Surgery Today最新文献

Purpose: Strangulated bowel obstruction is a critical condition requiring emergency surgery. This study investigated the clinical parameters of patients undergoing emergency surgery for strangulated and non-strangulated bowel obstructions and identified the predictive factors for intestinal ischemia.

Methods: This retrospective review included 270 patients who underwent surgery for bowel obstruction. The clinical and operative factors were analyzed to determine the predictive factors for intestinal ischemia. A novel predictive scoring system was developed based on significant parameters identified by a multivariate analysis.

Results: Among patients with strangulated bowel obstruction, independent predictors for the need for intestinal resection were massive ascites, computed tomography value ≤ 50 Hounsfield units, lactate levels ≥ 30 mg/dL, and neutrophil-lymphocyte ratio ≥ 8.5. A novel predictive score was developed using these four parameters. Patients with a score of 0 did not require intestinal resection because of strangulation. Fifteen patients, with a score of 7, developed irreversible ischemia and required intestinal resection.

Conclusions: A predictive score incorporating ascites, computed tomography values, lactate levels, and neutrophil-lymphocyte ratio effectively stratified patients with strangulated bowel obstruction, aiding early diagnosis and risk stratification.

Purpose: The safety and efficacy of robotic surgery in obese patients with rectal cancer remain unclear.

Methods: Rectal cancer surgery was performed in 1145 patients at Nagasaki University and seven affiliated institutions between April 2016 and December 2024. Of these, 353 patients who were obese (body mass index, ≥ 25 kg/m²) were categorized into three groups based on the surgical approach: robotic surgery (R group, n = 75), laparoscopic surgery (L group, n = 262), and open surgery (O group, n = 15). We compared and analyzed the background factors and postoperative complications between the groups.

Results: The O group showed significantly greater frequencies of poor PS (R group vs. L group vs. O group; 5.3% vs. 8.4% vs. 33.3%, p = 0.002) and postoperative complications (9.3% vs. 18.7% vs. 40.0%, p = 0.011). A multivariate analysis identified that open surgery (odds ratio 6.888, 95% confidence interval 1.846-15.704; p = 0.004), laparoscopic surgery (odds ratio 2.197; 95% confidence interval 1.941-5.162; p = 0.048), and preoperative treatment (odds ratio 2.516; 95% confidence interval 1.284-4.930; p = 0.007) were independent predictors of postoperative complications.

Conclusion: Robotic surgery has shown good postoperative outcomes in obese patients, and it may, therefore, be useful in reducing complications, particularly in patients who have undergone prior treatment.

Purpose: The safety and benefits of intracorporeal anastomosis (ICAN) in overweight and obese colon cancer patients remain unclear. This study aimed to evaluate the short-term outcomes of ICAN compared to extracorporeal anastomosis (ECAN) in this population.

Methods: This nationwide multicenter retrospective cohort study included 46 institutions. Body mass index (BMI) ≥ 25 kg/m² in patients with clinical stage 0-III colon adenocarcinoma who underwent laparoscopic colectomy were assessed using propensity score matching to compare ICAN and ECAN.

Results: Between January 2020 and December 2021, 361 patients were analyzed (ICAN, n = 191; ECAN, n = 170). ICAN was associated with a longer operative time (252 vs. 232 min, p < 0.001), but significantly less blood loss (5 vs. 15.5 ml, p < 0.001) and a shorter wound length (4 vs. 5 cm, p < 0.001). There were no significant differences in the intraoperative (1.6 vs. 1.8%) or postoperative complication rates (9.4 vs. 7.6%). The time to first stool passage was shorter in the ICAN group (3 (IQR 2-4) vs. 3 (IQR 3-5) days, p < 0.001).

Conclusions: ICAN is safe and beneficial for overweight and obese patients undergoing laparoscopic colectomy, offering reduced blood loss, smaller incisions, and a faster bowel recovery.

Trial registration: This study was registered in the UMIN Clinical Trials Registry System in 2022 (UMIN000047994).

Purpose: Coexisting inflammation should be assessed following the diagnosis of malnutrition. This study aimed to determine the effect of low prealbumin levels on the overall survival (OS) of patients with gastric cancer following gastrectomy according to the intensity of inflammation.

Methods: This retrospective study included consecutive patients who underwent radical gastrectomy for pStages I-III gastric cancer between 2006 and 2020. Preoperative inflammation severity was classified according to the guidance of the Global Leadership Initiative on Malnutrition criteria as normal (C-reactive protein (CRP) < 0.3 mg/dL), mild (0.3-0.99 mg/dL), moderate (1.0-5.0 mg/dL), or severe (> 5.0 mg/dL). Prealbumin levels were categorized as high (≥ 22 mg/dL), moderate (15-22 mg/dL), or low (< 15 mg/dL).

Results: Among 5303 patients, 4583 were categorized into the normal group, 483 into the mild CRP group, 204 into the moderate CRP group, and 33 into the severe CRP group. A comparison of OS revealed that low prealbumin levels were associated with poorer OS, regardless of the severity of inflammation. Multivariate analyses confirmed that a low prealbumin level was an independent poor prognostic factor for OS in patients with or without inflammation (P < 0.001 and P < 0.001, respectively).

Conclusions: Prealbumin levels can be used as a predictor of OS in patients with gastric cancer after gastrectomy, regardless of preoperative inflammation.

Purpose: To assess whether frailty in older adults undergoing colorectal cancer surgery correlates with perioperative complication risks predicted by the Japanese National Clinical Database (NCD) Risk Calculator.

Methods: The subjects of this retrospective study were 143 patients aged ≥ 75 years, who underwent comprehensive geriatric assessment (CGA) before elective colorectal tumor resection at the NHO Kyushu Cancer Center (2018-2023). Frailty was evaluated using the 10-item CGA Frailty Index (FI-CGA-10) and the Robinson Frailty Score (RFS). Correlation and receiver operating characteristic (ROC) analyses were performed, with validation using descriptive statistics based on cutoff values derived from the ROC analysis.

Results: The median age of the patients was 80 years and frailty (FI-CGA-10 > 0.35 or RFS > 4) was identified in 29%. Both FI-CGA-10 (r = 0.8086) and RFS (r = 0.7362) showed strong correlations with the predicted postoperative fall risk. ROC analysis identified 52.0% and 46.1% of the patients as having optimal fall risk thresholds for detecting frailty, using FI-CGA-10 and RFS, respectively. Validation showed that patients with a predicted fall risk ≥ 52% had significantly higher rates of receiving palliative treatment, suffering postoperative complications, and not being discharged home.

Conclusion: The NCD Risk Calculator may serve as a practical surrogate for frailty assessment in older patients undergoing colorectal cancer surgery, particularly in resource-limited settings.

Purpose: To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy.

Methods: This multicenter retrospective study included 327 patients aged ≥ 80 years who underwent curative gastrectomy for gastric cancer. The patients were classified into urban (n = 118) and rural (n = 209) groups. The baseline characteristics, surgical outcomes, and long-term outcomes were compared.

Results: Patients in rural areas had poorer performance statuses, more comorbidities, worse nutritional and inflammatory profiles, and longer distances to the hospital. However, no differences were observed between the urban and rural groups in terms of the surgical approach, postoperative complication rates, or the administration of adjuvant chemotherapy. The 5-year overall survival rates in the rural and urban groups were 66.6% and 59.8%, respectively (p = 0.197). A multivariate Cox regression analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio: 2.02), carcinoembryonic antigen ≥ 5 ng/mL (hazard ratio: 1.92), pathological stage III (hazard ratio: 3.72), and Clavien-Dindo grade ≥ III complications (hazard ratio: 2.51) as independent predictors of overall survival.

Conclusion: The comparable surgical and long-term survival outcomes between patients treated in rural and urban areas suggest that equitable surgical care may be achievable across different geographic settings.