This study explores the evolving landscape of gastrectomy procedures in Japan, based on nationwide surveys conducted in 2014 and 2021. It highlights changes in surgical approaches, including a growing focus on minimally invasive and function-preserving procedures, as well as the increasing consideration of postoperative quality of life (QOL).
Methods
Two nationwide questionnaire surveys were conducted in 2014 and 2021, targeting members of the Japanese Society for Gastro-surgical Pathophysiology. The surveys covered institutional characteristics, surgical case volumes, procedure preferences for early gastric cancer by tumor location, and emerging topics such as robot-assisted surgery and sentinel node navigation surgery. Statistical analysis included Fisher's exact test and residual analysis for changes in procedure selection over time.
Results
The results indicate a marked shift toward laparoscopic and robot-assisted gastrectomy, alongside a rise in function-preserving procedures, particularly proximal gastrectomy and small remnant distal gastrectomy. However, procedures like pylorus-preserving gastrectomy and vagus nerve preservation, and total gastrectomy with jejunal pouch reconstruction remain underutilized due to concerns regarding unclear benefits, technical complexity, and oncological safety.
Conclusion
This study underscores advancements in minimally invasive and function-preserving gastrectomy procedures in Japan but emphasizes the need for more robust clinical evidence to support the broader adoption of certain procedures. Future research, guided by emerging evaluation tools, is crucial for optimizing surgical outcomes and enhancing QOL for gastric cancer patients.
{"title":"Current status, trends, and controversies in the selection of gastrectomy procedures: Insights from two nationwide questionnaire surveys conducted over a 7-year interval in Japan","authors":"Koji Nakada, Hideyuki Kashiwagi, Shinichi Kinami, Hiroharu Yamashita, Nobuyoshi Hanyu, Atsushi Oshio, Michio Kaminishi, Yasuyuki Seto","doi":"10.1002/ags3.70015","DOIUrl":"https://doi.org/10.1002/ags3.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study explores the evolving landscape of gastrectomy procedures in Japan, based on nationwide surveys conducted in 2014 and 2021. It highlights changes in surgical approaches, including a growing focus on minimally invasive and function-preserving procedures, as well as the increasing consideration of postoperative quality of life (QOL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two nationwide questionnaire surveys were conducted in 2014 and 2021, targeting members of the Japanese Society for Gastro-surgical Pathophysiology. The surveys covered institutional characteristics, surgical case volumes, procedure preferences for early gastric cancer by tumor location, and emerging topics such as robot-assisted surgery and sentinel node navigation surgery. Statistical analysis included Fisher's exact test and residual analysis for changes in procedure selection over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicate a marked shift toward laparoscopic and robot-assisted gastrectomy, alongside a rise in function-preserving procedures, particularly proximal gastrectomy and small remnant distal gastrectomy. However, procedures like pylorus-preserving gastrectomy and vagus nerve preservation, and total gastrectomy with jejunal pouch reconstruction remain underutilized due to concerns regarding unclear benefits, technical complexity, and oncological safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study underscores advancements in minimally invasive and function-preserving gastrectomy procedures in Japan but emphasizes the need for more robust clinical evidence to support the broader adoption of certain procedures. Future research, guided by emerging evaluation tools, is crucial for optimizing surgical outcomes and enhancing QOL for gastric cancer patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"903-919"},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Satoshi Yasuda, Minako Nagai, Kota Nakamura, Yasuko Matsuo, Masayuki Sho
This review discusses the evolving role of radiotherapy (RT) in the surgical treatment of pancreatic ductal adenocarcinoma (PDAC). Despite advancements in multidisciplinary treatment, PDAC continues to present significant challenges in surgical treatment strategies. Neoadjuvant therapy, in combination with chemotherapy and RT, aims to improve patient outcomes by reducing tumor size, controlling local spread, and eradicating micrometastatic disease that cannot be detected at the time of diagnosis. Recent randomized trials have shown that both neoadjuvant chemoradiotherapy (NACRT) and neoadjuvant chemotherapy (NAC) improve surgical outcomes compared with upfront surgery. A network meta-analysis integrating multiple trials demonstrated that NACRT significantly improves overall survival compared to NAC (HR: 0.79, 95% CI: 0.64–0.98). NACRT has also shown advantage in local tumor control. For locally advanced PDAC, the role of RT in conversion therapy is being actively investigated. The integration of RT in treatment regimens requires careful consideration of its therapeutic benefits against potential adverse effects. Although experimental studies suggest potential immunological benefits of RT, clinical validation remains incomplete. Recent advances in radiation delivery techniques have improved the therapeutic ratio, although further clinical validation is needed. The optimal sequence and combination of these treatment modalities with surgical strategies continue to be evaluated in ongoing clinical trials. This review synthesizes evidence from recent clinical trials and previous studies to evaluate the effectiveness, challenges, and potential of RT in PDAC treatment, aiming to inform both current clinical practice and future research directions.
{"title":"Role of radiotherapy in surgical approaches to pancreatic cancer treatment: A narrative review","authors":"Satoshi Yasuda, Minako Nagai, Kota Nakamura, Yasuko Matsuo, Masayuki Sho","doi":"10.1002/ags3.70012","DOIUrl":"https://doi.org/10.1002/ags3.70012","url":null,"abstract":"<p>This review discusses the evolving role of radiotherapy (RT) in the surgical treatment of pancreatic ductal adenocarcinoma (PDAC). Despite advancements in multidisciplinary treatment, PDAC continues to present significant challenges in surgical treatment strategies. Neoadjuvant therapy, in combination with chemotherapy and RT, aims to improve patient outcomes by reducing tumor size, controlling local spread, and eradicating micrometastatic disease that cannot be detected at the time of diagnosis. Recent randomized trials have shown that both neoadjuvant chemoradiotherapy (NACRT) and neoadjuvant chemotherapy (NAC) improve surgical outcomes compared with upfront surgery. A network meta-analysis integrating multiple trials demonstrated that NACRT significantly improves overall survival compared to NAC (HR: 0.79, 95% CI: 0.64–0.98). NACRT has also shown advantage in local tumor control. For locally advanced PDAC, the role of RT in conversion therapy is being actively investigated. The integration of RT in treatment regimens requires careful consideration of its therapeutic benefits against potential adverse effects. Although experimental studies suggest potential immunological benefits of RT, clinical validation remains incomplete. Recent advances in radiation delivery techniques have improved the therapeutic ratio, although further clinical validation is needed. The optimal sequence and combination of these treatment modalities with surgical strategies continue to be evaluated in ongoing clinical trials. This review synthesizes evidence from recent clinical trials and previous studies to evaluate the effectiveness, challenges, and potential of RT in PDAC treatment, aiming to inform both current clinical practice and future research directions.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"418-428"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to assess whether the use of spray-type anti-adhesion material during diverting ileostomy construction could reduce the surgeon's multidimensional workload, the degree of adhesion, and the operation time in ileostomy closure.
Methods
Patients diagnosed with rectal cancer, who were scheduled for laparoscopic or robotic rectal surgery followed by diverting ileostomy, were single-blindly (patient-blind), randomly assigned to either the AdSpray™ arm or the control arm. The primary endpoint was the multidimensional workload of the ileostomy closure operator (SURG-TLX value).
Results
Between January 2020 and December 2022, 126 patients were enrolled. Five patients were excluded and a total of 121 patients (control arm, n = 60; AdSpray™ arm, n = 61) were analyzed. The baseline factors were well balanced between the two arms. Regarding SURG-TLX in ileostomy closure, operators in the AdSpray™ arm required a significantly lower overall workload than those in the control arm (AdSpray™ arm, 28.1; control arm, 58.9; p < 0.001). Mental, physical, and temporal demands, task complexity, situation stress, and distractions were significantly lower in the AdSpray™ arm (p < 0.001). Operative time was significantly shorter in the AdSpray™ arm (AdSpray™ arm, 58 min; control arm, 65 min; p = 0.040). The degree of adhesion (p < 0.001) and extent of intra-abdominal adhesions (p < 0.001) in ileostomy closure were significantly lower in the AdSpray™ arm.
Conclusions
The use of spray-type anti-adhesion material was associated with a significantly lower SURG-TLX value, lower incidence of adhesion, less severe adhesion, and shorter operative time.
{"title":"A multicenter randomized controlled trial evaluating the effect of the use of an anti-adhesion barrier for diverting ileostomy on the multidimensional workload in minimally invasive surgery for rectal cancer (YCOG 2005: The ADOBARRIER study)","authors":"Emi Ota, Jun Watanabe, Yusuke Suwa, Masakatsu Numata, Hirokazu Suwa, Hiroki Ohya, Kazuya Nakagawa, Mayumi Ozawa, Itaru Endo","doi":"10.1002/ags3.70009","DOIUrl":"https://doi.org/10.1002/ags3.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The purpose of this study was to assess whether the use of spray-type anti-adhesion material during diverting ileostomy construction could reduce the surgeon's multidimensional workload, the degree of adhesion, and the operation time in ileostomy closure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients diagnosed with rectal cancer, who were scheduled for laparoscopic or robotic rectal surgery followed by diverting ileostomy, were single-blindly (patient-blind), randomly assigned to either the AdSpray™ arm or the control arm. The primary endpoint was the multidimensional workload of the ileostomy closure operator (SURG-TLX value).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between January 2020 and December 2022, 126 patients were enrolled. Five patients were excluded and a total of 121 patients (control arm, <i>n</i> = 60; AdSpray™ arm, <i>n</i> = 61) were analyzed. The baseline factors were well balanced between the two arms. Regarding SURG-TLX in ileostomy closure, operators in the AdSpray™ arm required a significantly lower overall workload than those in the control arm (AdSpray™ arm, 28.1; control arm, 58.9; <i>p</i> < 0.001). Mental, physical, and temporal demands, task complexity, situation stress, and distractions were significantly lower in the AdSpray™ arm (<i>p</i> < 0.001). Operative time was significantly shorter in the AdSpray™ arm (AdSpray™ arm, 58 min; control arm, 65 min; <i>p</i> = 0.040). The degree of adhesion (<i>p</i> < 0.001) and extent of intra-abdominal adhesions (<i>p</i> < 0.001) in ileostomy closure were significantly lower in the AdSpray™ arm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of spray-type anti-adhesion material was associated with a significantly lower SURG-TLX value, lower incidence of adhesion, less severe adhesion, and shorter operative time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"971-979"},"PeriodicalIF":3.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The effectiveness of intraperitoneal chemotherapy using paclitaxel (i.p.-PTX) in pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal dissemination remains elusive. The aim of this study is to investigate the clinical outcome of patients treated with i.p.-PTX combined with systemic chemotherapy compared with current standard chemotherapy including gemcitabine plus nab-paclitaxel and FOLFIRINOX.
Methods
Data of patients with peritoneal dissemination was retrospectively collected and analyzed (i.p.-PTX, n = 83; control, n = 86). Inverse probability of treatment-weighted analyses (IPTW) was used to balance baseline characteristics between two groups. Survival curves were estimated using Kaplan–Meier method, and the differences were compared using the log-rank test.
Results
No significant differences were noted in overall survival (14.9 vs. 15.5 months, p = 0.481) and progression free survival (9.5 vs. 9.1 months, p = 0.267) between i.p.-PTX and the control groups. Nevertheless, i.p.-PTX (9.9 months) significantly prolonged the median progression-free survival (PFS) time compared with the control (8.6 months), among the matched patients using IPTW (hazard ratio 0.666, p = 0.041). Moreover, subgroup analysis among the patients whose primary tumor were evaluated either as resectable or borderline resectable disease revealed significantly better overall survival in the i.p.-PTX group compared with the control group (21.3 vs. 14.7 months, hazard ratio; 0.532, p = 0.033). Conversion surgery was more frequently performed in the i.p.-PTX group than the control group (24% vs. 4%, p = 0.006).
Conclusion
The i.p. PTX regimen prolonged PFS but not overall survival, and subgroup analysis suggested the possibility of survival benefit in patients with occult peritoneal dissemination whose primary tumor was classified as resectable/borderline resectable disease.
背景紫杉醇腹腔化疗（ipp - ptx）治疗伴有腹膜播散的胰管腺癌（PDAC）的疗效尚不明确。本研究的目的是比较ipp - ptx联合全身化疗与目前标准化疗（吉西他滨+ nab-紫杉醇和FOLFIRINOX）的临床疗效。方法回顾性收集腹膜播散患者资料(ipp - ptx, n = 83；对照组，n = 86)。使用治疗加权逆概率分析（IPTW）来平衡两组之间的基线特征。生存曲线估计采用Kaplan-Meier法，差异比较采用log-rank检验。结果ipp - ptx组与对照组的总生存期（14.9个月vs 15.5个月，p = 0.481）和无进展生存期（9.5个月vs 9.1个月，p = 0.267）无显著差异。然而，在使用IPTW的匹配患者中，ipp - ptx（9.9个月）与对照组（8.6个月）相比，显著延长了中位无进展生存期（PFS）时间（风险比0.666,p = 0.041）。此外，对原发肿瘤被评估为可切除或交界性可切除疾病的患者进行亚组分析显示，与对照组相比，ipp - ptx组的总生存率显著提高(21.3个月vs 14.7个月，风险比；0.532, p = 0.033)。ipp - ptx组的转换手术发生率高于对照组（24% vs. 4%, p = 0.006）。结论ipp PTX方案可延长PFS，但不能延长总生存期，亚组分析提示原发肿瘤分类为可切除/交界性可切除的隐匿性腹膜播散患者的生存获益可能性。
{"title":"Clinical role of intraperitoneal chemotherapy in patients with pancreatic ductal adenocarcinoma concomitant with occult peritoneal dissemination: A multicenter retrospective study","authors":"Tomohisa Yamamoto, Toshio Shimokawa, Masamichi Hayashi, Masamichi Mizuma, Katsuhisa Hirano, Atsushi Oba, Toshimichi Asano, Hideyo Miyato, Makoto Yoshida, Ippei Matsumoto, Yasunari Kawabata, Katsunori Sakamoto, Fuyuhiko Motoi, Shigeto Ishii, Yuki Homma, Hiromitsu Maehira, Yutaro Matsunaga, Tetsuya Ikemoto, Masafumi Nakamura, Yuko Mataki, Tsuyoshi Notake, Keiichi Akahoshi, Hideki Takami, So Yamaki, Daisuke Hashimoto, Yasutoshi Kimura, Satoshi Hirano, Yosuke Inoue, Tsutomu Fujii, Michiaki Unno, Yasuhiro Kodera, Joji Kitayama, Sohei Satoi, the Study Group of Pancreatic Ductal Adenocarcinoma with Peritoneal Dissemination","doi":"10.1002/ags3.70001","DOIUrl":"https://doi.org/10.1002/ags3.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The effectiveness of intraperitoneal chemotherapy using paclitaxel (i.p.-PTX) in pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal dissemination remains elusive. The aim of this study is to investigate the clinical outcome of patients treated with i.p.-PTX combined with systemic chemotherapy compared with current standard chemotherapy including gemcitabine plus nab-paclitaxel and FOLFIRINOX.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of patients with peritoneal dissemination was retrospectively collected and analyzed (i.p.-PTX, <i>n</i> = 83; control, <i>n</i> = 86). Inverse probability of treatment-weighted analyses (IPTW) was used to balance baseline characteristics between two groups. Survival curves were estimated using Kaplan–Meier method, and the differences were compared using the log-rank test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were noted in overall survival (14.9 vs. 15.5 months, <i>p</i> = 0.481) and progression free survival (9.5 vs. 9.1 months, <i>p</i> = 0.267) between i.p.-PTX and the control groups. Nevertheless, i.p.-PTX (9.9 months) significantly prolonged the median progression-free survival (PFS) time compared with the control (8.6 months), among the matched patients using IPTW (hazard ratio 0.666, <i>p</i> = 0.041). Moreover, subgroup analysis among the patients whose primary tumor were evaluated either as resectable or borderline resectable disease revealed significantly better overall survival in the i.p.-PTX group compared with the control group (21.3 vs. 14.7 months, hazard ratio; 0.532, <i>p</i> = 0.033). Conversion surgery was more frequently performed in the i.p.-PTX group than the control group (24% vs. 4%, <i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The i.p. PTX regimen prolonged PFS but not overall survival, and subgroup analysis suggested the possibility of survival benefit in patients with occult peritoneal dissemination whose primary tumor was classified as resectable/borderline resectable disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"830-841"},"PeriodicalIF":2.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to determine the cutoff values of C-reactive protein (CRP) on postoperative day 3 to predict poor overall survival (OS) in men and women with gastric cancer after radical gastrectomy.
Methods
This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I–III gastric cancer between May 2006 and March 2017. The patients were randomly divided 6:4 into a training set, which examined the cutoff values for CRP, and a validation set, which validated the cutoff values. Patients with a CRP level higher than the cutoff value were defined as the high-CRP group, and those with a CRP level lower than the cutoff value were defined as the low-CRP group. We compared the OS of the high and low CRP groups using the log-rank test and identified prognostic factors using Cox proportional hazards regression analysis.
Results
We examined the cutoff values of CRP, which were 19.1 mg/dL for men and 8.1 mg/dL for women. The median follow-up duration was 66 months. The high-CRP group had poorer OS than the low-CRP group (p < 0.001). Multivariate analyses showed that a high CRP level was an independent poor prognostic factor for OS in all patients (hazard ratio, 1.356; 95% confidence interval, 1.168–1.576; p < 0.001), not only in patients without postoperative complications (p = 0.001) but also in patients with postoperative complications (p = 0.023).
Conclusion
This study demonstrated that a high postoperative CRP was an independent poor prognostic factor for OS in patients with gastric cancer after radical gastrectomy.
{"title":"Prognostic impact of postoperative fixed-point inflammation in patients with gastric cancer after curative gastrectomy: A validation cohort study","authors":"Ryota Matsui, Manabu Ohashi, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Masaru Hayami, Takeshi Sano, Souya Nunobe","doi":"10.1002/ags3.70006","DOIUrl":"https://doi.org/10.1002/ags3.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to determine the cutoff values of C-reactive protein (CRP) on postoperative day 3 to predict poor overall survival (OS) in men and women with gastric cancer after radical gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I–III gastric cancer between May 2006 and March 2017. The patients were randomly divided 6:4 into a training set, which examined the cutoff values for CRP, and a validation set, which validated the cutoff values. Patients with a CRP level higher than the cutoff value were defined as the high-CRP group, and those with a CRP level lower than the cutoff value were defined as the low-CRP group. We compared the OS of the high and low CRP groups using the log-rank test and identified prognostic factors using Cox proportional hazards regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We examined the cutoff values of CRP, which were 19.1 mg/dL for men and 8.1 mg/dL for women. The median follow-up duration was 66 months. The high-CRP group had poorer OS than the low-CRP group (<i>p</i> < 0.001). Multivariate analyses showed that a high CRP level was an independent poor prognostic factor for OS in all patients (hazard ratio, 1.356; 95% confidence interval, 1.168–1.576; <i>p</i> < 0.001), not only in patients without postoperative complications (<i>p</i> = 0.001) but also in patients with postoperative complications (<i>p</i> = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that a high postoperative CRP was an independent poor prognostic factor for OS in patients with gastric cancer after radical gastrectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"698-710"},"PeriodicalIF":2.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haruna Takeda, Koshi Mimori, Masanobu Oshima, Ken Shirabe, Yuko Kitagawa
This manuscript provides an in-depth interview with Prof. Luis Diaz, Head of Oncology at Memorial Sloan Kettering Cancer Center and Editor-in-Chief of Cancer Discovery. A globally recognized leader in oncology, Prof. Diaz discusses the transformative impact of precision oncology, particularly the role of mismatch repair deficiency (dMMR) and microsatellite instability-high (MSI-H) biomarkers in immunotherapy. He highlights the groundbreaking success of PD-1 blockade therapies, such as dostarlimab, which have achieved unprecedented complete response rates in dMMR/MSI-H rectal cancer, emphasizing its tumor-agnostic potential. Prof. Diaz reflects on the evolution of cancer diagnostics, notably circulating tumor DNA (ctDNA) for minimal residual disease (MRD) detection, and its implications for treatment personalization and early detection. He also addresses the challenges and prospects of cancer prevention, advocating for innovative approaches such as immunoprevention and vaccines targeting tumor-specific pathways, like the HPV vaccine for cervical cancer. The interview underscores the importance of fundamental research in advancing cancer care and the necessity of interdisciplinary collaboration to address unresolved questions in tumor biology. By sharing his vision and pioneering achievements, Prof. Diaz inspires the next generation of clinicians and researchers to pursue bold innovations, ultimately aiming to enhance patient outcomes and revolutionize the future of oncology. This dialogue serves as a significant resource for understanding current trends and future directions in cancer research and treatment.
{"title":"Interview with the World Class Authorities Frontiers of Cancer Research: An exclusive interview with Professor Luis Diaz","authors":"Haruna Takeda, Koshi Mimori, Masanobu Oshima, Ken Shirabe, Yuko Kitagawa","doi":"10.1002/ags3.70003","DOIUrl":"https://doi.org/10.1002/ags3.70003","url":null,"abstract":"<p>This manuscript provides an in-depth interview with Prof. Luis Diaz, Head of Oncology at Memorial Sloan Kettering Cancer Center and Editor-in-Chief of <i>Cancer Discovery</i>. A globally recognized leader in oncology, Prof. Diaz discusses the transformative impact of precision oncology, particularly the role of mismatch repair deficiency (dMMR) and microsatellite instability-high (MSI-H) biomarkers in immunotherapy. He highlights the groundbreaking success of PD-1 blockade therapies, such as dostarlimab, which have achieved unprecedented complete response rates in dMMR/MSI-H rectal cancer, emphasizing its tumor-agnostic potential. Prof. Diaz reflects on the evolution of cancer diagnostics, notably circulating tumor DNA (ctDNA) for minimal residual disease (MRD) detection, and its implications for treatment personalization and early detection. He also addresses the challenges and prospects of cancer prevention, advocating for innovative approaches such as immunoprevention and vaccines targeting tumor-specific pathways, like the HPV vaccine for cervical cancer. The interview underscores the importance of fundamental research in advancing cancer care and the necessity of interdisciplinary collaboration to address unresolved questions in tumor biology. By sharing his vision and pioneering achievements, Prof. Diaz inspires the next generation of clinicians and researchers to pursue bold innovations, ultimately aiming to enhance patient outcomes and revolutionize the future of oncology. This dialogue serves as a significant resource for understanding current trends and future directions in cancer research and treatment.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"401-407"},"PeriodicalIF":2.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic laryngopharyngeal surgery is an effective treatment for superficial laryngopharyngeal cancer, particularly in cases with prior esophageal cancer treatment. Despite its frequent application, reports on the risk factors for postoperative complications are limited. This study aimed to identify the risk factors for pneumonia after endoscopic laryngopharyngeal surgery and to examine the variations in pneumonia incidence among the types of prior esophageal cancer treatment.
Methods
Patients who had a history of esophageal cancer treatment and subsequently underwent endoscopic laryngopharyngeal surgery for superficial pharyngolaryngeal cancer were retrospectively analyzed. We examined the association between postoperative pneumonia and several factors, including number of lesions; diameter of the resected lesion; and type of previous esophageal cancer treatment, such as endoscopic submucosal dissection, chemoradiotherapy, and esophagectomy.
Results
The study included 79 patients who had a mean age of 67.4 years. Postoperative pneumonia occurred in 16.4%. Multivariate analysis showed that the pneumonia incidence significantly increased in cases with multiple lesions (OR 4.794, 95% CI 1.133–20.288, p = 0.033) and larger diameter of the resected lesion (OR 7.047, 95% CI 1.791–27.730, p = 0.005). Importantly, compared with other treatments, prior esophagectomy for esophageal cancer did not increase the pneumonia incidence.
Conclusions
Multiple lesions and larger lesion diameter were the significant predictors of postoperative pneumonia. Moreover, endoscopic laryngopharyngeal surgery can be safely performed even in patients who have previously undergone esophageal cancer surgery, although careful monitoring remains necessary.
背景与研究目的内镜喉部手术是浅表性喉咽癌的有效治疗方法，特别是对有食管癌治疗史的患者。尽管其应用频繁，但关于术后并发症危险因素的报道有限。本研究旨在确定内镜喉部手术后肺炎的危险因素，并探讨食管癌治疗前不同类型患者肺炎发病率的差异。方法回顾性分析有食管癌治疗史的浅表性咽喉癌患者行内镜喉部手术治疗的临床资料。我们检查了术后肺炎与几个因素之间的关系，包括病变数量；切除病灶直径；而以往食管癌的治疗类型，如内镜下粘膜剥离、放化疗、食管切除术等。结果纳入79例患者，平均年龄67.4岁。术后肺炎发生率为16.4%。多因素分析显示，多发病变（OR 4.794, 95% CI 1.133 ~ 20.288, p = 0.033）和切除病变直径较大（OR 7.047, 95% CI 1.791 ~ 27.730, p = 0.005）的患者肺炎发病率显著增加。重要的是，与其他治疗方法相比，食管癌既往食管切除术并未增加肺炎的发病率。结论多发病灶和较大病灶直径是术后肺炎的重要预测因素。此外，内窥镜喉部手术可以安全地进行，即使是以前接受过食管癌手术的患者，尽管仔细监测仍然是必要的。
{"title":"Risk factors for pneumonia after endoscopic laryngopharyngeal surgery in cases with prior esophageal cancer treatment","authors":"Atsushi Nakao, Hirofumi Kawakubo, Masashi Takeuchi, Satoru Matsuda, Kazumasa Fukuda, Yuko Kitagawa","doi":"10.1002/ags3.12907","DOIUrl":"https://doi.org/10.1002/ags3.12907","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Study Aims</h3>\u0000 \u0000 <p>Endoscopic laryngopharyngeal surgery is an effective treatment for superficial laryngopharyngeal cancer, particularly in cases with prior esophageal cancer treatment. Despite its frequent application, reports on the risk factors for postoperative complications are limited. This study aimed to identify the risk factors for pneumonia after endoscopic laryngopharyngeal surgery and to examine the variations in pneumonia incidence among the types of prior esophageal cancer treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who had a history of esophageal cancer treatment and subsequently underwent endoscopic laryngopharyngeal surgery for superficial pharyngolaryngeal cancer were retrospectively analyzed. We examined the association between postoperative pneumonia and several factors, including number of lesions; diameter of the resected lesion; and type of previous esophageal cancer treatment, such as endoscopic submucosal dissection, chemoradiotherapy, and esophagectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 79 patients who had a mean age of 67.4 years. Postoperative pneumonia occurred in 16.4%. Multivariate analysis showed that the pneumonia incidence significantly increased in cases with multiple lesions (OR 4.794, 95% CI 1.133–20.288, <i>p</i> = 0.033) and larger diameter of the resected lesion (OR 7.047, 95% CI 1.791–27.730, <i>p</i> = 0.005). Importantly, compared with other treatments, prior esophagectomy for esophageal cancer did not increase the pneumonia incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple lesions and larger lesion diameter were the significant predictors of postoperative pneumonia. Moreover, endoscopic laryngopharyngeal surgery can be safely performed even in patients who have previously undergone esophageal cancer surgery, although careful monitoring remains necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 3","pages":"456-463"},"PeriodicalIF":2.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuki Hirata, Laura Prakash, Jess Maxwell, Rebecca Snyder, Michael Kim, Hop Tran Cao, Ching-Wei D. Tzeng, Jefferey E. Lee, Matthew H. G. Katz, Naruhiko Ikoma
Background
The granular methods by which centers can safely implement and effectively expand robotic distal pancreatectomy (RDP), including those related to appropriate patient selection during the learning curve period, remain unclear. This study aimed to verify that our strategic robotic surgical oncology program effectively implemented RDP as standard practice and to identify factors associated with prolonged operation time.
Materials and Methods
We performed a detailed analysis of the intraoperative and short-term outcomes of consecutive patients (October 2018–September 2023) undergoing RDP at our center, beginning with the first patient in our program. Operation time was analyzed using a cumulative sum chart (CUSUM), and factors associated with prolonged operation time were analyzed.
Results
Throughout the study period, five surgeons performed RDP for 117 patients. The CUSUM analysis indicated our center required 18 cases to overcome the initial learning phase and 43 additional cases to become proficient. In contrast, when comparing short-term outcomes across the three observation periods, there were no significant changes in the incidence of ACCORDION grade ≥3 pancreatic fistulas (p = 0.684), or readmission rates (p = 0.457). A multivariable analysis revealed BMI ≥30 in male, the presence of pancreatitis or fibrosis, and the performance of concomitant procedures were associated with extended operation times, while BMI ≥30 in female was not.
Conclusions
Although an institutional learning curve was observed, our program enabled the safe implementation of RDP and successfully expanded the number of primary operating surgeons while maintaining stable short-term outcomes. The absence of an impact of high BMI on operation time in female patients suggests a notable advantage of robotic approach for these individuals.
{"title":"Institutional learning curve and factors of prolonged operation time of robotic distal pancreatectomy: An analysis of an initial 117 cases","authors":"Yuki Hirata, Laura Prakash, Jess Maxwell, Rebecca Snyder, Michael Kim, Hop Tran Cao, Ching-Wei D. Tzeng, Jefferey E. Lee, Matthew H. G. Katz, Naruhiko Ikoma","doi":"10.1002/ags3.70005","DOIUrl":"https://doi.org/10.1002/ags3.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The granular methods by which centers can safely implement and effectively expand robotic distal pancreatectomy (RDP), including those related to appropriate patient selection during the learning curve period, remain unclear. This study aimed to verify that our strategic robotic surgical oncology program effectively implemented RDP as standard practice and to identify factors associated with prolonged operation time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We performed a detailed analysis of the intraoperative and short-term outcomes of consecutive patients (October 2018–September 2023) undergoing RDP at our center, beginning with the first patient in our program. Operation time was analyzed using a cumulative sum chart (CUSUM), and factors associated with prolonged operation time were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Throughout the study period, five surgeons performed RDP for 117 patients. The CUSUM analysis indicated our center required 18 cases to overcome the initial learning phase and 43 additional cases to become proficient. In contrast, when comparing short-term outcomes across the three observation periods, there were no significant changes in the incidence of ACCORDION grade ≥3 pancreatic fistulas (<i>p</i> = 0.684), or readmission rates (<i>p</i> = 0.457). A multivariable analysis revealed BMI ≥30 in male, the presence of pancreatitis or fibrosis, and the performance of concomitant procedures were associated with extended operation times, while BMI ≥30 in female was not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although an institutional learning curve was observed, our program enabled the safe implementation of RDP and successfully expanded the number of primary operating surgeons while maintaining stable short-term outcomes. The absence of an impact of high BMI on operation time in female patients suggests a notable advantage of robotic approach for these individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"861-869"},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The concepts examined in tumor metabolism research have been moving away from cancer cells themselves and the tumor microenvironment has become a focus of investigation. Epigenetic changes affecting glucose metabolism in cancer-associated fibroblasts (CAFs) in the tumor microenvironment regulate the malignancy of cancer cells. Light-emitting diode (LED) have several functional effects, including anti-tumor effects, through a variety of mechanisms. We previously reported that blue LED irradiation had an anti-tumor effect via Opsin 3 that suppress CAF function in vivo and in vitro. However, the detailed mechanism by which LED affect CAF regulation remained unclear.
Methods
CAFs were induced from human intestinal fibroblasts co-cultured with colon cancer cells. Using lactate assays and reverse transcription-quantitative PCR, the effects of LED irradiation on glycolysis in CAFs were investigated. The effects of LED irradiation for metabolic coupling were evaluated in vitro.
Results
Reverse transcription-quantitative PCR showed higher expression of CAF marker genes in induced CAFs. Blue LED irradiation of induced CAFs suppressed their ability to promote characteristics of tumor malignancy of colon cancer cell line. LED treatment decreased expression of glycolysis markers, including phosphofructokinase and monocarboxylate transporter 4, indicating inhibition of glycolytic activity in CAFs. Extracellular secretion of lactate from CAFs was decreased by LED irradiation.
Conclusions
Blue LED irradiation targeted metabolic coupling between CAFs and colon cancer cells, thereby reducing the promotion of tumor progression by CAFs. Blue LED targeting glucose metabolism in CAFs is a promising anti-cancer treatment option.
{"title":"Light-emitting diode irradiation targets aerobic glycolysis in cancer-associated fibroblasts to inhibit metabolic coupling with colon cancer cells","authors":"Masaaki Nishi, Chiharu Nakasu, Toshiaki Yoshimoto, Takuya Tokunaga, T. Hideya Kashihara, Chie Takasu, Daichi Ishikawa, Yuma Wada, Mitsuo Shimada","doi":"10.1002/ags3.70004","DOIUrl":"https://doi.org/10.1002/ags3.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The concepts examined in tumor metabolism research have been moving away from cancer cells themselves and the tumor microenvironment has become a focus of investigation. Epigenetic changes affecting glucose metabolism in cancer-associated fibroblasts (CAFs) in the tumor microenvironment regulate the malignancy of cancer cells. Light-emitting diode (LED) have several functional effects, including anti-tumor effects, through a variety of mechanisms. We previously reported that blue LED irradiation had an anti-tumor effect via Opsin 3 that suppress CAF function in vivo and in vitro. However, the detailed mechanism by which LED affect CAF regulation remained unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CAFs were induced from human intestinal fibroblasts co-cultured with colon cancer cells. Using lactate assays and reverse transcription-quantitative PCR, the effects of LED irradiation on glycolysis in CAFs were investigated. The effects of LED irradiation for metabolic coupling were evaluated in vitro.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Reverse transcription-quantitative PCR showed higher expression of CAF marker genes in induced CAFs. Blue LED irradiation of induced CAFs suppressed their ability to promote characteristics of tumor malignancy of colon cancer cell line. LED treatment decreased expression of glycolysis markers, including phosphofructokinase and monocarboxylate transporter 4, indicating inhibition of glycolytic activity in CAFs. Extracellular secretion of lactate from CAFs was decreased by LED irradiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Blue LED irradiation targeted metabolic coupling between CAFs and colon cancer cells, thereby reducing the promotion of tumor progression by CAFs. Blue LED targeting glucose metabolism in CAFs is a promising anti-cancer treatment option.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"761-768"},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although docetaxel-based triplet neoadjuvant chemotherapy has yielded promising results for locally advanced esophageal cancer, there are concerns that the triplet regimen can increase perioperative adverse events in older patients. This retrospective study assessed the perioperative outcomes following doublet or docetaxel-based triplet chemotherapy and esophagectomy in older patients.
Methods
The data of patients aged 70–79 years who received cisplatin and 5-fluorouracil (CF) or docetaxel, cisplatin, and 5-fluorouracil (DCF) before esophagectomy were extracted from a nationwide Japanese inpatient database (April 2012–March 2022). The primary outcomes were major and respiratory complications. The secondary outcomes included anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality. Analyses were conducted using overlap propensity score weighting, propensity score matching, and instrumental variable methods to adjust for potential confounders.
Results
Of 5229 eligible patients, 3457 (66%) and 1772 (34%) patients received neoadjuvant CF and DCF, respectively. Major and respiratory complications occurred in 5229 (40%) and 1388 (27%) patients, respectively. After overlap weighting, DCF was not associated with a higher frequency of major (odds ratio 0.99 [95% confidence interval 0.87–1.12]) and respiratory complications (odds ratio 1.04 [0.90–1.19]) compared with CF. The frequencies of anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality did not differ between the groups. Propensity score matching and instrumental variable analyses yielded similar results.
Conclusions
Neoadjuvant DCF was not associated with a higher frequency of perioperative adverse events compared with CF after esophagectomy in patients aged 70–79 years.
{"title":"Perioperative outcomes of esophagectomy after doublet versus docetaxel-based triplet neoadjuvant chemotherapy in older patients: A nationwide inpatient database study in Japan","authors":"Yuki Hirano, Takaaki Konishi, Hidehiro Kaneko, Satoru Matsuda, Hirofumi Kawakubo, Yuya Kimura, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, Hideo Yasunaga, Yuko Kitagawa","doi":"10.1002/ags3.70000","DOIUrl":"https://doi.org/10.1002/ags3.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although docetaxel-based triplet neoadjuvant chemotherapy has yielded promising results for locally advanced esophageal cancer, there are concerns that the triplet regimen can increase perioperative adverse events in older patients. This retrospective study assessed the perioperative outcomes following doublet or docetaxel-based triplet chemotherapy and esophagectomy in older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data of patients aged 70–79 years who received cisplatin and 5-fluorouracil (CF) or docetaxel, cisplatin, and 5-fluorouracil (DCF) before esophagectomy were extracted from a nationwide Japanese inpatient database (April 2012–March 2022). The primary outcomes were major and respiratory complications. The secondary outcomes included anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality. Analyses were conducted using overlap propensity score weighting, propensity score matching, and instrumental variable methods to adjust for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 5229 eligible patients, 3457 (66%) and 1772 (34%) patients received neoadjuvant CF and DCF, respectively. Major and respiratory complications occurred in 5229 (40%) and 1388 (27%) patients, respectively. After overlap weighting, DCF was not associated with a higher frequency of major (odds ratio 0.99 [95% confidence interval 0.87–1.12]) and respiratory complications (odds ratio 1.04 [0.90–1.19]) compared with CF. The frequencies of anastomotic leakage, 30-day unplanned readmission, and 30- and 90-day mortality did not differ between the groups. Propensity score matching and instrumental variable analyses yielded similar results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neoadjuvant DCF was not associated with a higher frequency of perioperative adverse events compared with CF after esophagectomy in patients aged 70–79 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"687-697"},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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