Anemia has negative effects on long-term outcomes of rectal cancer patients; however, its status as a risk factor for severe complications is disputed. Perioperative risks may differ based on the severity of pre-surgical anemia; nonetheless, no previous study has investigated these differences. This study identified risks of severe postoperative complications in rectal cancer patients based on severity of their pre-surgical anemia.
Materials and Methods
This study enrolled patients who underwent low anterior resection for rectal cancer and were registered in the Japanese National Clinical Database (NCD) between 2017 and 2019. Anemia severity was categorized into three levels: mild, moderate, and severe. A logistic regression model was applied to calculate the risk-adjusted odds ratio (OR) of severe complications after surgery.
Results
This study analyzed a cohort of 51 765 rectal cancer patients who underwent low anterior resection. Results showed that severe complications occurred in 10.9% of patients and were significantly more frequent in patients with anemia (13.6%) than those with normal hemoglobin levels (9.2%). Risk-adjusted ORs of severe complications in the severe, moderate, and mild anemia groups versus the normal group for males were 1.19 (95% confidence interval [CI]: 0.89–1.58), 1.47 (1.34–1.62), and 1.21 (1.12–1.31), respectively. Those for females were 1.39 (0.90–2.15), 1.64 (1.37–1.97), and 1.36 (1.16–1.58), respectively.
Conclusions
According to this large cohort study, pre-surgical anemia significantly increases the risk of severe postoperative complications in rectal cancer patients. Even mild anemia presents a significant risk.
{"title":"Presurgical mild anemia is a risk factor for severe postoperative complications of rectal cancer surgery: A Japanese nationwide retrospective cohort study","authors":"Takeshi Yamada, Hideki Endo, Hiroshi Hasegawa, Yoshihiro Kakeji, Hiroyuki Yamamoto, Hiroaki Miyata, Koki Otsuka, Akihisa Matsuda, Hiroshi Yoshida, Yuko Kitagawa","doi":"10.1002/ags3.12770","DOIUrl":"10.1002/ags3.12770","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anemia has negative effects on long-term outcomes of rectal cancer patients; however, its status as a risk factor for severe complications is disputed. Perioperative risks may differ based on the severity of pre-surgical anemia; nonetheless, no previous study has investigated these differences. This study identified risks of severe postoperative complications in rectal cancer patients based on severity of their pre-surgical anemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study enrolled patients who underwent low anterior resection for rectal cancer and were registered in the Japanese National Clinical Database (NCD) between 2017 and 2019. Anemia severity was categorized into three levels: mild, moderate, and severe. A logistic regression model was applied to calculate the risk-adjusted odds ratio (OR) of severe complications after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study analyzed a cohort of 51 765 rectal cancer patients who underwent low anterior resection. Results showed that severe complications occurred in 10.9% of patients and were significantly more frequent in patients with anemia (13.6%) than those with normal hemoglobin levels (9.2%). Risk-adjusted ORs of severe complications in the severe, moderate, and mild anemia groups versus the normal group for males were 1.19 (95% confidence interval [CI]: 0.89–1.58), 1.47 (1.34–1.62), and 1.21 (1.12–1.31), respectively. Those for females were 1.39 (0.90–2.15), 1.64 (1.37–1.97), and 1.36 (1.16–1.58), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>According to this large cohort study, pre-surgical anemia significantly increases the risk of severe postoperative complications in rectal cancer patients. Even mild anemia presents a significant risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"471-480"},"PeriodicalIF":2.7,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441187","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}
Teijiro Hirashita, Naoki Ikenaga, Kohei Nakata, Masafumi Nakamura, Hiroshi Kurahara, Takao Ohtsuka, Takaaki Tatsuguchi, Kazuyoshi Nishihara, Hiromitsu Hayashi, Shigeki Nakagawa, Takao Ide, Hirokazu Noshiro, Tomohiko Adachi, Susumu Eguchi, Atsushi Miyoshi, Shiro Kohi, Atsushi Nanashima, Hiroaki Nagano, Mitsuhisa Takatsuki, Masafumi Inomata, Kyushu Study Group of Treatment for Pancreatobiliary Cancer
Background
Distal pancreatectomy (DP) with lymph node (LN) dissection is the standard procedure for pancreatic ductal adenocarcinoma of the tail (Pt-PDAC). However, the optimal surgery including extent of LN dissection is still being debated. The present study investigated the incidence and prognostic impact of LN metastasis on patients suffering from Pt-PDAC.
Patients and method
This multicenter, retrospective study involved 163 patients who underwent DP for resectable Pt-PDAC at 12 institutions between 2013 and 2017. The frequency of LN metastasis and the effect of LN dissection on Pt-PDAC prognosis were investigated.
Results
There were high incidences of metastases to the LNs along the splenic artery in the patients with Pt-PDAC (39%). The rate of metastases in the LNs along the common hepatic, left gastric, and celiac arteries were low, and the therapeutic index for these LNs was zero. In pancreatic tail cancer located more distally, there were no metastases to the LNs along the common hepatic artery. Multivariate analysis revealed that tumor size was the only independent factor related to recurrence-free survival (HR = 2.01, 95% CI = 1.33–3.05, p = 0.001). The level of pancreas division and LN dissection along the common hepatic artery did not affect the site of tumor recurrence or recurrence-free survival.
Conclusions
LN dissection along the hepatic artery for Pt-PDAC has little significance. Distal pancreatic transection may be acceptable in terms of oncological safety, but further examination of short-term outcomes and preservation of pancreatic function is required.
胰腺远端切除术（DP）加淋巴结（LN）清扫术是治疗胰腺尾部导管腺癌（Pt-PDAC）的标准手术方法。然而，包括淋巴结清扫范围在内的最佳手术方式仍存在争议。本研究调查了LN转移对Pt-PDAC患者的发生率和预后影响。这项多中心回顾性研究涉及2013年至2017年间在12家机构接受DP治疗的163例可切除Pt-PDAC患者。Pt-PDAC患者沿脾动脉转移至LN的发生率较高（39%）。沿肝总动脉、胃左动脉和腹腔动脉的淋巴结转移率较低，这些淋巴结的治疗指数为零。在位置较远的胰尾癌中，沿肝总动脉的淋巴结没有发生转移。多变量分析显示，肿瘤大小是唯一与无复发生存率相关的独立因素（HR = 2.01，95% CI = 1.33-3.05，P = 0.001）。胰腺分割水平和沿肝总动脉的LN切除并不影响肿瘤复发部位或无复发生存率。就肿瘤安全性而言，远端胰腺横断可能是可以接受的，但需要进一步检查短期疗效和胰腺功能的保留情况。
{"title":"Prognostic significance of lymph node metastasis in pancreatic tail cancer: A multicenter retrospective study","authors":"Teijiro Hirashita, Naoki Ikenaga, Kohei Nakata, Masafumi Nakamura, Hiroshi Kurahara, Takao Ohtsuka, Takaaki Tatsuguchi, Kazuyoshi Nishihara, Hiromitsu Hayashi, Shigeki Nakagawa, Takao Ide, Hirokazu Noshiro, Tomohiko Adachi, Susumu Eguchi, Atsushi Miyoshi, Shiro Kohi, Atsushi Nanashima, Hiroaki Nagano, Mitsuhisa Takatsuki, Masafumi Inomata, Kyushu Study Group of Treatment for Pancreatobiliary Cancer","doi":"10.1002/ags3.12771","DOIUrl":"10.1002/ags3.12771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Distal pancreatectomy (DP) with lymph node (LN) dissection is the standard procedure for pancreatic ductal adenocarcinoma of the tail (Pt-PDAC). However, the optimal surgery including extent of LN dissection is still being debated. The present study investigated the incidence and prognostic impact of LN metastasis on patients suffering from Pt-PDAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and method</h3>\u0000 \u0000 <p>This multicenter, retrospective study involved 163 patients who underwent DP for resectable Pt-PDAC at 12 institutions between 2013 and 2017. The frequency of LN metastasis and the effect of LN dissection on Pt-PDAC prognosis were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were high incidences of metastases to the LNs along the splenic artery in the patients with Pt-PDAC (39%). The rate of metastases in the LNs along the common hepatic, left gastric, and celiac arteries were low, and the therapeutic index for these LNs was zero. In pancreatic tail cancer located more distally, there were no metastases to the LNs along the common hepatic artery. Multivariate analysis revealed that tumor size was the only independent factor related to recurrence-free survival (HR = 2.01, 95% CI = 1.33–3.05, <i>p</i> = 0.001). The level of pancreas division and LN dissection along the common hepatic artery did not affect the site of tumor recurrence or recurrence-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LN dissection along the hepatic artery for Pt-PDAC has little significance. Distal pancreatic transection may be acceptable in terms of oncological safety, but further examination of short-term outcomes and preservation of pancreatic function is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 4","pages":"681-690"},"PeriodicalIF":2.9,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443117","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}
Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health-related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP-related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health-related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.
{"title":"Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis","authors":"Kei Yamane, Takayuki Anazawa, Kazuyuki Nagai, Takashi Ito, Etsuro Hatano","doi":"10.1002/ags3.12767","DOIUrl":"https://doi.org/10.1002/ags3.12767","url":null,"abstract":"<p>Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health-related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP-related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health-related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"401-412"},"PeriodicalIF":2.7,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140820685","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}
Masato Narita, Etsuro Hatano, Koji Kitamura, Ken Fukumitsu, Hirohisa Kitagawa, Yuhei Hamaguchi, Takefumi Yazawa, Hiroaki Terajima, Kazuhiko Kitaguchi, Toshihiko Hata, the Kyoto University Hepato-Biliary Pancreatic surgery Study Group (KUHBPS)
Aim
Carcinoma of the ampulla of Vater (CAV) shows a favorable prognosis compared to that with the other periampullary tumors, while some cases have a poor prognosis. The aims of the present study are to clarify the clinicopathological factors associated with poor recurrence-free survival (RFS) in patients with CAV after curative resection and to validate the usefulness of adjuvant chemotherapy (AC).
Patients
The study design is a multicenter retrospective cohort study. Patients with CAV who underwent pancreaticoduodenectomy between January 2008 and December 2020 at 26 hospitals were analyzed. The 30 clinicopathological factors were evaluated. A propensity score matching (PSM) was used to compare between patients with and without AC.
Results
Finally, 460 patients were analyzed. Median duration of follow-up was 47.2 months. Twenty-one prognostic factors associated with poor RFS were identified by univariate analysis. In multivariate analysis, aged ≥71, tumor diameter ≥12 mm, pT2 or higher stage (pT≥2), portal vein invasion (PV+), venous invasion(V+), and node positive disease (pN+) were independent prognostic factors for poor RFS. Out of 80 patients who received AC, 63 patients were assigned to analysis for PSM. The results showed no beneficial effect of AC on RFS. The preoperative factors potentially predicting pT≥2, V+, and/or N+ were at least one of following; (1) CA19-9 > 37 IU/mL, (2) ulcerative or mixed type appearance, (3) except for well-differentiated tumor, or (4) except for intestinal subtype of histology.
Conclusions
Aged ≥71, tumor diameter ≥12 mm, pT≥2, PV+, V+, and pN+ were independent prognostic factors for poor RFS in patients with CAV. An additional therapeutic strategy may be desirable in CAV patients at high risk for recurrence.
目的 与其他胰腺周围肿瘤相比，Vater ampulla 癌（CAV）的预后较好，但也有一些病例预后较差。本研究的目的是明确与根治性切除术后无复发生存率（RFS）低下相关的临床病理因素，并验证辅助化疗（AC）的有效性。 患者 研究设计为多中心回顾性队列研究。研究分析了2008年1月至2020年12月期间在26家医院接受胰十二指肠切除术的CAV患者。对 30 个临床病理因素进行了评估。采用倾向评分匹配法（PSM）对有 AC 和无 AC 的患者进行比较。 结果 最终分析了460名患者。中位随访时间为 47.2 个月。通过单变量分析，确定了 21 个与 RFS 差相关的预后因素。在多变量分析中，年龄≥71岁、肿瘤直径≥12毫米、pT2或更高分期（pT≥2）、门静脉侵犯（PV+）、静脉侵犯（V+）和结节阳性疾病（pN+）是RFS差的独立预后因素。在接受 AC 治疗的 80 例患者中，63 例患者被分配进行 PSM 分析。结果显示 AC 对 RFS 无益处。预测 pT≥2、V+ 和/或 N+ 的术前因素至少包括以下一项：（1）CA19-9 > 37 IU/mL；（2）溃疡型或混合型外观；（3）分化良好的肿瘤除外；或（4）组织学为肠亚型的肿瘤除外。 结论 年龄≥71岁、肿瘤直径≥12毫米、pT≥2、PV+、V+和pN+是CAV患者RFS不良的独立预后因素。对于复发风险较高的CAV患者，可能需要额外的治疗策略。
{"title":"Identification of patients at high risk for recurrence in carcinoma of the ampulla of Vater: Analysis in 460 patients","authors":"Masato Narita, Etsuro Hatano, Koji Kitamura, Ken Fukumitsu, Hirohisa Kitagawa, Yuhei Hamaguchi, Takefumi Yazawa, Hiroaki Terajima, Kazuhiko Kitaguchi, Toshihiko Hata, the Kyoto University Hepato-Biliary Pancreatic surgery Study Group (KUHBPS)","doi":"10.1002/ags3.12764","DOIUrl":"https://doi.org/10.1002/ags3.12764","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Carcinoma of the ampulla of Vater (CAV) shows a favorable prognosis compared to that with the other periampullary tumors, while some cases have a poor prognosis. The aims of the present study are to clarify the clinicopathological factors associated with poor recurrence-free survival (RFS) in patients with CAV after curative resection and to validate the usefulness of adjuvant chemotherapy (AC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>The study design is a multicenter retrospective cohort study. Patients with CAV who underwent pancreaticoduodenectomy between January 2008 and December 2020 at 26 hospitals were analyzed. The 30 clinicopathological factors were evaluated. A propensity score matching (PSM) was used to compare between patients with and without AC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Finally, 460 patients were analyzed. Median duration of follow-up was 47.2 months. Twenty-one prognostic factors associated with poor RFS were identified by univariate analysis. In multivariate analysis, aged ≥71, tumor diameter ≥12 mm, pT2 or higher stage (pT≥2), portal vein invasion (PV+), venous invasion(V+), and node positive disease (pN+) were independent prognostic factors for poor RFS. Out of 80 patients who received AC, 63 patients were assigned to analysis for PSM. The results showed no beneficial effect of AC on RFS. The preoperative factors potentially predicting pT≥2, V+, and/or N+ were at least one of following; (1) CA19-9 > 37 IU/mL, (2) ulcerative or mixed type appearance, (3) except for well-differentiated tumor, or (4) except for intestinal subtype of histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aged ≥71, tumor diameter ≥12 mm, pT≥2, PV+, V+, and pN+ were independent prognostic factors for poor RFS in patients with CAV. An additional therapeutic strategy may be desirable in CAV patients at high risk for recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"190-201"},"PeriodicalIF":2.7,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140043120","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 number of elderly patients with liver cancer is increasing with the aging society. The Geriatric Prognostic Scoring System is useful in predicting the postoperative prognosis for elderly patients with gastrointestinal cancer. The aim of the present study was to assess the predictive ability of the geriatric prognostic scoring system for postoperative survival in elderly patients with liver cancer.
Methods
Eighty-eight patients aged ≥75 years who were treated for primary liver cancer and metastatic liver tumor were retrospectively analyzed. The Geriatric Prognostic Score (GPS) was created by several clinical parameters such as age, sex, type of cancer, stage, performance status, body mass index, and comprehensive geriatric assessment. Each patient was divided into two groups of high-risk to low-risk according to their GPS: ≧30 high-risk group and <30 low-risk. The predictive ability of geriatric prognostic scoring system for postoperative survival was assessed in univariate and multivariate analyses.
Results
Of the 88 patients, 75 were diagnosed as hepatocellular carcinoma and 13 as colorectal liver metastasis. After geriatric prognostic scoring system assessments, 26 patients were diagnosed as high-risk and the remaining 62 as low-risk. The 3-year overall survival rates were 78.5% in the low-risk group and 35.1% in the high-risk group (p < 0.001). The univariate and multivariate analyses of overall survival identified high GPS as an independent significant factor (p < 0.001).
Conclusions
We could conclude that the geriatric prognostic scoring system is useful in predicting patients' prognosis after hepatectomy and it can provide helpful information to surgeons for determining treatment strategies for elderly patients with liver cancer.
{"title":"Geriatric prognostic scoring system predicts survival after hepatectomy for elderly patients with liver cancer","authors":"Yoshihiro Sakano, Takehiro Noda, Shogo Kobayashi, Hiroshi Akasaka, Kazuya Kato, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Yoshito Tomimaru, Hidenori Takahashi, Tadafumi Asaoka, Junzo Shimizu, Hiromi Rakugi, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1002/ags3.12762","DOIUrl":"10.1002/ags3.12762","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The number of elderly patients with liver cancer is increasing with the aging society. The Geriatric Prognostic Scoring System is useful in predicting the postoperative prognosis for elderly patients with gastrointestinal cancer. The aim of the present study was to assess the predictive ability of the geriatric prognostic scoring system for postoperative survival in elderly patients with liver cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty-eight patients aged ≥75 years who were treated for primary liver cancer and metastatic liver tumor were retrospectively analyzed. The Geriatric Prognostic Score (GPS) was created by several clinical parameters such as age, sex, type of cancer, stage, performance status, body mass index, and comprehensive geriatric assessment. Each patient was divided into two groups of high-risk to low-risk according to their GPS: ≧30 high-risk group and <30 low-risk. The predictive ability of geriatric prognostic scoring system for postoperative survival was assessed in univariate and multivariate analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 88 patients, 75 were diagnosed as hepatocellular carcinoma and 13 as colorectal liver metastasis. After geriatric prognostic scoring system assessments, 26 patients were diagnosed as high-risk and the remaining 62 as low-risk. The 3-year overall survival rates were 78.5% in the low-risk group and 35.1% in the high-risk group (<i>p</i> < 0.001). The univariate and multivariate analyses of overall survival identified high GPS as an independent significant factor (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We could conclude that the geriatric prognostic scoring system is useful in predicting patients' prognosis after hepatectomy and it can provide helpful information to surgeons for determining treatment strategies for elderly patients with liver cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"498-506"},"PeriodicalIF":2.7,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961197","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}
<p>Artificial intelligence (AI) has a significant impact on the field of health care, particularly imaging and video analyses. It can considerably support clinical decision-making, including the automatic diagnosis of gastrointestinal cancer during endoscopy and automated detection of pulmonary lesions on computed tomography (CT).<span><sup>1, 2</sup></span> In the future, AI may provide innovative solutions that improve surgical efficiency and patient outcomes in the field of surgical procedures. Integrating AI into surgery can potentially redefine the surgical procedures, ushering in a new era of personalized and data-driven healthcare.</p><p>The role of AI in preoperative planning is substantial. By analyzing large amounts of medical data, including patient records, imaging findings (e.g., CT and endoscopy), and previous history, AI can help surgeons plan more effective and personalized surgical strategies. For instance, it can predict potential perioperative complications, suggesting optimal surgical approaches, and even simulate surgical outcomes. Furthermore, AI can analyze CT scans to create 3D models of patient anatomy, such as blood vessels, allowing surgeons to plan surgeries with a level of detail that was previously unattainable.</p><p>Robotic surgery, one of the most notable applications of AI in surgery, has been a game changer. Compared with the conventional approach, robotic systems such as the da Vinci Surgical System enable surgeons to perform fine and complex procedures with more precision, flexibility, and control. AI enhances these systems by providing real-time analysis and precision in movement and learning from each surgery performed, thereby improving the outcomes over time. In particular, advanced image recognition powered by AI algorithms aids in quickly identifying critical anatomical structures, navigating complicated anatomy more easily, and reducing the risk of developing surgical complications.<span><sup>3, 4</sup></span> In addition, AI's ability to understand and analyze surgical process facilitates seamless information sharing across the surgical team, contributing to the early detection of complications and ensuring rapid intervention.<span><sup>5</sup></span> Moreover, incorporating AI into surgical robots represents a giant leap forward. These AI algorithm-controlled robotic systems perform complex procedures with unparalleled precision. They are often tailored to adapt to the unique skills of individual surgeons, thereby improving surgical accuracy while minimizing the potential for error. The synergistic cooperation between human surgeons and AI-guided robotic systems represents a new era of cooperative, high-leveled surgery.</p><p>AI also plays a pivotal role in overseeing and optimizing patient recovery after surgery. Through the use of sensors and data analysis, AI can foresee potential complications and readmissions before serious problems develop, enabling surgeons to provide timely and targeted interv
人工智能（AI）对医疗保健领域产生了重大影响，尤其是成像和视频分析。它可以为临床决策提供重要支持，包括在内窥镜检查中自动诊断胃肠道癌症，以及在计算机断层扫描（CT）中自动检测肺部病变。将人工智能融入外科手术可能会重新定义外科手术程序，开创个性化和数据驱动型医疗保健的新时代。通过分析大量医疗数据，包括患者记录、成像结果（如 CT 和内窥镜检查）以及既往病史，人工智能可以帮助外科医生制定更有效、更个性化的手术策略。例如，它可以预测潜在的围手术期并发症，建议最佳手术方法，甚至模拟手术结果。此外，人工智能还可以分析 CT 扫描，创建病人解剖结构（如血管）的 3D 模型，让外科医生能够以以前无法达到的详细程度规划手术。与传统方法相比，机器人系统（如达芬奇手术系统）使外科医生能够更精确、更灵活、更可控地进行精细复杂的手术。人工智能增强了这些系统的功能，可提供实时分析和精确运动，并从每次手术中学习，从而长期改善手术效果。3, 4 此外，人工智能理解和分析手术过程的能力有助于手术团队无缝共享信息，有助于及早发现并发症，确保快速干预。这些由人工智能算法控制的机器人系统能以无与伦比的精度完成复杂的手术。它们通常是为适应每个外科医生的独特技能而量身定制的，从而提高了手术的准确性，同时最大限度地减少了出错的可能性。人类外科医生与人工智能引导的机器人系统之间的协同合作，代表着一个合作式高水平外科手术的新时代。通过使用传感器和数据分析，人工智能可以在出现严重问题之前预见潜在的并发症和再入院情况，使外科医生能够提供及时和有针对性的干预，为整体术后护理做出重大贡献。人工智能的参与不仅仅是监测，而是根据每位患者的独特数据资料，通过高度个性化的方式为其量身定制术后护理计划。这种个性化方法考虑了个人健康参数、病史和特定的恢复需求。这种精确的护理计划可满足患者的特定需求，改善整体恢复体验，从而有可能加快愈合过程。在培训中实施人工智能包括使用虚拟现实和增强现实模拟等创新工具，从根本上改变外科医生的学习体验。由于人工智能能够根据每个学员的技能水平定制培训体验，这些模拟可以提供一个超越传统方法的动态自适应学习平台；因此，这些模块可以根据学员的需求和熟练程度进行个性化定制。通过利用人工智能增强型互动模拟，可以透彻地理解外科技术，为成功的外科手术奠定必要的实用技能基础。对人工智能和机器人系统的依赖引发了手术失误时的责任和问责问题。鉴于这些系统需要访问患者的个人数据，数据隐私和安全问题也随之出现。培训外科医生有效使用这些先进技术也是一项挑战，因为不同地域和社会经济群体需要公平地获得这些技术。
{"title":"Artificial intelligence and surgery","authors":"Masashi Takeuchi, Yuko Kitagawa","doi":"10.1002/ags3.12766","DOIUrl":"10.1002/ags3.12766","url":null,"abstract":"<p>Artificial intelligence (AI) has a significant impact on the field of health care, particularly imaging and video analyses. It can considerably support clinical decision-making, including the automatic diagnosis of gastrointestinal cancer during endoscopy and automated detection of pulmonary lesions on computed tomography (CT).<span><sup>1, 2</sup></span> In the future, AI may provide innovative solutions that improve surgical efficiency and patient outcomes in the field of surgical procedures. Integrating AI into surgery can potentially redefine the surgical procedures, ushering in a new era of personalized and data-driven healthcare.</p><p>The role of AI in preoperative planning is substantial. By analyzing large amounts of medical data, including patient records, imaging findings (e.g., CT and endoscopy), and previous history, AI can help surgeons plan more effective and personalized surgical strategies. For instance, it can predict potential perioperative complications, suggesting optimal surgical approaches, and even simulate surgical outcomes. Furthermore, AI can analyze CT scans to create 3D models of patient anatomy, such as blood vessels, allowing surgeons to plan surgeries with a level of detail that was previously unattainable.</p><p>Robotic surgery, one of the most notable applications of AI in surgery, has been a game changer. Compared with the conventional approach, robotic systems such as the da Vinci Surgical System enable surgeons to perform fine and complex procedures with more precision, flexibility, and control. AI enhances these systems by providing real-time analysis and precision in movement and learning from each surgery performed, thereby improving the outcomes over time. In particular, advanced image recognition powered by AI algorithms aids in quickly identifying critical anatomical structures, navigating complicated anatomy more easily, and reducing the risk of developing surgical complications.<span><sup>3, 4</sup></span> In addition, AI's ability to understand and analyze surgical process facilitates seamless information sharing across the surgical team, contributing to the early detection of complications and ensuring rapid intervention.<span><sup>5</sup></span> Moreover, incorporating AI into surgical robots represents a giant leap forward. These AI algorithm-controlled robotic systems perform complex procedures with unparalleled precision. They are often tailored to adapt to the unique skills of individual surgeons, thereby improving surgical accuracy while minimizing the potential for error. The synergistic cooperation between human surgeons and AI-guided robotic systems represents a new era of cooperative, high-leveled surgery.</p><p>AI also plays a pivotal role in overseeing and optimizing patient recovery after surgery. Through the use of sensors and data analysis, AI can foresee potential complications and readmissions before serious problems develop, enabling surgeons to provide timely and targeted interv","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 1","pages":"4-5"},"PeriodicalIF":2.7,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12766","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995285","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}
Naruhiko Sawada, Tomonori Akagi, Manabu Shimomura, Yukitoshi Todate, Kunihiko Nagakari, Hiroaki Takeshita, Satoshi Maruyama, Manabu Takata, Nobuki Ichikawa, Koya Hida, Hiroaki Iijima, Shigeki Yamaguchi, Akinobu Taketomi, Takeshi Naitoh, The EnSSURE Study Group Collaboratives in Japan Society of Laparoscopic Colorectal Surgery.
Background
A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II–III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection.
Aim
This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR).
Methods
The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (Q and non-Q groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated.
Results
The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the Q group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups.
Conclusion
The participation of qualified surgeons in LAR is technically advantageous.
{"title":"Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection","authors":"Naruhiko Sawada, Tomonori Akagi, Manabu Shimomura, Yukitoshi Todate, Kunihiko Nagakari, Hiroaki Takeshita, Satoshi Maruyama, Manabu Takata, Nobuki Ichikawa, Koya Hida, Hiroaki Iijima, Shigeki Yamaguchi, Akinobu Taketomi, Takeshi Naitoh, The EnSSURE Study Group Collaboratives in Japan Society of Laparoscopic Colorectal Surgery.","doi":"10.1002/ags3.12763","DOIUrl":"10.1002/ags3.12763","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II–III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (<i>Q</i> and non-<i>Q</i> groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the <i>Q</i> group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The participation of qualified surgeons in LAR is technically advantageous.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"464-470"},"PeriodicalIF":2.7,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138971594","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}
A positive resection margin (RM) is associated with poor survival after gastrectomy for gastric cancer (GC). However, the adequate RM length to avoid a positive RM remains controversial. We performed a systematic review to examine the RM length required to avoid a positive RM in gastrectomy for GC.
Methods
This systematic review involved all relevant articles identified in PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until August 2023. The incidence of a positive RM related to the RM length and the possible incidence of a positive RM estimated from the discrepancy between the gross and pathological RM length were evaluated. The Newcastle–Ottawa Scale was used to quantify study quality.
Results
Thirteen studies involving 8983 patients were analyzed. Investigation of the incidence of a positive RM in relation to the RM length showed that a proximal RM length of 6 cm guaranteed a negative RM in gastrectomy. Analyses of the possible incidence of a positive RM revealed that a negative RM would be guaranteed if the proximal RM length was 6 cm in distal gastrectomy, if the esophageal resection length was 2 cm in total gastrectomy for GC without esophageal invasion and 2.5 cm in total or proximal gastrectomy for GC with esophageal invasion or esophagogastric junction cancer, and if the distal RM length was 4 cm in proximal gastrectomy for early GC.
Conclusions
The adequate RM lengths to ensure a pathologically negative RM in each type of gastrectomy for GC were herein suggested.
胃癌(GC)胃切除术后，切缘阳性(RM)与生存率低相关。然而，足够的RM长度以避免正RM仍然存在争议。我们进行了一项系统的综述，以检查胃癌切除术中避免RM阳性所需的RM长度。该系统综述包括截至2023年8月在PubMed、Cochrane图书馆、Web of Science和ClinicalTrials.gov中发现的所有相关文章。评估与RM长度相关的阳性RM的发生率，以及从大体RM长度和病理RM长度之间的差异估计的阳性RM的可能发生率。纽卡斯尔-渥太华量表用于量化研究质量。13项研究涉及8983例患者进行了分析。对RM阳性的发生率与RM长度的关系的研究表明，近端RM长度为6cm保证了胃切除术中RM的阴性。对RM阳性可能发生率的分析显示，远端胃切除术中RM近端长度为6cm，未侵犯食管的胃癌全胃切除术中食管切除长度为2cm，伴食管侵犯或食管胃结癌的胃癌全胃或近端切除术中食管切除长度为2.5 cm，早期胃癌近端切除术中RM远端长度为4cm，均可保证RM阴性。适当的RM长度，以确保病理阴性RM在每一种胃切除术的胃癌在这里被建议。
{"title":"Adequate gross resection margin length ensuring pathologically complete resection in gastrectomy for gastric cancer: A systematic review and meta-analysis","authors":"Masaru Hayami, Manabu Ohashi, Nozomi Kurihara, Souya Nunobe","doi":"10.1002/ags3.12761","DOIUrl":"10.1002/ags3.12761","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>A positive resection margin (RM) is associated with poor survival after gastrectomy for gastric cancer (GC). However, the adequate RM length to avoid a positive RM remains controversial. We performed a systematic review to examine the RM length required to avoid a positive RM in gastrectomy for GC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review involved all relevant articles identified in PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until August 2023. The incidence of a positive RM related to the RM length and the possible incidence of a positive RM estimated from the discrepancy between the gross and pathological RM length were evaluated. The Newcastle–Ottawa Scale was used to quantify study quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies involving 8983 patients were analyzed. Investigation of the incidence of a positive RM in relation to the RM length showed that a proximal RM length of 6 cm guaranteed a negative RM in gastrectomy. Analyses of the possible incidence of a positive RM revealed that a negative RM would be guaranteed if the proximal RM length was 6 cm in distal gastrectomy, if the esophageal resection length was 2 cm in total gastrectomy for GC without esophageal invasion and 2.5 cm in total or proximal gastrectomy for GC with esophageal invasion or esophagogastric junction cancer, and if the distal RM length was 4 cm in proximal gastrectomy for early GC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The adequate RM lengths to ensure a pathologically negative RM in each type of gastrectomy for GC were herein suggested.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"202-213"},"PeriodicalIF":2.7,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138599145","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}
Intra-abdominal infectious complications (IAICs) following minimally invasive gastrectomy (MIG) for cancer sometimes worsen short- and long-term outcomes. In this study, we focused on the minimum umbilicus–vertebra diameter (MUVD) in preoperative computed tomography (CT) images and robotic surgery to prevent severe IAIC occurrence.
Patients and Methods
A total of 400 patients with gastric cancer who underwent 204 laparoscopic gastrectomy (LG) and 196 robotic gastrectomy (RG) procedures were enrolled in this study. We retrospectively investigated the significance of the MUVD and robotic surgery for preventing severe IAICs following MIG using multivariate and propensity score matching analysis.
Results
The MUVD cutoff value was 84 mm by receiver operating characteristic (ROC) curve using severe IAICs as the end point. The MUVD and visceral fat area (VFA) had significantly higher area under the curve (AUC) than BMI (MUVD vs. BMI, p = 0.032; VFA vs. BMI, p < 0.01). In the multivariate analysis, high MUVD (HR, 9.46; p = 0.026) and laparoscopic surgery (HR, 3.35; p = 0.042) were independent risk factors for severe IAIC occurrence. In the propensity matching analysis between robotic and laparoscopic surgery in the high MUVD group, the RG group tended to have a lower severe IAIC rate than the LG group (0% vs. 9.8%, p = 0.056).
Conclusion
The MUVD was a novel and easy-measuring predictor of severe IAICs following MIG. Robotic surgery should be considered first in patients with gastric cancer having an MUVD value of 84 mm or higher from the perspective of severe IAIC occurrence.
微创胃切除术(MIG)治疗癌症后腹腔内感染并发症(iiac)有时会恶化短期和长期预后。在本研究中，我们重点关注术前计算机断层扫描(CT)图像中的最小脐椎体直径(MUVD)和机器人手术，以防止严重的IAIC发生。共有400名胃癌患者接受了204例腹腔镜胃切除术(LG)和196例机器人胃切除术(RG)。我们采用多变量和倾向评分匹配分析回顾性研究了MUVD和机器人手术在预防MIG后严重iiac中的意义。以重度iiac为终点的受试者工作特征(ROC)曲线MUVD截止值为84 mm。MUVD和内脏脂肪面积(VFA)的曲线下面积(AUC)明显高于BMI (MUVD vs. BMI, p = 0.032;VFA vs. BMI, p < 0.01)。多因素分析中，高MUVD (HR, 9.46;p = 0.026)和腹腔镜手术(HR, 3.35;p = 0.042)是严重IAIC发生的独立危险因素。在高MUVD组机器人和腹腔镜手术的倾向匹配分析中，RG组倾向于比LG组有更低的严重IAIC发生率(0%比9.8%，p = 0.056)。MUVD是一种新颖且易于测量的MIG后严重iiac预测指标。从IAIC发生严重的角度来看，对于MUVD值≥84 mm的胃癌患者，应优先考虑机器人手术。
{"title":"How do we prevent severe intra-abdominal infectious complications following minimally invasive gastrectomy for cancer? The usefulness of a novel marker using computed tomography images (minimum umbilicus–vertebra diameter) and robotic surgery","authors":"Naoshi Kubo, Katsunobu Sakurai, Tsuyoshi Hasegawa, Junya Nishimura, Yasuhito Iseki, Takafumi Nishii, Sadatoshi Shimizu, Toru Inoue, Yukio Nishiguchi, Kiyoshi Maeda","doi":"10.1002/ags3.12760","DOIUrl":"10.1002/ags3.12760","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intra-abdominal infectious complications (IAICs) following minimally invasive gastrectomy (MIG) for cancer sometimes worsen short- and long-term outcomes. In this study, we focused on the minimum umbilicus–vertebra diameter (MUVD) in preoperative computed tomography (CT) images and robotic surgery to prevent severe IAIC occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A total of 400 patients with gastric cancer who underwent 204 laparoscopic gastrectomy (LG) and 196 robotic gastrectomy (RG) procedures were enrolled in this study. We retrospectively investigated the significance of the MUVD and robotic surgery for preventing severe IAICs following MIG using multivariate and propensity score matching analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The MUVD cutoff value was 84 mm by receiver operating characteristic (ROC) curve using severe IAICs as the end point. The MUVD and visceral fat area (VFA) had significantly higher area under the curve (AUC) than BMI (MUVD vs. BMI, <i>p</i> = 0.032; VFA vs. BMI, <i>p</i> < 0.01). In the multivariate analysis, high MUVD (HR, 9.46; <i>p</i> = 0.026) and laparoscopic surgery (HR, 3.35; <i>p</i> = 0.042) were independent risk factors for severe IAIC occurrence. In the propensity matching analysis between robotic and laparoscopic surgery in the high MUVD group, the RG group tended to have a lower severe IAIC rate than the LG group (0% vs. 9.8%, <i>p</i> = 0.056).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The MUVD was a novel and easy-measuring predictor of severe IAICs following MIG. Robotic surgery should be considered first in patients with gastric cancer having an MUVD value of 84 mm or higher from the perspective of severe IAIC occurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 3","pages":"420-430"},"PeriodicalIF":2.7,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138605821","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}
<p>We gratefully acknowledge Drs. Daungsupawong and Wiwanitkit's insights regarding our recently published article “Antibody titer after administration of mRNA-based vaccine against severe acute respiratory syndrome coronavirus 2 in liver transplant recipients.”<span><sup>1</sup></span> We reported that mRNA vaccines induce similar humoral responses and decay rates of acquired antibodies in liver-transplant recipients as in healthy individuals.<span><sup>2</sup></span> Accordingly, we deduced that liver-transplant recipients should receive booster vaccination. Although we agree with the majority of the authors' points, we would like to address some of their concerns that were expressed in their Letter to the Editor.</p><p>In Japan, as the local government has provided free vaccination against the coronavirus disease (COVID-19), liver-transplant recipients have good access to healthcare. Adults were eligible for vaccination throughout, and children could receive vaccination midway through, the study period. Based on the study's results, liver-transplant recipients received regular vaccinations, and continued to receive booster vaccinations (given every 6 months after the second vaccination) even after the study ended. The average observation period for target patients after the second vaccination was 328 ± 64 days in the study.</p><p>With regard to the pre-vaccination history of infections, the impact was likely small, as only two recipients tested positive for anti-nucleocapsid antibodies at the first measurement. Although, data on current infection rates are unavailable, no recipient has developed severe pneumonia in the 1 year since study completion. In the statistics reported by the Japan Society for Transplantation on COVID-19 cases up to August 31, 2022,<span><sup>3</sup></span> only 237 recipients, including those from our facility, were infected, which is a relatively low incidence. This is largely attributable to nonpharmaceutical preventive interventions, including the behavioral changes of liver-transplant recipients who refrained from venturing out during the COVID-19 pandemic. The infection rate could increase henceforth.</p><p>To investigate the protection conferred by neutralizing antibodies against infection, the antibody titer needs frequent measurement to determine the level necessary to prevent infection. However, this is not feasible in clinical practice. As COVID-19 is not a seasonal illness, perennial prevention is essential. Considering the decay rate of neutralizing antibodies, annual booster vaccination seems insufficient to provide preventive immunity. However, with the increased number of individuals with a history of COVID-19 in the community currently, the risk of cluster outbreaks has decreased. Therefore, with regard to vaccination, a multi-societal perspective, which includes infection severity, is needed. As there is an uncertain trend in SARS-CoV-2 infection rates in liver-transplant recipients, continuing booster
{"title":"Author's reply: COVID-19 vaccine in liver transplant recipients","authors":"Atsuyoshi Mita, Yasunari Ohno, Yuji Soejima","doi":"10.1002/ags3.12752","DOIUrl":"https://doi.org/10.1002/ags3.12752","url":null,"abstract":"<p>We gratefully acknowledge Drs. Daungsupawong and Wiwanitkit's insights regarding our recently published article “Antibody titer after administration of mRNA-based vaccine against severe acute respiratory syndrome coronavirus 2 in liver transplant recipients.”<span><sup>1</sup></span> We reported that mRNA vaccines induce similar humoral responses and decay rates of acquired antibodies in liver-transplant recipients as in healthy individuals.<span><sup>2</sup></span> Accordingly, we deduced that liver-transplant recipients should receive booster vaccination. Although we agree with the majority of the authors' points, we would like to address some of their concerns that were expressed in their Letter to the Editor.</p><p>In Japan, as the local government has provided free vaccination against the coronavirus disease (COVID-19), liver-transplant recipients have good access to healthcare. Adults were eligible for vaccination throughout, and children could receive vaccination midway through, the study period. Based on the study's results, liver-transplant recipients received regular vaccinations, and continued to receive booster vaccinations (given every 6 months after the second vaccination) even after the study ended. The average observation period for target patients after the second vaccination was 328 ± 64 days in the study.</p><p>With regard to the pre-vaccination history of infections, the impact was likely small, as only two recipients tested positive for anti-nucleocapsid antibodies at the first measurement. Although, data on current infection rates are unavailable, no recipient has developed severe pneumonia in the 1 year since study completion. In the statistics reported by the Japan Society for Transplantation on COVID-19 cases up to August 31, 2022,<span><sup>3</sup></span> only 237 recipients, including those from our facility, were infected, which is a relatively low incidence. This is largely attributable to nonpharmaceutical preventive interventions, including the behavioral changes of liver-transplant recipients who refrained from venturing out during the COVID-19 pandemic. The infection rate could increase henceforth.</p><p>To investigate the protection conferred by neutralizing antibodies against infection, the antibody titer needs frequent measurement to determine the level necessary to prevent infection. However, this is not feasible in clinical practice. As COVID-19 is not a seasonal illness, perennial prevention is essential. Considering the decay rate of neutralizing antibodies, annual booster vaccination seems insufficient to provide preventive immunity. However, with the increased number of individuals with a history of COVID-19 in the community currently, the risk of cluster outbreaks has decreased. Therefore, with regard to vaccination, a multi-societal perspective, which includes infection severity, is needed. As there is an uncertain trend in SARS-CoV-2 infection rates in liver-transplant recipients, continuing booster","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 2","pages":"367-368"},"PeriodicalIF":2.7,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12752","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140043046","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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