Annals of Gastroenterological Surgery最新文献_第4页

Texture analysis of CT colonography to develop a novel imaging biomarker for the management of colorectal cancer CT结肠镜的纹理分析为结直肠癌的治疗开发一种新的成像生物标志物。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-26 DOI: 10.1002/ags3.12852

Hisashi Mamiya, Toru Tochigi, Koichi Hayano, Gaku Ohira, Shunsuke Imanishi, Tetsuro Maruyama, Yoshihiro Kurata, Yumiko Takahashi, Atsushi Hirata, Hisahiro Matsubara

Background

Recent studies have focused on evaluating the biomarker value of textural features in radiological images. Our study investigated whether or not a texture analysis of computed tomographic colonography (CTC) images could be a novel biomarker for colorectal cancer (CRC).

Methods

This retrospective study investigated 263 patients with CRC who underwent contrast-enhanced CTC (CE-CTC) before curative surgery between January 2014 and December 2017. Multiple texture analyses (fractal, histogram, and gray-level co-occurrence matrix [GLCM] texture analyses) were applied to CE-CTC (portal-venous phase), and fractal dimension (FD), skewness, kurtosis, entropy, and GLCM texture parameters, including GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity, of the tumor were calculated. These texture parameters were compared with pathological factors (tumor depth, lymph node metastasis, vascular invasion, and lymphatic invasion) and overall survival (OS).

Results

Tumor depth was significantly associated with FD, kurtosis, entropy, GLCM-correlation, GLCM-autocorrelation, GLCM-entropy, and GLCM-homogeneity (p = 0.001, 0.001, 0.001, 0.001, 0.018, 0.008, and 0.001, respectively); lymph node metastasis was associated with GLCM-homogeneity (p = 0.004); lymphatic invasion was associated with GLCM-correlation and GLCM-homogeneity (p = 0.001 and 0.012, respectively); and venous invasion was associated with FD, entropy, GLCM-correlation, GLCM-autocorrelation, and GLCM-entropy of the tumor (p = 0.001, 0.033, 0.021, 0.046, respectively). In the Kaplan–Meier analysis, patients with high GLCM-correlation tumors or high GLCM-homogeneity tumors showed a significantly worse OS than others (p = 0.001 and 0.04, respectively). Multivariate analyses showed that the GLCM correlation was an independent prognostic factor for the OS (p = 0.021).

Conclusion

CE-CTC-derived texture parameters may be clinically useful biomarkers for managing CRC patients.

背景：近年来的研究主要集中在评估放射图像中纹理特征的生物标志物价值。我们的研究探讨了计算机断层结肠镜（CTC）图像的纹理分析是否可能成为结直肠癌（CRC）的一种新的生物标志物。方法：本回顾性研究调查了2014年1月至2017年12月期间在根治性手术前接受对比增强CTC （CE-CTC）的263例结直肠癌患者。对CE-CTC（门静脉相）进行多重纹理分析（分形、直方图和灰度共生矩阵[GLCM]纹理分析），计算肿瘤的分形维数（FD）、偏度、峰度、熵和GLCM纹理参数，包括GLCM相关性、GLCM自相关性、GLCM熵和GLCM均匀性。比较这些纹理参数的病理因素（肿瘤深度、淋巴结转移、血管浸润和淋巴浸润）和总生存期（OS）。结果：肿瘤深度与FD、峰度、熵、glcm相关性、glcm自相关性、glcm熵和glcm均匀性显著相关（p分别为0.001、0.001、0.001、0.001、0.018、0.008和0.001）；淋巴结转移与glcm均匀性相关（p = 0.004）；淋巴浸润与glcm相关性和glcm同质性相关（p分别为0.001和0.012）；与肿瘤的FD、熵、glcm相关性、glcm自相关性、glcm熵相关（p分别为0.001、0.033、0.021、0.046）。Kaplan-Meier分析显示，glcm相关性高或glcm同质性高的肿瘤患者的OS明显差于其他患者（p分别为0.001和0.04）。多因素分析显示，GLCM相关性是OS的独立预后因素（p = 0.021）。结论：ce - ctc衍生的结构参数可能是临床治疗结直肠癌患者有用的生物标志物。

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引用次数: 0

Effect of obesity on postoperative complications in ulcerative colitis: A systematic review and meta-analysis 肥胖对溃疡性结肠炎术后并发症的影响：系统回顾和荟萃分析。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-23 DOI: 10.1002/ags3.12855

L. M. Tóth, H. Székely, A. Rancz, Á. Zolcsák, M. D. Sárközi, S. Ábrahám, L. Földvári-Nagy, B. Erőss, P. Hegyi, P. Miheller

Background

The prevalence of ulcerative colitis (UC) is around 200/100 000 people. Colectomy is required in 7.5%–40% of patients and 58.8%–94% of these operations are elective. Approximately one in two adults with UC are overweight or obese.

Objective

Our aim was to compare postoperative complications between obese (defined by a body mass index (BMI) over 30 kg/m²) and non-obese UC patients who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA).

Methods

Our preregistered protocol can be found on PROSPERO (CRD42022377761). We conducted our search in three databases on the 26th of November 2022. PRISMA 2020 guideline and the Cochrane Handbook were applied. We used the GRADEpro program and the QUIPS tool. We applied a random-effects model to pool effect sizes. We included cohort and case–control studies investigating UC patients undergoing colectomy with IPAA and reported information on postoperative complications in obese and non-obese patients. We used mean difference (MD) for continuous variables and calculated odds ratio (OR) with a 95% confidence interval (CI) for dichotomous variables.

Results

Of the 6870 hits of our systematic search, we included three retrospective cohort studies for analyses involving 4929 patients in our research. Neither the incidence of complications at 30 days after surgery [OR = 1.08; CI: 0.65–1.79] nor the incidence of septic complications [OR = 1.11; CI: 0.85–1.46] had any clinical relevance, except for the length of hospital stay [MD = 0.36; CI:0.04–0.69]. When we assessed the risk of bias, we found that most of the aspects examined had a moderate overall risk. Our results have very low certainty of evidence.

Conclusions and Relevance

Our findings suggest that obesity defined as BMI over 30 kg/m² may not associated with an increased risk of higher rates of overall postoperative complications compared to non-obese patients. Obesity with a cut-off value of 30 kg/m² does not appear to be a primary reason for prehabilitation.

背景：溃疡性结肠炎（UC）的发病率约为 200/100 000。7.5%-40%的患者需要进行结肠切除术，其中58.8%-94%是选择性手术。大约每两名成人 UC 患者中就有一人超重或肥胖：我们的目的是比较肥胖（定义为体重指数（BMI）超过 30 kg/m2）和非肥胖 UC 患者的术后并发症：我们的预注册方案可在 PROSPERO（CRD42022377761）上找到。我们于 2022 年 11 月 26 日在三个数据库中进行了搜索。我们采用了 PRISMA 2020 指南和 Cochrane 手册。我们使用了 GRADEpro 程序和 QUIPS 工具。我们采用随机效应模型来汇集效应大小。我们纳入了对接受结肠切除术和 IPAA 的 UC 患者进行调查的队列研究和病例对照研究，并报告了肥胖和非肥胖患者的术后并发症信息。对于连续变量，我们使用了平均差（MD）；对于二分变量，我们计算了几率比（OR）和 95% 的置信区间（CI）：在系统搜索的 6870 次点击中，我们纳入了三项回顾性队列研究进行分析，研究涉及 4929 名患者。除住院时间[MD = 0.36; CI:0.04-0.69]外，术后30天并发症的发生率[OR = 1.08; CI: 0.65-1.79]和脓毒症并发症的发生率[OR = 1.11; CI: 0.85-1.46]均与临床无关。在对偏倚风险进行评估时，我们发现所研究的大多数方面都存在中度偏倚风险。我们的结果具有很低的证据确定性：我们的研究结果表明，与非肥胖患者相比，BMI 超过 30 kg/m2 的肥胖患者可能不会增加术后并发症的风险。以 30 kg/m2 为临界值的肥胖似乎并不是进行术前康复的主要原因。

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引用次数: 0

Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter retrospective cohort study in Japan 临床II/III期低位直肠癌患者局部复发的危险因素：日本的一项多中心回顾性队列研究

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-19 DOI: 10.1002/ags3.12849

Takumi Kozu, Takashi Akiyoshi, Takashi Sakamoto, Tomohiro Yamaguchi, Seiichiro Yamamoto, Ryosuke Okamura, Tsuyoshi Konishi, Yoshihisa Umemoto, Koya Hida, Takeshi Naitoh, Japan Society of Laparoscopic Colorectal Surgery

Background

Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.

Methods

Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine–Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.

Results

Across the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7–14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m², distance from anal verge ≤4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.

Conclusion

This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.

背景：确定局部复发（LR）的危险因素是优化直肠癌治疗的关键。全肠系膜切除（TME）和侧淋巴结清扫（LLND）是日本晚期低位直肠癌的标准治疗方法。然而，评估LR危险因素的大规模研究是有限的。方法：对2010年1月至2011年12月69家医院1479例经手术治疗的临床II/III期腹膜反射下低位直肠癌患者的资料进行分析。采用细灰色多变量回归模型确定与LR相关的危险因素。建立了两种模型：一种仅使用术前因素，另一种结合手术和术后因素。结果：在整个队列中，LR的5年累积发病率为12.3%（95%可信区间，10.7-14.1）。多变量分析将LR与术前（体重指数、与肛门边缘的距离、cN类型和组织学亚型）、治疗相关（新辅助治疗和LLND）和术后（pT、pN和切除边缘）的各种危险因素联系起来。对于未接受新辅助治疗的患者，存在2 - 3个术前危险因素（体重指数≥25kg /m2，距肛门边缘距离≤4.0 cm，非中度分化腺癌），LR风险高得不可接受。未接受LLND治疗的患者LR的5年累积发生率为24.7%，接受LLND治疗的患者LR的5年累积发生率为22.9%。结论：这项大型多中心队列研究确定了在前期TME占主导地位的情况下LR的一些危险因素，为优化直肠癌治疗提供了见解。

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引用次数: 0

Essential updates 2022–2023: Surgical and adjuvant therapies for locally advanced colorectal cancer 2022-2023 年基本更新：局部晚期结直肠癌的手术和辅助疗法。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-19 DOI: 10.1002/ags3.12853

Yoshiki Kajiwara, Hideki Ueno

Pivotal articles that had been published between 2022 and 2023 on surgical and perioperative adjuvant treatments for locally advanced colorectal cancer (CRC) were reviewed. This review focuses on new evidence in the following areas: optimization of surgical procedures for colon cancer, including the optimal length of bowel resection and use of the no-touch isolation technique; minimally invasive surgery for rectal cancer, such as laparoscopic transanal total mesorectal excision and robotic surgery; neoadjuvant treatments for rectal cancer, including total neoadjuvant therapy; neoadjuvant chemotherapy for colon cancer; and postoperative adjuvant chemotherapy for Stage II and III colon cancer. Although the current understanding may not enable perfect decision-making for patients and medical professionals, ongoing advancements are expected to result in more effective personalized treatment plans, ultimately improving the prognosis and quality of life of patients.

我们对 2022 年至 2023 年间发表的有关局部晚期结直肠癌 (CRC) 手术和围手术期辅助治疗的重要文章进行了回顾。本综述重点关注以下领域的新证据：结肠癌外科手术的优化，包括肠切除的最佳长度和无接触隔离技术的使用；直肠癌微创手术，如腹腔镜经肛门全直肠系膜切除术和机器人手术；直肠癌新辅助治疗，包括全新药辅助治疗；结肠癌新辅助化疗；II期和III期结肠癌术后辅助化疗。虽然目前的认识可能无法为患者和医疗专业人员提供完美的决策，但不断取得的进步有望带来更有效的个性化治疗方案，最终改善患者的预后和生活质量。

引用次数: 0

Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy 在安全的肝胰十二指肠大部切除术中，未来肝残余的最小比例。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-18 DOI: 10.1002/ags3.12850

Kentaro Umemura, Akira Shimizu, Tsuyoshi Notake, Koji Kubota, Kiyotaka Hosoda, Koya Yasukawa, Atsushi Kamachi, Takamune Goto, Hidenori Tomida, Yuji Soejima

Background and Aim

Post-hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD.

Methods

This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin-bilirubin [ALBI] / albumin-indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria.

Results

Grade B/C PHLF occurred in 40% of the patients (n = 19), leading to severe morbidity and two in-hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, p < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, p < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86.

Conclusion

To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function.

背景与目的：肝切除术后肝胰十二指肠切除术（HPD）后肝功能衰竭（PHLF）是一个需要克服的挑战。然而，未来肝残体（pFLR）预防重度HPD患者严重PHLF的适当目标比例仍不确定。本研究旨在确定安全重度HPD所需的最小pFLR。方法：对48例HPD患者进行回顾性研究。我们评估了pFLR和剩余肝功能评分（pFLR ×白蛋白胆红素[ALBI] /白蛋白吲哚菁绿评价[ALICE]/血浆吲哚菁绿清除率[KICG]）作为B级/C级PHLF的预测指标，并建立了安全标准。结果：40%的患者（n = 19）发生B/C级PHLF，导致严重发病率和2例院内死亡。pFLR是B/C级PHLF的良好预测指标[曲线下面积（AUC） 0.80， p p]结论：为预防B/C级PHLF，建议pFLR≥45%。然而，在残肝功能良好的患者中，可考虑重度HPD。

{"title":"Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy","authors":"Kentaro Umemura, Akira Shimizu, Tsuyoshi Notake, Koji Kubota, Kiyotaka Hosoda, Koya Yasukawa, Atsushi Kamachi, Takamune Goto, Hidenori Tomida, Yuji Soejima","doi":"10.1002/ags3.12850","DOIUrl":"10.1002/ags3.12850","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Post-hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin-bilirubin [ALBI] / albumin-indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Grade B/C PHLF occurred in 40% of the patients (<i>n</i> = 19), leading to severe morbidity and two in-hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, <i>p</i> < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, <i>p</i> < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"188-198"},"PeriodicalIF":2.9,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Phase II study of long-course chemoradiotherapy followed by consolidation chemotherapy as total neoadjuvant therapy in locally advanced rectal cancer in Japan: ENSEMBLE-2 日本对局部晚期直肠癌采用长程化放疗后巩固化疗作为新辅助治疗的 II 期研究：ENSEMBLE-2。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-08-03 DOI: 10.1002/ags3.12848

Yoshinori Kagawa, Koji Ando, Mamoru Uemura, Jun Watanabe, Koji Oba, Yasunori Emi, Nobuhisa Matsuhashi, Naoki Izawa, Osamu Muto, Tatsuya Kinjo, Ichiro Takemasa, Eiji Oki

Aim

To evaluate the feasibility and safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.

Methods

This prospective, multicenter, single-arm, phase II trial was conducted at 10 centers. The eligibility criteria included age ≥20 y, locally advanced rectal cancer within 12 cm of the anal verge, and cT3-4N0M or TanyN+M0 at diagnosis, enabling curative resection. The protocol treatment was capecitabine (1650 mg/m²/day)-based long-course chemoradiotherapy (50.4 Gy/28 fractions) and consolidation chemotherapy (CAPOX, four courses) followed by total mesorectal excision. Nonoperative management was allowed if a clinical complete response was achieved. The primary endpoint was the pathologic complete response rate.

Results

Among 28 enrolled patients (19 men, 9 women; median age, 69.5 [41–79] y), the long-course chemoradiotherapy and consolidation chemotherapy completion rates were 100% and 96.4%, respectively. The clinical responses included clinical complete response, (35.7%, 10/28), near-complete response (28.6%, 8/28), and incomplete response (32.1%, 9/28). Total mesorectal excision and nonoperative management were performed in 21 and six patients, respectively. The final analysis included 21 patients. Five patients (23.8% [90% confidence interval 11.8%–41.8%]) achieved pathologic complete response, while 10 of 28 patients (35.7%) achieved a pathological complete response or a sustained clinical complete response. No treatment-related deaths occurred. Grade ≥3 adverse events included diarrhea (7.1%) and leukopenia (7.1%).

Conclusion

ENSEMBLE-2 demonstrated comparable pathologic complete response rates and well-tolerated safety of total neoadjuvant therapy with long-course chemoradiotherapy followed by consolidation chemotherapy in Japanese patients with locally advanced rectal cancer.

目的：评估日本局部晚期直肠癌患者接受长程化放疗和巩固化疗的新辅助治疗的可行性和安全性：这项前瞻性、多中心、单臂、II期试验在10个中心进行。入选标准包括年龄≥20岁，肛缘12厘米以内的局部晚期直肠癌，诊断时为cT3-4N0M或TanyN+M0，可进行根治性切除。治疗方案为以卡培他滨（1650 毫克/平方米/天）为基础的长程化放疗（50.4 Gy/28次）和巩固化疗（CAPOX，四个疗程），然后进行全直肠系膜切除术。如果达到临床完全反应，则允许进行非手术治疗。主要终点是病理完全反应率：在28名入组患者中（19名男性，9名女性；中位年龄69.5 [41-79]岁），长程化放疗和巩固化疗完成率分别为100%和96.4%。临床反应包括临床完全反应（35.7%，10/28）、接近完全反应（28.6%，8/28）和不完全反应（32.1%，9/28）。分别有 21 名和 6 名患者接受了全直肠系膜切除术和非手术治疗。最终分析包括 21 名患者。5例患者（23.8% [90%置信区间 11.8%-41.8%] ）获得了病理完全应答，28例患者中有10例（35.7%）获得了病理完全应答或持续临床完全应答。无治疗相关死亡病例发生。≥3级不良反应包括腹泻（7.1%）和白细胞减少（7.1%）：ENSEMBLE-2证明，在日本局部晚期直肠癌患者中，采用长程化放疗和巩固化疗的新辅助治疗具有相当的病理完全反应率和良好的耐受性。

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引用次数: 0

Evaluation of preoperative visceral fat area / psoas muscle area ratio and prognosis in patients with colorectal cancer 大肠癌患者术前内脏脂肪面积/腰肌面积比与预后的评价。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-30 DOI: 10.1002/ags3.12845

Nobuhiro Hosoi, Takuya Shiraishi, Takuhisa Okada, Katsuya Osone, Takehiko Yokobori, Makoto Sakai, Hiroomi Ogawa, Makoto Sohda, Ken Shirabe, Hiroshi Saeki

Background

Recent research has focused on the prognostic relevance of preoperative sarcopenia and sarcopenic obesity in various cancers. In this study we investigated the relationship between visceral fat area (VFA), psoas muscle area (PMA), and the prognosis of patients undergoing colorectal cancer surgery.

Methods

Patients with stage III colorectal cancer who underwent surgery between July 2013 and April 2020 were included. The analysis was performed on 151 patients who met the criteria. The VFA and PMA were measured at the level of the third lumbar vertebra on computed tomography (CT) scans, and the ratio of VFA to PMA (V/P ratio) was determined.

Results

Patients with high V/P ratios were significantly older (p = 0.0213), had a higher body mass index (BMI) (p < 0.0001), a higher percentage of sarcopenic obesity (p < 0.0001), and more diabetes complications (p < 0.0001). Prognostic analysis showed that the overall survival (OS) (p = 0.0154) and relapse-free survival (RFS) (p = 0.0378) were significantly worse in patients with a high V/P ratio. Multivariate analysis revealed that a high V/P ratio was an independent poor prognostic factor for OS. Subgroup analysis was then performed in patients with BMI < 25 kg/m². OS (p = 0.0259) and RFS (p = 0.0275) were significantly worse in the high V/P ratio group. A high V/P ratio was an independent poor prognostic factor in the multivariate analysis.

Conclusion

In colorectal cancer, the preoperative V/P ratio is an independent factor for poor prognosis. Preoperative evaluation of the V/P ratio may identify a wide range of high-risk patients because it is an independent poor prognostic factor in patients without obesity.

背景：最近的研究集中在各种癌症术前肌肉减少和肌肉减少性肥胖的预后相关性。在本研究中，我们探讨了内脏脂肪面积（VFA）、腰肌面积（PMA）与结直肠癌手术患者预后的关系。方法：纳入2013年7月至2020年4月期间接受手术治疗的III期结直肠癌患者。对符合标准的151例患者进行了分析。计算机断层扫描（CT）测量第三腰椎水平的VFA和PMA，并测定VFA与PMA的比值（V/P比）。结果：高V/P比的患者年龄显著增高（P = 0.0213），体重指数（BMI）显著增高（P = 0.0154），无复发生存期（RFS）显著增高（P = 0.0378）。多因素分析显示，高V/P比值是OS的独立不良预后因素。然后对BMI为2的患者进行亚组分析。高V/ p比组的OS （p = 0.0259）和RFS （p = 0.0275）明显较差。在多变量分析中，高V/P比值是一个独立的不良预后因素。结论：在结直肠癌中，术前V/P比值是预后不良的独立因素。术前评估V/P比值可以识别大范围的高危患者，因为它是无肥胖患者的独立预后不良因素。

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引用次数: 0

Essential updates 2022/2023: Recent advances in perioperative management of esophagectomy to improve operative outcomes 2022/2023 年基本更新：食管切除术围手术期管理的最新进展，以改善手术效果。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-29 DOI: 10.1002/ags3.12847

Hirotoshi Kikuchi, Eisuke Booka, Yoshihiro Hiramatsu, Hiroya Takeuchi

In the era of minimally invasive surgery, esophagectomy remains a highly invasive procedure with a high rate of postoperative complications. Preoperative risk assessment is essential for planning esophagectomy in patients with esophageal cancer, and it is crucial to implement evidence-based perioperative management to mitigate these risks. Perioperative support from multidisciplinary teams has recently been reported to improve the perioperative nutritional status and long-term survival of patients undergoing esophagectomy. Intraoperative management of anesthesia and fluid therapy also significantly affects short-term outcomes after esophagectomy. In this narrative review, we outline the recent updates in the perioperative management of esophagectomy, focusing on preoperative risk assessment, intraoperative management, and perioperative support by multidisciplinary teams to improve operative outcomes.

在微创手术盛行的时代，食管切除术仍然是一种创伤性很大的手术，术后并发症发生率很高。术前风险评估对于食管癌患者制定食管切除术计划至关重要，而实施循证围手术期管理以降低这些风险也至关重要。最近有报道称，多学科团队提供的围手术期支持可改善食管切除术患者的围手术期营养状况和长期生存率。麻醉和液体治疗的术中管理对食管切除术后的短期效果也有很大影响。在这篇叙述性综述中，我们概述了食管切除术围手术期管理的最新进展，重点关注术前风险评估、术中管理和多学科团队的围手术期支持，以改善手术效果。

引用次数: 0

The steatosis-associated fibrosis estimator score is a useful indicator of recurrence and survival after initial curative hepatectomy for hepatocellular carcinoma 脂肪变性相关纤维化估算器评分是衡量肝细胞癌初次根治性肝切除术后复发和存活率的有效指标

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-23 DOI: 10.1002/ags3.12846

Tomoaki Bekki, Masahiro Ohira, Yuki Imaoka, Minoru Hattori, Ryosuke Nakano, Hiroshi Sakai, Shintaro Kuroda, Hiroyuki Tahara, Kentaro Ide, Tsuyoshi Kobayashi, Hideki Ohdan

Aims

Liver fibrosis predisposes patients to liver failure and hepatocellular carcinoma. Various markers, which can be calculated easily from serum parameters, have been reported to predict liver fibrosis accurately. This study investigated the prognostic factors, including blood-based markers for liver fibrosis of patients with hepatocellular carcinoma following initial curative hepatectomy.

Methods

This retrospective study included 407 patients with hepatocellular carcinoma who underwent initial curative hepatectomy between April 2010 and December 2017. We investigated prognosis-associated variables in these patients.

Results

Among the blood-based markers for liver fibrosis examined in this study, the steatosis-associated fibrosis estimator score demonstrated the best predictive capabilities. This score was revealed as a poor prognostic factor for both overall survival and recurrence-free survival in patients with hepatocellular carcinoma following initial curative hepatectomy. A high steatosis-associated fibrosis estimator score was independently associated with poor overall survival and recurrence-free survival. After propensity score-matching to minimize bias between high- and low-steatosis-associated fibrosis estimator score groups, the high steatosis-associated fibrosis estimator score remained associated with poor overall survival and recurrence-free survival.

Conclusions

The steatosis-associated fibrosis estimator score is an independent predictor of long-term prognosis in patients with hepatocellular carcinoma following initial curative hepatectomy.

肝纤维化易导致肝功能衰竭和肝细胞癌。有报道称，从血清参数中很容易计算出的各种标志物可准确预测肝纤维化。这项回顾性研究纳入了2010年4月至2017年12月间接受初次治愈性肝切除术的407例肝细胞癌患者，调查了他们的预后因素，包括基于血液的肝纤维化标志物。我们对这些患者的预后相关变量进行了调查。在本研究中检测的基于血液的肝纤维化标记物中，脂肪变性相关纤维化估计评分显示出最佳预测能力。在这项研究中，脂肪变性相关肝纤维化估算值显示出最佳的预测能力。该估算值是肝细胞癌患者初次肝切除术后总生存期和无复发生存期的不良预后因素。脂肪变性相关纤维化估计因子评分越高，总生存率和无复发生存率越低。在进行倾向评分匹配以尽量减少高脂肪变相关纤维化估计因子评分组和低脂肪变相关纤维化估计因子评分组之间的偏差后，高脂肪变相关纤维化估计因子评分仍与总生存率和无复发生存率低有关。

{"title":"The steatosis-associated fibrosis estimator score is a useful indicator of recurrence and survival after initial curative hepatectomy for hepatocellular carcinoma","authors":"Tomoaki Bekki, Masahiro Ohira, Yuki Imaoka, Minoru Hattori, Ryosuke Nakano, Hiroshi Sakai, Shintaro Kuroda, Hiroyuki Tahara, Kentaro Ide, Tsuyoshi Kobayashi, Hideki Ohdan","doi":"10.1002/ags3.12846","DOIUrl":"10.1002/ags3.12846","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Liver fibrosis predisposes patients to liver failure and hepatocellular carcinoma. Various markers, which can be calculated easily from serum parameters, have been reported to predict liver fibrosis accurately. This study investigated the prognostic factors, including blood-based markers for liver fibrosis of patients with hepatocellular carcinoma following initial curative hepatectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 407 patients with hepatocellular carcinoma who underwent initial curative hepatectomy between April 2010 and December 2017. We investigated prognosis-associated variables in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the blood-based markers for liver fibrosis examined in this study, the steatosis-associated fibrosis estimator score demonstrated the best predictive capabilities. This score was revealed as a poor prognostic factor for both overall survival and recurrence-free survival in patients with hepatocellular carcinoma following initial curative hepatectomy. A high steatosis-associated fibrosis estimator score was independently associated with poor overall survival and recurrence-free survival. After propensity score-matching to minimize bias between high- and low-steatosis-associated fibrosis estimator score groups, the high steatosis-associated fibrosis estimator score remained associated with poor overall survival and recurrence-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The steatosis-associated fibrosis estimator score is an independent predictor of long-term prognosis in patients with hepatocellular carcinoma following initial curative hepatectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"178-187"},"PeriodicalIF":2.9,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12846","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812931","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

Minimally invasive surgery versus open gastrectomy for older patients with gastric cancer: A propensity score-matching analysis 老年胃癌患者的微创手术与开腹胃切除术：倾向得分匹配分析

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-15 DOI: 10.1002/ags3.12842

Masaaki Yamamoto, Takeshi Omori, Yasunori Masuike, Naoki Shinno, Hisashi Hara, Takahito Sugase, Takashi Kanemura, Atsushi Takeno, Motohiro Hirao, Hiroshi Miyata

Aim

To compare minimally invasive and open surgery for older patients with gastric cancer.

Methods

This study included 464 consecutive patients with gastric cancer aged ≥75 years who underwent open or laparoscopic gastrectomy at our institution from January 2004 to December 2018. We performed propensity score-matching and compared short- and long-term outcomes between the two groups.

Results

After matching, 332 patients were included in the study (166 in each group). The laparoscopy group had a longer operative time, lesser blood loss, and shorter hospital stays than the open surgery group (all p < 0.020). The laparoscopy group had a lower complication rate than the open surgery group (p = 0.002). No significant differences were noted in the 3-y overall, recurrence-free, and disease-free survival between the groups (all p > 0.200).

Conclusion

Minimally invasive surgery for older patients with gastric cancer may be more beneficial than open gastrectomy in terms of blood loss and hospital stay.

本研究纳入了2004年1月至2018年12月期间在我院接受开腹或腹腔镜胃切除术的464名年龄≥75岁的连续胃癌患者。我们进行了倾向得分匹配，并比较了两组患者的短期和长期预后。匹配后，332 名患者被纳入研究（每组 166 人）。与开腹手术组相比，腹腔镜手术组的手术时间更长、失血量更少、住院时间更短（P均为0.200）。微创手术治疗老年胃癌患者在失血量和住院时间方面可能比开腹胃切除术更有利。

{"title":"Minimally invasive surgery versus open gastrectomy for older patients with gastric cancer: A propensity score-matching analysis","authors":"Masaaki Yamamoto, Takeshi Omori, Yasunori Masuike, Naoki Shinno, Hisashi Hara, Takahito Sugase, Takashi Kanemura, Atsushi Takeno, Motohiro Hirao, Hiroshi Miyata","doi":"10.1002/ags3.12842","DOIUrl":"10.1002/ags3.12842","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To compare minimally invasive and open surgery for older patients with gastric cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 464 consecutive patients with gastric cancer aged ≥75 years who underwent open or laparoscopic gastrectomy at our institution from January 2004 to December 2018. We performed propensity score-matching and compared short- and long-term outcomes between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, 332 patients were included in the study (166 in each group). The laparoscopy group had a longer operative time, lesser blood loss, and shorter hospital stays than the open surgery group (all <i>p</i> < 0.020). The laparoscopy group had a lower complication rate than the open surgery group (<i>p</i> = 0.002). No significant differences were noted in the 3-y overall, recurrence-free, and disease-free survival between the groups (all <i>p</i> > 0.200).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Minimally invasive surgery for older patients with gastric cancer may be more beneficial than open gastrectomy in terms of blood loss and hospital stay.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"69-78"},"PeriodicalIF":2.9,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12842","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141647789","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