Surgery Today最新文献

Purpose: Postoperative infections remain a significant problem in lung transplantation. We explored factors associated with postoperative infection after lung transplantation, including intraoperative hyperglycemia.

Methods: Forty-six lung transplant patients were included in the study. The background of these patients and the relationship between each factor and postoperative infectious complications were retrospectively investigated. In the present study, intraoperative hyperglycemia was defined as a mean intraoperative blood glucose level of ≥ 180 mg/dL.

Results: Nineteen patients were classified into the intraoperative hyperglycemia group. Eighteen patients had postoperative infections, and the intraoperative hyperglycemia group had a higher rate of postoperative infections than the non-hyperglycemia group. A multivariate analysis showed that intraoperative hyperglycemia was independently associated with post-transplantation infection (p < 0.01). The 5-year overall survival rates of the intraoperative hyperglycemia and non-hyperglycemia groups were 59.2% and 75.0%, respectively, whereas those of the post-transplant infection and non-infected groups were 47.7% and 80.0%, respectively, with a trend toward a worse prognosis in the intraoperative hyperglycemia and post-transplant infection groups (p = 0.234 and 0.059, respectively).

Conclusion: Intraoperative hyperglycemia is associated with the development of postoperative infections after lung transplantation. Patients with poor intraoperative blood glucose control may have an increased risk of postoperative infections. Intraoperative blood glucose management is crucial for improving the post-transplant clinical course.

Purpose: The CheckMate 577 trial revealed that adjuvant nivolumab administration following neoadjuvant chemoradiotherapy and surgery significantly improved the disease-free survival (DFS). However, evidence supporting its effectiveness following neoadjuvant chemotherapy and surgery for advanced esophageal cancer remains limited. This study evaluated the efficacy and safety of adjuvant nivolumab therapy in patients receiving neoadjuvant chemotherapy followed by esophagectomy.

Methods: We retrospectively analyzed 53 patients who underwent neoadjuvant chemotherapy followed by esophagectomy for advanced esophageal cancer between 2021 and 2024 years. Patients were divided into the adjuvant nivolumab and non-adjuvant groups. Clinicopathological factors, surgical outcomes, adverse events, and survival rates were compared between the groups. We also investigated the association between immune-related adverse events (irAEs) and survival outcome.

Results: Of the 53 patients, 15 (28%) received adjuvant nivolumab therapy. The DFS was significantly better in the adjuvant nivolumab group. In the multivariate analysis, although not significantly, adjuvant nivolumab was identified as a favorable prognostic factor. In total, 8 patients (53%) developed irAEs; those who developed irAEs and completed 1-year adjuvant nivolumab therapy showed a longer DFS than those without irAEs.

Conclusion: Adjuvant nivolumab therapy following neoadjuvant chemotherapy and surgery may improve the DFS in patients with advanced esophageal cancer. Appropriate irAE management may support therapy completion and improve patient outcome.

Purpose: This study explored the trends, demographic patterns, and regional disparities in gastrostomy procedures using Japanese nationwide receipt databases.

Methods: Age- and sex-stratified data on gastrostomy procedures from 2014 to 2022 were analyzed using Jonckheere-Terpstra tests and Poisson regression models. The number of inpatient gastrostomies, surgeons, physicians in gastroenterology, and neurologists (with and without board certification) were assessed by prefecture. Disparities across 47 prefectures and urban-rural disparities were quantified using Gini coefficients and unpaired t-tests. Correlations were assessed using Pearson's correlation method.

Results: The average annual number of gastrostomies was 55,577 (rate: 44.0 per 100,000), with a slight male predominance (male-to-female ratio, 1:0.9). A minor peak occurred in the 0-4 year-old age group (9.6 procedures), followed by a sharp increase after 40 years old, peaking at ≥ 90 years (374.8 procedures). The age-adjusted rates declined overall (risk ratio: 0.957-0.959, P < 0.0001), particularly among the elderly. The Gini coefficient showed low inequality for gastrostomies. The number of gastrostomies was significantly higher in rural than in urban regions. Moderate correlations were found between the number of gastrostomies and the number of surgeons and physicians in gastroenterology without board certification.

Conclusion: This study highlights demographic and regional disparities in gastrostomy practices in Japan.

Purpose: The robotic approach improves the safety and effectiveness of gastric cancer surgery; however, it increases operative time. This study evaluated the effect of individualized adjustment of camera port positioning on short-term outcomes of robotic gastrectomy (RG).

Methods: This study included consecutive patients who underwent RG for gastric cancer at our department between August 2019 and April 2025. Short-term outcomes were compared between RG with adjustment for camera port positioning at the height of the angle of Treitz using computed tomography images (A group, n = 30) and those without adjustment (NA group, n = 89).

Results: No significant differences were observed in patient characteristics between the groups; however, both operative and console times were significantly shorter in group A (both P < 0.001). The estimated blood loss and duration of postoperative stay were also lower in Group A, whereas the incidence of postoperative morbidity was similar. In a multivariate analysis, adjustment of the camera port was identified as an independent predictor of shortened operative time (odds ratio 0.039, P < 0.001).

Conclusions: Individualized adjustment of camera port positioning could be useful for improving the short-term outcomes of RG, including reduction in operative time.

Purpose: Robotic surgery (RS) in colorectal procedures is growing but remains costly. This study evaluated the cost-saving potential of hybrid robotic surgery (hybrid RS), which integrates laparoscopic devices, compared to conventional RS (pure RS).

Methods: This single-center retrospective study (2022-2024) compared pure RS and hybrid RS for sigmoid and rectosigmoid cancers. Propensity score matching minimizes bias. Total revenue is calculated as the total fee minus the total cost.

Results: After matching, 20 patients (10 per group) were analyzed. Hybrid RS improved total revenue ($3515.15 vs. $3229.33) by reducing the total cost ($3652.45 vs. $4061.33), mainly through lower material costs for staplers and ultrasonic devices. The operative time was shorter, and the safety and pathological outcomes were comparable.

Conclusions: Hybrid RS enhances cost efficiency by substituting expensive devices with affordable alternatives, supporting wider adoption of robotic surgery. Further validation using larger studies is necessary.

Purpose: The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC).

Methods: A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (n = 111) that received PVE.

Results: Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9-8.4; p < 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6-7.4; p = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6-12.7; p = 0.005).

Conclusion: PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.

Purpose: Surgical site infection (SSI) of perineal wounds after abdominoperineal resection (APR) or total pelvic exenteration (TPE) for pelvic malignancies is a common postoperative complication. Although several attempts have been made to prevent this complication, SSI of perineal wounds remain common. The efficacy of prophylactic negative-pressure wound therapy (NPWT) in abdominal surgery has been reported; however, few studies have focused on perineal wounds, where the incidence of SSI is particularly high. This study investigated the prophylactic effect of NPWT on closed perineal wounds after APR/TPE to prevent SSI.

Methods: This study enrolled 127 consecutive patients with malignant tumors who underwent elective APR/TPE between January 2013 and December 2022. We used the Prevena™ incision management system (IMS) on the perineal wound in 10 patients for prophylactic NPWT (pNPWT group), whereas 117 patients underwent conventional primary closure (cPC group). We compared the incidence of perineal wound SSI between the groups and explored the risk factors associated with SSI.

Results: Patients' backgrounds were essentially the same between the groups. There were no SSI cases in the pNPWT group, whereas 29 patients (25%) in the cPC group had SSI (P = 0.067). Exploratory analyses revealed that a body mass index ≥ 25, disinfection method, and neoadjuvant chemotherapy were significantly correlated with SSI in perineal wounds.

Conclusion: Prophylactic NPWT for closed perineal wounds after APR/TPE in patients with malignancies can be effective in preventing SSI.

Purpose: To investigate the long-term outcomes of patients with cStage IV esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy (dCRT) and the impacts of this treatment on inflammatory and nutrition markers.

Methods: The subjects of this study were 84 patients who underwent initial dCRT for cStage IV (cT4 and/or cM1 according to eighth UICC staging system) esophageal squamous cell carcinoma (ESCC). Survival outcomes were investigated according to treatment modalities. Various inflammatory and nutrition markers, such as the C-reactive protein (CRP)-to-albumin ratio (CAR) and the lymphocyte-to-CRP ratio (LCR), were evaluated.

Results: The 3-year overall survival (OS) rate of the 84 patients was 45.8%. Clinical complete response (CR) to dCRT was achieved in 30 patients (dCRT-CR group). Salvage surgery was performed for 35 patients and curative (R0) resection was achieved in 28 patients (surg-R0 group). Patients in the surg-R0 group exhibited comparable 3-year OS (60.7%) to patients in the dCRT-CR group (60.0%). CRP-derived markers (LCR and CAR) were significantly associated with the response to dCRT (both P < 0.01) and OS (both P < 0.01).

Conclusions: Definitive chemoradiotherapy is appropriate for patients with cStage IV ESCC. Curative salvage surgery provides survival benefits for the tumor entity. Pre-therapeutic CRP-derived markers are useful for predicting the response to dCRT and long-term outcomes.

Purpose: The simple patch closure technique is an alternative method for repairing ventricular septal rupture following myocardial infarction. This single-center study aimed to investigate the outcomes of ventricular septal rupture repair.

Methods: This retrospective study included 23 patients who underwent initial surgery using the simple patch-closure technique between January 2009 and August 2024. Three primary endpoints were established: the rupture recurrence rate, in-hospital mortality rate, and mid-term survival rate. Survival curves were constructed using the Kaplan-Meier method.

Results: The mean patient age was 71.0 years, and 13 patients were male. Intraoperative transesophageal echocardiography detected no residual shunts; however, five (21.7%) patients experienced rupture recurrence at a median of 21 (range, 12-150) days postoperatively, all requiring reoperation. The hospital mortality rate was 8.7%, with one death each in the early and late surgery groups. The 60 month survival rate was 75.7% over a median follow-up period of 36 months (range: 4-149 months).

Conclusion: The simple patch closure technique is safe and effective for ventricular septal rupture repair, even in early surgery; however, recurrence remains a challenge. Preventive measures, such as bovine pericardial patches and the double-patch technique for extensive infarctions, warrant further validation through larger studies with longer follow-up periods.

Purpose: Most cases of postoperative non-small-cell lung cancer (NSCLC) recurrence occur within 5 years of curative resection, with rare cases of late recurrence occurring after 5 years. However, the unique characteristics of late recurrence remain unclear. This study aimed to elucidate the characteristics and risk factors for late recurrence in patients with NSCLC.

Methods: We retrospectively analyzed 693 patients who underwent curative resection for NSCLC between 2004 and 2013. The primary endpoint was the identification of risk factors for late recurrence, that is, recurrence 5 years after resection.

Results: The 5- and 10-year overall survival (OS) rates were 80.6% and 63.7%, respectively. Among the 435 patients who were recurrence-free for 5 years postoperatively, late recurrence occurred in 24(5.5%). A multivariate analysis identified age at resection (≥ 75 years) as a significant risk factor for late recurrence. Post-recurrence survival did not differ between patients with recurrence within five years and those with late recurrence.

Conclusions: Age at resection (≥ 75 years) was a potential risk factor for late NSCLC recurrence. These patients require long-term follow-up and monitoring for up to five years after resection.