Surgery Today最新文献

Purposes: The enhanced view totally extraperitoneal (eTEP) technique offers the advantage of preserving peritoneal integrity by utilizing an extraperitoneal dissection plane, thereby avoiding visceral-mesh contact and reducing the risk of complications. This study presents our initial experience and outcomes of using the eTEP technique to repair various ventral and incisional hernias.

Methods: This prospective cohort study included adult patients with abdominal wall hernias classified according to the European Hernia Society (EHS) system. The eTEP approach was used for the hernia repair. Trocar placement was tailored to the size and location of the hernia defect. The surgical techniques are described in detail, and the outcomes that were assessed included both intraoperative and postoperative complications.

Results: This prospective study included 72 patients who underwent an eTEP hernia repair between 2023 and 2024. Intraoperative conversion was required in 10 (13.9%) patients. The mean operative time was 156.6 ± 80.6 min. The overall postoperative complication rate was 12.9% and the average hospitalization length was 3.2 days. The postoperative pain scores decreased from 3.6 to 0.1 at 3 months, and no recurrence was observed.

Conclusion: The eTEP technique offers a minimally invasive extraperitoneal approach for abdominal wall hernia repair. Our findings demonstrated its feasibility, efficacy, and safety profile.

Purpose: Determining the optimal timing of surgery for Crohn disease (CD) is challenging. The C-reactive protein-to-albumin ratio (CAR) is inexpensive and widely available; however, its utility in determining surgical timing remains unclear.

Methods: We retrospectively analyzed 112 cases of penetrating-type CD resection (screened 2010-2024). Preoperative CAR was measured within 7 days of surgery. A receiver operating characteristic analysis defined the CAR threshold to maximize the negative predictive value (NPV) for 30-day complications. Patients were categorized as having a low or high CAR and were matched 1:1 using propensity scores. The early morbidity and 5-year re-operation-free survival rates were compared.

Results: A CAR cutoff value of 0.102 yielded the highest NPV. A high CAR was associated with increased overall morbidity (55% vs. 20%) and increased wound infection (21% vs. 5%). After matching (25 pairs), a high CAR was correlated with more complications (52% vs. 24%; P = 0.04) and prolonged stay (median 17 vs. 11 days; P = 0.02). The five-year reoperation risk was higher with a high CAR (14.6% vs. 4.0%; P = 0.03).

Conclusions: Preoperative CAR < 0.102 indicates a candidate rule-out threshold for elective CD surgery, predicting fewer early complications and a lower 5-year re-operation rate. Because CAR is rapidly available and treatment-agnostic, serial monitoring could support a testable preoperative timing framework. Further prospective validation is required.

This study evaluated a novel detachable purse-string suture instrument-assisted esophagojejunostomy technique using a circular stapler for minimally invasive surgery. The detachable purse-string suture instrument facilitated simplified anvil placement, enhanced visualization, and allowed flexible manipulation without the addition or extension of an incision. A total of 22 patients with gastric or esophagogastric junction cancer underwent this procedure at our institution between January 2023 and December 2024. The median intracorporeal anastomosis time for esophagojejunostomy (excluding the time required for extracorporeal jejunal limb creation and jejunojejunostomy) was 54.5 min, with no cases of anastomotic leakage. Conversion to hand-sewn methods was required in two cases due to technical difficulties. Two patients required endoscopic dilation for stenosis within one year. This method demonstrated favorable short-term outcomes and may be a safe and effective alternative to esophagojejunostomy in minimally invasive surgeries. Large-scale studies are warranted to validate the long-term efficacy and broad applicability of this method.

Purposes: Robotic staplers offer several advantages in rectal surgery owing to their wide range of articulation and ergonomic manipulation. These benefits are evident during mobilization of the mesentery from the surrounding tissue and dissection of the rectum. However, no study has quantitatively evaluated the robotic stapler articulation in rectal surgery.

Methods: We retrospectively enrolled 110 patients who underwent robotic anterior resection and double-stapling anastomosis. Stapling-related variables, including the type of cartridge, number of firings, time for initial stapling, and pitch/yaw of the stapling arm joint, were collated, and their association with patient background variables was analyzed.

Results: The pitch ranged from - 56° to - 0.2° (median, - 36.3°), and the yaw ranged from - 57.9° to 54.2° (median, - 7.5°). A multivariate analysis showed that a more negative pitch value was independently associated with surgery for cT3/4 cancers (p = 0.042). Moreover, the pitch decreased as the distance from the anus to the staple line increased (p < 0.001). Female sex was the only factor independently associated with yaw (p = 0.029). Univariate analyses revealed that age ≥ 70 years, preoperative treatment, short cartridge selection, and multiple firings were correlated with a high anastomotic leakage rate.

Conclusions: This study clearly demonstrates how surgeons utilize the unique functions of robotic staplers during rectal transection.

Purposes: The symptoms of low anterior resection syndrome (LARS) are diverse, and its ambiguous definition has made estimating its prevalence difficult. In 2018, an international consensus proposed a new LARS definition based on eight symptoms and consequences. We conducted this study to evaluate the prevalence of LARS, using this new definition (LARS-ND), and to identify its risk factors.

Methods: This multicenter, cross-sectional study surveyed patients who underwent curative resection for rectal tumors between 2020 and 2022 at 10 institutions. A one-time questionnaire based on the new LARS definition was distributed. Outcomes included LARS-ND prevalence and risk factors.

Results: A total of 343 patients responded (response rate: 86.6%). The prevalence of LARS-ND was 72.5%, with no significant differences across groups with different follow-up durations. The most frequent symptom and consequence were "emptying difficulties" (93.3%) and "the need for strategies and compromises" (47.5%). Among patients categorized as having "no LARS" by the conventional score, 25% were diagnosed with LARS-ND. Multivariate analysis identified younger age (< 70 years; OR = 2.28) and short anastomosis distance (≤ 5 cm; OR = 1.96) as risk factors.

Conclusions: The prevalence of LARS-ND was high, and the new LARS definition identified patients with symptoms previously missed by the conventional score. Younger age and a lower anastomosis level appear to be risk factors for LARS-ND.

The clinical benefits of anaplastic lymphoma kinase (ALK) inhibitors in patients with recurrent ALK-rearranged lung adenocarcinoma after surgical resection remain poorly understood. We retrospectively reviewed the medical records of 10 patients who received alectinib as first-line therapy for postoperative recurrence between 2014 and 2018, following complete resection at multiple institutions in Japan. Clinical outcomes, including the progression-free survival (PFS) and overall survival (OS), were analyzed. The median follow-up duration was 93.6 months from surgery. The median OS was 96.8 months after surgery and 82.8 months from recurrence. The median PFS from recurrence was not reached, with a 5-year PFS rate of 58.3%. One patient discontinued treatment because of adverse events. Alectinib, as a first-line therapy for recurrent ALK-rearranged lung adenocarcinoma, demonstrated durable efficacy and acceptable safety. These findings suggest that targeted therapy for recurrence is a valuable treatment strategy. Prospective studies are warranted to determine the optimal timing for ALK-TKI initiation.

Purpose: This study examined the decline in the number of surgeons in Japan compared with other specialists in urban and rural areas using a secondary analysis of government-owned census data. Furthermore, it evaluated the impact of the regional quota system in addressing the shortage of surgeons by comparing their proportion among the graduates of this system with that of the overall physician population.

Methods: We analyzed national census data (2012-2022) to evaluate trends in the numbers of physicians and surgeons in 47 prefectures from urban and rural groups. Data on regional quota graduates were obtained from an open-source study.

Results: The number of physicians increased by 13.4%, whereas the number of surgeons decreased by 2.1%. The change in the number of surgeons per 100,000 population did not differ between the rural (+ 0.6%) and urban (+ 0.7%; p = 0.997) prefectures. Regional quota graduates had a higher likelihood of being surgeons (9.5%) than all (8.2%; p < 0.01) or young (age 26-39 years) physicians (7.8%; p < 0.01), although female representation was highest among regional quotas (38.7%) relative to all (22.8%; p < 0.01) and young (32.8%; p < 0.01) physicians.

Conclusion: The regional quota demonstrates the potential of addressing surgeon shortages.