Annals of Gastroenterological Surgery最新文献_第3页

Impact of Sarcopenia During Induction Treatment in Patients With Unresectable Locally Advanced Pancreatic Cancer 不可切除的局部晚期胰腺癌诱导治疗中肌少症的影响

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-18 DOI: 10.1002/ags3.70078

Sho Uemura, Masayuki Tanaka, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa, Shutaro Hori, Yutaka Nakano, Yuko Kitagawa

Background

Chemotherapeutic advances have increased opportunities for conversion surgery (CS) in unresectable locally advanced (UR-LA) pancreatic cancer (PC). However, the optimal indications for CS remain unclear. Sarcopenia has been associated with poor outcomes in PC, except UR-LA PC. Herein, we aimed to evaluate the impact of sarcopenia on the prognosis of patients with UR-LA PC.

Methods

In this retrospective study, we reviewed consecutive patients with UR-LA PC who had received chemo(radio)therapy as an initial treatment between 2015 and 2023. We examined relevant clinical variables and CT findings at initial diagnosis and at 6 months after starting treatment.

Results

Ten of the 41 patients had undergone CS. Tumor size at 6 months, clinical lymph node metastasis at diagnosis, and changes in sarcopenia over 6 months were associated with overall survival (OS) (multivariate analysis: hazard ratio = 3.25, 2.79, and 3.51, respectively). In the entire cohort, patients without any of these three factors had significantly better OS than those with one or more (median OS: 30.3 months vs. 17.3 months, p = 0.013). CS was associated with better OS among patients without these factors (not reached vs. 25.5 months, p = 0.039), but not in those with one or more.

Conclusions

The impact of change in sarcopenia on prognosis was demonstrated in patients with UR-LA PC. Although, given the limited number of cases, CS might provide a survival benefit in carefully selected patients without prognostic factors such as tumor size at 6 months, clinical lymph node metastasis at diagnosis, and the rate of change of the psoas muscle mass index (PMI).

化疗的进步增加了不可切除的局部晚期（UR-LA）胰腺癌（PC）转换手术（CS）的机会。然而，CS的最佳适应症仍不清楚。骨骼肌减少症与PC的不良预后相关，但UR-LA PC除外。在此，我们旨在评估肌肉减少症对UR-LA PC患者预后的影响。方法在这项回顾性研究中，我们回顾了2015年至2023年间连续接受化疗（放疗）作为初始治疗的UR-LA PC患者。我们在最初诊断和开始治疗后6个月检查了相关的临床变量和CT表现。结果41例患者中，有10例患者行了CS。6个月时的肿瘤大小、诊断时的临床淋巴结转移以及6个月后肌肉减少的变化与总生存率（OS）相关（多因素分析：风险比分别为3.25、2.79和3.51）。在整个队列中，没有这三个因素中的任何一个的患者的OS明显优于有一个或多个因素的患者（中位OS: 30.3个月vs. 17.3个月，p = 0.013）。在没有这些因素的患者中，CS与更好的OS相关（未达到vs. 25.5个月，p = 0.039），但在有一种或多种因素的患者中则没有。结论肌少症改变对UR-LA PC患者预后的影响。虽然，由于病例数量有限，CS可能会在精心挑选的患者中提供生存优势，这些患者没有预后因素，如6个月时的肿瘤大小、诊断时的临床淋巴结转移和腰肌质量指数（PMI）的变化率。

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引用次数: 0

Prolonged Prophylactic Antibiotics Based on Preoperative Bile Culture Reduce Surgical Site Infections After Pancreaticoduodenectomy Following Preoperative Biliary Drainage: A Propensity-Matched Analysis 基于术前胆汁培养的长期预防性抗生素减少术前胆道引流后胰十二指肠切除术后手术部位感染：倾向匹配分析

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-14 DOI: 10.1002/ags3.70076

Kyohei Matsumoto, Atsushi Shimizu, Yuji Kitahata, Akihiro Takeuchi, Hideki Motobayashi, Masatoshi Sato, Tomohiro Yoshimura, Shinya Hayami, Atsushi Miyamoto, Manabu Kawai

Objective

The optimum duration of prophylactic antibiotics after pancreaticoduodenectomy following preoperative biliary drainage to prevent surgical site infections remains controversial. We evaluate whether a prolonged course of prophylactic antibiotics reduces surgical site infection after pancreaticoduodenectomy following biliary drainage more than that within the standard duration.

Methods

We enrolled 352 consecutive patients from one hospital who underwent pancreaticoduodenectomy following biliary drainage between 2010 and 2023. The patients were prospectively assigned to two groups according to prophylactic antibiotic duration. In the standard duration group (2010–2013; 112 patients), the duration was within 24 h postoperatively. In the prolonged duration group (2014–2023; 240 patients), it was 3 days postoperatively. The primary endpoint was the incidence of surgical site infection between these groups. We performed 1:1 propensity score matching to balance baseline characteristics, which yielded 77 patients per group.

Results

There was significantly less surgical site infection in the longer duration group (13%) than in the standard duration group (29%) (p = 0.0010). After matching, the prolonged duration group maintained significantly lower rates of all surgical site infection (32% vs. 14%, p = 0.0126), organ/space surgical site infection (27% vs. 13%, p = 0.0433), incisional surgical site infection (18% vs. 3%, p = 0.0026), superficial incisional surgical site infection (13% vs. 3%, p = 0.0314). In the multivariate analysis, independent risk factors for surgical site infection after pancreaticoduodenectomy following biliary drainage were elevated drain fluid amylase on postoperative day 1 (p < 0.0001) and 1-day prophylactic antibiotics (p = 0.00012).

Conclusions

Prolonged prophylactic antibiotics significantly reduced surgical site infection incidence after pancreaticoduodenectomy in patients undergoing preoperative biliary drainage.

目的胰十二指肠切除术后术前胆道引流术后预防性抗生素的最佳使用时间对预防手术部位感染仍存在争议。我们评估在胆道引流后胰十二指肠切除术后延长预防性抗生素疗程是否比在标准疗程内更能减少手术部位感染。方法：我们从一家医院连续招募了352例2010年至2023年间胆道引流后行胰十二指肠切除术的患者。根据预防性抗生素持续时间将患者前瞻性分为两组。标准持续时间组（2010-2013；112例），持续时间在术后24 h内。延长时间组（2014-2023；240例）为术后3天。主要终点是两组之间手术部位感染的发生率。我们进行了1:1的倾向评分匹配，以平衡基线特征，每组产生77例患者。结果延长疗程组手术部位感染发生率（13%）明显低于标准疗程组（29%）（p = 0.0010）。匹配后，延长治疗时间组的所有手术部位感染（32%比14%，p = 0.0126）、器官/空间手术部位感染（27%比13%，p = 0.0433）、切口手术部位感染（18%比3%，p = 0.0026）、切口浅表手术部位感染（13%比3%，p = 0.0314）的发生率均显著降低。在多因素分析中，胰十二指肠切除术术后胆道引流术后手术部位感染的独立危险因素为术后第1天引流液淀粉酶升高（p < 0.0001）和第1天预防性使用抗生素（p = 0.00012）。结论术前行胆道引流的患者，长期预防性使用抗生素可显著降低胰十二指肠切除术后手术部位感染的发生率。

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引用次数: 0

Development of a Scoring System to Predict the Treatment Success for Nonoperative Management of Peptic Ulcer Perforation: A Secondary Data Analysis of PPAP Study 预测消化性溃疡穿孔非手术治疗成功的评分系统的开发：PPAP研究的二次数据分析

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-12 DOI: 10.1002/ags3.70074

Kei Ito, Akira Endo, Hiromasa Hoshi, Koji Ito, Tomohiro Akutsu, Hikaru Odera, Hideto Shiraki, Takeshi Yokoyama, Yasukazu Narita, Taro Masuda, Akira Suekane, Shigeru Yamagishi, Koji Morishita

Background

Although surgical treatment is the primary measure for patients with perforated peptic ulcer (PPU), nonoperative management (NOM) has become a common alternative. However, risk score models predicting the success of NOM based on the analysis of a large number of patients remain scarce. We developed a clinically applicable scoring system to predict the success of NOM in patients with PPU using data from a large cohort.

Method

We analyzed data of the Perforated Peptic ulcer Analyzing Project (PPAP), which was a retrospective survey of adult patients with PPU between January 2011 to December 2022. The successful NOM case was defined as patients who survived until hospital discharge without requiring surgery. Factors associated with NOM were identified using a multivariable logistic regression analysis, and a scoring system to predict NOM was developed by weighting these factors based on the regression coefficients.

Result

Of 702 potentially eligible patients, 584 were treated with NOM, of which 130 patients (22.2%) were treated successfully. Age, sex, body temperature, heart rate, the extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis were included in the final model. Using these variables, we developed the scoring system named PPAP score, which had favorable discriminating ability with the area under receiving operating characteristic curve of 0.799. When the cut-off was set to 56, the sensitivity and the specificity were 0.738 and 0.722, respectively.

Conclusion

A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability.

背景虽然手术治疗是穿孔性消化性溃疡（PPU）患者的主要措施，但非手术治疗（NOM）已成为一种常见的替代方法。然而，基于对大量患者的分析来预测NOM成功的风险评分模型仍然很少。我们开发了一种临床适用的评分系统，使用来自大型队列的数据来预测PPU患者的NOM成功。方法对2011年1月至2022年12月成人消化性溃疡穿孔分析项目（PPAP）的数据进行回顾性调查。成功的NOM病例被定义为存活到出院而不需要手术的患者。使用多变量logistic回归分析确定与NOM相关的因素，并根据回归系数对这些因素进行加权，建立一个预测NOM的评分系统。结果702例潜在符合条件的患者中，584例接受了NOM治疗，其中130例（22.2%）成功治疗。最终模型包括年龄、性别、体温、心率、腹膜刺激症状程度、C反应蛋白、腹水扩散和败血症。利用这些变量，我们开发了PPAP评分系统，该评分系统具有较好的判别能力，其接收工作特征曲线下面积为0.799。截止值设为56时，敏感性为0.738，特异性为0.722。结论建立了预测评分模型。然而，该模型需要外部验证才能证实其临床适用性。

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引用次数: 0

Gastric Distension Index: A Novel Radiographic Marker Associated With Postoperative Gastric Stasis After Gastrectomy 胃膨胀指数：与胃切除术后胃淤积相关的一种新的影像学指标

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-11 DOI: 10.1002/ags3.70077

Hiroki Harada, Yoshiko Yamaoka, Akiko Watanabe, Kota Okuno, Shohei Fujita, Mikiko Sakuraya, Tadashi Higuchi, Koshi Kumagai, Keishi Yamashita, Naoki Hiki

Background

Gastric remnant distension after gastrectomy is associated with gastrointestinal symptoms and poor postoperative outcomes, particularly in elderly patients. However, no objective clinical index has been established to define or predict this condition.

Methods

We retrospectively analyzed 67 patients who underwent distal gastrectomy (DG) in 2019 with upright abdominal X-ray imaging. Radiographic indices were evaluated for their association with gastrointestinal symptoms and the need for intervention for postoperative gastric stasis. The maximum width of the gastric bubble was the most predictive and standardized into the Hiki Index (HI). A cutoff value was determined from ROC analysis based on stasis-related intervention. Validation was performed in a prospectively collected cohort of 136 patients who underwent DG or pylorus-preserving gastrectomy (PPG) between 2022 and 2023 after clinical implementation of the HI.

Results

In the test set, HI showed high predictive accuracy for stasis-related intervention (AUC 0.78, sensitivity 85.7%, specificity 76.7%). In the validation set, HI predicted symptoms such as nausea (AUC 0.77), bloating (0.77), and belching (0.90). HI-based gastric distension was not associated with postoperative complications. Age < 75 years (OR 3.29), female sex (OR 2.58), and undergoing PPG (OR 6.21) were identified as independent risk factors for gastric distension.

Conclusion

The HI is a reproducible and practical radiographic indicator for identifying patients at risk of postoperative gastric stasis and related symptoms. Its use may facilitate early intervention and improve postoperative care. Prospective implementation of the HI contributed to more consistent symptom documentation and clearer associations between HI and gastrointestinal symptoms.

背景胃切除术后残胃膨胀与胃肠道症状和术后不良预后相关，尤其是老年患者。然而，目前还没有客观的临床指标来定义或预测这种情况。方法回顾性分析2019年接受远端胃切除术（DG）的67例患者的直立腹部x线影像。评估影像学指标与胃肠道症状的关系以及术后胃淤积干预的必要性。胃泡的最大宽度是最具预测性和标准化的Hiki指数（HI）。通过基于停滞相关干预的ROC分析确定截断值。在临床实施HI后，在2022年至2023年期间前瞻性收集136例接受DG或保幽门胃切除术（PPG）的患者进行验证。结果在测试集中，HI对停滞相关干预具有较高的预测准确度（AUC 0.78，敏感性85.7%，特异性76.7%）。在验证集中，HI预测了恶心（AUC 0.77）、腹胀（0.77）和打嗝（0.90）等症状。hi型胃胀与术后并发症无关。年龄75岁（OR 3.29）、女性（OR 2.58）、行PPG （OR 6.21）是胃胀的独立危险因素。结论HI是鉴别术后胃淤积危险及相关症状的一种可重复性高、实用的影像学指标。它的使用可以促进早期干预和改善术后护理。前瞻性实施HI有助于更一致的症状记录和更清晰的HI与胃肠道症状之间的关联。

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引用次数: 0

Mechanism of Lenvatinib Resistance via Exosomal miRNA-132/Nrf2 Axis in Hepatocellular Carcinoma 肝细胞癌外泌体miRNA-132/Nrf2轴对Lenvatinib耐药的机制

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-06 DOI: 10.1002/ags3.70068

Chie Takasu, Chiharu Nakasu, Yu Saito, Yuji Morine, Tetsuya Ikemoto, Shinichiro Yamada, Hiroki Teraoku, Mitsuo Shimada

Introduction

Lenvatinib is a multiple receptor tyrosine kinase inhibitor and a first-line targeted therapy for hepatocellular carcinoma (HCC). However, its efficacy is insufficient because of acquired resistance. We investigated the role of exosomal miRNA exchange between resistant cancer cells and naive cancer cells in the development of lenvatinib resistance.

Materials and Methods

We generated lenvatinib-resistant (LVT-res) Huh7 and PLC cell lines. We first analyzed the miRNA expression profiles of Nrf2 in cancer using three public datasets and then investigated exosomal miRNA expressions. Exosomal miRNA-132 was found to be elevated in resistant cells compared with parental cells. The parental cells were cocultured with LVT-res cultured conditioned medium as recipient cells. We then compared the characteristics in parental cancer cells, resistant cells, and recipient cells.

Results

The proliferation and migration rates of recipient cells were significantly increased compared with the parental cells. Recipient cells also showed chemoresistance. The PTEN/GSK3β/Nrf2 signaling pathway was significantly upregulated in recipient cells compared with the parental cells. Inhibition of exosomal miRNA-132 reduced the malignant potential of recipient cells, chemoresistance, cell proliferation, and migration rates. Furthermore, the PTEN/GSK3β/Nrf2 signaling pathway was downregulated in recipient cells with inhibition of exosomal miRNA-132.

Conclusion

Our study provides new findings on the role of the miRNA-132/Nrf2 axis in LVT-res cancer cells. This might be a potential therapeutic target in HCC chemoresistance.

Lenvatinib是一种多受体酪氨酸激酶抑制剂，是肝细胞癌（HCC）的一线靶向治疗药物。但由于获得性耐药，其疗效不足。我们研究了耐药癌细胞和初始癌细胞之间的外泌体miRNA交换在lenvatinib耐药发展中的作用。材料与方法制备lenvatinib耐药（LVT-res） Huh7和PLC细胞系。我们首先使用三个公共数据集分析了Nrf2在癌症中的miRNA表达谱，然后研究了外泌体miRNA的表达。与亲本细胞相比，耐药细胞的外泌体miRNA-132升高。亲代细胞与LVT-res培养条件培养基共培养为受体细胞。然后，我们比较了亲代癌细胞、耐药细胞和受体细胞的特征。结果与亲代细胞相比，受体细胞的增殖和迁移率明显提高。受体细胞也表现出化学耐药。受体细胞的PTEN/GSK3β/Nrf2信号通路与亲本细胞相比显著上调。外泌体miRNA-132的抑制降低了受体细胞的恶性潜能、化疗耐药性、细胞增殖和迁移率。此外，PTEN/GSK3β/Nrf2信号通路在受体细胞中下调，抑制外泌体miRNA-132。结论本研究为miRNA-132/Nrf2轴在LVT-res癌细胞中的作用提供了新的发现。这可能是HCC化疗耐药的潜在治疗靶点。

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引用次数: 0

Letter to Editor Regarding “Prognostic Impact of Hepatectomy Versus Radiofrequency Ablation for Non-Small Hepatocellular Carcinoma (2–3 Cm): A Case-Matched Study” 关于“肝切除术与射频消融术对非小肝细胞癌（2-3 Cm）的预后影响：一项病例匹配研究”的致编辑信

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-06 DOI: 10.1002/ags3.70075

Changzhi Chen, Jieyun Cai, Jinfeng Qiu, Lin Li

We read with interesting the study by Yuki Kitano et al. [1], this study on hepatocellular carcinoma (HCC) measuring 2–3 cm (≤ 3 nodules) demonstrates that compared to radiofrequency ablation (RFA), hepatectomy significantly reduces local recurrence rates and shows a trend toward improved overall survival (OS) and recurrence-free survival (RFS) after propensity score matching. The findings suggest that for such patients, hepatectomy should be prioritized when liver function and tumor location permit, while alpha-fetoprotein (AFP) levels may serve as a key indicator for individualized treatment decisions.

In clinical practice, the decision to perform radiofrequency ablation (RFA) is influenced by both liver function and tumor location. For patients with poor liver function, clinicians often choose RFA, however, when a tumor lies on the liver surface or is adjacent to other organs, concerns about bleeding, tumor dissemination, or injury to surrounding structures frequently lead to selection of hepatectomy or laparoscopic ablation. When the tumor is located near major blood vessels or deep within the liver, extensive surgical damage or large liver resection may be required. Due to concerns about the liver function of some patients, ablation is often chosen as the preferred treatment. The study has mitigated the impact of poor liver function through Propensity Score Matching (PSM). However, proximity of the tumor to blood vessels often compromises the ablation zone and effectiveness of RFA [2]. Furthermore, while the RFA ablation margin in the study was 5 mm, surgical resection margins typically exceed this range [3]. This discrepancy may explain the higher local recurrence rate observed in the study.

Changzhi Chen: writing – original draft, conceptualization, writing – review and editing. Jieyun Cai: conceptualization, writing – review and editing. Jinfeng Qiu: writing – review and editing. Lin Li: writing – review and editing.

The authors declare no conflicts of interest.

This article is linked to Kitano et al. paper. To view this article, visit https://doi.org/10.1002/ags3.70046.

我们很感兴趣地阅读了Yuki Kitano等人的研究，这项针对2-3厘米（≤3个结节）的肝细胞癌（HCC）的研究表明，与射频消融（RFA）相比，肝切除术可显著降低局部复发率，并在倾向评分匹配后显示出提高总生存率（OS）和无复发生存率（RFS）的趋势。研究结果表明，对于此类患者，当肝功能和肿瘤位置允许时，应优先考虑肝切除术，而甲胎蛋白（AFP）水平可作为个体化治疗决策的关键指标。在临床实践中，实施射频消融术（RFA）的决定受到肝功能和肿瘤位置的影响。对于肝功能较差的患者，临床医生通常选择RFA，然而，当肿瘤位于肝表面或与其他器官相邻时，考虑到出血、肿瘤播散或周围结构损伤，往往选择肝切除术或腹腔镜消融。当肿瘤位于大血管附近或肝脏深处时，可能需要广泛的手术损伤或大面积的肝脏切除术。由于对部分患者肝功能的担忧，常选择消融术作为首选治疗方法。该研究通过倾向评分匹配（PSM）减轻了肝功能不良的影响。然而，肿瘤靠近血管往往会影响射频消融术的消融区和有效性。此外，虽然研究中的RFA消融边缘为5mm，但手术切除边缘通常超过这个范围。这种差异可能解释了研究中观察到的较高的局部复发率。陈昌志：写作-原稿、构思、写作-审稿、编辑。蔡杰云：构思、写作、审稿、编辑。邱金峰：写作-审编。林丽：写作-评论和编辑。作者声明无利益冲突。这篇文章链接到Kitano等人的论文。要查看本文，请访问https://doi.org/10.1002/ags3.70046。

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引用次数: 0

Essential Updates 2023/2024: Minimally Invasive Surgery for Biliary Tract Cancer 基本更新2023/2024：胆道癌的微创手术

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-03 DOI: 10.1002/ags3.70073

Osamu Itano, Takuya Minagawa

Minimally invasive surgery (MIS) for biliary tract cancer (BTC) has gained traction with advancements in laparoscopic and robotic techniques. However, its oncological impact remains uncertain. This review highlights key studies from 2023 and 2024 on MIS for BTC, including distal bile duct, hilar bile duct, gallbladder, and intrahepatic bile duct cancer. Although feasibility and safety are supported in experienced centers, long-term prognostic equivalence to open surgery remains debatable. Further studies are required to clarify surgical and oncological outcomes.

随着腹腔镜和机器人技术的进步，胆道癌的微创手术（MIS）得到了广泛的关注。然而，其对肿瘤的影响仍不确定。本文回顾了2023年和2024年关于BTC MIS的关键研究，包括远端胆管癌、肝门胆管癌、胆囊癌和肝内胆管癌。虽然可行性和安全性在经验丰富的中心得到了支持，但与开放手术的长期预后等效性仍存在争议。需要进一步的研究来阐明手术和肿瘤的结果。

引用次数: 0

Non-Flap Tunnel Technique (NFTT): A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy for Gastric and Esophagogastric Junction Cancer 非皮瓣隧道技术（NFTT）：一种新型微创胃近端切除术后胃及食管胃结癌重建方法

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-03 DOI: 10.1002/ags3.70072

Masaru Hayami, Qingjiang Hu, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Takeshi Sano, Souya Nunobe

Aim

The incidence of upper-third gastric cancer and esophagogastric junction cancer is increasing, prompting wider adoption of proximal gastrectomy (PG) to preserve postoperative nutritional status and quality of life. Although the double-flap technique (DFT) is effective in preventing reflux after PG, procedural complexity and flap manipulation may contribute to longer reconstruction time and anastomotic stenosis, especially in robotic-assisted procedures. This study aimed to evaluate the non-flap tunnel technique (NFTT) as a simplified alternative to DFT with respect to operative efficiency and anastomotic integrity.

Methods

We retrospectively reviewed patients who underwent minimally invasive PG at a single institution between January 2019 and November 2024. Surgical outcomes, including reconstruction time, incidence of anastomotic stenosis, and reflux symptoms, were compared between the DFT and NFTT groups using 2:1 propensity score matching.

Results

After matching, 62 patients in the DFT group and 31 patients in the NFTT group were included. NFTT was associated with shorter reconstruction time (87 vs. 108 min; p = 0.004) and a lower incidence of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%; p = 0.003). This difference in stenosis rate remained significant in robot-assisted cases (2.5% vs. 30.8%; p = 0.008). No reflux symptoms were observed in the NFTT group, compared to 6.5% in the DFT group (p = 0.30).

Conclusion

NFTT reduced reconstruction time and anastomotic stenosis while maintaining anti-reflux efficacy. These results support NFTT as a technically feasible and effective alternative to DFT for reconstruction following minimally invasive PG. Prospective studies are warranted to validate long-term outcomes.

目的随着上三分之一胃癌和食管胃结癌发病率的增加，越来越多的患者采用近端胃切除术（PG）来维持术后营养状况和生活质量。虽然双瓣技术（DFT）在预防PG后反流方面是有效的，但操作的复杂性和皮瓣操作可能导致重建时间延长和吻合口狭窄，特别是在机器人辅助手术中。本研究旨在评估非皮瓣隧道技术（NFTT）作为一种简化的替代DFT的手术效率和吻合口完整性。方法回顾性分析2019年1月至2024年11月在同一家机构接受微创PG治疗的患者。采用2:1倾向评分匹配，比较DFT组和NFTT组的手术结果，包括重建时间、吻合口狭窄发生率和反流症状。结果经配对后，DFT组62例，NFTT组31例。NFTT与较短的重建时间（87对108分钟，p = 0.004）和较低的吻合口狭窄发生率相关（3.2%对29.0%,p = 0.003）。在机器人辅助的病例中，狭窄率的差异仍然显著（2.5% vs. 30.8%; p = 0.008）。NFTT组未观察到反流症状，而DFT组为6.5% （p = 0.30）。结论NFTT在保持抗反流效果的同时，减少了重建时间和吻合口狭窄。这些结果支持NFTT作为微创PG术后重建的技术上可行和有效的替代DFT。需要前瞻性研究来验证长期结果。

{"title":"Non-Flap Tunnel Technique (NFTT): A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy for Gastric and Esophagogastric Junction Cancer","authors":"Masaru Hayami, Qingjiang Hu, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Takeshi Sano, Souya Nunobe","doi":"10.1002/ags3.70072","DOIUrl":"https://doi.org/10.1002/ags3.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The incidence of upper-third gastric cancer and esophagogastric junction cancer is increasing, prompting wider adoption of proximal gastrectomy (PG) to preserve postoperative nutritional status and quality of life. Although the double-flap technique (DFT) is effective in preventing reflux after PG, procedural complexity and flap manipulation may contribute to longer reconstruction time and anastomotic stenosis, especially in robotic-assisted procedures. This study aimed to evaluate the non-flap tunnel technique (NFTT) as a simplified alternative to DFT with respect to operative efficiency and anastomotic integrity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients who underwent minimally invasive PG at a single institution between January 2019 and November 2024. Surgical outcomes, including reconstruction time, incidence of anastomotic stenosis, and reflux symptoms, were compared between the DFT and NFTT groups using 2:1 propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, 62 patients in the DFT group and 31 patients in the NFTT group were included. NFTT was associated with shorter reconstruction time (87 vs. 108 min; <i>p</i> = 0.004) and a lower incidence of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%; <i>p</i> = 0.003). This difference in stenosis rate remained significant in robot-assisted cases (2.5% vs. 30.8%; <i>p</i> = 0.008). No reflux symptoms were observed in the NFTT group, compared to 6.5% in the DFT group (<i>p</i> = 0.30).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NFTT reduced reconstruction time and anastomotic stenosis while maintaining anti-reflux efficacy. These results support NFTT as a technically feasible and effective alternative to DFT for reconstruction following minimally invasive PG. Prospective studies are warranted to validate long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"87-94"},"PeriodicalIF":3.3,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891526","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}

引用次数: 0

Frailty Recovery Following Minimally Invasive Surgery: An Emerging Perspective on Surgical Benefits in Elderly Colorectal Cancer Patients 微创手术后的虚弱恢复：老年结直肠癌患者手术获益的新观点

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-08-03 DOI: 10.1002/ags3.70070

Hajime Ushigome, Yushi Yamakawa, Shunsuke Hayakawa, Akira Kato, Takuya Suzuki, Takafumi Sato, Hiroyuki Sagawa, Ryo Ogawa, Hiroki Takahashi, Shuji Takiguchi

Background

Frailty is common among elderly colorectal cancer (CRC) patients and affects both perioperative and long-term outcomes. However, many aspects of how minimally invasive surgery (MIS) influences frailty remain unclear. Moreover, very few reports have specifically evaluated postoperative changes in frailty status.

Methods

In this prospective observational study, 239 CRC patients aged ≥ 70 years undergoing MIS with R0 resection were assessed for frailty using the FRAIL Scale and Kihon Checklist preoperatively and 1 year postoperatively. Short- and long-term oncological outcomes and frailty status changes were analyzed.

Results

A total of 88 patients (37%) were diagnosed as frail on the basis of either of the frailty assessment tools, and MIS was performed in all cases. Short-term outcomes were comparable between frail and non-frail patients; however, overall survival (OS) was significantly worse in frail patients (log-rank, p = 0.01). Among the 141 patients who remained recurrence-free for 1 year and completed the second questionnaire, frailty status significantly improved according to the FRAIL Scale (p = 0.001). In patients whose frailty status improved, significant improvements in hemoglobin levels, the prognostic nutritional index, and psoas muscle index were observed compared with their preoperative values.

Conclusions

Curative MIS was safely performed in elderly frail colorectal cancer patients without increasing perioperative complications; however, their long-term outcomes remained poor. Nevertheless, in patients who remained recurrence-free, frailty status significantly improved 1 year after surgery, suggesting an emerging potential benefit of surgical resection in the elderly population.

背景：虚弱在老年结直肠癌（CRC）患者中很常见，并影响围手术期和长期预后。然而，微创手术（MIS）如何影响虚弱的许多方面仍不清楚。此外，很少有报道专门评估术后虚弱状态的变化。方法在这项前瞻性观察性研究中，239例年龄≥70岁、接受MIS + R0切除术的结直肠癌患者术前和术后1年采用虚弱量表和Kihon Checklist评估虚弱程度。分析短期和长期的肿瘤预后和虚弱状态的变化。结果共有88例（37%）患者在两种虚弱评估工具的基础上被诊断为虚弱，所有病例均进行了MIS。体弱和非体弱患者的短期结果具有可比性；然而，虚弱患者的总生存期（OS）明显较差（log-rank, p = 0.01）。141例1年无复发并完成第二次问卷的患者，虚弱状态根据虚弱量表明显改善（p = 0.001）。在虚弱状态改善的患者中，与术前相比，血红蛋白水平、预后营养指数和腰肌指数均有显著改善。结论老年体弱结直肠癌患者行根治性MIS是安全的，不会增加围手术期并发症；然而，他们的长期结果仍然很差。然而，在无复发的患者中，衰弱状态在手术后1年显著改善，这表明手术切除在老年人群中具有潜在的益处。

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引用次数: 0

Optimal Cutoff Size of Large Borrmann Type III Gastric Cancer: Is 8 cm Accurate in Predicting Survival and Incidence of Peritoneal Metastasis? 大Borrmann III型胃癌的最佳切除尺寸：8cm在预测生存和腹膜转移发生率方面准确吗？

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-07-31 DOI: 10.1002/ags3.70071

Yutaka Sugita, Manabu Ohashi, Naoki Miyazaki, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Masaru Hayami, Takeshi Sano, Souya Nunobe

Background

Large type III gastric cancer (GC) ≥ 8 cm has conventionally been categorized with type IV GC in Japan, leading to alternative treatment strategies such as neoadjuvant chemotherapy and staging laparoscopy (SL). However, whether 8 cm is the correct cutoff remains unclear.

Methods

We retrospectively analyzed patients clinically diagnosed with advanced GC who underwent surgery at our department. Patients were classified by Borrmann type, and clinicopathological characteristics including survival outcomes and peritoneal metastasis incidence were analyzed based on tumor size to determine the optimal cutoff for large type III GC.

Results

Tumor size correlated with overall survival in type III GC. Although hazard ratios (HRs) for “large” and “small” type III vs. type IV remained comparable up to the 8 cm cutoff (0.60 and 0.41, respectively), HR for “large” type III GC increases sharply to 0.74 with a 10 cm cutoff. Subgroup analysis based on histological subtype revealed similar results in the undifferentiated type. Conversely, a larger cutoff value appeared more appropriate for the differentiated type. The largest difference in the incidence of peritoneal metastasis was observed with a 6 cm cutoff (36.1% in “large” type III and 10.2% in “small” type III), and similar results were observed in the undifferentiated type at the same cutoff.

Conclusions

In terms of survival, a 10 cm cutoff may more accurately define large type III GC than the conventional 8 cm. However, if surgeons intend to identify peritoneal metastasis by SL, type III GC ≥ 6 cm could be a possible candidate.

在日本，≥8 cm的大III型胃癌（GC）通常被归类为IV型胃癌，这导致了新辅助化疗和分期腹腔镜检查（SL）等替代治疗策略。然而，8厘米是否是正确的临界值仍不清楚。方法回顾性分析在我科接受手术治疗的晚期胃癌患者。根据Borrmann型对患者进行分类，并根据肿瘤大小分析临床病理特征，包括生存结局和腹膜转移发生率，以确定大III型GC的最佳临界值。结果III型胃癌患者肿瘤大小与总生存率相关。尽管“大”和“小”III型与IV型的风险比（HR）在8 cm的临界值下保持相当（分别为0.60和0.41），但“大”III型GC的风险比（HR）在10 cm的临界值下急剧增加到0.74。基于组织学亚型的亚组分析显示未分化型的结果相似。相反，较大的截断值似乎更适合分化类型。腹膜转移发生率的最大差异发生在6 cm的切断处（“大”III型为36.1%，“小”III型为10.2%），相同切断处的未分化型也有类似的结果。结论就生存期而言，10 cm的断线比常规的8 cm断线更能准确地定义大III型胃癌。然而，如果外科医生打算通过SL识别腹膜转移，III型GC≥6 cm可能是可能的候选人。

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引用次数: 0