Surgery Today最新文献

Purpose: Persistent descending mesocolon (PDM) is a rare congenital anomaly that may complicate minimally invasive surgery (MIS) for colorectal cancer (CRC). This systematic review and meta-analysis evaluated the perioperative impact of PDM on MIS for CRC.

Methods: This study followed the PRISMA guidelines and was registered in PROSPERO (CRD420251055757). A systematic search was performed in PubMed, Cochrane, and Scopus (January, 2000 to April, 2025). Observational studies (OBSs) compared MIS for CRC in patients with and patients without PDM. The primary outcome was operative time and the secondary outcomes included intraoperative blood loss, open conversion rate, complications, and vascular anatomy. Meta-analyses used a random-effects model.

Results: Seven OBSs (4,255 patients) were included in the analysis. PDM patients had significantly longer operative times (Mean difference [MD]:26.4; 95%CI:11.3-41.4) and greater intraoperative blood loss (MD:15.9; 95%CI:3.3-28.4). The rates of conversion to open surgery (Odds rate [OR]:9.6; 95%CI: 3.3-27.8) and anastomotic leakage (OR:2.49; 95%CI:1.2-5.1) were higher in PDM patients. The IMV-colon distance was significantly shorter in PDM patients, potentially increasing the marginal vessel injury risk.

Conclusion: PDM increases the intraoperative complexity of MIS for CRC. Thus, preoperative recognition of vascular variations is critical and such procedures should be performed at expert centers.

Purpose: Stapled closure is the standard technique for pancreatic resection via distal pancreatectomy (DP). The Signia™ Stapling System allows for adaptive stapling based on real-time tissue resistance. This study aims to investigate whether DP using the Signia™ system could reduce the incidence of clinically relevant post-operative pancreatic fistula (CR-POPF).

Methods: We retrospectively analyzed 53 patients who underwent DP between 2020 and 2025. 26 patients underwent DP using the Signia™ Stapling System (powered stapler group), and 27 patients using a manual stapler (manual stapler group). The primary outcome was the CR-POPF rate.

Results: In the powered stapler group, 38.5% of patients developed biochemical leakage, but no cases of CR-POPF were observed. In contrast, the manual stapler group had a CR-POPF rate of 18.5% (p = 0.021). A receiver operating characteristic curve was generated to determine the pancreatic thickness threshold predictive of CR-POPF. The calculated cut-off value was 16 mm. In the powered group, there were no cases of CR-POPF even if the pancreatic thickness at the resection line was ≥ 16 mm.

Conclusions: The use of a powered stapler may therefore help reduce the risk of POPF associated with variability in the thickness and hardness of the pancreas during DP.

Purpose: Spread through air spaces (STAS) is a poor prognostic factor for lung adenocarcinoma, particularly in patients undergoing limited resection, and its accurate prediction can improve the patient outcomes. This study evaluated the impact of STAS on the surgical outcomes and predictive factors.

Methods: We analyzed 511 patients with clinical stage IA lung adenocarcinoma who underwent curative resection between 2007 and 2022. STAS was assessed histologically, and logistic regression was used to identify the predictors. The recurrence-free and overall survival rates were also evaluated.

Results: Among the patients, 27.8% had STAS with significantly poor 5-year recurrence-free survival (65.6% vs. 88.5% in STAS-positive vs.-negative cases, respectively), particularly in patients treated with sublobar resection. STAS was an independent, poor prognostic factor for the recurrence-free survival in the sublobar group but not in the lobectomy group. Elevated serum carcinoembryonic antigen (≥ 5.8 ng/mL), consolidation tumor ratio (≥ 0.9), and SUVmax (≥ 2.3) were independent predictors. STAS positivity increased with the number of risk factors as follows: 8.0% (none), 27.1% (one), 38.5% (two), and 60.4% (all three).

Conclusions: The prediction of STAS using carcinoembryonic antigen levels, consolidation tumor ratio, and SUVmax can guide surgical decision-making and facilitate the provision of individualized treatment strategies for stage IA lung adenocarcinoma.

Purpose: Addressing the decline in the number of surgeons in Japan and an uneven specialty distribution is crucial for a sustainable working environment. We conducted this study to investigate the motivations behind the choice of medical specialty among thoracic surgeons across multiple institutions in Japan.

Methods: A nationwide online questionnaire survey was distributed by the Japanese Association for Surgical Education's thoracic surgery working group, targeting all thoracic surgeons.

Results: Of the 725 respondents, 95.6% decided on thoracic surgery after starting clinical training. The key influencing factors included respectful supervisors and seniors (79.3%), procedures (78.1%), organs (77.9%), diseases (75.4%), and atmosphere (70.3%). The final deciding factors were procedures (37.1%), atmosphere (17.0%), and organs (11.2%), with work-life balance reported by 7.0%. More thoracic surgeons in the 20 s-30 s age group than those in the over 40 s age group prioritized procedures (47.3% vs 31.5%; P < 0.0001), organs (14.3% vs 9.4%; P = 0.049), and work-life balance (11.2% vs 4.7%; P = 0.0014). Only 9.2% of respondents chose a career in thoracic surgery exclusively, whereas 90.8% considered other specialties (81.3% surgical, 18.7% non-surgical).

Conclusion: This survey revealed that the broad appeal of thoracic surgery often attracted individuals from diverse backgrounds, sometimes after they had considered other specialties. Increasing the number of thoracic surgeons requires promoting its appeal and fostering a positive work and educational environment.

Background: The aim of this study was to assess the efficacy and safety of pimitespib in real-world clinical settings for tyrosine kinase inhibitor-resistant GISTs.

Methods: We retrospectively analyzed 15 patients at Osaka University Hospital. Patients treated with pimitespib as a fourth- or later-line treatment for unresectable or recurrent GISTs were included. Patient background, pimitespib dose, number of courses, adverse events, best response, progression-free survival, and overall survival were analyzed.

Results: The median overall survival of patients treated with pimitespib was 24.4 months（95% confidence interval [CI] 7.2-not reached) and the one-year overall survival rate was 70.9%. The median progression-free survival was 4.6 months (95%CI 1.8-7.4), and the one-year progression-free survival rate was 15.2%. A partial response was observed in 0 patients, stable disease lasting for ≥ 12 weeks in 7 (46.7%), progressive disease in 7 (40.0%), and a non-evaluable state in 2 (13.3%). The disease control rate was 40%. Treatment-related adverse events were reported in all patients, with the most common being diarrhea (87%), followed by anorexia (27%), nausea (27%), and increased blood creatinine levels (27%). None of the patients discontinued the treatment because of adverse events.

Conclusion: Pimitespib may offer a tolerable and effective treatment option for patients with unresectable or recurrent GISTs in clinical practice.

Purpose: This study examined the relationship between preoperative prealbumin levels and long-term outcomes in patients with advanced gastric cancer after gastrectomy.

Methods: This study included patients who underwent radical gastrectomy for primary stage I-III gastric cancer with preoperative prealbumin levels measured from May 2006 to March 2017. The patients were categorized into 3 groups based on their preoperative prealbumin levels: high (≥ 22 mg/dL), moderate (15-22 mg/dL), and low (< 15 mg/dL).

Results: Of the 3,050 pStage I patients, 2488 (81.6%) were classified as high, 511 (16.8%) as moderate, and 51 (1.7%) as low. Of the 1682 patients with pStage II-III, 1161 (69.0%) were classified as high, 414 (24.6%) as moderate, and 107 (6.4%) as low. A comparison of the overall survival (OS) revealed that lower prealbumin levels were associated with a worse prognosis (P < 0.001). A multivariate analysis indicated that prealbumin levels of 15-22 mg/dL and < 15 mg/dL were independent poor prognostic factors for the OS, regardless of the pStage. When stratified by cause of death, prealbumin levels were associated with the other-cause survival but not the cancer-specific survival.

Conclusions: Preoperative prealbumin levels were correlated with the OS, especially the other-cause survival, in patients with gastric cancer after gastrectomy. (200 words). Data Access Statement: Research data supporting this publication are available from the NN repository at located at www.NNN.org/download/ .

Purpose: We investigated the surgical outcomes of completion lobectomy after primary segmentectomy for lung malignancies.

Methods: A review of 1139 patients who underwent pulmonary segmentectomy for lung malignancies, identified 17 (1.5%) who underwent completion lobectomy. We analyzed the clinicopathological outcomes of completion lobectomy in these 17 patients, statistically, and evaluated the degree of surgical difficulty, using logistic regression models.

Results: The primary segmentectomy was performed on the right-side in six patients, centrally in seven, in the upper lobe in nine, and as a complex segmentectomy in ten. Lung cancer was diagnosed in 13 patients. Completion lobectomy required an intrapericardial procedure in five patients, main pulmonary artery (PA) clamping in seven, bronchial plasty in five, and PA-plasty in five. The mean operative time was 219 min, and the mean blood loss was 193 ml. Cut-end recurrence was confirmed in nine (56%) patients, and Grade III or higher morbidity occurred in six patients (38%) with no short-term mortality. Logistic regression analysis revealed that upper lobe completion lobectomy was a significant predictor of surgical difficulty (OR 23.8, 95%CI 1.742-333.3, p = 0.018).

Conclusion: Completion lobectomy is technically challenging, especially in the upper lobe, but the oncological and surgical results are acceptable. This procedure is a promising and important strategy for treating secondary lesions in the residual lobe after segmentectomy.

Purpose: We aimed to compare the safety, feasibility, required human resources, and surgical costs of a combined robotic transabdominal and conventional transanal (TaRob) approach with those of a robotic transabdominal approach alone for rectal cancer.

Methods: Forty-nine patients who underwent robotic surgery for rectal cancer were retrospectively enrolled and categorized into two groups: robotic transabdominal approach alone (Rob-alone, n = 29) and TaRob approach (TaRob, n = 20). Patient characteristics, short-term postoperative outcomes, human resources, and surgical costs were compared between the groups.

Results: The tumor distance from the anal verge was shorter and preoperative treatment was performed more frequently in the TaRob group. The total operation time was shorter in the TaRob group (258 vs. 325 min), with no between-group differences in postoperative complications or pathological outcomes. Although the TaRob group required more staff than the Robot-alone group, the staff time consumed did not differ. The TaRob group had higher surgical costs for consumables than the robot alone group. These results were consistent before and after performing propensity score matching.

Conclusions: The combined approach after preoperative treatment for low rectal cancer resulted in a reduced operation time without any increased postoperative complications. The combined approach increased surgical costs, but could potentially reduce staff work hours, provided that sufficient staff is available.