Purpose: We performed a combined assessment of skeletal muscle mass using the skeletal muscle mass index (SMI) and the psoas muscle index (PMI) to evaluate their association with the overall survival (OS) of gastric cancer patients after curative gastrectomy.

Methods: We analyzed, retrospectively, the computed tomography records of skeletal muscle mass of patients who underwent radical gastrectomy for pStage I-III gastric cancer between April, 2010 and April, 2016. We then compared OS as the primary outcome, stratifying patients according to their SMI or PMI, and investigated prognostic factors using multivariate analyses.

Results: The median follow-up duration was 62 months. Of the 550 patients analyzed, 262 (47.6%), 194 (35.3%), and 94 (17.1%) were classified into normal, single-low, and double-low SMI and PMI groups, respectively. Patients with double-low SMI and PMI had the poorest OS (P = 0.018). Multivariate analysis revealed that double-low indices were an independent prognostic factor for poor OS (hazard ratio, 1.808; 95% confidence interval 1.009-3.238; P = 0.046).

Conclusions: This study revealed that evaluation of skeletal muscle mass based on the combined SMI and PMI can predict the survival outcomes of patients after curative gastrectomy for gastric cancer, and that the coexistence of a low-SMI and low-PMI was associated with the poorest survival.

Purpose: Middle-segment preserving pancreatectomy (MSPP) serves as an alternative to total pancreatectomy (TP) for preserving the pancreatic body in multifocal pancreatic neoplasms. Despite the potential benefits of TP, the detailed short- and long-term prognoses remain unclear. We evaluated the feasibility of MSPP by comparing the perioperative outcomes and postoperative endocrine and exocrine functions with those of TP.

Methods: The study included 10 TP and 7 MSPP patients. Patients with pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous carcinoma were excluded.

Results: MSPP was associated with a high incidence (57.1%) of postoperative pancreatic fistula (POPF); however, there were no cases of post-pancreatectomy hemorrhage or postoperative mortality in any group. The postoperative hospital stay and readmission rates were comparable between the groups. At 1 year postoperatively, MSPP reduced the risk of new-onset insulin-dependent diabetes mellitus, maintained good glycemic control with minimal hypoglycemic events, and preserved skeletal muscle, subcutaneous fat, and visceral fat. One patient in the MSPP group with a neuroendocrine tumor had postoperative recurrence in the para-aortic lymph node.

Conclusions: Despite the high POPF rate and oncologic limitations, MSPP showed superior long-term outcomes in glycemic control and preservation of body composition. MSPP may be an acceptable treatment option for selected patients.

Purpose: To investigate the surgical safety and benefits of using the BirdView camera system with a wide field of view in robotic surgery for rectal cancer in a prospective clinical study.

Methods: This study included 20 consecutive patients who underwent robotic surgery at our institution between the years 2022 and 2023. The primary endpoint was perioperative safety, which was defined as the occurrence of adverse events, including other organ injuries and malfunctions, caused by the BirdView camera system.

Results: There were no injuries to any other organs caused by the console surgeon or assistant forceps during surgery. Surgical adverse events occurred in five cases (atelectasis, paralytic ileus, and anastomotic leakage) during the postoperative course. There were no cases of device failure or damage to the surrounding organs, including peritoneal heat damage.

Conclusions: We believe that the BirdView system could be valuable in improving the safety of robotic surgery by enabling the observation of blind spots, thus preventing harm to other organs.

Purpose: This study aimed to investigate the current practices in the diagnosis and surgical management of anorectal malformations (ARMs) in female patients in Japan, specifically focusing on anovestibular fistula (AVF), rectovaginal fistula (RVF), and persistent cloaca (PC).

Methods: An anonymous online survey was conducted with 61 institutional members of the Japanese Study Group for Anorectal Anomalies.

Results: Sixty-one institutions (100%) completed the survey. For AVF, fistulography/vaginography was the most common diagnostic method (98.4%), and anorectoplasty was usually performed at 3-6 months of age (86.9%) using anterior sagittal anorectoplasty (62.3%) or anal transposition (39.3%). Distal colostography (100%), MRI (71.7%), and cystscopy/urethroscopy/vaginoscopy (83.3%) were commonly used for PC. Patients with PC underwent anorectoplasty at 7-24 months (93.3%), predominantly posterior sagittal anorecto-urethro-vaginoplasty (PSARUVP) (41.7%), or laparoscopy-assisted anorectoplasty (LAARP) (43.3%). A subgroup analysis revealed that PSARUVP used blunt dissection (70.0% vs. 28.6%, p < 0.05) and visual confirmation by opening the rectum (80.0% vs. 4.8%, p < 0.001) significantly more often than LAARP for PC.

Conclusion: This nationwide survey revealed distinct patterns in the diagnostic timing and surgical approaches for female ARMs in Japan, highlighting the varying preferences in fistula management techniques across different types of malformations.

Work-life balance is often discussed in Japan. Yet surgeons find it challenging to take paternity leave because of their demanding surgical duties and a strong sense of responsibility. One Japanese male surgeon had his first paternity experience as a research fellow in the US. When he returned to Japan, he resumed his surgical training and started a research project to become an academic surgeon. When he and his wife were expecting their second child, they discussed his paternity participation before the delivery and decided on a sustainable paternity participation plan. By coordinating his responsibilities with his co-workers, he limited his attendance at work to daytime hours only for 1 month to manage paternity duties. This adjustment did not affect the number of main and assistant operations conducted that month and effective optimization of workflow processes decreased the extra workload for other team members. His experience suggests that the optimization of workflow processes can enhance personal life, including paternity participation. (150/150).

Purpose: Stoma outlet obstruction (SOO) is an early postoperative complication of rectal cancer. We devised a novel surgical technique: end-ileostomy, to reduce SOO. Here, we describe the surgical technique used for constructing an end ileostomy and assess its impact on SOO.

Methods: The subjects of this retrospective study were 78 patients who underwent low anterior resection or total colectomy with a defunctioning ileostomy (DI) between 2018 and 2022. The surgical procedure for end ileostomy can be summarized as follows: First, the ileum was separated using a linear stapler, approximately 30 cm from the Bauhin valve; then the opposite sides of the mesentery of the oral and anal ilea were sutured; and finally, end ileostomy was performed using standard techniques. End and loop ileostomies were performed in 34 and 44 patients, respectively. We assessed the independent risk factors for SOO.

Results: SOO occurred in 12 patients (15.3%): 1 (2.9%) with an end ileostomy and 11 (25%) with a loop ileostomy. Multivariate analysis identified loop ileostomy as an independent risk factor for SOO (p = 0.037).

Conclusions: End ileostomy construction is a useful and safe technique for reducing the incidence of SOO in defunctioning ileostomies following rectal resection.

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: To investigate the current status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery in Japan.

Methods: We reviewed data on eight gastroenterological procedures from the Japanese National Clinical Database (NCD), accrued between 2018 and 2020. Patient characteristics, prophylactic methods, postoperative bleeding, cardiac arrest, and postoperative mortality rate within 30 days were retrieved.

Results: Despite recommendations, approximately 30% of patients did not receive VTE prophylaxis, suggesting a lack of awareness. Pharmacological prophylaxis was associated with a higher incidence of VTE than mechanical or no prophylaxis for all procedures. Combined prophylaxis resulted in a lower incidence of VTE than pharmacological prophylaxis alone. Pharmacological prophylaxis was also associated with an increased incidence of bleeding events. The risk of cardiac arrest and death was higher in patients with pulmonary embolism (PE), but there was a trend toward lower mortality in the group that received pharmacological prophylaxis.

Conclusion: Pharmacological prophylaxis for VTE was limited in reducing the incidence of VTE, but it may reduce the risk of death. Combining pharmacological and mechanical prophylaxis tended to be more effective for preventing VTE than either method alone. Conversely, pharmacological prophylaxis may increase the risk of bleeding.

Purpose: Bariatric/metabolic surgery has been reported to reduce the incidence of severe coronavirus disease 2019 (COVID-19); however, its ability to reduce risk is controversial. Therefore, this study aimed to elucidate the incidence and severity of COVID-19 in bariatric patients in Japan.

Methods: The first survey of patients infected with COVID-19 after bariatric/metabolic surgery until June 30, 2022, was sent to 83 Japanese institutions. A second survey was conducted in institutions that reported on COVID-19 patients. The severity of COVID-19 was compared between the general population and bariatric patients, and risk factors correlated with severity were also evaluated.

Results: Twenty-six institutions (31.3%) reported 119 patients with COVID-19 after laparoscopic bariatric/metabolic surgery. There were no severe cases or deaths; however, moderate COVID-19 (pneumonia) was significantly more common in bariatric patients than in the general population (11.4% vs. 1.3%). The risk factors for moderate COVID-19 in bariatric patients included incurable dyslipidemia and infection before the 6th wave of the pandemic.

Conclusion: In Japan, the number of moderate COVID-19 cases may be higher in bariatric patients than in the general population. This study did not show that bariatric/metabolic surgery reduces the risk of COVID-19 complications.

Purpose: Frailty, characterized by sarcopenia and osteopenia, is associated with poor survival after the resection of biliary tract cancer (BTC). Osteosarcopenia, the coexistence of sarcopenia and osteopenia, has recently been associated with poor outcomes in various cancers. This study assessed the prognostic value of osteosarcopenia after the resection of BTC.

Methods: We analyzed 109 patients who underwent BTC resection between 2014 and 2021 for the following conditions: intrahepatic cholangiocarcinoma (n = 21), perihilar cholangiocarcinoma (n = 16), distal cholangiocarcinoma (n = 32), gallbladder carcinoma (n = 17), and ampullary carcinoma (n = 23). Sarcopenia was evaluated using computed tomography of the psoas muscle at the third lumbar vertebra, while osteopenia was measured using bone mineral density at the 11th thoracic vertebra. Osteosarcopenia was defined as the presence of both the conditions.

Results: Sarcopenia was present in 54 patients (50%), osteopenia in 50 patients (46%), and osteosarcopenia in 30 patients (28%). Lymph node metastasis is common in patients with osteosarcopenia. A multivariate analysis revealed that lymph node metastasis (p = 0.0278), poor tumor differentiation (p = 0.0027), and osteosarcopenia (p = 0.0436) were independent predictors of poor disease-free survival. Osteosarcopenia was also a significant predictor of poor overall survival (p < 0.0001).

Conclusion: Osteosarcopenia serves as a prognostic factor for poor outcomes after BTC resection.