The advantages of robot-assisted minimally invasive esophagectomy (RA-MIE) over conventional minimally invasive esophagectomy (C-MIE) are unknown. This nationwide large-scale study aimed to compare surgical outcomes between RA-MIE and C-MIE using rigorous propensity score methods, including detailed covariates and relevant outcomes.
Methods
This Japanese nationwide retrospective cohort study included RA-MIE or C-MIE for esophageal malignant tumors performed between October 2018 and December 2019 and registered in the Japanese National Clinical Database. The primary outcome measure was postoperative complications classified as Clavien–Dindo Grade IIIa or higher. Propensity score matching was performed to create a balanced covariate distribution between the two groups.
Results
After propensity score matching, 1092 patients were selected. The RA-MIE group had a significantly longer operation time and greater blood loss than the C-MIE group (565 vs. 477 min and 120 vs. 90 mL). Furthermore, the R0 resection rate was lower in the RA-MIE group than in the C-MIE group (95.1% vs. 97.8%). The RA-MIE and C-MIE groups had no differences regarding overall complications ≥ Grade IIIa (22.0% vs. 20.3%, p = 0.52), 30-day mortality rates (0.4% vs. 0.5%), and operative mortality rates (0.7% vs. 0.7%). Deep SSI was less frequent (2.7% vs. 6.0%) and pulmonary embolism was more frequent (2.4% vs. 0.5%) in the RA-MIE group than in the C-MIE group.
Conclusions
In the initial phase of implementation, RA-MIE and C-MIE demonstrated comparable morbidity rates when performed by skilled board-certified endoscopic surgeons.
背景：机器人辅助微创食管切除术（RA-MIE）相对于传统微创食管切除术（C-MIE）的优势尚不清楚。这项全国性的大规模研究旨在使用严格的倾向评分方法比较RA-MIE和C-MIE的手术结果，包括详细的协变量和相关结果。方法：这项日本全国范围的回顾性队列研究包括2018年10月至2019年12月期间进行的食管恶性肿瘤RA-MIE或C-MIE，并在日本国家临床数据库中注册。主要结局指标是术后并发症，Clavien-Dindo分级为IIIa级或更高。进行倾向评分匹配以在两组之间创建平衡的协变量分布。结果：经倾向评分匹配后，入选1092例患者。RA-MIE组手术时间明显长于C-MIE组（565 vs. 477 min, 120 vs. 90 mL），出血量明显大于C-MIE组。此外，RA-MIE组的R0切除率低于C-MIE组（95.1%比97.8%）。RA-MIE组和C-MIE组在总并发症≥IIIa级（22.0% vs. 20.3%, p = 0.52）、30天死亡率（0.4% vs. 0.5%）和手术死亡率（0.7% vs. 0.7%）方面无差异。与C-MIE组相比，RA-MIE组的深度SSI发生率较低（2.7%对6.0%），肺栓塞发生率较高（2.4%对0.5%）。结论：在实施的初始阶段，RA-MIE和C-MIE在由熟练的委员会认证的内窥镜外科医生执行时显示出相当的发病率。
{"title":"Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy: A propensity score-matched study via a nationwide database","authors":"Tatsuto Nishigori, Hiraku Kumamaru, Kazutaka Obama, Koichi Suda, Shigeru Tsunoda, Yukie Yoda, Makoto Hikage, Susumu Shibasaki, Tsuyoshi Tanaka, Masanori Terashima, Yoshihiro Kakeji, Masafumi Inomata, Yuko Kitagawa, Hiroaki Miyata, Yoshiharu Sakai, Hirokazu Noshiro, Ichiro Uyama","doi":"10.1002/ags3.12854","DOIUrl":"10.1002/ags3.12854","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The advantages of robot-assisted minimally invasive esophagectomy (RA-MIE) over conventional minimally invasive esophagectomy (C-MIE) are unknown. This nationwide large-scale study aimed to compare surgical outcomes between RA-MIE and C-MIE using rigorous propensity score methods, including detailed covariates and relevant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This Japanese nationwide retrospective cohort study included RA-MIE or C-MIE for esophageal malignant tumors performed between October 2018 and December 2019 and registered in the Japanese National Clinical Database. The primary outcome measure was postoperative complications classified as Clavien–Dindo Grade IIIa or higher. Propensity score matching was performed to create a balanced covariate distribution between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching, 1092 patients were selected. The RA-MIE group had a significantly longer operation time and greater blood loss than the C-MIE group (565 vs. 477 min and 120 vs. 90 mL). Furthermore, the R0 resection rate was lower in the RA-MIE group than in the C-MIE group (95.1% vs. 97.8%). The RA-MIE and C-MIE groups had no differences regarding overall complications ≥ Grade IIIa (22.0% vs. 20.3%, <i>p</i> = 0.52), 30-day mortality rates (0.4% vs. 0.5%), and operative mortality rates (0.7% vs. 0.7%). Deep SSI was less frequent (2.7% vs. 6.0%) and pulmonary embolism was more frequent (2.4% vs. 0.5%) in the RA-MIE group than in the C-MIE group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the initial phase of implementation, RA-MIE and C-MIE demonstrated comparable morbidity rates when performed by skilled board-certified endoscopic surgeons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"109-118"},"PeriodicalIF":2.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930573","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}
In this study, we evaluated the difference in short-term outcomes and postoperative nutritional status between subtotal gastrectomy (sTG) and proximal gastrectomy (PG) to determine the optimal surgical treatment for early gastric cancer in the upper third of the stomach.
Methods
Patients who underwent laparoscopic or robotic sTG or PG at the Shizuoka Cancer Center in Shizuoka between January 2014 and December 2020 were enrolled in this retrospective study. Patient characteristics, surgical outcomes, endoscopic findings, and postoperative nutritional changes, including blood tests, body weight, psoas muscle, and subcutaneous and visceral adipose tissue, were measured and compared between the two groups.
Results
A total of 110 patients were enrolled, including 42 in the sTG group and 68 in the PG group. Albumin and hemoglobin levels were comparable between the two groups. Changes in body weight and psoas mass index measured over 36 months postoperatively were favorable in the sTG group compared with the PG group (p = 0.005 and p = 0.002, respectively). There were no significant differences in subcutaneous or visceral adipose tissue between the two groups (p = 0.331 and 0.845, respectively).
Conclusion
sTG is the preferred function-preserving gastrectomy procedure for early gastric cancer in the upper third of the stomach because it is associated with less postoperative body weight loss and psoas mass index loss.
{"title":"Comparison of surgical outcomes and postoperative nutritional parameters between subtotal and proximal gastrectomy in patients with proximal early gastric cancer","authors":"Wataru Soneda, Masanori Terashima, Yusuke Koseki, Kenichiro Furukawa, Keiichi Fujiya, Yutaka Tanizawa, Hiroya Takeuchi, Etsuro Bando","doi":"10.1002/ags3.12856","DOIUrl":"10.1002/ags3.12856","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In this study, we evaluated the difference in short-term outcomes and postoperative nutritional status between subtotal gastrectomy (sTG) and proximal gastrectomy (PG) to determine the optimal surgical treatment for early gastric cancer in the upper third of the stomach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent laparoscopic or robotic sTG or PG at the Shizuoka Cancer Center in Shizuoka between January 2014 and December 2020 were enrolled in this retrospective study. Patient characteristics, surgical outcomes, endoscopic findings, and postoperative nutritional changes, including blood tests, body weight, psoas muscle, and subcutaneous and visceral adipose tissue, were measured and compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 110 patients were enrolled, including 42 in the sTG group and 68 in the PG group. Albumin and hemoglobin levels were comparable between the two groups. Changes in body weight and psoas mass index measured over 36 months postoperatively were favorable in the sTG group compared with the PG group (<i>p</i> = 0.005 and <i>p</i> = 0.002, respectively). There were no significant differences in subcutaneous or visceral adipose tissue between the two groups (<i>p</i> = 0.331 and 0.845, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>sTG is the preferred function-preserving gastrectomy procedure for early gastric cancer in the upper third of the stomach because it is associated with less postoperative body weight loss and psoas mass index loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"89-97"},"PeriodicalIF":2.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930502","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}
Recent studies have focused on evaluating the biomarker value of textural features in radiological images. Our study investigated whether or not a texture analysis of computed tomographic colonography (CTC) images could be a novel biomarker for colorectal cancer (CRC).
Methods
This retrospective study investigated 263 patients with CRC who underwent contrast-enhanced CTC (CE-CTC) before curative surgery between January 2014 and December 2017. Multiple texture analyses (fractal, histogram, and gray-level co-occurrence matrix [GLCM] texture analyses) were applied to CE-CTC (portal-venous phase), and fractal dimension (FD), skewness, kurtosis, entropy, and GLCM texture parameters, including GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity, of the tumor were calculated. These texture parameters were compared with pathological factors (tumor depth, lymph node metastasis, vascular invasion, and lymphatic invasion) and overall survival (OS).
Results
Tumor depth was significantly associated with FD, kurtosis, entropy, GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity (p = 0.001, 0.001, 0.001, 0.001, 0.018, 0.008, and 0.001, respectively); lymph node metastasis was associated with GLCM-homogeneity (p = 0.004); lymphatic invasion was associated with GLCM-correlation and GLCM-homogeneity (p = 0.001 and 0.012, respectively); and venous invasion was associated with FD, entropy, GLCM-correlation, GLCM-autocorrelation, and GLCM-entropy of the tumor (p = 0.001, 0.033, 0.021, 0.046, respectively). In the Kaplan–Meier analysis, patients with high GLCM-correlation tumors or high GLCM-homogeneity tumors showed a significantly worse OS than others (p = 0.001 and 0.04, respectively). Multivariate analyses showed that the GLCM correlation was an independent prognostic factor for the OS (p = 0.021).
Conclusion
CE-CTC-derived texture parameters may be clinically useful biomarkers for managing CRC patients.
{"title":"Texture analysis of CT colonography to develop a novel imaging biomarker for the management of colorectal cancer","authors":"Hisashi Mamiya, Toru Tochigi, Koichi Hayano, Gaku Ohira, Shunsuke Imanishi, Tetsuro Maruyama, Yoshihiro Kurata, Yumiko Takahashi, Atsushi Hirata, Hisahiro Matsubara","doi":"10.1002/ags3.12852","DOIUrl":"10.1002/ags3.12852","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent studies have focused on evaluating the biomarker value of textural features in radiological images. Our study investigated whether or not a texture analysis of computed tomographic colonography (CTC) images could be a novel biomarker for colorectal cancer (CRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study investigated 263 patients with CRC who underwent contrast-enhanced CTC (CE-CTC) before curative surgery between January 2014 and December 2017. Multiple texture analyses (fractal, histogram, and gray-level co-occurrence matrix [GLCM] texture analyses) were applied to CE-CTC (portal-venous phase), and fractal dimension (FD), skewness, kurtosis, entropy, and GLCM texture parameters, including GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity, of the tumor were calculated. These texture parameters were compared with pathological factors (tumor depth, lymph node metastasis, vascular invasion, and lymphatic invasion) and overall survival (OS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Tumor depth was significantly associated with FD, kurtosis, entropy, GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity (<i>p</i> = 0.001, 0.001, 0.001, 0.001, 0.018, 0.008, and 0.001, respectively); lymph node metastasis was associated with GLCM-homogeneity (<i>p</i> = 0.004); lymphatic invasion was associated with GLCM-correlation and GLCM-homogeneity (<i>p</i> = 0.001 and 0.012, respectively); and venous invasion was associated with FD, entropy, GLCM-correlation, GLCM-autocorrelation, and GLCM-entropy of the tumor (<i>p</i> = 0.001, 0.033, 0.021, 0.046, respectively). In the Kaplan–Meier analysis, patients with high GLCM-correlation tumors or high GLCM-homogeneity tumors showed a significantly worse OS than others (<i>p</i> = 0.001 and 0.04, respectively). Multivariate analyses showed that the GLCM correlation was an independent prognostic factor for the OS (<i>p</i> = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CE-CTC-derived texture parameters may be clinically useful biomarkers for managing CRC patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"145-152"},"PeriodicalIF":2.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930574","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}
L. M. Tóth, H. Székely, A. Rancz, Á. Zolcsák, M. D. Sárközi, S. Ábrahám, L. Földvári-Nagy, B. Erőss, P. Hegyi, P. Miheller
Background
The prevalence of ulcerative colitis (UC) is around 200/100 000 people. Colectomy is required in 7.5%–40% of patients and 58.8%–94% of these operations are elective. Approximately one in two adults with UC are overweight or obese.
Objective
Our aim was to compare postoperative complications between obese (defined by a body mass index (BMI) over 30 kg/m2) and non-obese UC patients who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA).
Methods
Our preregistered protocol can be found on PROSPERO (CRD42022377761). We conducted our search in three databases on the 26th of November 2022. PRISMA 2020 guideline and the Cochrane Handbook were applied. We used the GRADEpro program and the QUIPS tool. We applied a random-effects model to pool effect sizes. We included cohort and case–control studies investigating UC patients undergoing colectomy with IPAA and reported information on postoperative complications in obese and non-obese patients. We used mean difference (MD) for continuous variables and calculated odds ratio (OR) with a 95% confidence interval (CI) for dichotomous variables.
Results
Of the 6870 hits of our systematic search, we included three retrospective cohort studies for analyses involving 4929 patients in our research. Neither the incidence of complications at 30 days after surgery [OR = 1.08; CI: 0.65–1.79] nor the incidence of septic complications [OR = 1.11; CI: 0.85–1.46] had any clinical relevance, except for the length of hospital stay [MD = 0.36; CI:0.04–0.69]. When we assessed the risk of bias, we found that most of the aspects examined had a moderate overall risk. Our results have very low certainty of evidence.
Conclusions and Relevance
Our findings suggest that obesity defined as BMI over 30 kg/m2 may not associated with an increased risk of higher rates of overall postoperative complications compared to non-obese patients. Obesity with a cut-off value of 30 kg/m2 does not appear to be a primary reason for prehabilitation.
{"title":"Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta-analysis","authors":"L. M. Tóth, H. Székely, A. Rancz, Á. Zolcsák, M. D. Sárközi, S. Ábrahám, L. Földvári-Nagy, B. Erőss, P. Hegyi, P. Miheller","doi":"10.1002/ags3.12855","DOIUrl":"10.1002/ags3.12855","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prevalence of ulcerative colitis (UC) is around 200/100 000 people. Colectomy is required in 7.5%–40% of patients and 58.8%–94% of these operations are elective. Approximately one in two adults with UC are overweight or obese.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our aim was to compare postoperative complications between obese (defined by a body mass index (BMI) over 30 kg/m<sup>2</sup>) and non-obese UC patients who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our preregistered protocol can be found on PROSPERO (CRD42022377761). We conducted our search in three databases on the 26th of November 2022. PRISMA 2020 guideline and the Cochrane Handbook were applied. We used the GRADEpro program and the QUIPS tool. We applied a random-effects model to pool effect sizes. We included cohort and case–control studies investigating UC patients undergoing colectomy with IPAA and reported information on postoperative complications in obese and non-obese patients. We used mean difference (MD) for continuous variables and calculated odds ratio (OR) with a 95% confidence interval (CI) for dichotomous variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 6870 hits of our systematic search, we included three retrospective cohort studies for analyses involving 4929 patients in our research. Neither the incidence of complications at 30 days after surgery [OR = 1.08; CI: 0.65–1.79] nor the incidence of septic complications [OR = 1.11; CI: 0.85–1.46] had any clinical relevance, except for the length of hospital stay [MD = 0.36; CI:0.04–0.69]. When we assessed the risk of bias, we found that most of the aspects examined had a moderate overall risk. Our results have very low certainty of evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>Our findings suggest that obesity defined as BMI over 30 kg/m<sup>2</sup> may not associated with an increased risk of higher rates of overall postoperative complications compared to non-obese patients. Obesity with a cut-off value of 30 kg/m<sup>2</sup> does not appear to be a primary reason for prehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"153-160"},"PeriodicalIF":2.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930533","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}
Takumi Kozu, Takashi Akiyoshi, Takashi Sakamoto, Tomohiro Yamaguchi, Seiichiro Yamamoto, Ryosuke Okamura, Tsuyoshi Konishi, Yoshihisa Umemoto, Koya Hida, Takeshi Naitoh, Japan Society of Laparoscopic Colorectal Surgery
Background
Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.
Methods
Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine–Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.
Results
Across the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7–14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m2, distance from anal verge ≤4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.
Conclusion
This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.
{"title":"Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter retrospective cohort study in Japan","authors":"Takumi Kozu, Takashi Akiyoshi, Takashi Sakamoto, Tomohiro Yamaguchi, Seiichiro Yamamoto, Ryosuke Okamura, Tsuyoshi Konishi, Yoshihisa Umemoto, Koya Hida, Takeshi Naitoh, Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1002/ags3.12849","DOIUrl":"10.1002/ags3.12849","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine–Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7–14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m<sup>2</sup>, distance from anal verge ≤4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"128-136"},"PeriodicalIF":2.9,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930540","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}
Pivotal articles that had been published between 2022 and 2023 on surgical and perioperative adjuvant treatments for locally advanced colorectal cancer (CRC) were reviewed. This review focuses on new evidence in the following areas: optimization of surgical procedures for colon cancer, including the optimal length of bowel resection and use of the no-touch isolation technique; minimally invasive surgery for rectal cancer, such as laparoscopic transanal total mesorectal excision and robotic surgery; neoadjuvant treatments for rectal cancer, including total neoadjuvant therapy; neoadjuvant chemotherapy for colon cancer; and postoperative adjuvant chemotherapy for Stage II and III colon cancer. Although the current understanding may not enable perfect decision-making for patients and medical professionals, ongoing advancements are expected to result in more effective personalized treatment plans, ultimately improving the prognosis and quality of life of patients.
{"title":"Essential updates 2022–2023: Surgical and adjuvant therapies for locally advanced colorectal cancer","authors":"Yoshiki Kajiwara, Hideki Ueno","doi":"10.1002/ags3.12853","DOIUrl":"10.1002/ags3.12853","url":null,"abstract":"<p>Pivotal articles that had been published between 2022 and 2023 on surgical and perioperative adjuvant treatments for locally advanced colorectal cancer (CRC) were reviewed. This review focuses on new evidence in the following areas: optimization of surgical procedures for colon cancer, including the optimal length of bowel resection and use of the no-touch isolation technique; minimally invasive surgery for rectal cancer, such as laparoscopic transanal total mesorectal excision and robotic surgery; neoadjuvant treatments for rectal cancer, including total neoadjuvant therapy; neoadjuvant chemotherapy for colon cancer; and postoperative adjuvant chemotherapy for Stage II and III colon cancer. Although the current understanding may not enable perfect decision-making for patients and medical professionals, ongoing advancements are expected to result in more effective personalized treatment plans, ultimately improving the prognosis and quality of life of patients.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"977-986"},"PeriodicalIF":2.9,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580940","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}
Post-hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD.
Methods
This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin-bilirubin [ALBI] / albumin-indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria.
Results
Grade B/C PHLF occurred in 40% of the patients (n = 19), leading to severe morbidity and two in-hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, p < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, p < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86.
Conclusion
To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function.
背景与目的：肝切除术后肝胰十二指肠切除术（HPD）后肝功能衰竭（PHLF）是一个需要克服的挑战。然而，未来肝残体（pFLR）预防重度HPD患者严重PHLF的适当目标比例仍不确定。本研究旨在确定安全重度HPD所需的最小pFLR。方法：对48例HPD患者进行回顾性研究。我们评估了pFLR和剩余肝功能评分（pFLR ×白蛋白胆红素[ALBI] /白蛋白吲哚菁绿评价[ALICE]/血浆吲哚菁绿清除率[KICG]）作为B级/C级PHLF的预测指标，并建立了安全标准。结果：40%的患者（n = 19）发生B/C级PHLF，导致严重发病率和2例院内死亡。pFLR是B/C级PHLF的良好预测指标[曲线下面积（AUC） 0.80， p p]结论：为预防B/C级PHLF，建议pFLR≥45%。然而，在残肝功能良好的患者中，可考虑重度HPD。
{"title":"Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy","authors":"Kentaro Umemura, Akira Shimizu, Tsuyoshi Notake, Koji Kubota, Kiyotaka Hosoda, Koya Yasukawa, Atsushi Kamachi, Takamune Goto, Hidenori Tomida, Yuji Soejima","doi":"10.1002/ags3.12850","DOIUrl":"10.1002/ags3.12850","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Post-hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin-bilirubin [ALBI] / albumin-indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Grade B/C PHLF occurred in 40% of the patients (<i>n</i> = 19), leading to severe morbidity and two in-hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, <i>p</i> < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, <i>p</i> < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"188-198"},"PeriodicalIF":2.9,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930497","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}
Yoshinori Kagawa, Koji Ando, Mamoru Uemura, Jun Watanabe, Koji Oba, Yasunori Emi, Nobuhisa Matsuhashi, Naoki Izawa, Osamu Muto, Tatsuya Kinjo, Ichiro Takemasa, Eiji Oki
Aim
To evaluate the feasibility and safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.
Methods
This prospective, multicenter, single-arm, phase II trial was conducted at 10 centers. The eligibility criteria included age ≥20 y, locally advanced rectal cancer within 12 cm of the anal verge, and cT3-4N0M or TanyN+M0 at diagnosis, enabling curative resection. The protocol treatment was capecitabine (1650 mg/m2/day)-based long-course chemoradiotherapy (50.4 Gy/28 fractions) and consolidation chemotherapy (CAPOX, four courses) followed by total mesorectal excision. Nonoperative management was allowed if a clinical complete response was achieved. The primary endpoint was the pathologic complete response rate.
Results
Among 28 enrolled patients (19 men, 9 women; median age, 69.5 [41–79] y), the long-course chemoradiotherapy and consolidation chemotherapy completion rates were 100% and 96.4%, respectively. The clinical responses included clinical complete response, (35.7%, 10/28), near-complete response (28.6%, 8/28), and incomplete response (32.1%, 9/28). Total mesorectal excision and nonoperative management were performed in 21 and six patients, respectively. The final analysis included 21 patients. Five patients (23.8% [90% confidence interval 11.8%–41.8%]) achieved pathologic complete response, while 10 of 28 patients (35.7%) achieved a pathological complete response or a sustained clinical complete response. No treatment-related deaths occurred. Grade ≥3 adverse events included diarrhea (7.1%) and leukopenia (7.1%).
Conclusion
ENSEMBLE-2 demonstrated comparable pathologic complete response rates and well-tolerated safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.
{"title":"Phase II study of long-course chemoradiotherapy followed by consolidation chemotherapy as total neoadjuvant therapy in locally advanced rectal cancer in Japan: ENSEMBLE-2","authors":"Yoshinori Kagawa, Koji Ando, Mamoru Uemura, Jun Watanabe, Koji Oba, Yasunori Emi, Nobuhisa Matsuhashi, Naoki Izawa, Osamu Muto, Tatsuya Kinjo, Ichiro Takemasa, Eiji Oki","doi":"10.1002/ags3.12848","DOIUrl":"10.1002/ags3.12848","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the feasibility and safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, multicenter, single-arm, phase II trial was conducted at 10 centers. The eligibility criteria included age ≥20 y, locally advanced rectal cancer within 12 cm of the anal verge, and cT3-4N0M or TanyN+M0 at diagnosis, enabling curative resection. The protocol treatment was capecitabine (1650 mg/m<sup>2</sup>/day)-based long-course chemoradiotherapy (50.4 Gy/28 fractions) and consolidation chemotherapy (CAPOX, four courses) followed by total mesorectal excision. Nonoperative management was allowed if a clinical complete response was achieved. The primary endpoint was the pathologic complete response rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 28 enrolled patients (19 men, 9 women; median age, 69.5 [41–79] y), the long-course chemoradiotherapy and consolidation chemotherapy completion rates were 100% and 96.4%, respectively. The clinical responses included clinical complete response, (35.7%, 10/28), near-complete response (28.6%, 8/28), and incomplete response (32.1%, 9/28). Total mesorectal excision and nonoperative management were performed in 21 and six patients, respectively. The final analysis included 21 patients. Five patients (23.8% [90% confidence interval 11.8%–41.8%]) achieved pathologic complete response, while 10 of 28 patients (35.7%) achieved a pathological complete response or a sustained clinical complete response. No treatment-related deaths occurred. Grade ≥3 adverse events included diarrhea (7.1%) and leukopenia (7.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ENSEMBLE-2 demonstrated comparable pathologic complete response rates and well-tolerated safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"1067-1075"},"PeriodicalIF":2.9,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581087","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}
Recent research has focused on the prognostic relevance of preoperative sarcopenia and sarcopenic obesity in various cancers. In this study we investigated the relationship between visceral fat area (VFA), psoas muscle area (PMA), and the prognosis of patients undergoing colorectal cancer surgery.
Methods
Patients with stage III colorectal cancer who underwent surgery between July 2013 and April 2020 were included. The analysis was performed on 151 patients who met the criteria. The VFA and PMA were measured at the level of the third lumbar vertebra on computed tomography (CT) scans, and the ratio of VFA to PMA (V/P ratio) was determined.
Results
Patients with high V/P ratios were significantly older (p = 0.0213), had a higher body mass index (BMI) (p < 0.0001), a higher percentage of sarcopenic obesity (p < 0.0001), and more diabetes complications (p < 0.0001). Prognostic analysis showed that the overall survival (OS) (p = 0.0154) and relapse-free survival (RFS) (p = 0.0378) were significantly worse in patients with a high V/P ratio. Multivariate analysis revealed that a high V/P ratio was an independent poor prognostic factor for OS. Subgroup analysis was then performed in patients with BMI < 25 kg/m2. OS (p = 0.0259) and RFS (p = 0.0275) were significantly worse in the high V/P ratio group. A high V/P ratio was an independent poor prognostic factor in the multivariate analysis.
Conclusion
In colorectal cancer, the preoperative V/P ratio is an independent factor for poor prognosis. Preoperative evaluation of the V/P ratio may identify a wide range of high-risk patients because it is an independent poor prognostic factor in patients without obesity.
{"title":"Evaluation of preoperative visceral fat area / psoas muscle area ratio and prognosis in patients with colorectal cancer","authors":"Nobuhiro Hosoi, Takuya Shiraishi, Takuhisa Okada, Katsuya Osone, Takehiko Yokobori, Makoto Sakai, Hiroomi Ogawa, Makoto Sohda, Ken Shirabe, Hiroshi Saeki","doi":"10.1002/ags3.12845","DOIUrl":"10.1002/ags3.12845","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent research has focused on the prognostic relevance of preoperative sarcopenia and sarcopenic obesity in various cancers. In this study we investigated the relationship between visceral fat area (VFA), psoas muscle area (PMA), and the prognosis of patients undergoing colorectal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with stage III colorectal cancer who underwent surgery between July 2013 and April 2020 were included. The analysis was performed on 151 patients who met the criteria. The VFA and PMA were measured at the level of the third lumbar vertebra on computed tomography (CT) scans, and the ratio of VFA to PMA (V/P ratio) was determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with high V/P ratios were significantly older (<i>p</i> = 0.0213), had a higher body mass index (BMI) (<i>p</i> < 0.0001), a higher percentage of sarcopenic obesity (<i>p</i> < 0.0001), and more diabetes complications (<i>p</i> < 0.0001). Prognostic analysis showed that the overall survival (OS) (<i>p</i> = 0.0154) and relapse-free survival (RFS) (<i>p</i> = 0.0378) were significantly worse in patients with a high V/P ratio. Multivariate analysis revealed that a high V/P ratio was an independent poor prognostic factor for OS. Subgroup analysis was then performed in patients with BMI < 25 kg/m<sup>2</sup>. OS (<i>p</i> = 0.0259) and RFS (<i>p</i> = 0.0275) were significantly worse in the high V/P ratio group. A high V/P ratio was an independent poor prognostic factor in the multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In colorectal cancer, the preoperative V/P ratio is an independent factor for poor prognosis. Preoperative evaluation of the V/P ratio may identify a wide range of high-risk patients because it is an independent poor prognostic factor in patients without obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"119-127"},"PeriodicalIF":2.9,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930535","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}
In the era of minimally invasive surgery, esophagectomy remains a highly invasive procedure with a high rate of postoperative complications. Preoperative risk assessment is essential for planning esophagectomy in patients with esophageal cancer, and it is crucial to implement evidence-based perioperative management to mitigate these risks. Perioperative support from multidisciplinary teams has recently been reported to improve the perioperative nutritional status and long-term survival of patients undergoing esophagectomy. Intraoperative management of anesthesia and fluid therapy also significantly affects short-term outcomes after esophagectomy. In this narrative review, we outline the recent updates in the perioperative management of esophagectomy, focusing on preoperative risk assessment, intraoperative management, and perioperative support by multidisciplinary teams to improve operative outcomes.
{"title":"Essential updates 2022/2023: Recent advances in perioperative management of esophagectomy to improve operative outcomes","authors":"Hirotoshi Kikuchi, Eisuke Booka, Yoshihiro Hiramatsu, Hiroya Takeuchi","doi":"10.1002/ags3.12847","DOIUrl":"10.1002/ags3.12847","url":null,"abstract":"<p>In the era of minimally invasive surgery, esophagectomy remains a highly invasive procedure with a high rate of postoperative complications. Preoperative risk assessment is essential for planning esophagectomy in patients with esophageal cancer, and it is crucial to implement evidence-based perioperative management to mitigate these risks. Perioperative support from multidisciplinary teams has recently been reported to improve the perioperative nutritional status and long-term survival of patients undergoing esophagectomy. Intraoperative management of anesthesia and fluid therapy also significantly affects short-term outcomes after esophagectomy. In this narrative review, we outline the recent updates in the perioperative management of esophagectomy, focusing on preoperative risk assessment, intraoperative management, and perioperative support by multidisciplinary teams to improve operative outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"966-976"},"PeriodicalIF":2.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580938","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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