Surgery Today最新文献

Purpose: To investigate the current status of regional disparities in surgical residency training between urban and regional hospitals.

Methods: Based on a nationwide online questionnaire survey of newly certified surgical trainees, the responding residents were divided into the following two groups according to the size of the city in which they had trained: the urban city group (UC group; population > 1 million) and the regional city group (RC group; population < 1 million. Surgical education and work environment of the two groups were compared.

Results: The UC group (n = 317, 42%) was characterized by greater post-graduate experience, older age, a higher proportion of female surgeons, and a higher percentage of full-time working partners relative to the RC group (n = 439, 58%). More residents in the UC group were from urban areas, whereas the RC group had more residents from regional areas. No differences were observed in the number of surgeries performed, published papers, opportunities for off-the-job training, or satisfaction with the surgical residency training program. With the exception of higher income in the RC group, no differences were observed for other factors related to the work environment.

Conclusions: There was little regional disparity regarding the impressions of surgical residency training between urban and regional cities, including surgical education and work environment.

Purpose: The relationship between sarcopenia and post-liver transplant (LT) mortality is still not well understood. This study aims to provide an updated and comprehensive meta-analysis evaluating the impact of sarcopenia on the survival of LT patients.

Methods: We conducted searches in PubMed, Web of Science, and EMBASE up until May 2, 2024, without language restrictions. The primary outcome measured was the overall post-LT mortality risk associated with sarcopenia. The DerSimonian-Laird random effects model was used to calculate pooled adjusted hazard ratios (HRs).

Results: Eighteen cohort studies comprising a total 6297 LT patients were included. The overall prevalence of sarcopenia was 27% (95% CI: 26%-28%), and this rate was lower when sarcopenia was defined using the third lumbar-skeletal muscle index in men, and among patients with lower Child-Pugh class. Sarcopenia remained significantly associated with higher mortality, with a pooled adjusted HR of 1.55 (95% CI 1.28-1.89). This association held across subgroups based on sex, study location, sarcopenia definition, study quality, and living donor LT recipients. A sensitivity analysis excluding groups with a high proportion of hepatocellular carcinoma patients showed similar findings (HR 1.63, 95% CI 1.13-2.35). No significant heterogeneity was identified in any of the analyses.

Conclusions: This meta-analysis shows that sarcopenia is significantly associated with increased mortality after LT. Thus, the risk of sarcopenia should be factored into the initial evaluation of LT candidates.

Purpose: To investigate the feasibility of combined robotic rectal surgery and transanal total mesorectal excision (hybrid robotic surgery).

Methods: Among 143 robotic rectal surgeries performed from 2017 to 2022, 85 were hybrid robotic surgeries and were analyzed in this study. The cohort comprised 59 males and 26 females with a mean age of 65.8 years old and a mean body mass index of 22.6 kg/m². The cStage was I in 20 cases, II in 21, III in 36, IV in 4, and other in 4. The operation types were low anterior resection in 21 cases, intersphincteric resection in 27, abdominoperineal resection in 32, total pelvic exenteration in 2, and other in 3. Twelve patients (14.1%) received neoadjuvant chemotherapy or chemoradiotherapy, and 39 (45.9%) underwent lateral lymph node dissection.

Results: The mean operation time for total mesorectal excision was 302.7 min, and the median blood loss was 71.5 ml. No cases required conversion to laparotomy. The median length of postoperative hospital stay was 15.9 days. Complications of Clavien-Dindo grade ≥ 3 occurred in 3 cases (4.2%). Urinary dysfunction occurred in 6 cases (8.3%). Three (4.2%) patients were diagnosed with positive circumferential resection margins.

Conclusion: Hybrid robotic surgery is safe and oncologically feasible.

Purpose: Elderly patients with esophageal squamous cell carcinoma (ESCC) have more comorbidities than young patients do. Elderly smokers have a high mortality rate owing to physical dysfunction. This study aimed to identify risk factors for long-term outcomes after minimally invasive esophagectomy (MIE) in elderly patients with ESCC.

Methods: This study included 110 elderly patients (aged ≥ 75 years) with ESCC who underwent MIE at Kobe University Hospital. Multivariate Cox proportional hazards regression analyses were performed to identify risk factors, including the geriatric nutritional risk index (GNRI), Charlson comorbidity index, and elderly smoker status, defined as smoking at the age of 70 years.

Results: Multivariate analysis identified that elderly smokers, cT or cN status (≥ cT2 or cN-positive), and GNRI (≤ 92) were independent prognostic factors for overall survival (p = 0.026, 0.019, and 0.038, respectively). For patients with ≥ cT2 or cN-positive ESCC, elderly smokers or patients with GNRI (≤ 92) have significantly worse survival (p = 0.038). Elderly smokers were at risk of death from other diseases five years postoperatively (p = 0.016).

Conclusions: Elderly smokers, cT2 or cN positivity, and low GNRI were risk factors for poor survival. Furthermore, for patients with ≥ cT2 or cN-positive ESCC, these risk factors were associated with poor survival.

Purpose: To analyze the clinicopathological features and perioperative outcomes of patients who underwent robot-assisted thoracoscopic surgery (RATS) for primary lung cancer in the initial period after insurance approval in Japan.

Methods: The data source was the National Clinical Database, using four annual datasets (2018, 2019, 2020, and 2021) that included information on individuals who underwent lobectomy with lymph-node dissection via robot-assisted thoracoscopic surgery for primary lung cancer. Clinicopathological features and perioperative outcomes by year were analyzed descriptively.

Results: The median console time was reduced by 22 min from 2018 to 2021 (from 171 min to 149 min, respectively). The median overall operative time was also reduced by 29 min from 2018 to 2021 (from 245 min to 216 min, respectively). The conversion rate from robotic to other approaches was 3.5% in 2018 and 2.4% in 2021, with the frequency decreasing each year. The incidence of postoperative complications ranged from 14.6% to 16.6%, and the 90-day mortality rate ranged from 0.3% to 0.5%, with no remarkable change within the study period.

Conclusions: The initial perioperative outcomes of RATS for lung cancer in Japan were favorable. Further accumulation of cases and comparative analyses of long-term outcomes with other approaches are expected.

Purpose: To identify the current challenges faced by children with surgically treated esophageal atresia (EA) at the start of elementary, junior high, and high schools.

Methods: Questionnaire surveys were administered at the pediatric surgery departments of 19 representative institutions across Japan between December 1, 2018, and January 31, 2019. The surveys included gross classification, status of hospital visits, surgical procedures, postoperative complications, symptoms at the time of the final evaluation, status of school attendance, and related information at 7, 13, and 16 years old.

Results: A total of 572 children with EA were included. Data from 59 first-grade elementary school students, 42 first-year junior high school students, and 30 first-year high school students were extracted for this study. Most postoperative complications remained unresolved, and many children with EA continued to exhibit symptoms at the final evaluation. Despite many children having clinical and academic problems, 33% (43/131) were lost to follow up.

Conclusion: Older children with EA experience various problems. Long-term follow-up and continuous support are important for all EA patients.

Sleeve segmentectomy was originally developed to preserve the lung volume in patients who were unable to tolerate lobectomy. We herein report an immunocompromised patient with potentially curable peripheral squamous cell carcinoma in whom sleeve basal segmentectomy was performed for a 1.8-cm tumor with endobronchial growth that occluded B7 and invaded the inlet of the middle lobar bronchus and B6. To provide sufficient surgical exposure for complex double-barrel reconstruction after segmentectomy, A6 was divided and reconstructed after the anastomosis was complete. This technique may be applicable to other peripheral bronchial reconstructions to minimize blood flow disruption to bronchial anastomosis.

Purpose: This study explored the predictive factors for surgical site infection (SSI) in a pediatric ulcerative colitis (UC) population.

Methods: Data from 35 patients with UC who underwent surgery before 15 years at Mie University Hospital between January 2000 and December 2022 were retrospectively reviewed. Potential preoperative and intraoperative predictors of SSI, including various demographic and clinical variables, were analyzed using the Mann-Whitney U test and logistic regression analysis. The optimal cutoff value for the variables was determined by examining the receiver operating characteristic curve.

Results: Of the 35 patients, 8 (22.9%) experienced SSI. The platelet-to-albumin ratio (PAR) is a more accurate predictor of SSI occurrence than the serum albumin level, platelet count, or C-reactive protein level. The sensitivity and specificity of PAR were 75.0% and 77.8%, respectively, with an area under the curve (AUC) of 0.782 (p = 0.018). A multivariable analysis revealed that preoperative PAR was the only significant independent predictor (cutoff value: 115,000, p = 0.047) when the optimal cutoff value was applied rather than the median value.

Conclusions: This study demonstrated the value of the preoperative PAR in the management of pediatric patients with UC. Assessing the patient's PAR before surgery allows proactive treatment to reduce the risk of SSI.

Purpose: Colorectal necrosis is a serious condition associated with high morbidity and mortality. We investigated the clinical features and prognostic factors of patients who underwent emergency surgery for colorectal necrosis.

Methods: Data from 40 patients who underwent surgery for colorectal necrosis were reviewed retrospectively to assess the various clinical and operative factors and risk factors for hospital mortality.

Results: The Kaplan-Meier method showed that total colectomy, a platelet count < 100,000/μL, a prothrombin time-international normalized ratio ≥ 1.5, creatine kinase ≥ 566 U/L, lactate ≥ 22.8 mg/dL, base excess < - 12 mmol/L, platelet-lymphocyte ratio < 321, and C-reactive protein/albumin ratio < 1.0 were significantly associated with poor prognosis. Multivariate analyses identified that a platelet count < 100,000/μL (hazard ratio = 7.101, p = 0.0070) and base excess < -12 mmol/L (hazard ratio = 3.663, p = 0.0464) were independent predictive factors for hospital mortality in patients with colorectal necrosis. We established a novel prognostic score based on platelet count, creatine kinase, and base excess. Patients with a novel prognostic score ≥ 4 had significantly poorer survival rates than patients with a score ≤ 3 (0.0% vs. 73.4%, p < 0.001).

Conclusions: A platelet count < 100,000/μL and base excess < - 12 mmol/L are associated with a poor prognosis for patients with colorectal necrosis. This novel prognostic score may be a more accurate prognostic factor for patients with colorectal necrosis.

Purpose: This study aimed to examine the influence of ground-glass opacity (GGO) on the prognosis of epidermal growth factor receptor (EGFR)-mutated pathological (p)-stage IB non-small cell lung cancer (NSCLC).

Methods: Between 2009 and 2021, 115 patients underwent complete anatomical lung resection with mediastinal lymphadenectomy for p-stage IB non-squamous NSCLC harboring common EGFR mutations. The patients were classified into the part-solid and pure-solid arms based on the presence of GGO components.

Results: The median follow-up time was 70.2 months. Sixty-seven patients (58%) had pure-solid tumors and 112 (97%) were diagnosed with adenocarcinoma. No patients received adjuvant EGFR-tyrosine kinase inhibitors (TKIs). The 5-year disease-free survival (DFS) rates in the pure-solid arm were significantly lower than those in the part-solid arm (5-year DFS: 45.3% vs. 86.8%, p < 0.01). The 5-year cumulative incidence of recurrence was higher in the pure-solid arm than that in the part-solid arm (49.9% vs. 9.0%, p < 0.01). A multivariable analysis revealed that pure-solid tumors were an independent prognostic predictor of disease-free survival, whereas pathological factors were not.

Conclusions: In EGFR-mutated p-stage IB NSCLC, pure-solid tumors were significant predictors of DFS. The presence of GGO components should be considered in the decision criteria for adjuvant therapy with TKIs.