Surgery Today最新文献

Purposes: The three main components of body composition: skeletal muscle, adipose tissue, and bone, have been associated with cancer outcomes individually, but an integrative assessment combining all three has not been carried out. We aimed to establish a body composition scoring system incorporating all three components to stratify prognosis following hepatic resection for colorectal liver metastases (CRLM).

Methods: The subjects of this retrospective study were 164 patients who underwent hepatic resection for CRLM. The skeletal muscle index (SMI), fat area, and bone mineral density (BMD) were quantified using preoperative computed tomography (CT). A main body composition score (0-3) was developed by assigning 1 point for each high-value component. Patients were stratified into three groups according to their score: low (0), medium (1), and high (2-3).

Results: The main body composition score correlated significantly with disease-free survival and overall survival (OS). The 5-year OS rate was 27.1% in the low-score group, 62.1% in the medium-score group, and 70.6% in the high-score group (p < 0.01). In the multivariable analysis, a low main body composition score predicted poor OS independently (hazard ratio, 3.18; 95% confidence interval, 1.68-6.03; p < 0.01).

Conclusion: The main body composition score, incorporating the SMI, fat area, and BMD, effectively stratified the survival outcomes of patients undergoing hepatic resection for CRLM.

Purpose: To investigate the risk factors for incisional hernia (IH) in colorectal cancer patients treated with laparoscopic surgery and midline laparotomy.

Methods: We retrospectively reviewed 140 patients with colorectal cancer and examined their risk factors for IH. We analyzed the clinical findings and associations between these factors and the incidence of IH using Cox proportional hazards models. In particular, we considered umbilical fat.

Results: The cumulative incidence of IH was 33.6% (47 patients), with three symptomatic patients (2.1%). In a multivariate proportional hazard analysis, umbilical fat (p < 0.01; hazard ratio, 6.56; 95% confidence interval, 2.73-15.70) and intermittent suturing with polyglycolic acid (p < 0.01; hazard ratio, 3.56; 95% confidence interval, 1.43-8.87) were significant risk factors for IH. Additionally, long operative times and adjuvant chemotherapy were associated with a high risk of IH in patients with running sutures for abdominal midline incisions.

Conclusion: Umbilical fat may be a significant risk factor for IH after laparoscopic colorectal surgery. Preoperative computed tomography is useful for assessing umbilical fat and identifying high-risk patients. Short-pitch running sutures performed for abdominal closure using a slowly absorbable monofilament suture material within a controlled operative time are essential for preventing IH.

Purpose: Urachal remnants are common in neonates and can persist into adulthood. However, their epidemiology in adults remains poorly characterized. We aimed to investigate the prevalence and clinical features of urachal remnants in adult Japanese patients with omphalitis using a nationwide claims database.

Methods: We analyzed data from the Japan Medical Data Center Claims Database (2005-2023) to identify patients  ≥ 15 years of age who were diagnosed with omphalitis. The prevalence of urachal remnants, associated diagnoses, surgical interventions, and time to surgery was examined, focusing on sex differences and age distribution.

Results: Of the 11,477 patients with omphalitis, 1836 (16.0%) had urachal remnants, with a male-to-female ratio of 2.53:1. The prevalence peaked in males of 20-34 years of age, exceeding 30%. Surgical intervention was performed in 39.7% of the cases, with a median time to surgery of 2 months. The number of laparoscopic procedures increased after 2014 and surpassed that of open surgeries by 2018. One case of urachal cancer (0.054%) was also identified.

Conclusion: Urachal remnants are relatively common in adults with omphalitis, particularly in young males, and usually require surgery. Given the high prevalence and risk of recurrence, early imaging should be considered in adult omphalitis cases to support a timely diagnosis and intervention.

Purpose: Pleural lavage cytology (PLC) is a recognized prognostic marker in non-small cell lung cancer (NSCLC); however, the impact of serial intraoperative changes remains unclear.

Methods: We retrospectively analyzed 439 patients who underwent curative NSCLC resection. PLC was performed at three intraoperative points: after thoracotomy (pre-PLC), after lung resection, and after lavage at chest closure (post-PLC). Associations between recurrence-free survival (RFS) and pleural dissemination were evaluated by a Kaplan-Meier analysis and Fine and Gray competing risks regression.

Results: Forty-one patients had at least one positive PLC result. RFS was the lowest in pre-PLC( +)/post-PLC( +) (n = 10), intermediate in pre-PLC(-)/post-PLC( +) (n = 11), and best in post-PLC( -) (n = 20). Importantly, post-PLC( -) patients included 13 patients with pre-PLC positivity, yet their RFS matched that of consistently negative cases (n = 398). The cumulative incidence of pleural dissemination exhibited a similar pattern. In a multivariate analysis, post-PLC positivity, but not pre-PLC positivity, independently predicted poor RFS (hazard ratio, 3.06; p < 0.001).

Conclusion: Post-PLC, but not pre-PLC, provides decisive prognostic information for recurrence and pleural dissemination, likely reflecting residual lavage-resistant tumor clusters. Importantly, combining pre- and post-PLC results refines risk stratification and identifies the poorest-outcome subgroup that may benefit from adjuvant therapy.

Stem cell transplantation has emerged as a promising therapeutic modality for the treatment of anal fistulas, showing significant potential in addressing this challenging condition. This review aims to summarize the latest research advancements in the field of stem cell therapy for anal fistula, focusing on the underlying mechanisms that contribute to healing, the clinical applications that have been explored in various studies, and the assessment of therapeutic efficacy. Despite these encouraging results, several issues remain, including the optimal source of stem cells, methods of administration, and long-term outcomes. The review will also discuss future research directions, emphasizing the need for standardized protocols and larger-scale clinical trials to establish the safety and effectiveness of stem cell transplantation in routine clinical practice.

Purpose: To compare survival outcomes between patients undergoing upfront surgery and those receiving neoadjuvant therapy followed by surgery for pancreatic cancer stratified by pathological stage.

Methods: We retrospectively analyzed data from 456 patients who underwent curative-intent pancreatectomy between 2011 and 2023. The study patients were categorized into upfront surgery (n = 290) and neoadjuvant therapy (n = 166) groups. The overall and disease-free survival rates were compared between the groups within each pathological stage. Univariate and multivariate analyses were performed for patients with Stage I disease.

Results: In Stage IA, overall and disease-free survival were significantly better in the upfront surgery group than in the neoadjuvant therapy group (P = 0.0022 and P = 0.0012, respectively). There were no significant differences between the groups in patients with Stage II disease. A multivariate analysis of patients with Stage I disease identified neoadjuvant therapy (HR: 4.053, P = 0.0010), biliary drainage (HR: 2.342, P = 0.0399), and absence of adjuvant chemotherapy (HR: 4.563, P = 0.0004) as independent predictors of poor overall survival.

Conclusion: Even within the same pathological stage, the survival outcomes differed between the upfront surgery and neoadjuvant therapy groups. These findings suggest that treatment history should be considered when interpreting the pathological stage and assessing the prognosis of patients with pancreatic cancer.

Purpose: This study aimed to evaluate the feasibility and outcomes of curative-intent surgery in patients with clinically node-positive non-small cell lung cancer (NCSLC) and interstitial lung disease (ILD).

Methods: We retrospectively evaluated patients with clinically node-positive NSCLC and ILD, who underwent curative-intent surgery between 2012 and 2022. Survival outcomes and complications were also assessed. Risk stratification for acute exacerbations of ILD (AE-ILD) was performed using the Japanese Association for Chest Surgery (JACS) score.

Results: Twenty-eight patients were included in the study. Postoperative AE-ILD developed in 17.9% of patients within 30 days and 25.0% within 90 days. The incidence was lower in the low-risk group than in the intermediate-risk group (30 days: 12.5 vs. 20.0%; 90 days: 12.5 vs. 30.0%). No ILD-related deaths occurred within one year postoperatively in the low-risk group, whereas 71.4% of the deaths in the intermediate-risk group were ILD-related. The median overall survival (OS) and recurrence-free survival (RFS) were 19.5 and 13.7 months, respectively. Patients with cN1 or cN2a had favorable outcomes (OS: 28.5 and 28.6 months; RFS: 13.7 and 28.6 months, respectively), whereas those with cN2b showed poor survival (OS/RFS: 2.4 months).

Conclusions: Curative-intent surgery may offer survival benefits for selected patients, particularly those with limited nodal disease and a low risk of AE-ILD.

Purposes: Postoperative delirium (POD) is a serious complication in elderly patients undergoing gastrointestinal (GI) cancer surgery. This study aimed to identify the perioperative risk factors for POD, focusing on domain-specific cognitive function.

Methods: We retrospectively analyzed patients ≥ 65 years old who underwent GI cancer surgery and preoperative geriatric screening. POD was assessed using the Delirium Symptomatology Test. Cognitive domains were evaluated using the Japanese Montreal Cognitive Assessment (MoCA-J). A receiver operating characteristic (ROC) analysis identified the most predictive domain combination and compared its discriminative performance with that of conventional tools. Independent associations with POD were examined using Firth's logistic regression.

Results: Of 167 patients, 13 (7.8%) developed POD. The MoCA-J Memory + Orientation composite score showed the highest predictive accuracy. In the multivariable analysis, a composite score < 7 (odds ratio [OR] = 12.81, 95% confidence interval [CI]: 1.95-84.0), older age (per year, OR = 1.10, 95% CI: 1.01-1.21), preexisting respiratory disease (OR = 7.82, 95% CI: 1.40-43.9), and intraoperative blood loss (per 100 ml increment, OR = 1.53, 95% CI: 1.05-2.25) were independently associated with POD.

Conclusions: The MoCA-J domain-specific composite score for memory and orientation was the strongest predictor of POD, alongside established factors, such as older age, preexisting respiratory disease, and intraoperative blood loss.