Helicobacter pylori (H. pylori) eradication is recommended in patients undergoing endoscopic resection for early gastric cancer to reduce recurrence. However, due to the possibility of spontaneous regression secondary to dynamic changes in the remnant stomach, the immediate eradication after gastrectomy for H. pylori carriers remains unclear. This study aimed to investigate the prevalence of H. pylori in Japanese patients with gastric cancer and the spontaneous eradication rate after distal or proximal gastrectomy.
Methods
This multicenter prospective cohort study was conducted at 22 institutions. Eligibility criteria was patients over 20 years planned to undergo R0 gastrectomy for gastric cancer. The primary endpoint was spontaneous eradication rate 1 year after distal or proximal gastrectomy. The prevalence of H. pylori infection before surgery and clinical features related to spontaneous eradication were examined.
Results
A total of 1247 patients were included in this study. The preoperative H. pylori status was positive in 756 patients and negative in 491. Seventy-nine of the negative patients had an eradication history, totaling 835 (67%) patients preoperatively infected with H. pylori. The infection status of 541 patients was examined 1 year postoperatively; 285 were negative, with a 52.7% spontaneous eradication rate. Spontaneous eradication was significantly higher in male and older patients (>70 years); other factors, such as histological type, gastrectomy method and adjuvant chemotherapy presence, did not affect the rate.
Conclusions
As spontaneous H. pylori eradication occurred in more than half of the analyzed patients, retesting for H. pylori. should be considered before postoperative eradication therapy (UMIN000020280).
{"title":"Helicobacter pylori prevalence and its spontaneous eradication rate after distal or proximal gastrectomy for gastric cancer: A multicenter prospective cohort study","authors":"Takeshi Omori, Tsuyoshi Takahashi, Yukinori Kurokawa, Toru Masuzawa, Yusuke Akamaru, Masaaki Motoori, Takuro Saito, Kazuyoshi Yamamoto, Kazuhiro Nishikawa, Hiroshi Imamura, Atsushi Takeno, Ryohei Kawabata, Yoshiyuki Fujiwara, Hidetoshi Eguchi, Yuichiro Doki","doi":"10.1002/ags3.12860","DOIUrl":"https://doi.org/10.1002/ags3.12860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication is recommended in patients undergoing endoscopic resection for early gastric cancer to reduce recurrence. However, due to the possibility of spontaneous regression secondary to dynamic changes in the remnant stomach, the immediate eradication after gastrectomy for <i>H. pylori</i> carriers remains unclear. This study aimed to investigate the prevalence of <i>H. pylori</i> in Japanese patients with gastric cancer and the spontaneous eradication rate after distal or proximal gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter prospective cohort study was conducted at 22 institutions. Eligibility criteria was patients over 20 years planned to undergo R0 gastrectomy for gastric cancer. The primary endpoint was spontaneous eradication rate 1 year after distal or proximal gastrectomy. The prevalence of <i>H. pylori</i> infection before surgery and clinical features related to spontaneous eradication were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1247 patients were included in this study. The preoperative <i>H. pylori</i> status was positive in 756 patients and negative in 491. Seventy-nine of the negative patients had an eradication history, totaling 835 (67%) patients preoperatively infected with <i>H. pylori</i>. The infection status of 541 patients was examined 1 year postoperatively; 285 were negative, with a 52.7% spontaneous eradication rate. Spontaneous eradication was significantly higher in male and older patients (>70 years); other factors, such as histological type, gastrectomy method and adjuvant chemotherapy presence, did not affect the rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As spontaneous <i>H. pylori</i> eradication occurred in more than half of the analyzed patients, retesting for <i>H. pylori</i>. should be considered before postoperative eradication therapy (UMIN000020280).</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"244-250"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534006","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 relationship between sarcopenia, tumor-infiltrating lymphocytes (TILs), and long-term survival in patients with hepatocellular carcinoma (HCC) has not been investigated. We aimed to evaluate the prognostic relevance of sarcopenia and TILs in patients with HCC.
Methods
We included 351 patients with HCC following liver resection. Sarcopenia was defined based on the skeletal muscle index using computed tomography. Tumor-infiltrating CD4+ and CD8+ T cells, perforin, and granzyme B were examined in liver resection specimens.
Results
Sarcopenia patients had a significantly lower lymphocyte count (p = 0.003), prognostic nutritional index (p = 0.017), and CD4+ and CD8+ T cell counts (p = 0.008 and p = 0.006, respectively). The overall survival (OS) and recurrence-free survival (RFS) rates of sarcopenia patients were significantly lower than non-sarcopenia patients (both p < 0.001). Multivariate analysis revealed that sarcopenia and low CD8 levels were strong independent poor prognostic factors for OS and RFS (both p < 0.001). Regardless of sarcopenia, patients with high CD8 levels had significantly better OS and RFS rates and increased expression of perforin and granzyme B. Particularly, sarcopenia patients with high CD8 levels had much better OS and RFS than those with low CD8 levels and were even comparable to non-sarcopenia patients with high CD8 levels.
Conclusions
Sarcopenia and low CD8 levels are strong independent poor prognostic factors in patients with HCC. Furthermore, sarcopenia patients with high CD8 levels had favorable survival and activated local immunity, suggesting that tumor-infiltrating CD8+ T cells may play a functionally important role in sarcopenia patients.
目的 肝细胞癌（HCC）患者的肌肉疏松症、肿瘤浸润淋巴细胞（TILs）和长期存活率之间的关系尚未得到研究。我们旨在评估肌肉疏松症和肿瘤浸润淋巴细胞与肝细胞癌患者预后的相关性。 方法 我们纳入了 351 名肝脏切除术后的 HCC 患者。根据计算机断层扫描的骨骼肌指数定义肌肉疏松症。对肝切除标本中的肿瘤浸润 CD4+ 和 CD8+ T 细胞、穿孔素和颗粒酶 B 进行了检测。 结果 癌症患者的淋巴细胞计数（p = 0.003）、预后营养指数（p = 0.017）、CD4+和 CD8+ T 细胞计数（p = 0.008 和 p = 0.006）均明显较低。肌肉疏松症患者的总生存率（OS）和无复发生存率（RFS）明显低于非肌肉疏松症患者（P均为0.001）。多变量分析显示，肌肉疏松症和低 CD8 水平是影响 OS 和 RFS 的强有力的独立不良预后因素（均为 p <0.001）。尤其是高 CD8 水平的肌肉疏松症患者的 OS 和 RFS 远好于低 CD8 水平的患者，甚至与非肌肉疏松症的高 CD8 水平患者相当。 结论 肌肉疏松症和低 CD8 水平是导致 HCC 患者预后不良的重要独立因素。此外，CD8水平高的肌肉疏松症患者的生存率较高，且激活了局部免疫，这表明肿瘤浸润的CD8+ T细胞可能在肌肉疏松症患者中发挥着重要的功能作用。
{"title":"Prognostic relevance of sarcopenia and tumor-infiltrating CD8+ T cells in patients with hepatocellular carcinoma","authors":"Shunsuke Doi, Satoshi Yasuda, Miu Miyashita, Minako Nagai, Kota Nakamura, Yasuko Matsuo, Taichi Terai, Yuichiro Kohara, Takeshi Sakata, Masayuki Sho","doi":"10.1002/ags3.12875","DOIUrl":"https://doi.org/10.1002/ags3.12875","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The relationship between sarcopenia, tumor-infiltrating lymphocytes (TILs), and long-term survival in patients with hepatocellular carcinoma (HCC) has not been investigated. We aimed to evaluate the prognostic relevance of sarcopenia and TILs in patients with HCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 351 patients with HCC following liver resection. Sarcopenia was defined based on the skeletal muscle index using computed tomography. Tumor-infiltrating CD4<sup>+</sup> and CD8<sup>+</sup> T cells, perforin, and granzyme B were examined in liver resection specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sarcopenia patients had a significantly lower lymphocyte count (<i>p</i> = 0.003), prognostic nutritional index (<i>p</i> = 0.017), and CD4<sup>+</sup> and CD8<sup>+</sup> T cell counts (<i>p</i> = 0.008 and <i>p</i> = 0.006, respectively). The overall survival (OS) and recurrence-free survival (RFS) rates of sarcopenia patients were significantly lower than non-sarcopenia patients (both <i>p</i> < 0.001). Multivariate analysis revealed that sarcopenia and low CD8 levels were strong independent poor prognostic factors for OS and RFS (both <i>p</i> < 0.001). Regardless of sarcopenia, patients with high CD8 levels had significantly better OS and RFS rates and increased expression of perforin and granzyme B. Particularly, sarcopenia patients with high CD8 levels had much better OS and RFS than those with low CD8 levels and were even comparable to non-sarcopenia patients with high CD8 levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sarcopenia and low CD8 levels are strong independent poor prognostic factors in patients with HCC. Furthermore, sarcopenia patients with high CD8 levels had favorable survival and activated local immunity, suggesting that tumor-infiltrating CD8<sup>+</sup> T cells may play a functionally important role in sarcopenia patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"359-368"},"PeriodicalIF":2.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536033","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}
Appropriate antibiotic prophylaxis is essential for preventing surgical site infections (SSI); however, the clinical benefit of intraoperative redosing remains unclear and controversial owing to insufficient reliable evidence. Therefore, we performed a systematic review and meta-analysis to assess the effectiveness of prophylactic antibiotic redosing in lengthy surgical procedures.
Methods
We systematically searched the PubMed, Cochrane Library, Web of Science, and Ichushi-Web databases for articles published until 31 December, 2023. We compared the incidence of SSI between patients receiving and not receiving intraoperative redosing of antibiotics in surgeries lasting ≥3 h. Subgroup analyses were conducted across study characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random effects model. The risk of bias was assessed using the ROBINS-I.
Results
Overall, seven observational studies involving 4,671 patients were included. Intraoperative antibiotic redosing significantly reduced the risk of SSI compared with non-redosing (OR = 0.65, 95% CI = 0.45–0.94, p = 0.02). Subgroup analyses showed that intraoperative redosing decreased SSI risk in studies with a minimum 4-h operative time, no postoperative antibiotic continuation, and a moderate risk of bias. However, the statistical heterogeneity of the analyses was high among the studies.
Conclusions
Intraoperative redosing with prophylactic antibiotics during lengthy surgeries may be associated with a lower risk of SSI than non-redosing. Therefore, we recommend intraoperative redosing for surgeries lasting beyond 3–4 h to reduce the risk of infection. Further research is required to clarify the optimal redosing interval, which should be prioritized in future studies.
{"title":"Intraoperative redosing of antibiotics for prevention of surgical site infections: A systematic review and meta-analysis","authors":"Yuki Hanai, Jun Hirai, Masahiro Kobayashi, Kazuhiro Matsuo, Keita Kouzu, Hiroji Shinkawa, Seiichi Shinji, Motomu Kobayashi, Yuichi Kitagawa, Chizuru Yamashita, Yasuhiko Mohri, Hiroshi Nobuhara, Katsunori Suzuki, Junzo Shimizu, Motoi Uchino, Seiji Haji, Masahiro Yoshida, Toru Mizuguchi, Toshihiko Mayumi, Yuko Kitagawa, Hiroki Ohge","doi":"10.1002/ags3.12866","DOIUrl":"https://doi.org/10.1002/ags3.12866","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Appropriate antibiotic prophylaxis is essential for preventing surgical site infections (SSI); however, the clinical benefit of intraoperative redosing remains unclear and controversial owing to insufficient reliable evidence. Therefore, we performed a systematic review and meta-analysis to assess the effectiveness of prophylactic antibiotic redosing in lengthy surgical procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched the PubMed, Cochrane Library, Web of Science, and Ichushi-Web databases for articles published until 31 December, 2023. We compared the incidence of SSI between patients receiving and not receiving intraoperative redosing of antibiotics in surgeries lasting ≥3 h. Subgroup analyses were conducted across study characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random effects model. The risk of bias was assessed using the ROBINS-I.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, seven observational studies involving 4,671 patients were included. Intraoperative antibiotic redosing significantly reduced the risk of SSI compared with non-redosing (OR = 0.65, 95% CI = 0.45–0.94, <i>p</i> = 0.02). Subgroup analyses showed that intraoperative redosing decreased SSI risk in studies with a minimum 4-h operative time, no postoperative antibiotic continuation, and a moderate risk of bias. However, the statistical heterogeneity of the analyses was high among the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative redosing with prophylactic antibiotics during lengthy surgeries may be associated with a lower risk of SSI than non-redosing. Therefore, we recommend intraoperative redosing for surgeries lasting beyond 3–4 h to reduce the risk of infection. Further research is required to clarify the optimal redosing interval, which should be prioritized in future studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"369-378"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535729","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 Japanese National Clinical Database, which covers more than 95% of the surgeries performed in Japan, is the largest nationwide database. This is the 2021 annual report of the Gastroenterological Section of the National Clinical Database, which aims to present the short-term outcomes of cases registered in 2021 and discuss significant changes and insights into gastroenterological surgeries observed over the decade.
Methods
We reviewed the data of patients registered in the National Clinical Database between 2012 and 2021.
Results
In total, 5 788 093 cases, including 597 780 cases in 2021, were extracted from the National Clinical Database. The number of surgeries resumed its original trend after a uniform decrease due to the coronavirus disease 2019 pandemic. The patient population continues to age, and the proportion of female patients is steadily increasing. The trend of surgeries being conducted in certified institutions with the involvement of board-certified surgeons is consistently rising. Moreover, the increasing trend of endoscopic surgery rate is still maintained. Although operative mortality is declining, the trend of increasing postoperative complications continues. Surgery on the esophagus, liver, and pancreas has shown substantial improvements in operative mortality, with a high participation rate of board-certified surgeons. Surgical procedures with a high incidence of emergency surgeries are characterized by low participation rates of board-certified surgeons, increased morbidity rates, and worse mortality outcomes.
Conclusion
This overview of surgical patients in Japan, obtained using data extracted from the National Clinical Database, may serve as a critical cornerstone for the future development of gastroenterological surgery.
目的：日本国家临床数据库（Japanese National Clinical Database）是日本最大的全国性数据库，涵盖了日本95%以上的手术。这是国家临床数据库胃肠病学部门的2021年年度报告，旨在介绍2021年注册病例的短期结果，并讨论十年来观察到的胃肠病学手术的重大变化和见解。方法：我们回顾了2012年至2021年在国家临床数据库中登记的患者数据。结果：共从国家临床数据库中提取5 788 093例，其中2021年提取597 780例。受新型冠状病毒感染症（covid - 19）的影响，手术数量在持续减少后，恢复了原来的趋势。患者人口持续老龄化，女性患者比例稳步上升。在获得认证的机构中，由获得委员会认证的外科医生参与的手术趋势不断上升。此外，内镜手术率仍保持上升趋势。虽然手术死亡率在下降，但术后并发症仍有增加的趋势。食道、肝脏和胰腺的手术在手术死亡率方面已经有了很大的改善，有委员会认证的外科医生的参与率很高。急诊手术发生率高的外科手术的特点是获得委员会认证的外科医生的参与率低，发病率增加，死亡率更差。结论：从国家临床数据库中提取的数据获得了日本手术患者的概况，这可能是胃肠外科手术未来发展的关键基石。
{"title":"Annual report on National Clinical Database 2021 for gastroenterological surgery in Japan","authors":"Sunao Ito, Arata Takahashi, Hideki Ueno, Shuji Takiguchi, Yoshiki Kajiwara, Yoshihiro Kakeji, Susumu Eguchi, Takanori Goi, Akio Saiura, Akira Sasaki, Hiroya Takeuchi, Chie Tanaka, Masaji Hashimoto, Naoki Hiki, Akihiko Horiguchi, Satoru Matsuda, Tsunekazu Mizushima, Hiroyuki Yamamoto, Yuko Kitagawa, Ken Shirabe","doi":"10.1002/ags3.12868","DOIUrl":"10.1002/ags3.12868","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The Japanese National Clinical Database, which covers more than 95% of the surgeries performed in Japan, is the largest nationwide database. This is the 2021 annual report of the Gastroenterological Section of the National Clinical Database, which aims to present the short-term outcomes of cases registered in 2021 and discuss significant changes and insights into gastroenterological surgeries observed over the decade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the data of patients registered in the National Clinical Database between 2012 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 5 788 093 cases, including 597 780 cases in 2021, were extracted from the National Clinical Database. The number of surgeries resumed its original trend after a uniform decrease due to the coronavirus disease 2019 pandemic. The patient population continues to age, and the proportion of female patients is steadily increasing. The trend of surgeries being conducted in certified institutions with the involvement of board-certified surgeons is consistently rising. Moreover, the increasing trend of endoscopic surgery rate is still maintained. Although operative mortality is declining, the trend of increasing postoperative complications continues. Surgery on the esophagus, liver, and pancreas has shown substantial improvements in operative mortality, with a high participation rate of board-certified surgeons. Surgical procedures with a high incidence of emergency surgeries are characterized by low participation rates of board-certified surgeons, increased morbidity rates, and worse mortality outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This overview of surgical patients in Japan, obtained using data extracted from the National Clinical Database, may serve as a critical cornerstone for the future development of gastroenterological surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"32-59"},"PeriodicalIF":2.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose was to clarify the oncological outcomes of rectal cancer (RC) with lateral lymph node metastasis (LLNM) on high-resolution MRI (HRMRI), considering preoperative treatments.
Methods
Two hundred and twelve patients, from 13 hospitals, diagnosed with RC with lateral lymph node dissection (LLND), between 2017 and 2019, were prospectively registered. LLNM was defined as a short-axis size ≥5 mm. Ultimately, this study included 102 patients. Upfront surgery (Upfront), chemoradiotherapy (CRT), and neoadjuvant chemotherapy (NAC) were performed at each institution's discretion.
Results
Sixty-six (64.7%) had mesorectal fascia (MRF) involvement, 35 (34.3%) had extramural venous invasion, and 33 (32.4%) had bilateral LLNMs. A positive radial margin (RM1) was observed in nine patients (8.8%), and 35 (34.3%) had pathological LLNM (pLLNM). Overall, 3-year relapse-free survival (3yRFS) and local recurrence-free survival (3yLRFS) were 69.6% and 92.9%. Upfront 3yRFS (N = 54), CRT (N = 23) and NAC (N = 25) constituted 62.9%, 82.6%, and 72.0%; 3yLRFS was 92.4%, 100%, and 88.0%. RM1 and pLLNM were significantly associated with LRFS (RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%; pLLNM negative vs. positive, 97.0% vs. 84.7%). 3yRFS Upfront non-MRF (N = 21), post CRT non-MRF (N = 15), and post NAC non-MRF (N = 14) were 61.9%, 86.7%, and 100%; 3yLRFS was 90.2%, 100%, and 100%.
Conclusions
Good local control of Upfront LLND for RC with LLNM was shown, but multidisciplinary treatments were required. CRT followed by surgery was preferable for RC with LLNM, but a radiation-sparing strategy is promising for post NAC non-MRF.
{"title":"Upfront surgery, neoadjuvant chemoradiotherapy, or neoadjuvant chemotherapy for rectal cancer with lateral lymph node metastasis: A multicenter MRI and lateral lymph node dissection study","authors":"Takuya Miura, Kazushige Kawai, Hiromasa Fujita, Shinsuke Kazama, Hideki Ueno, Yusuke Kinugasa, Kazuhiro Sakamoto, Hirotoshi Kobayashi, Kenichi Hakamada, Yoichi Ajioka","doi":"10.1002/ags3.12873","DOIUrl":"https://doi.org/10.1002/ags3.12873","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The purpose was to clarify the oncological outcomes of rectal cancer (RC) with lateral lymph node metastasis (LLNM) on high-resolution MRI (HRMRI), considering preoperative treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred and twelve patients, from 13 hospitals, diagnosed with RC with lateral lymph node dissection (LLND), between 2017 and 2019, were prospectively registered. LLNM was defined as a short-axis size ≥5 mm. Ultimately, this study included 102 patients. Upfront surgery (Upfront), chemoradiotherapy (CRT), and neoadjuvant chemotherapy (NAC) were performed at each institution's discretion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-six (64.7%) had mesorectal fascia (MRF) involvement, 35 (34.3%) had extramural venous invasion, and 33 (32.4%) had bilateral LLNMs. A positive radial margin (RM1) was observed in nine patients (8.8%), and 35 (34.3%) had pathological LLNM (pLLNM). Overall, 3-year relapse-free survival (3yRFS) and local recurrence-free survival (3yLRFS) were 69.6% and 92.9%. Upfront 3yRFS (<i>N</i> = 54), CRT (<i>N</i> = 23) and NAC (<i>N</i> = 25) constituted 62.9%, 82.6%, and 72.0%; 3yLRFS was 92.4%, 100%, and 88.0%. RM1 and pLLNM were significantly associated with LRFS (RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%; pLLNM negative vs. positive, 97.0% vs. 84.7%). 3yRFS Upfront non-MRF (<i>N</i> = 21), post CRT non-MRF (<i>N</i> = 15), and post NAC non-MRF (<i>N</i> = 14) were 61.9%, 86.7%, and 100%; 3yLRFS was 90.2%, 100%, and 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Good local control of Upfront LLND for RC with LLNM was shown, but multidisciplinary treatments were required. CRT followed by surgery was preferable for RC with LLNM, but a radiation-sparing strategy is promising for post NAC non-MRF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"309-318"},"PeriodicalIF":2.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12873","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533528","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}
Intestinal anastomosis is performed by two main methods: hand-sewn anastomosis (HA) and stapling anastomosis (SA). Studies on anastomosis are still being reported and are an ongoing area of interest. The aim of this study was to evaluate the characteristics of each by comparing them with description and statistical analysis using a nationwide inpatient database.
Methods
We collected data for colon cancer patients who underwent colectomy between April 2014 and March 2022 using the Diagnosis Procedure Combination (DPC) database. In the descriptive analysis, we described the background of the study population and the number of each method. In the statistical analysis, we used propensity score matching to achieve balanced covariates and showed the results of the comparative study using risk ratios and risk differences.
Results
A total of 232 155 cases were selected (HA group: 40 764; SA group: 191 391). SA was performed more frequently than HA during the study period, with the proportion of SA increasing over the last few years (~80% in 2015 and 85% in 2021). We obtained 40 760 pairs through propensity score matching. The comparison of postoperative events varied by outcome (reoperation: 517 [1.27%] vs 380 [0.93%]; risk ratio [RR]: 1.36 [95% confidence interval [CI], 1.19 to 1.55], endoscopic intestinal hemostasis: 17 [0.04%] vs 80 [0.20%]; RR: 0.21 [95% CI, 0.13 to 0.36]).
Conclusion
SA is becoming more common in colectomy. The risk of reoperation could be higher in the HA group, while the risk of postoperative endoscopic intestinal hemostasis could be higher in the SA group.
{"title":"Comparative retrospective study on surgical outcomes of hand-sewn anastomosis versus stapling anastomosis for colectomy using a nationwide inpatient database in Japan with propensity score matching","authors":"Shota Ebinuma, Susumu Kunisawa, Kiyohide Fushimi, Nobuki Ichikawa, Tadashi Yoshida, Shigenori Homma, Akinobu Taketomi, Yuichi Imanaka","doi":"10.1002/ags3.12870","DOIUrl":"https://doi.org/10.1002/ags3.12870","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intestinal anastomosis is performed by two main methods: hand-sewn anastomosis (HA) and stapling anastomosis (SA). Studies on anastomosis are still being reported and are an ongoing area of interest. The aim of this study was to evaluate the characteristics of each by comparing them with description and statistical analysis using a nationwide inpatient database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected data for colon cancer patients who underwent colectomy between April 2014 and March 2022 using the Diagnosis Procedure Combination (DPC) database. In the descriptive analysis, we described the background of the study population and the number of each method. In the statistical analysis, we used propensity score matching to achieve balanced covariates and showed the results of the comparative study using risk ratios and risk differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 232 155 cases were selected (HA group: 40 764; SA group: 191 391). SA was performed more frequently than HA during the study period, with the proportion of SA increasing over the last few years (~80% in 2015 and 85% in 2021). We obtained 40 760 pairs through propensity score matching. The comparison of postoperative events varied by outcome (reoperation: 517 [1.27%] vs 380 [0.93%]; risk ratio [RR]: 1.36 [95% confidence interval [CI], 1.19 to 1.55], endoscopic intestinal hemostasis: 17 [0.04%] vs 80 [0.20%]; RR: 0.21 [95% CI, 0.13 to 0.36]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SA is becoming more common in colectomy. The risk of reoperation could be higher in the HA group, while the risk of postoperative endoscopic intestinal hemostasis could be higher in the SA group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"379-388"},"PeriodicalIF":2.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535850","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}
Hidekazu Takahashi, Kazuhiro Saso, Masayuki Ohue, Shingo Noura, Tsukasa Tanida, Takamichi Komori, Mitsuyoshi Tei, Yoshinori Kagawa, Shunji Morita, Shu Okamura, Masakazu Miyake, Norikatsu Miyoshi, Mamoru Uemura, Makoto Fujii, Yuko Ohno, Hirofumi Yamamoto, Kohei Murata, Yuichiro Doki, Hidetoshi Eguchi, Clinical Study Group of Osaka University, Colorectal Cancer Treatment Group (CSGOCG)
Objective
We investigated how Japanese D3 dissection with left colic artery (LCA) preservation affects anastomotic leakage after anterior resection with anastomosis for rectal cancer, based on the leak rate. The correlation between LCA preservation, survival, and cancer recurrence after resection was also analyzed.
Summary and Background Data
It remains unclear how LCA preservation affects the anastomotic leak rate and oncological outcomes after resection remains unclear. Some reports suggested that anastomotic leakage increases local recurrence and decreases cancer-specific survival.
Methods
In this study, we enrolled and analyzed 457 patients who underwent radical resection of rectal cancer in the period October 2011 through December 2016. The attending surgeon decided preoperatively and registered whether to preserve the LCA. This trial was registered under the UMIN-CTR Identifier UMIN000006160.
Results
D3 with LCA preservation was successfully completed in 218 (89.3%) of the 244 patients registered in this group, whereas D3 without LCA preservation was successfully completed in all 213 patients registered in this group. After propensity score matching, the anastomotic leakage rate was 7.86% (11/140) after D3 with LCA preservation and 7.14% (10/140) after D3 without LCA preservation. The overall survival rates were 90.1% and 89.3%, and the recurrence-free survival rates were 77.6% and 77.3%, respectively.
Conclusions
Our findings suggest that LCA preservation has no effect on the incidence of anastomotic leakage after rectal resection with anastomosis using DST and that oncological outcomes may not be affected.
{"title":"Efficacy of lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery for rectal cancer","authors":"Hidekazu Takahashi, Kazuhiro Saso, Masayuki Ohue, Shingo Noura, Tsukasa Tanida, Takamichi Komori, Mitsuyoshi Tei, Yoshinori Kagawa, Shunji Morita, Shu Okamura, Masakazu Miyake, Norikatsu Miyoshi, Mamoru Uemura, Makoto Fujii, Yuko Ohno, Hirofumi Yamamoto, Kohei Murata, Yuichiro Doki, Hidetoshi Eguchi, Clinical Study Group of Osaka University, Colorectal Cancer Treatment Group (CSGOCG)","doi":"10.1002/ags3.12869","DOIUrl":"https://doi.org/10.1002/ags3.12869","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We investigated how Japanese D3 dissection with left colic artery (LCA) preservation affects anastomotic leakage after anterior resection with anastomosis for rectal cancer, based on the leak rate. The correlation between LCA preservation, survival, and cancer recurrence after resection was also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary and Background Data</h3>\u0000 \u0000 <p>It remains unclear how LCA preservation affects the anastomotic leak rate and oncological outcomes after resection remains unclear. Some reports suggested that anastomotic leakage increases local recurrence and decreases cancer-specific survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, we enrolled and analyzed 457 patients who underwent radical resection of rectal cancer in the period October 2011 through December 2016. The attending surgeon decided preoperatively and registered whether to preserve the LCA. This trial was registered under the UMIN-CTR Identifier UMIN000006160.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>D3 with LCA preservation was successfully completed in 218 (89.3%) of the 244 patients registered in this group, whereas D3 without LCA preservation was successfully completed in all 213 patients registered in this group. After propensity score matching, the anastomotic leakage rate was 7.86% (11/140) after D3 with LCA preservation and 7.14% (10/140) after D3 without LCA preservation. The overall survival rates were 90.1% and 89.3%, and the recurrence-free survival rates were 77.6% and 77.3%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that LCA preservation has no effect on the incidence of anastomotic leakage after rectal resection with anastomosis using DST and that oncological outcomes may not be affected.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"298-308"},"PeriodicalIF":2.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535851","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}
Preventing gastroesophageal reflux after proximal gastrectomy for proximal gastric and esophagogastric junction cancer remains challenging due to the lack of standardized reconstructive techniques. The double flap technique (DFT) in valvuloplastic esophagogastrostomy prevents reflux esophagitis but is less effective in esophagogastric junction cancer because of negative pressure on the inferior mediastinum. We developed the U-shaped flap technique (UFT) to enhance the anti-reflux efficacy.
Methods
This study analyzed data from patients who underwent minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer between August 2014 and May 2022, using a prospectively maintained database. We compared DFT and UFT for short- and long-term outcomes, focusing on gastroesophageal reflux, using one-to-one propensity score matching to control for patient-related variables.
Results
Among 217 eligible patients, 205 (100 in DFT, 105 in UFT) completed a 1-year follow-up. After propensity score matching, we selected 42 pairs of patients who underwent DFT and UFT. UFT had significantly shorter operative time (p = 0.044), similar blood loss, and similar morbidity. The UFT group had significantly fewer reflux symptoms (0% vs. 14.3%, p = 0.0011) and endoscopic Los Angeles grade B or higher reflux esophagitis (0% vs. 14.3%, p = 0.0011) than the DFT group. In lower mediastinal reconstructions for esophagogastric junction cancer, UFT showed a reduced incidence of reflux esophagitis.
Conclusion
Our study indicates that the U-shaped flap technique (UFT) offered significant advantages in reducing postoperative reflux symptoms and endoscopic esophagitis, in a cohort of patients with proximal gastric and esophagogastric junction cancer.
{"title":"Efficacy of the U-shaped flap technique in preventing reflux after minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer","authors":"Takeshi Omori, Hisashi Hara, Yoshitomo Yanagimoto, Naoki Shinno, Yasunori Masuike, Takashi Kanemura, Hiroshi Wada, Masayoshi Yasui, Masayuki Ohue, Hiroshi Miyata","doi":"10.1002/ags3.12864","DOIUrl":"https://doi.org/10.1002/ags3.12864","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preventing gastroesophageal reflux after proximal gastrectomy for proximal gastric and esophagogastric junction cancer remains challenging due to the lack of standardized reconstructive techniques. The double flap technique (DFT) in valvuloplastic esophagogastrostomy prevents reflux esophagitis but is less effective in esophagogastric junction cancer because of negative pressure on the inferior mediastinum. We developed the U-shaped flap technique (UFT) to enhance the anti-reflux efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzed data from patients who underwent minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer between August 2014 and May 2022, using a prospectively maintained database. We compared DFT and UFT for short- and long-term outcomes, focusing on gastroesophageal reflux, using one-to-one propensity score matching to control for patient-related variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 217 eligible patients, 205 (100 in DFT, 105 in UFT) completed a 1-year follow-up. After propensity score matching, we selected 42 pairs of patients who underwent DFT and UFT. UFT had significantly shorter operative time (<i>p</i> = 0.044), similar blood loss, and similar morbidity. The UFT group had significantly fewer reflux symptoms (0% vs. 14.3%, <i>p</i> = 0.0011) and endoscopic Los Angeles grade B or higher reflux esophagitis (0% vs. 14.3%, <i>p</i> = 0.0011) than the DFT group. In lower mediastinal reconstructions for esophagogastric junction cancer, UFT showed a reduced incidence of reflux esophagitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study indicates that the U-shaped flap technique (UFT) offered significant advantages in reducing postoperative reflux symptoms and endoscopic esophagitis, in a cohort of patients with proximal gastric and esophagogastric junction cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"251-262"},"PeriodicalIF":2.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533541","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}
Evidence regarding the reliability of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for assessing histological proliferation and WHO grading of small (≤20 mm) pancreatic neuroendocrine tumors (PanNETs) is limited.
Methods
In this multicenter retrospective study, we analyzed data from 122 patients with small PanNETs who underwent EUS-TA followed by surgical resection between 2006 and 2022. We compared the histopathological proliferation assessment and WHO grading between preoperative EUS-TA and surgical definitive specimens.
Results
Among the 122 patients with small PanNETs (80% with surgical definitive WHO grade G1 and 20% with G2), EUS-TA histology identified neuroendocrine tumors in 101 (83%) patients and provided WHO grading in 85 (70%) patients. Histopathological WHO grading for EUS-TA was concordant with surgical definitive grading in 86% (73/85) of cases, overstaged in 4% (3/85), and understaged in 11% (9/85). Moderate, severe, and fatal adverse events associated with EUS-TA, as classified by the lexicon, were not reported in this cohort.
Conclusion
EUS-TA is a reliable method for assessing histopathological proliferation and WHO grading of small PanNETs. However, grading discordance may occur, and a risk–benefit evaluation on a per-patient basis is recommended.
{"title":"Endoscopic ultrasound-guided tissue acquisition allows a reliable proliferation assessment of small (≤20 mm) pancreatic neuroendocrine tumors","authors":"Yoshihide Nanno, Hirochika Toyama, Kazuyuki Nagai, Dongha Lee, Yuichiro Uchida, Jun Ishida, Takeshi Takahara, Ippei Matsumoto, Etsuro Hatano, Takumi Fukumoto","doi":"10.1002/ags3.12871","DOIUrl":"https://doi.org/10.1002/ags3.12871","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Evidence regarding the reliability of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for assessing histological proliferation and WHO grading of small (≤20 mm) pancreatic neuroendocrine tumors (PanNETs) is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multicenter retrospective study, we analyzed data from 122 patients with small PanNETs who underwent EUS-TA followed by surgical resection between 2006 and 2022. We compared the histopathological proliferation assessment and WHO grading between preoperative EUS-TA and surgical definitive specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 122 patients with small PanNETs (80% with surgical definitive WHO grade G1 and 20% with G2), EUS-TA histology identified neuroendocrine tumors in 101 (83%) patients and provided WHO grading in 85 (70%) patients. Histopathological WHO grading for EUS-TA was concordant with surgical definitive grading in 86% (73/85) of cases, overstaged in 4% (3/85), and understaged in 11% (9/85). Moderate, severe, and fatal adverse events associated with EUS-TA, as classified by the lexicon, were not reported in this cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-TA is a reliable method for assessing histopathological proliferation and WHO grading of small PanNETs. However, grading discordance may occur, and a risk–benefit evaluation on a per-patient basis is recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"339-346"},"PeriodicalIF":2.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12871","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535726","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}
Colorectal cancer is a common malignancy, and many patients with colorectal cancer experience preoperative anemia. Anemia and transfusions negatively impact short-term surgical outcomes. Management of anemia, including iron supplementation, has not been extensively studied in Japanese patients. Thus, the impact of anemia and blood transfusions on short-term surgical outcomes in colorectal cancer patients and the effectiveness of oral iron supplementation with ferrous citrate were investigated.
Methods
A retrospective study of patients with colorectal cancer (≥18 y) who underwent elective surgery from April 2015 to March 2023 was conducted. Patients with benign tumors, malignant lymphoma, emergency surgeries, or nonresectable lesions were excluded from the study. Hemoglobin levels were assessed at consultation, admission, the day after surgery, and discharge. Patients were categorized by anemia severity and divided into iron supplementation and no supplementation groups. Outcomes, including transfusions and postoperative complications, were compared with univariate and multivariate analyses.
Results
The prevalence of postoperative anemia in the 545 enrolled patients increased significantly from 52.8% at admission to 78.7% the day after surgery (p < 0.001). Severe anemia immediately before surgery was an independent risk factor for postoperative complications (odds ratio [OR] = 9.24, p < 0.001). Iron supplementation significantly improved hemoglobin levels and reduced transfusions and complications. The median duration of iron supplementation was 30 d, suggesting a positive influence on outcomes.
Conclusion
Severe anemia immediately before surgery is an independent risk factor for postoperative complications. Iron supplementation with ferrous citrate improves short-term outcomes.
{"title":"Impact of preoperative anemia and perioperative transfusion on short-term outcomes in colorectal cancer surgery: The role of iron supplementation","authors":"Junpei Takashima, Hirotoshi Kobayashi, Ayaka Koizumi, Fumi Shigehara, Kenji Yamazaki, Daisuke Fujimoto, Fumihiko Miura","doi":"10.1002/ags3.12867","DOIUrl":"https://doi.org/10.1002/ags3.12867","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Colorectal cancer is a common malignancy, and many patients with colorectal cancer experience preoperative anemia. Anemia and transfusions negatively impact short-term surgical outcomes. Management of anemia, including iron supplementation, has not been extensively studied in Japanese patients. Thus, the impact of anemia and blood transfusions on short-term surgical outcomes in colorectal cancer patients and the effectiveness of oral iron supplementation with ferrous citrate were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of patients with colorectal cancer (≥18 y) who underwent elective surgery from April 2015 to March 2023 was conducted. Patients with benign tumors, malignant lymphoma, emergency surgeries, or nonresectable lesions were excluded from the study. Hemoglobin levels were assessed at consultation, admission, the day after surgery, and discharge. Patients were categorized by anemia severity and divided into iron supplementation and no supplementation groups. Outcomes, including transfusions and postoperative complications, were compared with univariate and multivariate analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of postoperative anemia in the 545 enrolled patients increased significantly from 52.8% at admission to 78.7% the day after surgery (<i>p</i> < 0.001). Severe anemia immediately before surgery was an independent risk factor for postoperative complications (odds ratio [OR] = 9.24, <i>p</i> < 0.001). Iron supplementation significantly improved hemoglobin levels and reduced transfusions and complications. The median duration of iron supplementation was 30 d, suggesting a positive influence on outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Severe anemia immediately before surgery is an independent risk factor for postoperative complications. Iron supplementation with ferrous citrate improves short-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 2","pages":"288-297"},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536001","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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