Surgery Today最新文献

Purposes: Postoperative swallowing dysfunction is a complication that adversely affects elderly patients undergoing gastrointestinal cancer surgery. However, the perioperative changes in swallowing function and their predictive factors remain unclear.

Methods: The subjects of this retrospective analysis were 170 patients aged ≥ 65 years who underwent gastrointestinal cancer surgery and screened positively for sarcopenia and/or cognitive or swallowing concerns. Swallowing function was assessed using the Fujishima Eating and Swallowing Ability Grade (Fujishima Grade), a 10-point scale commonly used in Japan, at four perioperative time points. Dysfunction was defined as Grade ≤ 7 on postoperative day (POD) 1. Predictors were identified using univariate and multivariate logistic regression.

Results: Swallowing dysfunction developed in 63 patients (37.1%). The median grade declined on POD1 and improved by POD7 and on discharge. Among those with dysfunction, 21.0% remained at grade 7 on discharge. These patients had significantly lower cognitive scores (p < 0.001). Multivariate analysis identified age ≥ 75 years (OR 2.56, p = 0.034), sarcopenia (OR 2.13, p = 0.048), MMSE (Mini-Mental State Examination) ≤ 23 (OR 3.09, p = 0.007), and preoperative Fujishima Grade 8 (OR 2.48, p = 0.011) as independent predictors.

Conclusions: Swallowing function declines transiently after gastrointestinal cancer surgery in elderly patients. Older age, sarcopenia, MMSE ≤ 23, and preoperative Fujishima Grade 8 are independent predictors of postoperative swallowing dysfunction.

Purpose: Traumatic abdominal wall hernia (TAWH) is a rare injury caused by high-energy blunt trauma. Its diagnosis is often missed, and the current management strategies remain inconsistent. This study aimed to describe the clinical characteristics, diagnostic challenges, and surgical outcomes of TAWH based on a 15-year experience at a high-volume trauma center in Korea.

Methods: We retrospectively reviewed the records of patients diagnosed with TAWH between 2010 and 2024. The data included demographics, injury mechanisms, hernia features, surgical timing, and outcomes.

Results: Of 17,852 patients with blunt abdominal trauma, 28 (0.16%) were diagnosed with TAWH. Although CT identified most hernias (96.4%), only 48.1% were noted in official radiology reports. Common hernia locations were lumbar (38.7%) and anterior (29.0%). Associated intra-abdominal injuries were present in 89.3% of cases. Surgical repair was performed in 22 patients, with 90.9% undergoing early repair during the index admission. Two patients underwent delayed mesh repair, without recurrence. Overall recurrence and surgical site infection rates were both 18.2%.

Conclusion: TAWH remains under-recognized despite its strong association with high-energy trauma and clear CT detectability. Findings from this long-term single-center study support early repair when feasible and selective delayed mesh repair is performed in appropriate patients, underscoring the need for greater awareness among trauma providers.

Purpose: To identify the risk factors for mortality and morbidity after distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using prospectively registered data from the National Clinical Database (NCD).

Methods: We retrospectively analyzed patients registered in the NCD between 2018 and 2021 who underwent DP-CAR. Surgical morbidity, mortality, and associated clinical factors were evaluated.

Results: The study included 136 patients. Preoperative therapy included chemotherapy in 110 (80.9%) patients. The surgical mortality rate was 2.2% (3/136 patients). Recent weight loss (≥ 10% in the past 6 months) was significantly more prevalent in the mortality group than in the non-mortality group (33.3% [1/3] vs. 4.5% [6/133], respectively). Clavien-Dindo grade ≥ III complications occurred in 34.6% of the patients. Age ≥ 80 years old (odds ratio [OR], 8.75; 95% confidence interval [CI]: 1.21-63.43; p = 0.032) and portal vein resection (OR, 2.72; 95% CI: 1.04-7.13; p = 0.042) were identified as potential risk factors for severe postoperative complications. Recent weight loss (OR, 5.18; 95% CI: 0.96-27.8; p = 0.055) approached statistical significance.

Conclusion: Although specific mortality risk factors could not be identified, the low mortality rate suggests that DP-CAR is safely performed in Japanese practice. Future efforts should focus on achieving zero DP-CAR-associated mortality.

Purpose: Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mFI-5) are established tools, their combined predictive value for postoperative complications remains unclear. Therefore, we investigated whether their combination improved risk prediction.

Methods: We analyzed 399 CRC ≥ 65 years of age who underwent curative surgery. Preoperative assessment included frailty (mFI-5 ≥ 2) and nutritional risk (GNRI < 98). Patients were stratified into low- (no factors), intermediate- (one factor), and high-risk (both factors) groups. Clavien-Dindo grade ≥ II complications were analyzed by multivariate logistic regression to identify predictive factors.

Results: Infectious complications increased significantly across the low-, intermediate-, and high-risk groups (13.3%, 14.6%, and 30.2%, respectively), with overall complication rates of 20.7%, 22.2%, and 45.3%, respectively. The median postoperative stay increased with increased risk (12, 14, and 18 days, respectively). Anastomotic leakage was more frequent, though not to a statistically significant extent, in high-risk patients. High-risk status independently predicted infectious and overall complications.

Conclusions: Combined GNRI and mFI-5 assessments facilitated effective stratification of postoperative risk in older adults with CRC. These assessments may help in routine preoperative evaluations and support individualized perioperative care.

Purpose: Chronic inflammation contributes to carcinogenesis and pulmonary emphysema is characterized by chronic pulmonary inflammation. We hypothesized that the severity of emphysema, quantitatively assessed using the Goddard score (GS), correlates with outcomes following surgical treatment for pancreatic cancer.

Methods: We retrospectively analyzed 191 patients who underwent surgery for pancreatic cancer between 2013 and 2022. GS was assessed using routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of GS on oncological outcomes.

Results: A high GS (≥ 7) was identified in 46 (24.1%) patients, who were significantly older and had a lower body mass index than patients with a low GS. In the multivariate analysis, a high GS emerged as an independent predictor of both a worse disease-free survival (DFS) (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.06-2.36; p = 0.01) and worse overall survival (OS) (HR, 1.80; 95% CI, 1.09-2.97; p = 0.02). Other independent risk factors included a poor DFS, sarcopenia, lymph node metastasis, poor tumor differentiation, poor OS, poor tumor differentiation, lack of adjuvant chemotherapy, and postoperative complications.

Conclusion: The GS, a simple radiological index of emphysema, may serve as a novel preoperative prognostic indicator in patients undergoing pancreatic cancer surgery.

Living-donor lobar lung transplantation (LDLLT) poses greater technical challenges than conventional lung transplantation using deceased-donor grafts. The lower lobes are the most commonly used grafts in LDLLT. However, when using a left lobar graft with lingular branch preservation, the pulmonary artery may need to be diagonally incised. This often necessitates pulmonary arterioplasty with an autologous pericardial patch on the donor side to maintain the integrity of the lingular branch and correct caliber mismatch on the recipient side. In hybrid lung transplantation combining a right lung from a deceased donor with a left lower lobe from a living donor, the donor's right pulmonary artery can be repurposed to resolve a short cuff and large caliber mismatch of the left pulmonary artery. We demonstrated a simple back-table arterioplasty technique using a deceased donor's pulmonary artery to overcome size mismatch, reduce surgical complexity, and eliminate the need for a pericardial patch.

Purpose: The actual incidence of incisional hernia (IH) after abdominal aortic aneurysm repair in Japanese patients is unknown. This study examined the incidence of IH after aortic reconstruction surgery.

Methods: Patients who underwent elective midline laparotomy for AAA at a single institution between November 2012 and September 2021 were retrospectively analyzed. The primary endpoint was IH diagnosed by physical examination and CT.

Results: A total of 285 patients were analyzed. The median follow-up was 3.7 years (interquartile range: 1.6-5.9 years). 67 patients (23.5%) developed IH; of these patients, 16 (23.9%) underwent hernia repair. The cumulative incidence of IH was 28.0% at five years. According to a multivariate analysis, body mass index (BMI) was identified as an independent risk factor for IH (hazard ratio, 1.22; 95% confidence interval: 1.13-1.32, p < 0.001). Obese patients with BMI ≥ 25 kg/m² had a significantly higher incidence of IH than normal-weight patients with BMI of 18.5 to 25 kg/m² (5-year cumulative incidence: 44.5% vs. 22.1%, p = 0.001), and underweight patients with BMI < 18.5 kg/m² had no IH.

Conclusion: Approximately half of all obese patients developed IH within 5 years, although underweight patients had no IH.

Purpose: Serum levels of cardiovascular markers, including brain natriuretic peptide (BNP), are associated with the prognosis of cancer patients. This study examined the relationship between the preoperative blood BNP level and the long-term prognosis after curative lung cancer resection.

Methods: Patients who underwent radical resection for lung cancer at our institution between January 2012 and June 2019 were divided into the high- (≥ 18.5 pg/ml) and low- (< 18.5 pg/ml) BNP groups. Kaplan-Meier curves were used to analyze the postoperative overall survival (OS) and relapse-free survival (RFS). The cumulative incidence function (CIF) was analyzed using the Gray's test. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of the OS.

Results: The postoperative OS was significantly worse in the high-BNP group than in the low-BNP group (p = 0.03), but there was no statistically significant difference in the RFS (p = 0.09). A CIF analysis indicated that non-cancer-related deaths had a greater impact on the RFS than cancer recurrence. Blood BNP levels possibly affected the OS independently (hazard ratio, 1.50).

Conclusions: Preoperative BNP levels in patients with lung cancer may indicate a potentially compromised condition and can be associated with the postoperative OS. However, the link between the BNP level and lung cancer severity remains unclear.

Purpose: Endocrine surgery encompasses various organ systems, but thyroid surgery represents the major component. The Japanese Association of Thyroid Surgeons published nationwide data on thyroid cancer surgery until 2005, since when no further reports have been published. Thus, we analyzed thyroid surgery trends using data from the National Clinical Database (NCD) from 2014 to 2023.

Methods: We analyzed cases of thyroid surgery, for malignant and benign conditions, recorded in the NCD. A detailed analysis of papillary thyroid carcinoma (PTC) cases was conducted in 2014, 2019, and 2023 to assess TNM classification, surgical procedures, complications, and outcomes.

Results: The number of thyroid surgery facilities and the number of thyroid surgeries being performed have both declined since 2020. A trend toward more hemithyroidectomies and fewer total thyroidectomies for PTC is evident. The number of surgeries for cancers < 1 cm and lateral node dissection for PTC have also decreased. Endoscopically assisted surgery has increased continuously, accounting for > 4% of thyroid operations in 2020. The incidence of permanent hypoparathyroidism has decreased and perioperative mortality is rare.

Conclusion: The changes in surgical trends are aligned with guideline updates and shifts in surgical practice. Future efforts will refine data collection and utilize the NCD to improve thyroid surgical quality and research.

Purpose: We assessed the efficacy and safety of Purastat^®, a novel synthetic hemostat, for the treatment of exudative hemorrhaging in pulmonary artery (PA) stumps.

Methods: This single-arm prospective interventional study included eligible patients scheduled for anatomical pulmonary resection. Purastat^® was applied intraoperatively to patients with exudative hemorrhaging at the PA stump, where hemorrhaging persisted despite 30 s of compression following dissection with an automatic suturing device. The primary endpoint was the rate of additional hemostatic treatment required, with a prespecified threshold of 25%. The secondary endpoints included the time to achieve hemostasis, rate of postoperative rebleeding, and adverse events.

Results: Sixty-four patients were enrolled, and 80 PAs from 56 patients were dissected using an automatic suture device. Exudative hemorrhaging occurred in 31 PA stumps (38.8%), and hemorrhaging persisted after 30 s of compression in 23 cases (28.8%) in which Purastat^® was applied. The rate of additional hemostatic treatment required was 4.35% (95% confidence interval, 0%-19.0%; only 1 patient), meeting the prespecified threshold. The median time to achieve hemostasis was 30.0 s. No serious adverse events or postoperative rebleeding was observed.

Conclusion: Hemostasis with Purastat^® for exudative hemorrhaging at the PA stumps was effective and had no serious safety concerns.