Surgery Today最新文献

Purpose: To investigate the independent predictors of progression-free survival (PFS) after gemcitabine, cisplatin, and durvalumab (GCD) therapy for advanced biliary tract cancer (BTC), including the thyroid-stimulating hormone (TSH) ratio pre- and post-GCD.

Methods: The subjects of this retrospective analysis were 29 patients receiving GCD for advanced BTC. The cutoff TSH ratios were determined by a receiver operating characteristic (ROC) curve for PFS. The independent predictors of PFS after GCD were determined by univariate and multivariate analyses.

Results: The median PFS was 4.9 (range, 0.9-16.8) months. The objective response and disease control rates were 13.0% and 52.2%, respectively. The cutoff values of the TSH ratio after one and two cycles were 0.97 [area under the ROC curve (AUROC): 0.86, 95% confidence interval (CI): 0.70-1.00], p = 0.02] and 1.2 (AUROC: 0.820, 95% CI: 0.664-0.976), respectively. Multivariate analysis identified pretreatment neutrophil-to-lymphocyte ratio (NLR) ≥ 5 [hazard ratio (HR): 6.27, 95% CI: 1.83-21.5, p = 0.004] and TSH ratio after two cycles of < 1.2 (HR: 3.25, 95% CI: 1.25-8.46, p = 0.02) as independent predictors of PFS.

Conclusion: The TSH ratio after two GCD cycles of < 1.2 and a pretreatment NLR ≥ 5 are potential prognostic factors for poor PFS.

Purpose: This study evaluated the clinical impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with different stages of colorectal cancer.

Methods: We retrospectively included patients diagnosed with colon and rectal cancer who underwent colectomy or proctectomy at a single institute between 2017 and 2018. The primary outcome was to investigate the cutoff value of the NLR for 5-year recurrence and survival. The secondary outcome was to evaluate the clinical impact of the NLR according to stage.

Results: In this cohort of 192 patients, the optimal NLR cutoff value was 4.0. Univariate analyses showed that carcinoembryonic antigen (CEA) level, white blood cell (WBC) count, lymphocyte count, stage, and high NLR were associated with 5-year overall survival (p < 0.001, p = 0.01, p = 0.008, p < 0.001, and p < 0.001, respectively), and multivariate analyses showed that NLR was independently associated with 5-year overall survival (p = 0.013). When stratified by cancer stage, NLR influenced survival outcomes in patients with stage III and IV disease (p < 0.001 and 0.047, respectively).

Conclusion: A cutoff value of NLR 4.0 is strongly associated with 5-year overall survival in patients with stage III and IV colorectal cancer.

Purpose: In this study, we aimed to investigate the association between preoperative oral frailty, nutritional status, and postoperative complications in patients who underwent curative gastrointestinal (GI) cancer surgery.

Methods: We retrospectively analyzed 181 patients who underwent curative resection for GI malignancies between April 2022 and March 2024. Oral frailty and nutritional status were assessed using the Oral Frailty Index-8 (OFI-8) and Mini Nutritional Assessment-Short Form (MNA-SF) through structured, nurse-administered preoperative questionnaires. Complications were defined as Clavien-Dindo grade ≥ 2. Logistic regression analyses were used to identify independent risk factors.

Results: Complications occurred in 30.9% of the participants. Participants with both oral frailty (OFI-8 ≥ 4) and a risk of malnutrition (MNA-SF ≤ 11) had the highest complication rate (55.2%). In the multivariate analysis, the combination of these two factors was an independent predictor of postoperative complications (odds ratio: 3.16, p = 0.01).

Conclusions: Preoperative oral frailty and malnutrition are significant predictors of postoperative complications in patients with GI cancers. A simple composite score combining OFI-8 and MNA-SF may improve risk stratification and inform multidisciplinary preoperative care strategies to optimize surgical outcomes.

Purpose: Rituximab-based desensitization has enabled successful ABO-incompatible (ABO-I) liver transplantation (LT) by preventing antibody-mediated rejection (AMR). However, its effect on T cell-mediated rejection (TCMR) remains unclear. We conducted a comparative analysis between ABO-compatible (ABO-C) and ABO-I LT to evaluate the effects of rituximab-based desensitization on TCMR.

Methods: We retrospectively analyzed 45 LT recipients (32 ABO-C and 13 ABO-I recipients) treated with basiliximab-based immunosuppression. The ABO-I group additionally received rituximab-based desensitization therapy. The lymphocyte subpopulations, rejection, adverse events, and outcomes were assessed.

Results: AMR was not observed in either group. TCMR occurred within 4 weeks post-transplantation in 0% of ABO-C cases and 38.5% of ABO-I cases (P = 0.0011). In ABO-C, a significant increase in B cells (CD19+) was observed within the first week, whereas in ABO-I, B cells remained depleted and an increase in T cells (CD3+) was observed. In all the ABO-I cases, TCMR occurred under suppressed CD25 + conditions. Adverse events were comparable between the groups. The 1-year survival rates for the ABO-C and ABO-I groups were 96.9% and 100%, respectively.

Conclusion: Rituximab-based desensitization in ABO-I LT is associated with an increased incidence of early TCMR. Rituximab-induced B-cell depletion may promote T-cell activation through an IL-2-independent pathway, potentially contributing to increased TCMR.

Purpose: Textbook outcome (TO) reflects ideal surgical and postoperative quality measures from the patient's perspective. Non-achievement of a TO has been linked to a poor prognosis after colorectal cancer surgery. Minimally invasive colectomy (MIC), being considerably less invasive than open colectomy (OC) may improve prognosis; however, its effect on the long-term prognosis of patients with non-achievement of a TO remains unclear. This study investigated the impact of TO achievement on prognosis after OC and MIC.

Methods: The subjects of this retrospective analysis were 256 patients who underwent OC and 472 patients who underwent MIC for colorectal cancer at Miyazaki Prefectural Nobeoka Hospital or Kumamoto University. TO was defined by five criteria: surgery within 6 weeks of diagnosis, radical resection, lymph node (LN) yield ≥ 12, no stoma, and no adverse outcomes. TO was achieved when all criteria were met; otherwise, the result was defined as non-TO (nTO). Both OC and MIC groups were stratified by TO status.

Results: TO achievement was significantly higher after MIC than after OC (39.0%, and 31.6%, respectively; p = 0.049). After OC, nTO patients had significantly worse 5-year overall survival than TO patients (log-rank p = 0.011). Multivariate analysis identified nTO as an independent risk factor for poor prognosis after OC [hazard ratio: 2.81; 95% confidence intervals (CI): 1.330-6.428; p = 0.0060]. In contrast, nTO had no significant impact on prognosis after MIC (log-rank p = 0.14).

Conclusions: Non-achievement of a TO predicted poorer prognosis after OC but not MIC. The lower invasiveness of MIC may promote better long-term outcomes, even if a TO is not achieved.