Surgery Today最新文献

Purpose: Addressing the decline in the number of surgeons in Japan and an uneven specialty distribution is crucial for a sustainable working environment. We conducted this study to investigate the motivations behind the choice of medical specialty among thoracic surgeons across multiple institutions in Japan.

Methods: A nationwide online questionnaire survey was distributed by the Japanese Association for Surgical Education's thoracic surgery working group, targeting all thoracic surgeons.

Results: Of the 725 respondents, 95.6% decided on thoracic surgery after starting clinical training. The key influencing factors included respectful supervisors and seniors (79.3%), procedures (78.1%), organs (77.9%), diseases (75.4%), and atmosphere (70.3%). The final deciding factors were procedures (37.1%), atmosphere (17.0%), and organs (11.2%), with work-life balance reported by 7.0%. More thoracic surgeons in the 20 s-30 s age group than those in the over 40 s age group prioritized procedures (47.3% vs 31.5%; P < 0.0001), organs (14.3% vs 9.4%; P = 0.049), and work-life balance (11.2% vs 4.7%; P = 0.0014). Only 9.2% of respondents chose a career in thoracic surgery exclusively, whereas 90.8% considered other specialties (81.3% surgical, 18.7% non-surgical).

Conclusion: This survey revealed that the broad appeal of thoracic surgery often attracted individuals from diverse backgrounds, sometimes after they had considered other specialties. Increasing the number of thoracic surgeons requires promoting its appeal and fostering a positive work and educational environment.

Background: The aim of this study was to assess the efficacy and safety of pimitespib in real-world clinical settings for tyrosine kinase inhibitor-resistant GISTs.

Methods: We retrospectively analyzed 15 patients at Osaka University Hospital. Patients treated with pimitespib as a fourth- or later-line treatment for unresectable or recurrent GISTs were included. Patient background, pimitespib dose, number of courses, adverse events, best response, progression-free survival, and overall survival were analyzed.

Results: The median overall survival of patients treated with pimitespib was 24.4 months（95% confidence interval [CI] 7.2-not reached) and the one-year overall survival rate was 70.9%. The median progression-free survival was 4.6 months (95%CI 1.8-7.4), and the one-year progression-free survival rate was 15.2%. A partial response was observed in 0 patients, stable disease lasting for ≥ 12 weeks in 7 (46.7%), progressive disease in 7 (40.0%), and a non-evaluable state in 2 (13.3%). The disease control rate was 40%. Treatment-related adverse events were reported in all patients, with the most common being diarrhea (87%), followed by anorexia (27%), nausea (27%), and increased blood creatinine levels (27%). None of the patients discontinued the treatment because of adverse events.

Conclusion: Pimitespib may offer a tolerable and effective treatment option for patients with unresectable or recurrent GISTs in clinical practice.

Purpose: This study examined the relationship between preoperative prealbumin levels and long-term outcomes in patients with advanced gastric cancer after gastrectomy.

Methods: This study included patients who underwent radical gastrectomy for primary stage I-III gastric cancer with preoperative prealbumin levels measured from May 2006 to March 2017. The patients were categorized into 3 groups based on their preoperative prealbumin levels: high (≥ 22 mg/dL), moderate (15-22 mg/dL), and low (< 15 mg/dL).

Results: Of the 3,050 pStage I patients, 2488 (81.6%) were classified as high, 511 (16.8%) as moderate, and 51 (1.7%) as low. Of the 1682 patients with pStage II-III, 1161 (69.0%) were classified as high, 414 (24.6%) as moderate, and 107 (6.4%) as low. A comparison of the overall survival (OS) revealed that lower prealbumin levels were associated with a worse prognosis (P < 0.001). A multivariate analysis indicated that prealbumin levels of 15-22 mg/dL and < 15 mg/dL were independent poor prognostic factors for the OS, regardless of the pStage. When stratified by cause of death, prealbumin levels were associated with the other-cause survival but not the cancer-specific survival.

Conclusions: Preoperative prealbumin levels were correlated with the OS, especially the other-cause survival, in patients with gastric cancer after gastrectomy. (200 words). Data Access Statement: Research data supporting this publication are available from the NN repository at located at www.NNN.org/download/ .

Purpose: We investigated the surgical outcomes of completion lobectomy after primary segmentectomy for lung malignancies.

Methods: A review of 1139 patients who underwent pulmonary segmentectomy for lung malignancies, identified 17 (1.5%) who underwent completion lobectomy. We analyzed the clinicopathological outcomes of completion lobectomy in these 17 patients, statistically, and evaluated the degree of surgical difficulty, using logistic regression models.

Results: The primary segmentectomy was performed on the right-side in six patients, centrally in seven, in the upper lobe in nine, and as a complex segmentectomy in ten. Lung cancer was diagnosed in 13 patients. Completion lobectomy required an intrapericardial procedure in five patients, main pulmonary artery (PA) clamping in seven, bronchial plasty in five, and PA-plasty in five. The mean operative time was 219 min, and the mean blood loss was 193 ml. Cut-end recurrence was confirmed in nine (56%) patients, and Grade III or higher morbidity occurred in six patients (38%) with no short-term mortality. Logistic regression analysis revealed that upper lobe completion lobectomy was a significant predictor of surgical difficulty (OR 23.8, 95%CI 1.742-333.3, p = 0.018).

Conclusion: Completion lobectomy is technically challenging, especially in the upper lobe, but the oncological and surgical results are acceptable. This procedure is a promising and important strategy for treating secondary lesions in the residual lobe after segmentectomy.

Purpose: We aimed to compare the safety, feasibility, required human resources, and surgical costs of a combined robotic transabdominal and conventional transanal (TaRob) approach with those of a robotic transabdominal approach alone for rectal cancer.

Methods: Forty-nine patients who underwent robotic surgery for rectal cancer were retrospectively enrolled and categorized into two groups: robotic transabdominal approach alone (Rob-alone, n = 29) and TaRob approach (TaRob, n = 20). Patient characteristics, short-term postoperative outcomes, human resources, and surgical costs were compared between the groups.

Results: The tumor distance from the anal verge was shorter and preoperative treatment was performed more frequently in the TaRob group. The total operation time was shorter in the TaRob group (258 vs. 325 min), with no between-group differences in postoperative complications or pathological outcomes. Although the TaRob group required more staff than the Robot-alone group, the staff time consumed did not differ. The TaRob group had higher surgical costs for consumables than the robot alone group. These results were consistent before and after performing propensity score matching.

Conclusions: The combined approach after preoperative treatment for low rectal cancer resulted in a reduced operation time without any increased postoperative complications. The combined approach increased surgical costs, but could potentially reduce staff work hours, provided that sufficient staff is available.

Purpose: To compare the safety and efficacy of barbed and non-barbed sutures for fascial closure in abdominal surgery.

Methods: A systematic literature search through February 2025 identified studies comparing overall surgical site infections (SSI), fascial complications, and hospital stays between barbed and non-barbed sutures. A meta-analysis using random-effects models calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).

Results: Seven studies involving 12,278 patients (barbed group, n = 4912; non-barbed group, n = 7366) were included. The overall SSI rates were 1.9% and 4.0% in the barbed and non-barbed groups, respectively. Barbed sutures significantly reduced overall SSIs (OR, 0.41; 95% CI: 0.31-0.53; P < 0.001) without statistical heterogeneity. Barbed suture also significantly reduced the length of hospital stay (MD, - 1.13; 95% CI: - 1.42- - 0.83, P < 0.001) without statistical heterogeneity. No significant difference was observed in fascial complications between the groups (OR, 0.66; 95% CI: 0.36-1.22, P = 0.19).

Conclusions: This is the first meta-analysis to focus specifically on barbed sutures for abdominal fascial closure. Barbed sutures significantly reduce SSI and hospital stay without increasing fascial complications, thus suggesting that they are safe and efficient options for abdominal wall closure.

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 appropriate regimen and dosage of preoperative chemotherapy for gastric cancer (GC) with bulky lymph nodes (LNs) remain controversial. We conducted this study to evaluate the efficacy of preoperative chemotherapy using a modified regimen of docetaxel, cisplatin, and S-1 (DCS) for GC with bulky LNs, assessing feasibility, toxicity, response rate, and oncological outcomes.

Methods: Thirty-two patients who had GC with bulky LNs diagnosed between Jan, 2018 and Oct, 2022 received three or four cycles of modified DCS regimen preoperatively. The primary outcome was 3 year overall survival (OS).

Results: The completion rate of preoperative chemotherapy was 90.6% (4 cycles: 50.0%, 3 cycles: 40.6%). The disease control rate (DCR) and clinical response rate (RR) were 87.5% and 81.3%, respectively. Grade-3/4 neutropenia and anemia developed in 6.2% and 9.4%, respectively. Twenty-two patients with partial response (PR) agreed to undergo gastrectomy and LN dissection. Pathologic complete response (CR) was achieved in 15.6%. After surgery, there were no grade >  = 3 postoperative complications. The R0-resection rate was 65.6%. The 3 year OS and progression-free survival (PFS) rates were 43.0% and 37%, respectively, for all eligible patients. The 3 year OS and PFS of patients in the surgery group with negative para-aortic LNs were 58% and 47.0%, respectively.

Conclusion: Preoperative chemotherapy with a modified DCS regimen demonstrated high tolerance, a clinical response rate, and satisfactory 3 year survival outcomes. Thus, a preoperative modified DCS regimen with 3-4 cycles is a promising approach for GC with bulky LNs.

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.