Surgery Today最新文献

Purpose: To assess the safety and efficacy of neoadjuvant chemoradiotherapy with cisplatin plus S-1 for advanced non-small cell lung cancer (NSCLC), with a focus on real-world outcomes.

Methods: This retrospective study analyzed 32 patients with stage II-III NSCLC eligible for resection, who received preoperative induction therapy between January 2012 and December 2022. Specifically, 20 patients received cisplatin, S-1, and radiation therapy.

Results: Among the 32 patients who received induction therapy, the objective response rate (ORR) was 56.2%, and surgical resection was feasible in 29 patients (90.6%). The 5 year recurrence-free survival (RFS) rate was 76.4%, and the 3- and 5 year overall survival (OS) rates were 86.2% and 82.3%, respectively. In the cisplatin + S-1 + radiation therapy group (n = 20), the ORR was 65.0%, and surgical resection was feasible in 17 patients (85.0%). The 3-year RFS and OS rates were 78.3% and 83.8%, respectively. Ef. 3 (complete pathological response) was observed in 3 patients (10.3%). No recurrences occurred in the non-adenocarcinoma subgroup (n = 6), indicating better outcomes relative to the adenocarcinoma group (5-year RFS, 100% vs. 61.4%; p = 0.07).

Conclusions: Induction therapy, particularly with cisplatin + S-1 + radiation was associated with promising RFS and OS in locally advanced NSCLC, with favorable tolerability and effectiveness.

Purpose: Pleural adhesions, which may be present in varying degrees and involve blood vessels, often complicate thoracic surgery. The blood flow within pleural adhesions can be identified on computed tomography (CT) as micro-vessels beneath the pleural surface (MVBP). We conducted a prospective study to assess if MVBP can be detected on preoperative CT to predict intraoperative pleural adhesions.

Methods: This prospective study investigated the preoperative CT images of patients scheduled to undergo surgery for lung tumors. MVBP was defined as positive when lung vessels were identified below the pleura on CT. MVBP was evaluated for each lung segment, and intraoperative findings of pleural adhesions on the segments were then recorded.

Results: This study included 173 patients, with 1532 segments evaluated. Pleural adhesions were found in 51 patients and confirmed in 92 segments. The number of segments evaluated preoperatively as MVBP-positive was 134 (9%), of which 36 (26.9%) had pleural adhesions. Multivariable analysis identified that MVBP was an independent significant predictor (odds ratio = 2.29, 95% confidence interval 1.09-4.80, P = 0.028) of pleural adhesions on a per-patient basis.

Conclusions: MVBP is a valuable predictor of pleural adhesions. The method is useful in clinical practice because it does not require additional examinations and is easy to assess.

Aim: The best modality for evaluating lateral pelvic lymph node (LPLN) metastases from rectal cancer remains unclear. This study compared the diagnostic ability of 1-mm computed tomography (CT) and 3-mm magnetic resonance imaging (MRI) in identifying LPLN metastases based on size.

Methods: This observational study analyzed not individual patients but 191 sides from 100 rectal cancer patients without preoperative treatment for whom preoperative CT and MRI and corresponding pathological results for LPLNs were available. A swollen LPLN was defined as an LN with a short-axis size of ≥5 mm on 1-mm CT.

Results: LPLNs were detected significantly more frequently with 1-mm CT than with 3-mm MRI (p < 0.001). Among the 117 sides without swollen LPLNs, metastasis was observed in 1.7% of patients. In contrast, LPLN metastasis was confirmed in 28.4% of 74 sides with swollen LPLNs. In the evaluation of swollen LPLNs, 3-mm MRI yielded a 34% improvement in the diagnostic performance of LPLN metastasis over 1-mm CT (categorical net reclassification improvement: 0.341, p = 0.045).

Conclusions: In conclusion, 1-mm CT should be performed preoperatively to evaluate LPLNs. Further evaluations can be omitted in the absence of swollen LPLNs. In patients with swollen LPLNs, a careful assessment of LPLN metastasis should be conducted via additional MRI, even in early T-stage tumors.

Purposes: Postoperative stress hyperglycemia is reported to be associated with increased postoperative complications (PCs) following various surgical procedures. However, most reports of postoperative hyperglycemia are based on conventional, point blood glucose measurements. We sought to clarify trends in post-gastrectomy glucose levels using continuous glucose monitoring (CGM) and investigate the relationship between postoperative hyperglycemia and stress-related factors such as PCs and the degree of surgical invasiveness.

Methods: The subjects of this prospective study were 40 patients who underwent gastrectomy between November, 2022 and September, 2023. We recorded their glucose levels by CGM immediately after surgery until discharge (up to 2 weeks postoperatively).

Results: There was no increase in glucose levels caused by open gastrectomy, a strong inflammatory response, or PCs. Hyperglycemia, defined as the percentage of time that the glucose level was > 140 mg/dL, was associated only with the preoperative HbA1c value (P = 0.039). Patients with an HbA1c ≥ 6% had a significantly longer duration of hyper- and hypo-glycemia and greater glycemic variability than those with an HbA1c < 6% (glucose level < 70 mg/dL, P = 0.027; > 140 mg/dL, P = 0.001, coefficient of variation P = 0.024).

Conclusions: No association was observed between stress hyperglycemia during the acute phase following gastrectomy and PCs. Only patients with an elevated HbA1c had high rates of hypo- and hyper-glycemia and large glycemic variability, despite perioperative glucose management.

Purpose: To assess the influence of supervisory surgeons certified by the Japanese Society of Pediatric Surgeons (JSPS) and patient-related factors on the manipulation time of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC).

Methods: We retrospectively reviewed 469 SILPEC procedures that were performed between 2017 and 2023. Procedures were categorized based on whether or not the attending surgeons possessed JSPS certification as supervisors, and patient characteristics and manipulation time were compared. A multivariate analysis was also performed to evaluate the factors affecting manipulation time.

Results: In male patients, procedures attended by JSPS-certified supervisory surgeon had a shorter median (IQR) manipulation time (491.5 [396, 626.3] s) than those attended by non-certified surgeons (581 [445.3, 753] s; P = 0.0092). However, no significant difference was observed in female patients (367 [267.8, 623] vs. 399 [269.5, 593] s; P = 0.94). A multivariate analysis showed that, in males, attendance by a certified supervisor was associated with shorter manipulation times, whereas a history of hernia incarceration lengthened them. Furthermore, asymptomatic contralateral patent processus vaginalis repair was associated with shorter manipulation times in females.

Conclusion: Attendance by JSPS-certified supervisory surgeons significantly reduced manipulation time in male SILPEC cases. Considering patient background and procedural complexity, assigning JSPS-certified supervisory surgeons as attending surgeons may further enhance surgical efficiency.

Purpose: This study compared the peri- and postoperative outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer.

Methods: This retrospective cohort study included patients who underwent RATS or VATS at Nagoya University Hospital between April 2018 and March 2022. Propensity score matching was used to balance patient characteristics between the two groups. The following long-term outcomes were assessed: the 3-year overall survival (OS), causes of death, 3-year disease-free survival (DFS), and recurrence patterns. Various peri- and postoperative outcomes were examined as short-term outcomes.

Results: After propensity score-matching, 137 patients were included in each group. RATS was associated with a longer operative time (median 180 vs. 144 min, p < 0.001), less blood loss (median 5 vs. 12 ml, p = 0.005), and a lower rate of conversion to open thoracotomy (1 [0.7%] vs. 10 [7.4%], p = 0.010) than VATS. The 3-year OS and DFS were comparable between the groups.

Conclusion: In lobectomy for lung cancer, RATS demonstrated long-term outcomes that were comparable to those of VATS. Although RATS has a longer operative time, it is associated with less blood loss and a lower conversion rate to open thoracotomy than VATS, suggesting that it is a beneficial surgical approach for patients.

Purpose: This study investigated perioperative changes in quality of life (QOL) and the impact of preoperative QOL on the time to return to work (RTW) after surgery in patients with colorectal cancer.

Methods: Patients with clinical stage I-III colorectal cancer who were employed at the diagnosis and scheduled for curative surgery between 2019 and 2020 were prospectively enrolled at 7 hospitals in Japan. The patients' EORTC-QLQ-C30 scores and employment status were collected before and at 6 and 12 months after surgery and compared using a paired t test. The Kaplan-Meier method and multivariable Cox regression model were applied to examine the impact of preoperative QOL on the time to RTW.

Results: A total of 127 patients were analyzed. Regarding financial difficulties, 48% of patients had low preoperative scores, which significantly improved at 6 (preoperatively: 21.7 vs 6 months: 11.3; p < 0.001) and 12 months (6 months: 11.3; 12 months: 7.9; p = 0.016) postoperatively. RTW was significantly delayed in patients with a low preoperative cognitive function (p = 0.039) and severe fatigue (p = 0.024). The adjusted hazard ratio was 0.73 for a low cognitive function and 0.62 for strong fatigue.

Conclusion: Working patients with colorectal cancer experienced severe financial difficulties preoperatively, which decreased postoperatively. The preoperative cognitive function and fatigue affected the postoperative time to RTW.

Purpose: To evaluate the incidence of IgG4-related vascular disease (IgG4-VD) in aneurysm enlargement after endovascular aneurysm repair (EVAR).

Methods: Of 1482 EVAR cases in which patients underwent initial treatment at our hospital, 33 patients who underwent open surgery for an enlarged aneurysm were retrospectively identified. Histopathological examination of the aneurysm wall specimens was performed and the relationship of the histopathological findings with IgG4-VD was investigated.

Results: The median aneurysm diameter at EVAR was 53 mm (interquartile range [IQR] 50-55), and the aneurysm diameter at open surgery was 79 mm (IQR 75-88). Six patients (18%) were histopathologically diagnosed with IgG4-VD. Relative to the non-IgG4-VD cases, the patients with IgG4-VD had a higher incidence of coronary artery disease (83% vs. 30%, p = 0.015) and greater aneurysm wall thickness at the time of open surgery (2.4 mm vs. 1.6 mm, p < 0.001). Serum IgG4 levels were significantly higher in patients with IgG4-VD than in those without IgG4-VD (218 mg/L vs. 46 mg/L, p = 0.002).

Conclusions: IgG4-VD was found in 18% cases with enlarged aneurysms after EVAR. If aneurysm enlargement is observed after EVAR, measurement of the aneurysm wall thickness using preoperative CT angiography and the evaluation of serum IgG4 levels could be useful for diagnosing occult IgG4-VD.

Purpose: To compare the benefits of ultrasound-guided reduction (UGR) followed by elective versus emergency repair for incarcerated obturator hernia (OH).

Methods: This is a retrospective cohort study. Before UGR implementation, all patients with incarcerated OH underwent emergency surgery. To compare the UGR candidates fairly, only patients who did not require bowel resection were classified as the emergency group. Following UGR implementation, the patients without bowel necrosis, based on our criteria, underwent UGR. Among these, those who underwent elective repair were classified into the elective group. The surgical outcomes were compared between the groups and are presented as the median (range).

Results: Among the 60 patients with incarcerated OH, 23 were in the emergency group and 11 in the elective group. UGR was successful in 16 of 17 cases (94%). The elective group had significantly shorter times to first defecation (4 [1-7] vs. 0 [0-1]) and meal initiation (3 [1-8] vs. 1 [1-3] days) than the emergency group. Although not statistically significant, the mesh repair rate was higher in the elective group (100% vs. 78%, respectively).

Conclusions: UGR can be safely performed with an appropriate diagnosis. Compared with emergency surgery, UGR followed by elective repair led to reduced postoperative ileus and elevated mesh repair rates.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) in the first-order or main trunk/contralateral branches (Vp3/4) is poor. The present study aimed to clarify the real-world data of atezolizumab plus bevacizumab treatment (Ate/bev) for HCC patients with Vp3/4 PVTT.

Methods: The subjects of this study were 22 consecutive HCC patients with Vp3/4 PVTT, who were treated with Ate/bev. Survival rates and radiological responses were evaluated based on the modified albumin-bilirubin (mALBI) grade [mALBI 1 + 2a (1/2a) versus 2b + 3 (2b/3)] using the modified Response Evaluation Criteria in Solid Tumors.

Results: The median survival time of the 22 patients was 15.0 months, with 1- and 2-year survival rates of 62.7% and 49.3%, respectively. The objective response (OR) rates of patients with mALBI 1/2a and 2b/3 were 91.7% (11/12) and 10.0% (1/10), respectively, with a significant difference (p < 0.001). The 2-year survival rates of patients with mALBI 1/2a and 2b/3 were 78.6% and 20.0%, respectively, with a significant difference (p = 0.0041).

Conclusion: Ate/bev was effective for treating HCC patients with Vp3/4 PVTT. OR rate and MST were favorable, particularly for patients with preserved liver function (mALBI 1/2a), suggesting its great potential for the treatment of HCC in patients with Vp3/4 PVTT.