Surgery Today最新文献

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.

Purpose: Few reports have so far compared cases of Stage IV colorectal cancer in which primary tumor resection or stoma creation was performed prior to systemic chemotherapy.

Methods: We retrospectively reviewed 246 patients with clinical Stage IV colorectal cancer who underwent surgery followed by systemic chemotherapy. The patients were divided into two groups: those who underwent only stoma creation (stoma group, n = 62) and those who underwent primary tumor resection (resection group, n = 164).

Results: The stoma group had more male patients (stoma group vs. resection group, 74.2% vs. 54.8%; p = 0.009), more comorbidities (88.7% vs. 73.2%, p = 0.012), and more rectal tumors (38.7% vs. 11.0%; p < 0.001); after propensity score matching, no differences were seen, but shorter operation time (110 vs. 174 min; p < 0.001), less blood loss (5 vs. 11 mL; p < 0.001), longer hospital stay (19 vs. 14 days; p = 0.003), and a shorter duration from surgery to first chemotherapy (27 vs. 35 days; p < 0.001) were seen in the stoma group, with a better overall survival in the resection group (p = 0.036).

Conclusion: Primary resection of stage IV colorectal cancer is associated with a better prognosis. However, highly invasive surgery may cause postoperative complications and a poor prognosis; therefore, careful consideration of its appropriateness is necessary.