Surgery Today最新文献

Purpose: Traditionally, cardiovascular surgeons (CSs) in Japan work long hours. To evaluate the impact of the 2024 Work Style Reform on their work environment, we analyzed how the working conditions of CSs have changed since the reform's implementation.

Methods: We conducted an anonymous web-based survey during a patient-safety session at the 55th Annual Meeting of the Japanese Society for Cardiovascular Surgery.

Results: Of the 1,229 respondents, 1,124 board-certified CSs were included in the analysis. Among them, 64.6% reported working over 60 h per week and 29.5% were unaware of their institution's designated work-hour category. Younger age (adjusted odds ratio [aOR]: 0.594) and employment at a university hospital (aOR: 2.071) were independently associated with extended working hours. Over 80% of respondents reported no significant change in their working hours or job responsibilities post-reform. The availability of nurse practitioners (NPs) or nurses certified in specified medical-acts training (SNs) had no significant impact on workload, although most surgeons perceived their benefit.

Conclusion: Extended working hours remain prevalent among CSs in Japan despite the implementation of the work-style reforms. Strategic adoption of task-shifting and enhanced staffing is required urgently to ensure the sustainability of cardiovascular surgical care.

The treatment of benign splenic diseases is trending toward a conservative approach, especially for young patients, due to the importance of preserving as much splenic parenchyma as possible. Minimally invasive partial splenectomy (PS), which has become the gold standard for managing benign splenic conditions, is generally associated with low morbidity and near-zero mortality. Herein, we describe a standardized and safe technique to perform this procedure. This new approach combines preoperative selective distal embolization of the splenic artery with indocyanine green (ICG)-guided robotic partial splenectomy using the technique of negative staining as applied in liver surgery.

Purpose: Recent randomized controlled trials have shown the non-inferiority of sublobar-to-lobar resection for small peripheral non-small cell lung cancer (NSCLC); however, whether wedge resection (WR) or anatomical segmentectomy (SG) is superior remains unclear. We hypothesized that ground-glass opacity (GGO) is associated with the outcomes of WR and SG.

Methods: Between 2010 and 2022, 219 consecutive patients with clinical stage IA peripheral NSCLC who underwent sublobar resection for frailty at our institution were retrospectively reviewed. Based on the high-resolution computed tomography findings, the tumors were classified into two groups: part-solid (GGO (+)) and solid (GGO (-)). The long-term outcomes were compared between the WR and SG groups.

Results: In the part-solid group (n = 124; median CTR, 0.62), WR was equivalent to SG in terms of 5-year disease-free survival [DFS] (98% vs. 91%; p = 0.2) and recurrence rate (0% vs. 4.3%; p = 0.3). In the solid tumor group (n = 95), WR was inferior to SG in terms of the 5-year DFS (43% vs. 80%; p < 0.01) and recurrence rate (32% vs. 3.7%; p < 0.01).

Conclusions: In our study population, WR was not inferior to SG for part-solid tumors. However, for solid tumors, the long-term outcomes of SG are superior to those of WR.

Purpose: Lung transplant (LTx) recipients are at a higher risk of infection and mortality due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The course of coronavirus disease 2019 (COVID-19) in Japanese LTx recipients remains unknown. This study aimed to clarify the incidence, outcomes, and clinical characteristics of COVID-19 in LTx recipients in Japan over a 3-year period.

Methods: This single-center retrospective study enrolled all LTx recipients who underwent LTx at Kyoto University Hospital between June 2008 and December 2022 and who were followed up during the COVID-19 pandemic from March 2020 to June 2023.

Results: Among 230 LTx recipients, 64 (27.8%) developed SARS-CoV-2 infection and one (1.6%) died due to COVID-19. No significant differences in baseline characteristics, except for hypertension, were observed between the LTx recipients with and without COVID-19. Disease severity decreased as variants of concern transitioned but remained high even after 2022. Unilateral LTx, advanced age, and diabetes mellitus were associated with COVID-19 severity.

Conclusions: The incidence of COVID-19 in LTx recipients was similar to that in the general Japanese population, whereas the disease severity in LTx recipients remained high even after the Omicron era. Continuous development of preventive and early therapeutic interventions is required for these vulnerable groups.

Preoperative chemotherapy combined with gastrectomy and radical surgery may be useful in patients with gastric cancer and metastasis-positive para-aortic lymph nodes. Although robotic surgery is considered useful in difficult cases because it provides highly magnified three-dimensional high-definition images of anatomical views and precise techniques, a meticulous approach for para-aortic lymph node dissection (PALND) is important. We typically perform PALND via the left renal vein at our institution. Robotic PALND was performed in six patients from April 2018 to July 2024. The median total operative time and volume of blood loss were 552 (271-634) min and 316 (75-771) mL, respectively. The time required for dissection of No. 16b1-int and No. 16a2-lat was 68 (65-103) min and approximately 30 min, respectively. All six patients underwent rapid postoperative treatment, including postoperative chemotherapy. A clear understanding of the relevant anatomy, beginning with the left renal vein, should result in a safe and reliable robotic surgical approach for PALND.

Purpose: Prehabilitation is known to improve outcomes of gastrointestinal surgery; however, the issue of low adherence during the waiting period for surgery remains unresolved. This study evaluated the effectiveness and feasibility of a newly developed mobile health application, "Preha," designed to support home-based prehabilitation.

Methods: A single-group pilot study involving patients scheduled for major hepatobiliary-pancreatic (HBP) surgery for malignancy between March 2023 and September 2024 was conducted. The patients downloaded the Preha application, and there was no direct intervention from the medical staff during the preoperative period. The application recorded step counts, moderate-intensity exercise times, and squat counts. Adherence was defined as meeting at least one of the following: ≥ 5,000 steps/day, ≥ 10 min/day of ≥ 3 METS activities, or ≥ 30 squats/day, for more than three days per week.

Results: Among 30 eligible patients, 21 (median age, 67 years) were included in the analysis. During prehabilitation, 52% achieved the step goal, 67% met the exercise time target, and 33% completed the squat goal.

Conclusions: The "Preha" application facilitated good adherence to home-based prehabilitation without direct intervention, indicating its feasibility and potential as a perioperative support tool for patients undergoing HBP surgery. Trial registration https://jrct.niph.go.jp/ ; registration number: jRCTs042220106.

Purpose: To investigate the impact of chronic kidney disease (CKD) on perioperative and long-term outcomes of pulmonary resection in patients with lung cancer.

Methods: Data from 331 patients who underwent pulmonary surgery for non-small-cell Lung cancer associated with CKD between 2016 and 2020 were analyzed. Patients were categorized based on preoperative reduced renal function (estimated glomerular filtration rate [eGFR] < 45 mL/min/1.73m² [CKD grade ≥ G3b]). Patients with (n = 20) and without (n = 311) CKD were compared based on their clinicopathological characteristics and outcomes.

Results: Grades ≥ 2 and ≥ 3 postoperative pulmonary complications (PPCs) in the Clavien-Dindo classification and postoperative air leaks were common in the CKD group (p = 0.015, 0.005, and 0.025, respectively). The duration of drainage and hospital stay was long (p = 0.003, and p = 0.040, respectively). Kaplan-Meier curves showed a poor prognosis with regard to the overall survival (p = 0.022) and disease-free survival (p = 0.018) in the CKD group. A multivariate analysis confirmed that CKD with an eGFR < 45 mL/min/1.73 m² was a significant risk factor for grade ≥ 3 PPCs (p = 0.037).

Conclusions: CKD with an eGFR < 45 mL/min/1.73 m² involves various perioperative risks; therefore, care must be taken in intraoperative and perioperative management, and long-term collaboration with a nephrologist even before surgery is necessary.