Surgery Today最新文献

Purpose: To preserve the lung function, sublobar resection is considered better than lobectomy in octogenarians with clinical stage IA (c-stage IA) lung cancer. We explored the survival benefits of lobectomy versus sublobar resection in octogenarians undergoing surgery for c-stage IA lung cancer.

Methods: Between April 2004 and December 2024, 289 of the 2,650 patients who underwent surgery for lung cancer were octogenarians with c-stage IA. We analyzed survival and prognostic factors using propensity score matching to compare lobectomy and sublobar resection.

Results: The median patient age was 82 years (range, 80-91 years), and the 90-day mortality rate was 0.7%. Lobectomy, segmentectomy, and wedge resection were performed in 109 (37.7%), 86 (30.0%), and 94 (32.5%) patients, respectively. The 5-year OS rates for lobectomy, segmentectomy, and wedge resection were 61.7%, 74.0%, and 63.0%, respectively (p = 0.382). After propensity score matching, no significant differences in survival were observed between the lobectomy and sublobar resection groups (p = 0.382). There was no difference in the 5-year cumulative incidence of cancer-related deaths between lobectomy (10.5%) and sublobar resection (8.7%) (p = 0.822). A multivariate analysis confirmed that lower performance status was a significant prognostic factor (p < 0.001).

Conclusions: The surgical procedure type did not affect overall survival in octogenarians with c-stage IA lung cancer, and performance status was a key prognostic factor.

Purpose: Liver metastases from colorectal cancer (CRLM) are a major determinant of the prognosis of metastatic colorectal cancer. Although curative resection is recommended for resectable CRLM, recurrence remains a challenge and the criteria for patient selection and repeat resection are still unclear. We conducted this study to evaluate the outcomes of metastatic lesion resection with curative intent (R0 resection), to identify the factors associated with recurrence, and to establish the feasibility of repeat metastasectomy.

Methods: This single-center retrospective study analyzed 135 patients with synchronous CRLM, who underwent surgical resection or received chemotherapy between January, 2013 and March, 2023.

Results: R0 resection was achieved in 62 (45.9%), with a median recurrence-free survival of 12.3 months. Recurrence developed in 50 (80.6%) of these patients and 28 underwent repeat R0 resection. Initial R0 resection was associated with significantly improved overall survival (OS; hazard ratio [HR], 0.12; p < 0.01) and repeat R0 resection after recurrence improved survival further (HR, 0.32; p = 0.019). Conversion surgery, performed in 42 of 114 patients (36.8%) initially treated with chemotherapy, was significantly associated with the absence of extrahepatic metastases and H1 liver metastases.

Conclusions: These findings highlight the importance of individualized treatment strategies for optimizing CRLM outcomes.

Purpose: Predicting perioperative complications in high-risk elderly patients with lung cancer has become increasingly important as the population ages. This study investigated the relationship between preoperative diaphragmatic thickness (DT) and perioperative complications.

Methods: We enrolled 101 patients ≥ 75 years old who had undergone radical resection for primary lung cancer between 2013 and 2018. Bilateral DT was measured on axial and coronal computed tomography, and the mean DT (MDT) was calculated based on these measurements. Outcomes were assessed based on postoperative complications, defined as Clavien-Dindo classification ≥ 2.

Results: The MDT was 3.51 ± 1.00 mm. Thirteen patients who experienced postoperative respiratory complications had a significantly lower MDT than a higher MDT (p = 0.0390). Multivariate logistic regression analyses revealed that an MDT ≤ 3.63 mm was an independent factor associated with postoperative complications (odds ratio, 5.559).

Conclusions: Patients with a low MDT are at an increased risk of postoperative complications. Therefore, these patients require careful perioperative management.

Purpose: Patients with chronic limb-threatening ischemia (CLTI) often have multiple comorbidities and a poor prognosis. This study analyzes the association between the masseter muscle area (MMA), pneumonia, and the overall survival of CLTI patients older than 65 years.

Methods: The subjects of this retrospectively analysis were 54 consecutive patients with CLTI. The MMA was assessed by computed tomography (CT) as the largest cross-sectional area of the masseter muscle, located 2 cm below the zygomatic arch, at diagnosis. Pneumonia was defined as radiographic infiltrates with fever or leukocytosis, requiring hospitalization within 1 year after diagnosis. The endpoints were pneumonia incidence and survival.

Results: Pneumonia developed within 1 year in 22 patients (41%). Multivariate analysis revealed significant associations with male gender (OR: 6.24, p = 0.048), history of pneumonia (OR: 5.21, p = 0.048), and low MMA (OR: 4.46, p = 0.045). Survival rates were 72% at 1 year, 35% at 5 years, and 24% at 10 years. Low MMA was the only significant predictor of overall survival (p < 0.001).

Conclusion: The MMA was significantly associated with pneumonia and the poor prognosis of CLTI patients over the age of 65 years. As an indicator of oral frailty, the MMA may serve as a useful prognostic marker to guide treatment planning and interventions in this high-risk population.

Purpose: Incisional hernia (IH) often develops during surveillance after colorectal cancer surgery, with repair sometimes delayed due to the risk of recurrence. This study aimed to identify the risk factors for IH enlargement by objectively measuring the changes in defect size.

Methods: We retrospectively analyzed 83 patients who developed IH after curative laparoscopic colorectal surgery at the Osaka Rosai Hospital between 2017 and 2021. Computed tomography was used to measure the IH defect sizes at diagnosis and at the end of the surveillance. Univariate and multivariate analyses were performed to determine the risk factors for enlargement.

Results: The median IH defect size increased from 23.7 to 32.7 mm over a median follow-up of 1003 days. The highest quartile of defect size change was 12.1 mm and was used to classify patients into stable and enlarged IH groups. A multivariate analysis revealed that a high body mass index (≥ 25 kg/m²; odds ratio [OR] 3.527, p = 0.037), early IH discovery (< 225 days after surgery; OR 4.753, p = 0.012), and high neutrophil-to-lymphocyte ratio (> 2.45; OR 3.604, p = 0.031) were independent risk factors for IH enlargement.

Conclusions: Obesity, early IH development, and systemic inflammation are associated with IH progression. Careful monitoring of patients with these risk factors is warranted.

The Japan Society for Treatment of Obesity has repeated nationwide surveys on bariatric/metabolic procedures, including endoluminal procedures. We report the changes from 2021 to 2024. An e-mail survey was sent to 108 Japanese institutions that performed the bariatric/metabolic procedures. The number of laparoscopic bariatric/metabolic surgeries was as follows: 2021 (n = 890), 2022 (n = 985), 2023 (n = 936), and 2024 (n = 915). The number of laparoscopic sleeve gastrectomy (LSG) with bypass procedures increased in 2024 according to insurance coverage. Additionally, the number of LSGs for body mass index (BMI) < 35 kg/m² drastically increased in 2024 according to changes in insurance coverage. The number of endoluminal bariatric/metabolic procedures was as follows: 2021 (n = 40), 2022 (n = 51), 2023 (n = 72), and 2024 (n = 80). Intragastric balloon placement and endoscopic sleeve gastroplasty were performed. The proportions reversed over four years. In Japan, the number of LSG with bypass procedures and LSGs for BMI < 35 kg/m² is expected to increase in the future.

Background: The impact of perioperative chemotherapy, including neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC), given for resectable colorectal liver metastasis (CLM) remains unclear. This study evaluates the optimal strategy for managing high-risk CLM.

Methods: The subjects of this retrospective study were patients who underwent liver resection for initially resectable CLM between 2006 and 2021. High-risk status was defined by four or more metastases, a tumor size ≥ 5 cm, or the presence of resectable extrahepatic disease. Among 363 eligible patients, 293 received NAC and 70 underwent upfront surgery. Propensity score matching (PSM) created balanced groups of 70 each.

Results: Among the patients who received NAC, seven did not undergo resection because they had disease progression. Intention-to-treat analysis revealed significantly longer median progression-free survival (PFS) (1.1 vs. 0.6 years, p < 0.001) and overall survival (OS) (5.2 vs. 4.3 years, p = 0.044) in the NAC group. Matched analysis confirmed superior PFS (1.2 vs. 0.6 years, p = 0.004) and a favorable OS trend (5.4 vs. 4.3 years, p = 0.164). Completion of the perioperative sequence of NAC, surgery, and AC was associated with the most favorable outcomes.

Conclusion: Achieving a sequential strategy of NAC, surgery, and AC may improve the long-term survival of patients with high-risk CLM, supporting its potential as a standard treatment strategy.

Esophagectomy is the standard treatment for resectable esophageal cancer (EC). Recently, the prognosis of EC has gradually improved owing to the introduction of minimally invasive surgery, enhanced postoperative recovery, and perioperative nutritional treatment. However, more than half of the patients who undergo esophagectomy experience recurrence, even after curative esophagectomy. Once EC recurs, the prognosis for patients with recurrent EC is limited. Tumor cell metastasis is the most common cause of recurrence. Micrometastatic cells grow in unresectable regions after curative esophagectomy. Therefore, control of micrometastasis is necessary to prevent the recurrence of EC in the perioperative period. Perioperative adjuvant treatment has been introduced for various malignancies, including EC, to prevent recurrence due to micrometastasis. Since 1990, evidence has emerged regarding postoperative adjuvant treatment, preoperative adjuvant treatment, and perioperative adjuvant treatment for resectable EC. To optimize adjuvant treatment for resectable esophageal cancer, it is necessary to understand the characteristics of each approach before the introduction of adjuvant treatment for resectable esophageal cancer. This review summarizes the background, current status, and future perspectives of adjuvant therapy for resectable esophageal cancer.

Purpose: Colorectal cancer (CRC) is a major cause of cancer-related mortality. Current prognostic models rely primarily on tumor-specific features and may overlook host-tumor interactions. We conducted this study to assess the prognostic value of the cancer-inflammation prognostic index (CIPI), which combines carcinoembryonic antigen and neutrophil-to-lymphocyte ratio, in patients with stage II CRC.

Methods: The subjects of this retrospective study were 326 patients with pathologically confirmed stage II CRC who underwent curative resection at our hospital between 2008 and 2018. The optimal CIPI cutoff for predicting 5 year survival was established using receiver operating characteristic analysis. Patients were classified into High- and Low-CIPI groups, and survival outcomes were compared.

Results: Multivariate analysis identified a high CIPI (≥ 56.9) and inadequate lymph node dissection (≤ 12 nodes) as independent predictors of worse disease-free survival (DFS), and a high CIPI, older age, performance status ≥ 3, and limited lymph node dissection as independent predictors of worse overall survival (OS). Patients with a high-CIPI had significantly lower 5 year DFS and OS.

Conclusion: CIPI is a simple, objective preoperative biomarker independently associated with recurrence and survival in patients with stage II CRC and may enhance risk stratification for adjuvant therapy and postoperative surveillance.

Purpose: Pancreaticoduodenectomy is associated with high morbidity, notably due to complications, such as postoperative pancreatic fistula and intra-abdominal hemorrhaging. The early detection of such complications is crucial for improving outcomes. The peripheral blood eosinophil ratio, which reflects the endogenous corticosteroid activity, may indicate physiological stress or inflammation. This study evaluated whether or not changes in the eosinophil ratio could predict postoperative complications.

Methods: A retrospective review of patients who underwent pancreaticoduodenectomy between January 2011 and December 2020 at Jikei University Kashiwa Hospital was conducted. The postoperative eosinophil ratio trends were analyzed in relation to complications.

Results: Among 200 patients, 85 experienced Clavien-Dindo grade ≥ III complications. A biphasic pattern in the eosinophil ratio was observed in these patients, with a secondary decline correlating with the onset of complications. Using a cutoff of 0.95%, the sensitivity, specificity, and area under the curve for predicting severe complications were 0.92, 0.92, and 0.96, respectively (95% confidence interval 0.93-0.99).

Conclusion: A sustained decrease in the peripheral blood eosinophil ratio was associated with severe postoperative complications. This marker may be useful for early detection, enabling prompt diagnostic and therapeutic intervention following pancreaticoduodenectomy.