Katsuhiro Ogawa, Tomonori Akagi, Hidefumi Shiroshita, Hiroshi Yoshida, Masashi Miguchi, Ken Eto, Tetsuji Ohyama, Akiyoshi Kanazawa, Keiji Matsuda, Koya Hida, Seiichiro Yamamoto, Takeshi Naitoh, Masafumi Inomata, Japan Society of Laparoscopic Colorectal Surgery
Aim
Acute appendicitis in pregnant women requires accurate diagnosis and treatment because of potential pregnancy complications. Laparoscopic appendectomy (LA) has been associated with higher rates of fetal loss than open appendectomy (OA). Therefore, we conducted the first multicenter collaborative analysis in Japan to evaluate the safety and efficacy of LA during pregnancy.
Methods
We retrospectively reviewed 152 pregnant women who underwent appendectomy for acute appendicitis between 2012 and 2021 using data from the Japan Society of Laparoscopic Colorectal Surgery. The patients were divided into the OA (n = 92) and LA (n = 60) groups. The primary endpoint was fetal loss during hospitalization. Patient demographics, perioperative outcomes, pathology, and pregnancy outcomes were analyzed.
Results
No fetal loss occurred in either group. The operative time (p = 0.485) and postoperative complications (p = 0.708) were similar between the groups. However, the hospital stay was significantly shorter in the LA group than in the OA group (p = 0.037). The OA group had a higher rate of gangrenous or perforated appendicitis (p = 0.017).
Conclusions
LA is a safe alternative to OA in pregnant women, with no additional maternal complications and comparable fetal outcomes. LA does not negatively affect fetal health.
{"title":"A Multicenter Collaborative Study on the Safety and Efficacy of Laparoscopic Appendectomy During Pregnancy","authors":"Katsuhiro Ogawa, Tomonori Akagi, Hidefumi Shiroshita, Hiroshi Yoshida, Masashi Miguchi, Ken Eto, Tetsuji Ohyama, Akiyoshi Kanazawa, Keiji Matsuda, Koya Hida, Seiichiro Yamamoto, Takeshi Naitoh, Masafumi Inomata, Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1002/ags3.70089","DOIUrl":"https://doi.org/10.1002/ags3.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Acute appendicitis in pregnant women requires accurate diagnosis and treatment because of potential pregnancy complications. Laparoscopic appendectomy (LA) has been associated with higher rates of fetal loss than open appendectomy (OA). Therefore, we conducted the first multicenter collaborative analysis in Japan to evaluate the safety and efficacy of LA during pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 152 pregnant women who underwent appendectomy for acute appendicitis between 2012 and 2021 using data from the Japan Society of Laparoscopic Colorectal Surgery. The patients were divided into the OA (<i>n</i> = 92) and LA (<i>n</i> = 60) groups. The primary endpoint was fetal loss during hospitalization. Patient demographics, perioperative outcomes, pathology, and pregnancy outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No fetal loss occurred in either group. The operative time (<i>p</i> = 0.485) and postoperative complications (<i>p</i> = 0.708) were similar between the groups. However, the hospital stay was significantly shorter in the LA group than in the OA group (<i>p</i> = 0.037). The OA group had a higher rate of gangrenous or perforated appendicitis (<i>p</i> = 0.017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA is a safe alternative to OA in pregnant women, with no additional maternal complications and comparable fetal outcomes. LA does not negatively affect fetal health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"275-280"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887299","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}
Katsunori Shinozaki, Tsuyoshi Kobayashi, Yuji Takakura, Satoshi Ikeda, Hiroyuki Egi, Yuzo Hirata, Manabu Shimomura, Takafumi Oshiro, Takao Hinoi, Daisuke Sumitani, Masahiro Nakahara, Masanori Yoshimitsu, Naruhiko Honmyo, Junko Tanaka, Hideki Ohdan, the Hiroshima Surgical study group of Clinical Oncology (HiSCO)
<p>We would like to respond to Letter to the Editor by Okuno et al. entitled “Clarifying treatment compliance and future directions in perioperative chemotherapy for resectable colorectal liver metastases” in relation to our research group's original paper, “Preoperative Versus Postoperative Chemotherapy With CAPOX Plus Bevacizumab for Resectable Colorectal Liver Metastases: A Randomized Phase II Trial (HiSCO-01)” published in the <i>Annals of Gastroenterological Surgery</i>.</p><p>We appreciate your interest in our paper and your constructive comments.</p><p>First, in your comments, you mentioned that the reason for the low TCR in the postoperative group is still unclear. However, the consort flow diagram in figure 1 <i>of our original paper</i> shows that chemotherapy could not be started after hepatectomy in three cases (one due to a decline in PS, two due to postoperative complications), and chemotherapy was discontinued in eight cases (two due to postoperative complications, four due to adverse events associated with chemotherapy, and two due to disease progression) after five cycles or less [<span>1</span>]. This is the reason for the low TCR in the postoperative group. In other words, although there is no statistically significant difference between chemotherapy after hepatectomy and preoperative chemotherapy, we believe that it is highly likely to be difficult to implement.</p><p>As for your second comment, we understand the idea of selecting anti-EGFR antibodies or bevacizumab based on molecular profiling. However, we feel that the number of colorectal cancer patients with resectable liver metastases is by no means large. The HEPATICA trial is a phase III multicenter randomized controlled trial conducted in the Netherlands regarding postoperative adjuvant therapy for patients with resected liver metastases from colorectal cancer [<span>2</span>]. The purpose of this study was to evaluate the efficacy (disease-free survival, overall survival, etc.) and safety of adding bevacizumab (a molecularly targeted drug) to CAPOX (capecitabine + oxaliplatin) monotherapy as postoperative adjuvant therapy compared with CAPOX (capecitabine + oxaliplatin) monotherapy. Like ours, this study was terminated prematurely. In addition, the New EPOC study also evaluated the efficacy of adding cetuximab to chemotherapy as perioperative chemotherapy. However, an interim analysis showed shorter progression-free survival (PFS) than expected in the chemotherapy + cetuximab group, and the study was discontinued in November 2012 [<span>3</span>]. For this reason, the NCCN panel recommends against the use of panitumumab and cetuximab as perioperative treatment for resectable metachronous metastatic disease. Clinical trials based on the concept of selecting biologics based on molecular profiling and combining them with chemotherapy are interesting, but I believe they would be difficult to implement in reality.</p><p>In conclusion, if a phase 3 trial is considered feasi
{"title":"Response to Letter to the Editor Entitled “Clarifying Treatment Compliance and Future Directions in Perioperative Chemotherapy for Resectable Colorectal Liver Metastases”","authors":"Katsunori Shinozaki, Tsuyoshi Kobayashi, Yuji Takakura, Satoshi Ikeda, Hiroyuki Egi, Yuzo Hirata, Manabu Shimomura, Takafumi Oshiro, Takao Hinoi, Daisuke Sumitani, Masahiro Nakahara, Masanori Yoshimitsu, Naruhiko Honmyo, Junko Tanaka, Hideki Ohdan, the Hiroshima Surgical study group of Clinical Oncology (HiSCO)","doi":"10.1002/ags3.70086","DOIUrl":"https://doi.org/10.1002/ags3.70086","url":null,"abstract":"<p>We would like to respond to Letter to the Editor by Okuno et al. entitled “Clarifying treatment compliance and future directions in perioperative chemotherapy for resectable colorectal liver metastases” in relation to our research group's original paper, “Preoperative Versus Postoperative Chemotherapy With CAPOX Plus Bevacizumab for Resectable Colorectal Liver Metastases: A Randomized Phase II Trial (HiSCO-01)” published in the <i>Annals of Gastroenterological Surgery</i>.</p><p>We appreciate your interest in our paper and your constructive comments.</p><p>First, in your comments, you mentioned that the reason for the low TCR in the postoperative group is still unclear. However, the consort flow diagram in figure 1 <i>of our original paper</i> shows that chemotherapy could not be started after hepatectomy in three cases (one due to a decline in PS, two due to postoperative complications), and chemotherapy was discontinued in eight cases (two due to postoperative complications, four due to adverse events associated with chemotherapy, and two due to disease progression) after five cycles or less [<span>1</span>]. This is the reason for the low TCR in the postoperative group. In other words, although there is no statistically significant difference between chemotherapy after hepatectomy and preoperative chemotherapy, we believe that it is highly likely to be difficult to implement.</p><p>As for your second comment, we understand the idea of selecting anti-EGFR antibodies or bevacizumab based on molecular profiling. However, we feel that the number of colorectal cancer patients with resectable liver metastases is by no means large. The HEPATICA trial is a phase III multicenter randomized controlled trial conducted in the Netherlands regarding postoperative adjuvant therapy for patients with resected liver metastases from colorectal cancer [<span>2</span>]. The purpose of this study was to evaluate the efficacy (disease-free survival, overall survival, etc.) and safety of adding bevacizumab (a molecularly targeted drug) to CAPOX (capecitabine + oxaliplatin) monotherapy as postoperative adjuvant therapy compared with CAPOX (capecitabine + oxaliplatin) monotherapy. Like ours, this study was terminated prematurely. In addition, the New EPOC study also evaluated the efficacy of adding cetuximab to chemotherapy as perioperative chemotherapy. However, an interim analysis showed shorter progression-free survival (PFS) than expected in the chemotherapy + cetuximab group, and the study was discontinued in November 2012 [<span>3</span>]. For this reason, the NCCN panel recommends against the use of panitumumab and cetuximab as perioperative treatment for resectable metachronous metastatic disease. Clinical trials based on the concept of selecting biologics based on molecular profiling and combining them with chemotherapy are interesting, but I believe they would be difficult to implement in reality.</p><p>In conclusion, if a phase 3 trial is considered feasi","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1371-1372"},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although living-donor liver transplantation (LDLT) has become the standard treatment for end-stage liver disease, one of its major challenges is small-for-size syndrome (SFSS). SFSS is characterized by severe icterus and intractable ascites, although the severity of the condition can vary. Some cases are managed with medical treatment alone, others require interventions such as splenic embolization, and some may result in graft loss or necessitate re-transplantation. A recent area of interest in this field is the new grading system introduced through collaboration between the International Liver Transplantation Society, the International Living-Donor Liver Transplantation Study Group, and the Liver Transplant Society of India in 2003. This grading system has helped define SFSS in the context of LDLT. Recent trends also include right lobe graft selection with V5/V8 reconstruction and optimal outflow to manage the high venous pressure associated with end-stage liver disease. To develop effective strategies for transplanting small-for-size grafts and preventing SFSS, it is crucial to have a comprehensive understanding of how to evaluate graft quality and volume, alongside portal pressure management, during LDLT. We review the latest literature on the pathogenesis of SFSS and the strategies for overcoming it after LDLT.
{"title":"Essential Updates 2024/2025: History, Pathogenesis, Definition, Prevention, and Management of Small-for-Size Syndrome in Living-Donor Liver Transplantation","authors":"Toru Ikegami, Masashi Tsunematsu, Shinji Onda, Kenei Furukawa, Koichiro Haruki, Michinori Matsumoto, Yoshihiro Shirai","doi":"10.1002/ags3.70088","DOIUrl":"https://doi.org/10.1002/ags3.70088","url":null,"abstract":"<p>Although living-donor liver transplantation (LDLT) has become the standard treatment for end-stage liver disease, one of its major challenges is small-for-size syndrome (SFSS). SFSS is characterized by severe icterus and intractable ascites, although the severity of the condition can vary. Some cases are managed with medical treatment alone, others require interventions such as splenic embolization, and some may result in graft loss or necessitate re-transplantation. A recent area of interest in this field is the new grading system introduced through collaboration between the International Liver Transplantation Society, the International Living-Donor Liver Transplantation Study Group, and the Liver Transplant Society of India in 2003. This grading system has helped define SFSS in the context of LDLT. Recent trends also include right lobe graft selection with V5/V8 reconstruction and optimal outflow to manage the high venous pressure associated with end-stage liver disease. To develop effective strategies for transplanting small-for-size grafts and preventing SFSS, it is crucial to have a comprehensive understanding of how to evaluate graft quality and volume, alongside portal pressure management, during LDLT. We review the latest literature on the pathogenesis of SFSS and the strategies for overcoming it after LDLT.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"35-41"},"PeriodicalIF":3.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887645","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 survival benefit of adjuvant chemotherapy (AC) in intrahepatic cholangiocarcinoma (ICC) remains uncertain, particularly in advanced-stage disease.
Methods
We retrospectively analyzed 480 patients who underwent curative-intent hepatic resection for ICC at eight institutions between 2006 and 2023. Patients were stratified by receipt of AC, and survival outcomes were compared across LCSGJ stages. Multivariable Cox regression was used to identify prognostic factors.
Results
Among 480 patients, 206 received AC. While AC did not significantly improve survival in stage I–III disease, it was associated with significantly longer overall survival (median 25.5 vs. 17.1 months, p = 0.008) and recurrence-free survival (median 10.3 vs. 6.0 months, p = 0.010) in stage IV patients. Multivariable analysis in stage IV revealed that AC independently reduced the risk of death (HR 0.540, p = 0.020), while poor liver function, severe postoperative complications, tumor size, and lymph node metastasis were adverse prognostic factors. Among AC regimens, S-1 demonstrated significantly longer OS (69.3 vs. 17.1 months, p = 0.001) and RFS (9.6 vs. 6.0 months, p = 0.015) compared with no AC, whereas other regimens did not show statistically significant benefits.
Conclusions
Adjuvant chemotherapy was associated with improved survival in patients with resected stage IV ICC. Among available regimens, S-1 appeared to contribute to this benefit. These findings support the use of AC in advanced ICC and suggest that S-1 may play a potential role, warranting further prospective validation. Stage-specific treatment planning may be essential to optimize outcomes.
{"title":"Potential Survival Benefit of Adjuvant Chemotherapy in Stage IV Intrahepatic Cholangiocarcinoma: A Multicenter, Stage-Stratified Analysis","authors":"Hisashi Kosaka, Masaki Ueno, Hiroji Shinkawa, Yusuke Yamamoto, Masahiko Kinoshita, Koji Komeda, Tsukasa Aihara, Satoshi Yasuda, Haruki Mori, Masaki Kaibori","doi":"10.1002/ags3.70087","DOIUrl":"https://doi.org/10.1002/ags3.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The survival benefit of adjuvant chemotherapy (AC) in intrahepatic cholangiocarcinoma (ICC) remains uncertain, particularly in advanced-stage disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 480 patients who underwent curative-intent hepatic resection for ICC at eight institutions between 2006 and 2023. Patients were stratified by receipt of AC, and survival outcomes were compared across LCSGJ stages. Multivariable Cox regression was used to identify prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 480 patients, 206 received AC. While AC did not significantly improve survival in stage I–III disease, it was associated with significantly longer overall survival (median 25.5 vs. 17.1 months, <i>p</i> = 0.008) and recurrence-free survival (median 10.3 vs. 6.0 months, <i>p</i> = 0.010) in stage IV patients. Multivariable analysis in stage IV revealed that AC independently reduced the risk of death (HR 0.540, <i>p</i> = 0.020), while poor liver function, severe postoperative complications, tumor size, and lymph node metastasis were adverse prognostic factors. Among AC regimens, S-1 demonstrated significantly longer OS (69.3 vs. 17.1 months, <i>p</i> = 0.001) and RFS (9.6 vs. 6.0 months, <i>p</i> = 0.015) compared with no AC, whereas other regimens did not show statistically significant benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adjuvant chemotherapy was associated with improved survival in patients with resected stage IV ICC. Among available regimens, S-1 appeared to contribute to this benefit. These findings support the use of AC in advanced ICC and suggest that S-1 may play a potential role, warranting further prospective validation. Stage-specific treatment planning may be essential to optimize outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"241-250"},"PeriodicalIF":3.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891649","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}
Surgical resection for neuroendocrine liver metastasis (NELM) is the key to long survival; however, the indications remain unclear due to the high recurrence rate. We aimed to identify candidates who would benefit from surgical resection for NELM.
Methods
Patients with NELM treated at our institution from January 2005 to December 2020 were included. Neuroendocrine carcinoma (NEC) was excluded. Risk factors for overall survival (OS) and recurrence-free survival (RFS) were analyzed. The cut-off value for the number of NELM predicting poor RFS was determined by minimum p-value approach.
Results
Of the total 126 patients, 67 patients underwent liver resection. The median follow-up time from the date of initial diagnosis of NELM was 4.3 years. Surgical resection and NET-G1/2 were associated with good OS in multivariate analysis (p < 0.001). In patients underwent R0/1 resection (n = 44), NET-G3 [HR: 3.1 (95% CI 1.4–7.2)] and the number of NELM [HR: 1.1 (95% CI 1.0–1.1)] were associated with poor RFS in multivariate analysis. The optimal cut-off value for the number of NELM was calculated as 8. The median RFS for patients with 8 or more liver metastases or NET-G3 was 3.9 months, which was extremely short compared to patients with NET-G1/2 (13.8 months) and to those who had fewer than 8 liver metastases (19.1 months).
Conclusion
This study suggests that fewer than 8 liver metastases and NET-G1/2 are indications for surgical resection in patients with NELM considering the RFS. Surgical resection for patients with 8 or more liver metastases or NET-G3 needs deliberate selection.
背景神经内分泌性肝转移（neuroendocrine liver metastasis， NELM）手术切除是延长生存期的关键；然而，由于复发率高，适应症尚不清楚。我们的目的是确定将受益于手术切除NELM的候选人。方法纳入我院2005年1月至2020年12月收治的NELM患者。排除神经内分泌癌（NEC）。分析总生存期（OS）和无复发生存期（RFS）的危险因素。通过最小p值法确定预测不良RFS的NELM数目的临界值。结果126例患者中，67例行肝切除术。从首次诊断为NELM之日起，中位随访时间为4.3年。多因素分析显示，手术切除和NET-G1/2与良好的OS相关（p < 0.001）。在接受R0/1切除术的患者（n = 44）中，多因素分析显示，NET-G3 [HR: 3.1 (95% CI 1.4-7.2)]和NELM数量[HR: 1.1 (95% CI 1.0-1.1)]与较差的RFS相关。计算出NELM数量的最佳临界值为8。8例及以上肝转移或NET-G3患者的中位RFS为3.9个月，与NET-G1/2患者（13.8个月）和小于8例肝转移患者（19.1个月）相比，这是非常短的。结论考虑RFS，小于8例肝转移和NET-G1/2是NELM患者手术切除的指征。8例及以上肝转移或NET-G3患者的手术切除需要慎重选择。
{"title":"Indications for Surgical Resection in Patients With Neuroendocrine Tumor Liver Metastases: An Intensive Surgical Experience of a High-Volume Center","authors":"Daisuke Asano, Toshitaka Sugawara, Keiichi Akahoshi, Shotaro Gan, Shohei Motohashi, Shuichi Watanabe, Yoshiya Ishikawa, Hiroki Ueda, Atsushi Kudo, Daisuke Ban","doi":"10.1002/ags3.70082","DOIUrl":"https://doi.org/10.1002/ags3.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgical resection for neuroendocrine liver metastasis (NELM) is the key to long survival; however, the indications remain unclear due to the high recurrence rate. We aimed to identify candidates who would benefit from surgical resection for NELM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with NELM treated at our institution from January 2005 to December 2020 were included. Neuroendocrine carcinoma (NEC) was excluded. Risk factors for overall survival (OS) and recurrence-free survival (RFS) were analyzed. The cut-off value for the number of NELM predicting poor RFS was determined by minimum <i>p</i>-value approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total 126 patients, 67 patients underwent liver resection. The median follow-up time from the date of initial diagnosis of NELM was 4.3 years. Surgical resection and NET-G1/2 were associated with good OS in multivariate analysis (<i>p</i> < 0.001). In patients underwent R0/1 resection (<i>n</i> = 44), NET-G3 [HR: 3.1 (95% CI 1.4–7.2)] and the number of NELM [HR: 1.1 (95% CI 1.0–1.1)] were associated with poor RFS in multivariate analysis. The optimal cut-off value for the number of NELM was calculated as 8. The median RFS for patients with 8 or more liver metastases or NET-G3 was 3.9 months, which was extremely short compared to patients with NET-G1/2 (13.8 months) and to those who had fewer than 8 liver metastases (19.1 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests that fewer than 8 liver metastases and NET-G1/2 are indications for surgical resection in patients with NELM considering the RFS. Surgical resection for patients with 8 or more liver metastases or NET-G3 needs deliberate selection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"219-228"},"PeriodicalIF":3.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study compared the efficacy of sequential hepatic vein embolization (HVE) following portal vein embolization (PVE) with PVE alone in promoting both the volume and function of the future remnant liver (FRL) before right-sided major hepatectomy.
Methods
All patients underwent preoperative PVE with or without sequential HVE, followed by right hepatectomy ± extended from 2018 to 2023. Changes in FRL volume and function were analyzed and compared between groups, with liver function assessed using technetium-99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) scintigraphy.
Results
Eight patients underwent sequential PVE–HVE, while 24 underwent PVE alone. All patients underwent embolization without severe complications. The median regeneration rate of FRL volume was significantly higher in the sequential HVE–HVE group at 35.5% (20.6%–54.0%) compared with 26.2% (19.2%–31.0%) in the PVE group (p = 0.017). Moreover, the median FRL function regeneration rate was 59.5% (41.6%–80.9%) in the sequential PVE–HVE group, markedly greater than the rate of 25.2% (1.2%–41.4%) in the PVE group (p = 0.014). There was no significant difference in surgical outcomes between groups.
Conclusions
Sequential PVE–HVE is safe and practical, leading to a significant increase in both the volume and function of the FRL.
{"title":"Efficacy of Sequential Hepatic Vein Embolization Following Portal Vein Embolization in Promoting Regeneration of Liver Volume and Function Before Right-Sided Major Hepatectomy","authors":"Thanh Tung Lai, Kosuke Matsui, Hideyuki Matsushima, Hidekazu Yamamoto, Gozo Kiguchi, Hisashi Kosaka, Van Khanh Nguyen, Yasuhiro Ueno, Shuji Kariya, Masaki Kaibori","doi":"10.1002/ags3.70085","DOIUrl":"https://doi.org/10.1002/ags3.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Purpose</h3>\u0000 \u0000 <p>This study compared the efficacy of sequential hepatic vein embolization (HVE) following portal vein embolization (PVE) with PVE alone in promoting both the volume and function of the future remnant liver (FRL) before right-sided major hepatectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients underwent preoperative PVE with or without sequential HVE, followed by right hepatectomy ± extended from 2018 to 2023. Changes in FRL volume and function were analyzed and compared between groups, with liver function assessed using technetium-99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight patients underwent sequential PVE–HVE, while 24 underwent PVE alone. All patients underwent embolization without severe complications. The median regeneration rate of FRL volume was significantly higher in the sequential HVE–HVE group at 35.5% (20.6%–54.0%) compared with 26.2% (19.2%–31.0%) in the PVE group (<i>p</i> = 0.017). Moreover, the median FRL function regeneration rate was 59.5% (41.6%–80.9%) in the sequential PVE–HVE group, markedly greater than the rate of 25.2% (1.2%–41.4%) in the PVE group (<i>p</i> = 0.014). There was no significant difference in surgical outcomes between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sequential PVE–HVE is safe and practical, leading to a significant increase in both the volume and function of the FRL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"229-240"},"PeriodicalIF":3.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891609","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, Jun Watanabe, Koji Ando, Caleah Kitchens, Aron Bercz, J. Joshua Smith
The management of locally advanced rectal cancer (LARC) has evolved with the adoption of total neoadjuvant therapy (TNT), integrated chemoradiotherapy (CRT) or short-course radiotherapy (SCRT) with systemic chemotherapy. Although immune checkpoint inhibitors (ICIs) show remarkable efficacy in mismatch repair-deficient/MSI-H colorectal cancer, their role in proficient mismatch repair (pMMR)/microsatellite stable (MSS) tumors remains limited owing to poor immunogenicity. CRT or SCRT has emerged as a promising immunomodulator capable of converting “cold” pMMR/MSS tumors into “hot” immune-responsive environments, thereby enhancing antigen presentation and PD-L1 expression. Although CRT-ICI combinations have achieved modest efficacy with pathological complete response (pCR) rates generally plateauing around 40%, recent studies that incorporate ICIs into TNT (TNT-ICI), notably UNION, TORCH, and PRECAM, have achieved higher pCR and clinical complete response (cCR) rates (40%–60%). Focusing exclusively on TNT, this review underscores that optimal sequencing and chemotherapy intensity are paramount for maximizing synergy while limiting lymphodepletion. It consolidates the growing clinical evidence and mechanistic rationale for integrating ICIs into TNT, for pMMR/MSS LARC, and delineates a pathway toward higher pCR and cCR rates alongside organ-preserving treatment strategies.
{"title":"Integrating Immune Checkpoint Inhibitors With Total Neoadjuvant Therapy in Proficient Mismatch Repair Rectal Cancer","authors":"Yoshinori Kagawa, Jun Watanabe, Koji Ando, Caleah Kitchens, Aron Bercz, J. Joshua Smith","doi":"10.1002/ags3.70083","DOIUrl":"https://doi.org/10.1002/ags3.70083","url":null,"abstract":"<p>The management of locally advanced rectal cancer (LARC) has evolved with the adoption of total neoadjuvant therapy (TNT), integrated chemoradiotherapy (CRT) or short-course radiotherapy (SCRT) with systemic chemotherapy. Although immune checkpoint inhibitors (ICIs) show remarkable efficacy in mismatch repair-deficient/MSI-H colorectal cancer, their role in proficient mismatch repair (pMMR)/microsatellite stable (MSS) tumors remains limited owing to poor immunogenicity. CRT or SCRT has emerged as a promising immunomodulator capable of converting “cold” pMMR/MSS tumors into “hot” immune-responsive environments, thereby enhancing antigen presentation and PD-L1 expression. Although CRT-ICI combinations have achieved modest efficacy with pathological complete response (pCR) rates generally plateauing around 40%, recent studies that incorporate ICIs into TNT (TNT-ICI), notably UNION, TORCH, and PRECAM, have achieved higher pCR and clinical complete response (cCR) rates (40%–60%). Focusing exclusively on TNT, this review underscores that optimal sequencing and chemotherapy intensity are paramount for maximizing synergy while limiting lymphodepletion. It consolidates the growing clinical evidence and mechanistic rationale for integrating ICIs into TNT, for pMMR/MSS LARC, and delineates a pathway toward higher pCR and cCR rates alongside organ-preserving treatment strategies.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"145-153"},"PeriodicalIF":3.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891703","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 prognostic immune nutritional index (PINI) is increasingly recognized for its potential clinical utility. However, multifaceted evaluations of its ability to predict oncological outcomes in colorectal cancer (CRC) and its association with postoperative infectious complications remain limited.
Methods
We analyzed the preoperative PINI in 487 patients with CRC who underwent surgical treatment between 2006 and 2015 to clarify its clinical relevance.
Results
A low preoperative PINI was significantly associated with several clinicopathological factors indicative of disease progression, including advanced pathological T category (p < 0.001) and lymph node metastasis (p = 0.001). It was an independent prognostic factor for disease-free survival (DFS) (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.22–3.00; p = 0.005) and overall survival (OS) (HR: 2.51; 95% CI: 1.50–4.18; p < 0.001). A low preoperative PINI was also an independent risk factor for total infection (odds ratio [OR]: 1.82; 95% CI: 1.11–3.00; p = 0.02), encompassing all postoperative infectious complications. In a subgroup analysis of patients with stage III and high-risk stage II CRC, a low preoperative PINI was an independent prognostic factor for both DFS (HR: 2.03; 95% CI: 1.24–3.32; p = 0.005) and OS (HR: 3.64; 95% CI: 1.61–8.19; p = 0.002). Additionally, propensity score matching analysis demonstrated that patients with a low preoperative PINI had significantly worse DFS (p = 0.01) and OS (p = 0.02).
Conclusion
The preoperative PINI is a valuable biomarker for both perioperative risk assessment and long-term oncological management in patients with CRC.
目的预后免疫营养指数（PINI）因其潜在的临床应用价值而日益受到重视。然而，对其预测结直肠癌（CRC）肿瘤预后的能力及其与术后感染并发症的关联的多方面评估仍然有限。方法分析2006 - 2015年间487例结直肠癌手术患者的术前PINI，阐明其临床意义。结果术前低PINI与疾病进展的几个临床病理因素显著相关，包括晚期病理性T型（p < 0.001）和淋巴结转移（p = 0.001）。它是无病生存（DFS）（风险比[HR]: 1.91； 95%可信区间[CI]: 1.22-3.00; p = 0.005）和总生存（OS）（风险比：2.51;95% CI: 1.50-4.18; p < 0.001）的独立预后因素。术前低的PINI也是总感染的独立危险因素（优势比[OR]: 1.82; 95% CI: 1.11-3.00; p = 0.02），包括所有术后感染并发症。在III期和高风险II期CRC患者的亚组分析中，术前低PINI是DFS （HR: 2.03; 95% CI: 1.24-3.32; p = 0.005）和OS （HR: 3.64; 95% CI: 1.61-8.19; p = 0.002）的独立预后因素。此外，倾向评分匹配分析显示，术前低PINI患者的DFS （p = 0.01）和OS （p = 0.02）明显较差。结论术前PINI是CRC患者围手术期风险评估和长期肿瘤管理的有价值的生物标志物。
{"title":"Impact of Low Preoperative Prognostic Immune Nutritional Index on Survival and Postoperative Infectious Complications in Patients With Colorectal Cancer","authors":"Shinji Yamashita, Yoshinaga Okugawa, Hiroki Imaoka, Tadanobu Shimura, Takahito Kitajima, Mikio Kawamura, Yoshiki Okita, Masaki Ohi, Minako Kobayashi, Yuji Toiyama","doi":"10.1002/ags3.70084","DOIUrl":"https://doi.org/10.1002/ags3.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The prognostic immune nutritional index (PINI) is increasingly recognized for its potential clinical utility. However, multifaceted evaluations of its ability to predict oncological outcomes in colorectal cancer (CRC) and its association with postoperative infectious complications remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed the preoperative PINI in 487 patients with CRC who underwent surgical treatment between 2006 and 2015 to clarify its clinical relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A low preoperative PINI was significantly associated with several clinicopathological factors indicative of disease progression, including advanced pathological T category (<i>p</i> < 0.001) and lymph node metastasis (<i>p</i> = 0.001). It was an independent prognostic factor for disease-free survival (DFS) (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.22–3.00; <i>p</i> = 0.005) and overall survival (OS) (HR: 2.51; 95% CI: 1.50–4.18; <i>p</i> < 0.001). A low preoperative PINI was also an independent risk factor for total infection (odds ratio [OR]: 1.82; 95% CI: 1.11–3.00; <i>p</i> = 0.02), encompassing all postoperative infectious complications. In a subgroup analysis of patients with stage III and high-risk stage II CRC, a low preoperative PINI was an independent prognostic factor for both DFS (HR: 2.03; 95% CI: 1.24–3.32; <i>p</i> = 0.005) and OS (HR: 3.64; 95% CI: 1.61–8.19; <i>p</i> = 0.002). Additionally, propensity score matching analysis demonstrated that patients with a low preoperative PINI had significantly worse DFS (<i>p</i> = 0.01) and OS (<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The preoperative PINI is a valuable biomarker for both perioperative risk assessment and long-term oncological management in patients with CRC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"154-166"},"PeriodicalIF":3.3,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891384","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}
We previously reported the gender disparities in surgical procedures between male and female surgeons using National Clinical Database covering more than 95% of all operations performed in Japan. This study aims to examine the changes in gender disparity in the surgical experience of gastrointestinal surgeons in Japan before and after implementation of measures by the Japanese Society of Gastrointestinal Surgery to address gender inequality commenced in 2021.
Methods
We conducted a nationwide retrospective study to compare the number of operations performed by male and female surgeons using National Clinical Database. The number of operations per surgeon was calculated based on every 2 years of a surgeon's experience, and a comparison was made between male and female surgeons. The years selected for analysis were 2015, 2019, and 2023.
Results
Almost no gender differences were observed in the number of low-difficulty surgeries. For medium-difficulty surgeries, the number performed by female surgeons showed an improving trend over the study period, yet some disparities remained. The number of high-difficulty surgeries (low anterior resection and pancreaticoduodenectomy) performed by male surgeons was higher than the number performed by female surgeons, except for protrusions. This disparity remained unchanged over the study period.
Conclusions
The efforts of the Japanese Society of Gastrointestinal Surgery has been shown to be effective in mitigating gender disparities in the number of surgeries performed. High-difficulty surgeries have emerged as the primary target for further improvement initiatives.
{"title":"Trends in Gender Disparities in Surgical Experience: A National Clinical Database Study","authors":"Chie Tanaka, Hiroyuki Yamamoto, Sachiyo Nomura, Emiko Kono, Hideki Ueno, Yoshihiro Kakeji, Ken Shirabe","doi":"10.1002/ags3.70080","DOIUrl":"https://doi.org/10.1002/ags3.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We previously reported the gender disparities in surgical procedures between male and female surgeons using National Clinical Database covering more than 95% of all operations performed in Japan. This study aims to examine the changes in gender disparity in the surgical experience of gastrointestinal surgeons in Japan before and after implementation of measures by the Japanese Society of Gastrointestinal Surgery to address gender inequality commenced in 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide retrospective study to compare the number of operations performed by male and female surgeons using National Clinical Database. The number of operations per surgeon was calculated based on every 2 years of a surgeon's experience, and a comparison was made between male and female surgeons. The years selected for analysis were 2015, 2019, and 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Almost no gender differences were observed in the number of low-difficulty surgeries. For medium-difficulty surgeries, the number performed by female surgeons showed an improving trend over the study period, yet some disparities remained. The number of high-difficulty surgeries (low anterior resection and pancreaticoduodenectomy) performed by male surgeons was higher than the number performed by female surgeons, except for protrusions. This disparity remained unchanged over the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The efforts of the Japanese Society of Gastrointestinal Surgery has been shown to be effective in mitigating gender disparities in the number of surgeries performed. High-difficulty surgeries have emerged as the primary target for further improvement initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"263-274"},"PeriodicalIF":3.3,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891385","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}
Minimally invasive surgeries such as laparoscopic or robotic surgery for gastric cancer are becoming remarkably popular. Since the many robust pieces of evidence have been piled up, currently, the Japanese guidelines strongly recommend laparoscopic distal gastrectomy even for advanced cancer. However, regarding laparoscopic total gastrectomy (LTG) for advanced cancer, the technical difficulty is considerably higher because the tumor is likely to be large and is sometimes difficult to handle, and splenic hilar dissection is necessary in tumors that invade the greater curvature. So far, several studies have shown that the complication rate and survival outcomes are not inferior to those of open surgery, but the level of evidence is not high. In recent years, robotic surgery has become more penetrated in society. It is expected that especially in technically difficult procedures such as total gastrectomy, the advantages of robotic surgery could be exploited. In fact, several retrospective studies have suggested that robotic total gastrectomy reduces complications and increases the number of dissected lymph nodes compared to LTG. However, randomized trials are currently underway for these issues, and the results are awaited. In recent years, there has been a trend toward function-preserving surgery aimed at maintaining a patient's quality of life. Some retrospective studies suggested that total gastrectomy may not always be necessary, especially for proximal advanced gastric cancer with relatively small size and not high TN factor. All these points should be considered in the development of truly minimally invasive and curative procedures for patients.
{"title":"Is Laparoscopic/Robotic Total Gastrectomy a Reasonable and Adequate Treatment for Proximal Advanced Gastric Cancer?","authors":"Takahiro Kinoshita, Masahiro Yura, Mitsumasa Yoshida, Daiki Terajima","doi":"10.1002/ags3.70081","DOIUrl":"https://doi.org/10.1002/ags3.70081","url":null,"abstract":"<p>Minimally invasive surgeries such as laparoscopic or robotic surgery for gastric cancer are becoming remarkably popular. Since the many robust pieces of evidence have been piled up, currently, the Japanese guidelines strongly recommend laparoscopic distal gastrectomy even for advanced cancer. However, regarding laparoscopic total gastrectomy (LTG) for advanced cancer, the technical difficulty is considerably higher because the tumor is likely to be large and is sometimes difficult to handle, and splenic hilar dissection is necessary in tumors that invade the greater curvature. So far, several studies have shown that the complication rate and survival outcomes are not inferior to those of open surgery, but the level of evidence is not high. In recent years, robotic surgery has become more penetrated in society. It is expected that especially in technically difficult procedures such as total gastrectomy, the advantages of robotic surgery could be exploited. In fact, several retrospective studies have suggested that robotic total gastrectomy reduces complications and increases the number of dissected lymph nodes compared to LTG. However, randomized trials are currently underway for these issues, and the results are awaited. In recent years, there has been a trend toward function-preserving surgery aimed at maintaining a patient's quality of life. Some retrospective studies suggested that total gastrectomy may not always be necessary, especially for proximal advanced gastric cancer with relatively small size and not high TN factor. All these points should be considered in the development of truly minimally invasive and curative procedures for patients.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"42-53"},"PeriodicalIF":3.3,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887467","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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