Surgery Today最新文献

Purpose: Portal hypertension (PoH) after liver transplantation is a severe complication that results in graft loss. We investigated the characteristics and evaluated the treatment outcomes of PoH after living donor liver transplantation (LDLT).

Methods: This single-center, retrospective cohort study included 325 LDLT recipients.

Results: Of the subjects, 37 (11.4%) had a PoH. The 10- and 20-year graft survival rates were significantly lower in patients with PoH than in those without PoH (69.1% vs. 90.8% and 42.1% vs. 84.7%, respectively; p < 0.0001). The types of PoH were pre-hepatic, hepatic, and post-hepatic in 16, 13, and 8 patients, respectively. Interventional radiology was performed for PoH in all post-hepatic PoH patients and in 62.5% of pre-hepatic PoH patients. Notably, 46.2% of the patients with hepatic PoH required re-transplantation. The 10-year graft survival rate was significantly worse in patients with hepatic PoH than in those with pre- and post-hepatic PoH (46.2% vs. 86.7% and 75.0%, respectively; P < 0.05). Post-transplant PoH was an independent predictor of graft loss after LDLT (hazard ratio, 5.73; 95% confidence interval: 2.43-13.55, P < 0.0005).

Conclusions: Post-transplant PoH negatively affected the graft survival in LDLT recipients. Pre-hepatic, hepatic, and post-hepatic PoH cases had different characteristics, requiring different treatments. Therefore, an appropriate diagnosis and treatment are important.

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.