Although hepatopancreaticoduodenectomy (HPD) is effective for margin-negative curative resection of biliary tract cancer (BTC), it is a highly invasive procedure, and its high complication rate, especially post-operative pancreatic fistula, and hospital mortality are still problems. In this study, we investigated the clinical usefulness of pancreaticogastrostomy (PG) in BTC patients with HPD.
Patients and Methods
Of the 878 BTC resected in our institution from April 1992 to December 2022, 44 patients who underwent HPD for perihilar cholangiocarcinoma (PHC) or gallbladder cancer (GBC) were enrolled in this study. Perioperative factors and short-term postoperative outcomes were evaluated in two groups of 11 patients reconstructed with PJ and 33 patients reconstructed with PG. In addition, the temporal changes in glucose tolerance, nutritional status, and postoperative pancreatic morphology were examined.
Results
The incidence of Grade B/C postoperative pancreatic fistula (POPF) was 5 patients (45%) in the PJ group and 4 patients (12%) in the PG group, which was significantly lower in the PG group (p = 0.043). Hospital mortality was observed in 3 patients (27%) in the PJ group and 1 patient (3%) in the PG group (p = 0.060). In patients who underwent PG and were recurrence-free 24 months after surgery, there were no significant changes in HbA1c, serum Albumin, prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR) and pancreatic duct diameter at 12 and 24 months after surgery.
Conclusions
PG with immediate reconstruction in HPD for BTC patients may reduce the rate of POPF and operative death without affecting long-term postoperative physiological statuses.
{"title":"Immediate Reconstruction of Pancretaticogastrostomy Following Hepatopancreatoduodenectomy for Biliary Tact Cancer: A Single-Center Review of 33 Consecutive Patients","authors":"Ryusei Matsuyama, Yasuhiro Yabusita, Tomoaki Takahashi, Yutaro Kikuchi, Kouta Sahara, Kentaro Miyake, Yu Sawada, Yuuki Homma, Takafumi Kumamoto, Itaru Endo","doi":"10.1002/ags3.70069","DOIUrl":"https://doi.org/10.1002/ags3.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Although hepatopancreaticoduodenectomy (HPD) is effective for margin-negative curative resection of biliary tract cancer (BTC), it is a highly invasive procedure, and its high complication rate, especially post-operative pancreatic fistula, and hospital mortality are still problems. In this study, we investigated the clinical usefulness of pancreaticogastrostomy (PG) in BTC patients with HPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Of the 878 BTC resected in our institution from April 1992 to December 2022, 44 patients who underwent HPD for perihilar cholangiocarcinoma (PHC) or gallbladder cancer (GBC) were enrolled in this study. Perioperative factors and short-term postoperative outcomes were evaluated in two groups of 11 patients reconstructed with PJ and 33 patients reconstructed with PG. In addition, the temporal changes in glucose tolerance, nutritional status, and postoperative pancreatic morphology were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of Grade B/C postoperative pancreatic fistula (POPF) was 5 patients (45%) in the PJ group and 4 patients (12%) in the PG group, which was significantly lower in the PG group (<i>p</i> = 0.043). Hospital mortality was observed in 3 patients (27%) in the PJ group and 1 patient (3%) in the PG group (<i>p</i> = 0.060). In patients who underwent PG and were recurrence-free 24 months after surgery, there were no significant changes in HbA1c, serum Albumin, prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR) and pancreatic duct diameter at 12 and 24 months after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PG with immediate reconstruction in HPD for BTC patients may reduce the rate of POPF and operative death without affecting long-term postoperative physiological statuses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"187-196"},"PeriodicalIF":3.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891499","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}
Radical gastrectomy with lymph node dissection is the primary treatment for gastric cancer. However, the overall complication rate remains approximately 10%–20%, with a postoperative mortality rate of 2.3%. Therefore, preoperative stratification of patients based on their expected surgical risks is important. This study aimed to develop a deep learning prediction model using big data from the National Clinical Database (NCD) to predict operative mortality after total gastrectomy.
Methods
Patients aged 18 years or older who underwent total gastrectomy for gastric cancer and were registered in the NCD between January 2018 and December 2019 were included. A total of 62 variables, including age, sex, past medical history, preoperative blood test results, and tumor characteristics, were used as covariates, with operative mortality as the outcome variable. Deep learning models were developed using Python, TensorFlow and Keras. Hyperparameters were adjusted using the k-fold method with the training data. The model was evaluated using validation data.
Results
Of the 14 980 eligible cases, 11 980 were used for training and 3000 for validation. The event rate was 1.2%. A four-layer, 5217-variable model was developed. The final C-statistic was 0.79 (95% confidence intervals: 0.74–0.83) for the training data and 0.74 (95% confidence intervals: 0.62–0.85) for the validation data.
Conclusion
We developed a deep learning model to predict operative mortality using big data from the NCD. To improve the accuracy, it is necessary to introduce new variables related to postoperative complications or factors that cannot be analyzed using conventional methods.
{"title":"Deep Learning Model for Predicting Operative Mortality After Total Gastrectomy: Analysis of the Japanese National Clinical Database (NCD)","authors":"Ryosuke Fukuyo, Hiroyuki Yamamoto, Masanori Tokunaga, Yusuke Kinugasa, Yoshihiro Kakeji, Ken Shirabe","doi":"10.1002/ags3.70067","DOIUrl":"https://doi.org/10.1002/ags3.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Radical gastrectomy with lymph node dissection is the primary treatment for gastric cancer. However, the overall complication rate remains approximately 10%–20%, with a postoperative mortality rate of 2.3%. Therefore, preoperative stratification of patients based on their expected surgical risks is important. This study aimed to develop a deep learning prediction model using big data from the National Clinical Database (NCD) to predict operative mortality after total gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged 18 years or older who underwent total gastrectomy for gastric cancer and were registered in the NCD between January 2018 and December 2019 were included. A total of 62 variables, including age, sex, past medical history, preoperative blood test results, and tumor characteristics, were used as covariates, with operative mortality as the outcome variable. Deep learning models were developed using Python, TensorFlow and Keras. Hyperparameters were adjusted using the k-fold method with the training data. The model was evaluated using validation data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 14 980 eligible cases, 11 980 were used for training and 3000 for validation. The event rate was 1.2%. A four-layer, 5217-variable model was developed. The final C-statistic was 0.79 (95% confidence intervals: 0.74–0.83) for the training data and 0.74 (95% confidence intervals: 0.62–0.85) for the validation data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We developed a deep learning model to predict operative mortality using big data from the NCD. To improve the accuracy, it is necessary to introduce new variables related to postoperative complications or factors that cannot be analyzed using conventional methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"67-76"},"PeriodicalIF":3.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891469","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}
Few reports have described pelvic reinforcement procedure (PRP) to prevent perineal hernia (PH) in robotic abdominoperineal resection (Ro-APR) for rectal cancer. This study aimed to investigate the safety and efficacy of PRP in Ro-APR.
Methods
Patients who underwent Ro-APR for rectal cancer between January 2020 and June 2023 were retrospectively examined. PRP was performed as a prophylactic procedure for PH. Four types of PRP were performed depending on the case (closure of the levator ani muscles, the pelvic peritoneum with the uterus, the pelvic peritoneum, and the pelvic peritoneum with a bladder peritoneal flap). Background factors and surgical outcomes were compared between patients without PRP (PRP−) and with PRP (PRP+). Imaged PH was diagnosed using computed tomography 1 year postoperatively. Imaged PH with symptoms was defined as symptomatic PH.
Results
We evaluated 81 patients, including 51 PRP− (63.0%) and 30 PRP+ (37.0%). There were no differences in the characteristics between the two groups. There was no significant difference in operative time between the two groups (358 min vs. 329 min, p = 0.460). PRP− had a significantly higher rate of imaged PH (39.2% vs. 6.7%, p = 0.005) and symptomatic PH (19.6% vs. 3.3%, p = 0.047). The two groups had no significant differences in the other postoperative complications. In multivariate analysis, the independent risk factor for PH was not undergoing PRP (odds ratio 9.71, p = 0.005).
Conclusion
PRP in Ro-APR for rectal cancer can be safely performed and helps prevent PH.
目的很少有报道描述骨盆强化手术（PRP）预防会阴疝（PH）在机器人腹部会阴切除术（Ro-APR）直肠癌。本研究旨在探讨PRP治疗Ro-APR的安全性和有效性。方法回顾性分析2020年1月至2023年6月期间接受Ro-APR治疗的直肠癌患者。PRP作为ph的预防性手术进行。根据病例进行四种类型的PRP（关闭提肛肌，盆腔腹膜与子宫，盆腔腹膜和盆腔腹膜与膀胱腹膜瓣）。比较无PRP （PRP−）和有PRP （PRP+）患者的背景因素和手术结果。术后1年通过计算机断层扫描诊断PH。有症状的PH图像被定义为症状性PH。结果我们评估了81例患者，其中51例PRP−(63.0%)和30例PRP+(37.0%)。两组之间的特征没有差异。两组手术时间差异无统计学意义（358 min vs 329 min, p = 0.460）。PRP−有更高的PH显像率（39.2% vs. 6.7%, p = 0.005）和症状性PH （19.6% vs. 3.3%, p = 0.047）。两组术后其他并发症无明显差异。在多因素分析中，PH的独立危险因素未进行PRP（优势比9.71,p = 0.005）。结论直肠癌Ro-APR的PRP可以安全进行，并有助于预防PH。
{"title":"Safety and Efficacy of Pelvic Reinforcement Procedure for Preventing Postoperative Perineal Hernia After Robotic Abdominoperineal Resection: A Single-Center, Retrospective Cohort Study","authors":"Yoshihiro Sakai, Shunsuke Kasai, Akio Shiomi, Shoichi Manabe, Yusuke Yamaoka, Yusuke Tanaka, Takahiro Igaki, Hiroyasu Kagawa, Yusuke Kinugasa","doi":"10.1002/ags3.70066","DOIUrl":"https://doi.org/10.1002/ags3.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Few reports have described pelvic reinforcement procedure (PRP) to prevent perineal hernia (PH) in robotic abdominoperineal resection (Ro-APR) for rectal cancer. This study aimed to investigate the safety and efficacy of PRP in Ro-APR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent Ro-APR for rectal cancer between January 2020 and June 2023 were retrospectively examined. PRP was performed as a prophylactic procedure for PH. Four types of PRP were performed depending on the case (closure of the levator ani muscles, the pelvic peritoneum with the uterus, the pelvic peritoneum, and the pelvic peritoneum with a bladder peritoneal flap). Background factors and surgical outcomes were compared between patients without PRP (PRP−) and with PRP (PRP+). Imaged PH was diagnosed using computed tomography 1 year postoperatively. Imaged PH with symptoms was defined as symptomatic PH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We evaluated 81 patients, including 51 PRP− (63.0%) and 30 PRP+ (37.0%). There were no differences in the characteristics between the two groups. There was no significant difference in operative time between the two groups (358 min vs. 329 min, <i>p</i> = 0.460). PRP− had a significantly higher rate of imaged PH (39.2% vs. 6.7%, <i>p</i> = 0.005) and symptomatic PH (19.6% vs. 3.3%, <i>p</i> = 0.047). The two groups had no significant differences in the other postoperative complications. In multivariate analysis, the independent risk factor for PH was not undergoing PRP (odds ratio 9.71, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PRP in Ro-APR for rectal cancer can be safely performed and helps prevent PH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 1","pages":"128-136"},"PeriodicalIF":3.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The relationship between tumor location and lymphatic flow is generally known to affect the efficacy of lymph node dissection, but the specific impact in rectal cancer remains unclear. This study investigated the frequency of lymph node metastasis (LNM) and the efficacy of lymph node dissection based on tumor location.
Methods
We retrospectively investigated 882 patients with rectal adenocarcinoma who underwent total mesorectal excision with lateral lymph node dissection. Tumors were categorized by primary site into Ra (from the lower edge of S2 to the peritoneal reflection, n = 95), Rb (from the peritoneal reflection to the upper edge of the anal canal, n = 713), and P (anal canal, n = 74). LNM rates and dissection efficacy were assessed at each station. The therapeutic value index (TVI) was calculated as the LNM rate multiplied by the 5-year overall survival rate.
Results
LNM was observed in 447 patients (50.7%). Mesenteric LNM rates and the TVI were higher for tumors located more orally (49.5% and 43 for Ra, 46.1% and 29.7 for Rb, 43.2% and 17.6 for P), whereas lateral LNM rates and the TVI were higher for tumors located more anally (7.4% and 3.7 for Ra, 16.3% and 8 for Rb, 29.7% and 14.1 for P). Regardless of tumor location, the TVI in the lateral region was high in the distal internal iliac and obturator areas.
Conclusions
Tumor location influences LNM frequency and lymph node dissection efficacy in rectal cancer. Treatment strategies should be individualized based on tumor location to improve outcomes.
{"title":"Impact of Tumor Location on the Efficacy of Lateral and Mesenteric Lymph Node Dissection in Patients With Rectal Cancer Treated by Upfront Surgery","authors":"Tomofumi Uotani, Hiroshi Nagata, Yasuyuki Takamizawa, Konosuke Moritani, Shunsuke Tsukamoto, Tsutomu Fujii, Yukihide Kanemitsu","doi":"10.1002/ags3.70065","DOIUrl":"https://doi.org/10.1002/ags3.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The relationship between tumor location and lymphatic flow is generally known to affect the efficacy of lymph node dissection, but the specific impact in rectal cancer remains unclear. This study investigated the frequency of lymph node metastasis (LNM) and the efficacy of lymph node dissection based on tumor location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively investigated 882 patients with rectal adenocarcinoma who underwent total mesorectal excision with lateral lymph node dissection. Tumors were categorized by primary site into Ra (from the lower edge of S2 to the peritoneal reflection, <i>n</i> = 95), Rb (from the peritoneal reflection to the upper edge of the anal canal, <i>n</i> = 713), and P (anal canal, <i>n</i> = 74). LNM rates and dissection efficacy were assessed at each station. The therapeutic value index (TVI) was calculated as the LNM rate multiplied by the 5-year overall survival rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LNM was observed in 447 patients (50.7%). Mesenteric LNM rates and the TVI were higher for tumors located more orally (49.5% and 43 for Ra, 46.1% and 29.7 for Rb, 43.2% and 17.6 for P), whereas lateral LNM rates and the TVI were higher for tumors located more anally (7.4% and 3.7 for Ra, 16.3% and 8 for Rb, 29.7% and 14.1 for P). Regardless of tumor location, the TVI in the lateral region was high in the distal internal iliac and obturator areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tumor location influences LNM frequency and lymph node dissection efficacy in rectal cancer. Treatment strategies should be individualized based on tumor location to improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1233-1242"},"PeriodicalIF":3.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436116","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}
Masakatsu Numata, Jun Watanabe, Yuichiro Tsukada, Yusuke Suwa, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Takeshi Naitoh, Masahiko Watanabe, Motoko Suzuki, Toshihiro Misumi, Masaaki Ito, Ultimate Trial Group in Japan Society of Laparoscopic Colorectal Surgery
Background
Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post-operative anorectal dysfunction considerably affects quality of life. Both hand-sewn and stapled anastomoses are suitable options for tumors located 4–5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.
Methods
This multicenter, single-arm prospective study included patients with cT1-T2/N0/M0 adenocarcinoma located 4–5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post-operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.
Results
A total of 135 patients were analyzed and divided into hand-sewn (n = 65) and stapled (n = 70) groups. The patient characteristics were similar, except for the tumors in the hand-sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post-operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand-sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.
Conclusion
Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand-sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4–5 cm from the anal verge to ensure oncological safety.
Trial Registration
This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750)
{"title":"Patient-Reported Outcomes and Surgical Results of Hand-Sewn Versus Stapled Anastomosis for Lower Rectal Cancer Located 4–5 cm From the Anal Verge: A Subanalysis of the Ultimate Study","authors":"Masakatsu Numata, Jun Watanabe, Yuichiro Tsukada, Yusuke Suwa, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Takeshi Naitoh, Masahiko Watanabe, Motoko Suzuki, Toshihiro Misumi, Masaaki Ito, Ultimate Trial Group in Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1002/ags3.70063","DOIUrl":"https://doi.org/10.1002/ags3.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post-operative anorectal dysfunction considerably affects quality of life. Both hand-sewn and stapled anastomoses are suitable options for tumors located 4–5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, single-arm prospective study included patients with cT1-T2/N0/M0 adenocarcinoma located 4–5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post-operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 135 patients were analyzed and divided into hand-sewn (<i>n</i> = 65) and stapled (<i>n</i> = 70) groups. The patient characteristics were similar, except for the tumors in the hand-sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post-operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand-sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand-sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4–5 cm from the anal verge to ensure oncological safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750)</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1215-1224"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436248","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}
Yuta Suzuki, Daichi Kitaguchi, Norihito Kosugi, Hiro Hasegawa, Nobuyoshi Takeshita, Yusuke Kinugasa, Masaaki Ito
Aim
Total mesorectal excision entails dissection of the “holy plane” without damaging the mesorectal and parietal pelvic fasciae. We aimed to train a deep learning model to identify the anatomical landmarks of the pelvic fascial surface during total mesorectal excision and evaluate its performance to validate artificial intelligence-guided total mesorectal excision.
Methods
In this single-center, retrospective, observational study, a deep learning model that can automatically identify the anatomical landmarks in the pelvic fascial plane during laparoscopic total mesorectal excision in real time was developed. Target anatomical landmarks included the mesorectal fascia, parietal pelvic fascia, and the holy plane between them. Feature Pyramid Networks and EfficientNetB7 were adopted as the neural network architecture and backbone network, respectively. The surgical videos used for training and validation data were different. The Dice Similarity Coefficient, recall, and Normalized Surface Dice, which were calculated using five-fold cross-validation, were used as the evaluation metrics.
Results
Overall, 2861 images from 157 surgical videos were annotated and used for the training and validation datasets. In the semantic segmentation task, the Dice Similarity Coefficients for the mesorectal fascia, parietal pelvic fascia, and holy plane were 90.4%, 90.6%, and 68.5%, respectively. The Normalized Surface Dices for the three fasciae were 70.4%, 73.2%, and 54.6%, respectively.
Conclusions
We constructed a deep learning model that recognizes three regions for total mesorectal excision—the mesorectal fascia, parietal pelvic fascia, and intervening holy plane—with a relatively high Dice Similarity Coefficient, successfully providing proof of concept for artificial intelligence-guided total mesorectal excision.
{"title":"Artificial Intelligence-Guided Total Mesorectal Excision: Development of a Deep Learning Model to Identify the Pelvic Fascial Plane Anatomy","authors":"Yuta Suzuki, Daichi Kitaguchi, Norihito Kosugi, Hiro Hasegawa, Nobuyoshi Takeshita, Yusuke Kinugasa, Masaaki Ito","doi":"10.1002/ags3.70064","DOIUrl":"https://doi.org/10.1002/ags3.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Total mesorectal excision entails dissection of the “holy plane” without damaging the mesorectal and parietal pelvic fasciae. We aimed to train a deep learning model to identify the anatomical landmarks of the pelvic fascial surface during total mesorectal excision and evaluate its performance to validate artificial intelligence-guided total mesorectal excision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center, retrospective, observational study, a deep learning model that can automatically identify the anatomical landmarks in the pelvic fascial plane during laparoscopic total mesorectal excision in real time was developed. Target anatomical landmarks included the mesorectal fascia, parietal pelvic fascia, and the holy plane between them. Feature Pyramid Networks and EfficientNetB7 were adopted as the neural network architecture and backbone network, respectively. The surgical videos used for training and validation data were different. The Dice Similarity Coefficient, recall, and Normalized Surface Dice, which were calculated using five-fold cross-validation, were used as the evaluation metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 2861 images from 157 surgical videos were annotated and used for the training and validation datasets. In the semantic segmentation task, the Dice Similarity Coefficients for the mesorectal fascia, parietal pelvic fascia, and holy plane were 90.4%, 90.6%, and 68.5%, respectively. The Normalized Surface Dices for the three fasciae were 70.4%, 73.2%, and 54.6%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We constructed a deep learning model that recognizes three regions for total mesorectal excision—the mesorectal fascia, parietal pelvic fascia, and intervening holy plane—with a relatively high Dice Similarity Coefficient, successfully providing proof of concept for artificial intelligence-guided total mesorectal excision.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1225-1232"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436249","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}
<p>We read with great interest the recent article by Takakura et al. [<span>1</span>], reporting results from a multi-institutional phase II study (HiSCO-01) comparing treatment compliance rates (TCR)—defined as the completion of ≥ 6 cycles of CAPOX plus bevacizumab (CAPOX-Bev) and R0 resection—between preoperative and postoperative chemotherapy in patients with resectable colorectal liver metastases (CRLM). Although designed as the phase II portion of a planned sequential phase II/III trial, the study did not proceed to phase III due to slow patient accrual.</p><p>The study found TCRs of 89.2% and 71.8% in the pre- and postoperative groups, respectively (<i>p</i> = 0.06), with both exceeding the expected threshold of 70%. We would appreciate clarification on whether this trend favoring the preoperative group was considered a positive outcome, and how the authors intended to proceed with the phase III portion when patient enrollment continued as expected.</p><p>The optimal regimen for perioperative chemotherapy in patients with resectable CRLM remains a subject of debate in the era of molecular-targeted therapies. The EORTC 40983 trial demonstrated improved progression-free survival (PFS) with perioperative FOLFOX4; however, it did not incorporate molecular-targeted agents [<span>2</span>]. Similarly, prior studies suggesting improved PFS with adjuvant chemotherapy following hepatectomy also lacked the use of targeted therapies [<span>3, 4</span>]. In addition, important biomarkers—such as RAS and BRAF mutation status, microsatellite instability, and tumor sidedness—were not analyzed in the current trial, although they are now crucial for selecting appropriate targeted therapies. In this context, we are particularly interested in which regimen the authors would select for a future phase III trial based on the same concept, taking into account current molecular profiling strategies. Our proposed regimens are FOLFOX or CAPOX plus a molecular-targeted agent (selected on the basis of RAS/BRAF status and primary-tumor sidedness) for preoperative chemotherapy, and FOLFOX or CAPOX without a molecular-targeted agent for postoperative chemotherapy.</p><p>A major concern regarding postoperative chemotherapy, particularly after major hepatectomy, is increased toxicity, which may lead to reduced dose intensity and early termination of treatment. One possible rationale behind this study's design was the hypothesis that preoperative chemotherapy would be less toxic than postoperative treatment. Although the authors concluded that preoperative CAPOX-Bev was less toxic, the incidence of chemotherapy-related toxicities, relative dose intensity, and postoperative complications were reportedly similar between the two groups. Therefore, the reason for the lower TCR in the postoperative group remains unclear. One possible explanation may lie in physician inexperience with CAPOX-Bev at the time of study initiation in 2010. For example, in the JCOG0603 trial, the treat
{"title":"Clarifying Treatment Compliance and Future Directions in Perioperative Chemotherapy for Resectable Colorectal Liver Metastases","authors":"Masayuki Okuno, Hiroto Nishino, Takamichi Ishii, Etsuro Hatano","doi":"10.1002/ags3.70062","DOIUrl":"https://doi.org/10.1002/ags3.70062","url":null,"abstract":"<p>We read with great interest the recent article by Takakura et al. [<span>1</span>], reporting results from a multi-institutional phase II study (HiSCO-01) comparing treatment compliance rates (TCR)—defined as the completion of ≥ 6 cycles of CAPOX plus bevacizumab (CAPOX-Bev) and R0 resection—between preoperative and postoperative chemotherapy in patients with resectable colorectal liver metastases (CRLM). Although designed as the phase II portion of a planned sequential phase II/III trial, the study did not proceed to phase III due to slow patient accrual.</p><p>The study found TCRs of 89.2% and 71.8% in the pre- and postoperative groups, respectively (<i>p</i> = 0.06), with both exceeding the expected threshold of 70%. We would appreciate clarification on whether this trend favoring the preoperative group was considered a positive outcome, and how the authors intended to proceed with the phase III portion when patient enrollment continued as expected.</p><p>The optimal regimen for perioperative chemotherapy in patients with resectable CRLM remains a subject of debate in the era of molecular-targeted therapies. The EORTC 40983 trial demonstrated improved progression-free survival (PFS) with perioperative FOLFOX4; however, it did not incorporate molecular-targeted agents [<span>2</span>]. Similarly, prior studies suggesting improved PFS with adjuvant chemotherapy following hepatectomy also lacked the use of targeted therapies [<span>3, 4</span>]. In addition, important biomarkers—such as RAS and BRAF mutation status, microsatellite instability, and tumor sidedness—were not analyzed in the current trial, although they are now crucial for selecting appropriate targeted therapies. In this context, we are particularly interested in which regimen the authors would select for a future phase III trial based on the same concept, taking into account current molecular profiling strategies. Our proposed regimens are FOLFOX or CAPOX plus a molecular-targeted agent (selected on the basis of RAS/BRAF status and primary-tumor sidedness) for preoperative chemotherapy, and FOLFOX or CAPOX without a molecular-targeted agent for postoperative chemotherapy.</p><p>A major concern regarding postoperative chemotherapy, particularly after major hepatectomy, is increased toxicity, which may lead to reduced dose intensity and early termination of treatment. One possible rationale behind this study's design was the hypothesis that preoperative chemotherapy would be less toxic than postoperative treatment. Although the authors concluded that preoperative CAPOX-Bev was less toxic, the incidence of chemotherapy-related toxicities, relative dose intensity, and postoperative complications were reportedly similar between the two groups. Therefore, the reason for the lower TCR in the postoperative group remains unclear. One possible explanation may lie in physician inexperience with CAPOX-Bev at the time of study initiation in 2010. For example, in the JCOG0603 trial, the treat","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1369-1370"},"PeriodicalIF":3.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436219","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}
Kuan-Fu Liao, Cheng-Chan Yu, Sheng-Chun Chiu, Yu-Hung Kuo, Shih-Wei Lai
Objective
The association between cholecystectomy and gastric cancer is undetermined. The objective of this study was to assess whether subjects with cholecystectomy are at risk of gastric cancer in Taiwan.
Methods
This study used data from a cohort of 2 000 000 beneficiaries over a twelve-year period (2010–2021) from the Taiwan National Health Insurance Research Database. A total of 24 798 subjects aged 20 to 84 years underwent cholecystectomy, constituting the cholecystectomy group. An additional 68 781 randomly selected subjects without a history of cholecystectomy were included as the noncholecystectomy group. The incidence of gastric cancer was measured in both groups through the end of 2021. A multivariable Cox proportional hazards regression model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) for the risk of gastric cancer, adjusting for covariables.
Results
The overall incidence rate of gastric cancer was 1.02 times higher in the cholecystectomy group than in the noncholecystectomy group; however, this difference was not statistically significant (5.70 vs. 5.60 per 10 000 person-years, 95% CI = 0.80–1.31, p = 0.880). The multivariable Cox proportional hazards regression analysis demonstrated that the adjusted HR for gastric cancer in the cholecystectomy group compared to the noncholecystectomy group was 1.06, which was not statistically significant (95% CI = 0.83–1.36, p = 0.636).
Conclusion
This cohort study does not detect a significant association between cholecystectomy and gastric cancer risk.
目的胆囊切除术与胃癌的关系尚不明确。本研究的目的是评估台湾胆囊切除术患者是否有胃癌的风险。24 798例20 ~ 84岁的患者行胆囊切除术，构成胆囊切除术组。另外随机选择68781名无胆囊切除术史的受试者作为非胆囊切除术组。到2021年底，两组的胃癌发病率都进行了测量。采用多变量Cox比例风险回归模型评估胃癌风险的风险比（HR）和95%置信区间（CI），并对协变量进行调整。结果胆囊切除术组胃癌总发病率是非胆囊切除术组的1.02倍；然而，这种差异没有统计学意义（5.70 vs 5.60 / 10000人-年，95% CI = 0.80-1.31, p = 0.880）。多变量Cox比例风险回归分析显示，胆囊切除术组与非胆囊切除术组胃癌的校正HR为1.06，差异无统计学意义（95% CI = 0.83-1.36, p = 0.636）。结论：本队列研究未发现胆囊切除术与胃癌风险之间的显著关联。
{"title":"Association Between Cholecystectomy and Gastric Cancer in a Cohort Study in Taiwan","authors":"Kuan-Fu Liao, Cheng-Chan Yu, Sheng-Chun Chiu, Yu-Hung Kuo, Shih-Wei Lai","doi":"10.1002/ags3.70061","DOIUrl":"https://doi.org/10.1002/ags3.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The association between cholecystectomy and gastric cancer is undetermined. The objective of this study was to assess whether subjects with cholecystectomy are at risk of gastric cancer in Taiwan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used data from a cohort of 2 000 000 beneficiaries over a twelve-year period (2010–2021) from the Taiwan National Health Insurance Research Database. A total of 24 798 subjects aged 20 to 84 years underwent cholecystectomy, constituting the cholecystectomy group. An additional 68 781 randomly selected subjects without a history of cholecystectomy were included as the noncholecystectomy group. The incidence of gastric cancer was measured in both groups through the end of 2021. A multivariable Cox proportional hazards regression model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) for the risk of gastric cancer, adjusting for covariables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall incidence rate of gastric cancer was 1.02 times higher in the cholecystectomy group than in the noncholecystectomy group; however, this difference was not statistically significant (5.70 vs. 5.60 per 10 000 person-years, 95% CI = 0.80–1.31, <i>p</i> = 0.880). The multivariable Cox proportional hazards regression analysis demonstrated that the adjusted HR for gastric cancer in the cholecystectomy group compared to the noncholecystectomy group was 1.06, which was not statistically significant (95% CI = 0.83–1.36, <i>p</i> = 0.636).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This cohort study does not detect a significant association between cholecystectomy and gastric cancer risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1207-1214"},"PeriodicalIF":3.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436304","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}
Regarding the resectability of pancreatic adenocarcinoma (PDAC), not only anatomical factors but also biological and conditional factors have come to be considered. This study examined the impact of the Global Leadership Initiative on Malnutrition (GLIM) criteria on prognosis after resection of anatomically resectable PDAC.
Methods
The medical records of consecutive patients who underwent resection for resectable PDAC between January 1, 2014, and December 31, 2022, were retrospectively reviewed. Patients were classified as normal, moderately, or severely malnourished according to the GLIM criteria.
Results
In total, 194 patients were included in the analysis. According to the GLIM criteria, 61 (31.4%), 49 (25.2%), and 84 (42.3%) patients were normal, moderately, and severely malnourished, respectively. Patients with malnutrition had shorter overall, recurrence-free, and disease-specific survival (OS, RFS, and DSS) than normal patients (OS, normal vs. moderate, p = 0.015; normal vs. severe, p < 0.001; RFS, normal vs. moderate p = 0.012, normal vs. severe, p < 0.001; DSS, normal vs. moderate, p = 0.023; normal vs. severe, p < 0.001). In multivariate analysis regarding OS using all factors, moderate or severe malnutrition according to the GLIM criteria (p = 0.007), performance status (p = 0.086), preoperative diabetes (p = 0.017), tumor diameter ≥ 3 cm (p = 0.002), lymph node metastasis (p < 0.001), and postoperative adjuvant therapy (p = 0.027) were independent prognostic factors. In multivariate analysis using preoperative factors, malnutrition according to the GLIM criteria remained a significant prognostic factor (p = 0.003).
Conclusion
The GLIM criteria are effective prognostic predictors in patients with resectable PDAC undergoing upfront surgery. Preoperative nutritional assessment using these criteria may contribute to determining treatment plans for resectable PDAC.
{"title":"Prognostic Significance of GLIM-Defined Malnutrition in Patients With Resectable Pancreatic Adenocarcinoma Following Upfront Surgery","authors":"Takuya Mizumoto, Yoshihide Nanno, Jun Ishida, Dongha Lee, Kenji Fukushima, Shohei Komatsu, Hiroaki Yanagimoto, Sadaki Asari, Masahiro Kido, Takumi Fukumoto","doi":"10.1002/ags3.70059","DOIUrl":"https://doi.org/10.1002/ags3.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Regarding the resectability of pancreatic adenocarcinoma (PDAC), not only anatomical factors but also biological and conditional factors have come to be considered. This study examined the impact of the Global Leadership Initiative on Malnutrition (GLIM) criteria on prognosis after resection of anatomically resectable PDAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical records of consecutive patients who underwent resection for resectable PDAC between January 1, 2014, and December 31, 2022, were retrospectively reviewed. Patients were classified as normal, moderately, or severely malnourished according to the GLIM criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 194 patients were included in the analysis. According to the GLIM criteria, 61 (31.4%), 49 (25.2%), and 84 (42.3%) patients were normal, moderately, and severely malnourished, respectively. Patients with malnutrition had shorter overall, recurrence-free, and disease-specific survival (OS, RFS, and DSS) than normal patients (OS, normal vs. moderate, <i>p</i> = 0.015; normal vs. severe, <i>p</i> < 0.001; RFS, normal vs. moderate <i>p</i> = 0.012, normal vs. severe, <i>p</i> < 0.001; DSS, normal vs. moderate, <i>p</i> = 0.023; normal vs. severe, <i>p</i> < 0.001). In multivariate analysis regarding OS using all factors, moderate or severe malnutrition according to the GLIM criteria (<i>p</i> = 0.007), performance status (<i>p</i> = 0.086), preoperative diabetes (<i>p</i> = 0.017), tumor diameter ≥ 3 cm (<i>p</i> = 0.002), lymph node metastasis (<i>p</i> < 0.001), and postoperative adjuvant therapy (<i>p</i> = 0.027) were independent prognostic factors. In multivariate analysis using preoperative factors, malnutrition according to the GLIM criteria remained a significant prognostic factor (<i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GLIM criteria are effective prognostic predictors in patients with resectable PDAC undergoing upfront surgery. Preoperative nutritional assessment using these criteria may contribute to determining treatment plans for resectable PDAC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1351-1361"},"PeriodicalIF":3.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436455","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}
Excess intraoperative fluid can increase postoperative complications in elective surgery, but data on esophageal cancer surgery remain limited. We examined the relationship between intraoperative fluid volume and short-term outcomes after minimally invasive esophagectomy.
Methods
This study analyzed 8782 patients who underwent minimally invasive esophagectomy between 2018 and 2022 using data from the National Clinical Database in Japan. Multivariable logistic regression and smoothing spline models were used to assess associations between intraoperative fluid volume and short-term outcomes.
Results
The median intraoperative fluid volume was 3700 mL (3000–4500) or 7.8 mL/kg/h (6.2–9.7). Postoperatively, pneumonia occurred in 13.6% of patients, anastomotic leakage in 13.1%, prolonged ventilation (> 48 h) in 3.5%, and surgery-related mortality in 0.8%. Patients were classified into tertiles (low, middle, high) based on fluid volume. A high intraoperative fluid volume was significantly associated with pneumonia (risk-adjusted odds ratio 1.22, 95% confidence interval 1.04–1.45, p = 0.02). However, there was no significant association with anastomotic leakage, prolonged ventilation, or surgery-related mortality. Smoothing spline model showed a positive monotonic relationship between fluid volume and the risk-adjusted odds ratio for pneumonia, prolonged ventilation, and surgery-related mortality, whereas anastomotic leakage showed a negative monotonic trend.
Conclusions
Higher intraoperative fluid volume was significantly associated with an increased risk of pneumonia after minimally invasive esophagectomy.
{"title":"Impact of Intraoperative Fluid Volume on Complications After Minimally Invasive Esophagectomy: Analysis of 8782 Patients From the Japanese National Clinical Database","authors":"Akihiko Okamura, Hideki Endo, Masayuki Watanabe, Hiroyuki Yamamoto, Hirotoshi Kikuchi, Naoki Yoshimura, Hideki Ueno, Masayuki Chida, Ken Shirabe","doi":"10.1002/ags3.70060","DOIUrl":"https://doi.org/10.1002/ags3.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Excess intraoperative fluid can increase postoperative complications in elective surgery, but data on esophageal cancer surgery remain limited. We examined the relationship between intraoperative fluid volume and short-term outcomes after minimally invasive esophagectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzed 8782 patients who underwent minimally invasive esophagectomy between 2018 and 2022 using data from the National Clinical Database in Japan. Multivariable logistic regression and smoothing spline models were used to assess associations between intraoperative fluid volume and short-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median intraoperative fluid volume was 3700 mL (3000–4500) or 7.8 mL/kg/h (6.2–9.7). Postoperatively, pneumonia occurred in 13.6% of patients, anastomotic leakage in 13.1%, prolonged ventilation (> 48 h) in 3.5%, and surgery-related mortality in 0.8%. Patients were classified into tertiles (low, middle, high) based on fluid volume. A high intraoperative fluid volume was significantly associated with pneumonia (risk-adjusted odds ratio 1.22, 95% confidence interval 1.04–1.45, <i>p</i> = 0.02). However, there was no significant association with anastomotic leakage, prolonged ventilation, or surgery-related mortality. Smoothing spline model showed a positive monotonic relationship between fluid volume and the risk-adjusted odds ratio for pneumonia, prolonged ventilation, and surgery-related mortality, whereas anastomotic leakage showed a negative monotonic trend.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher intraoperative fluid volume was significantly associated with an increased risk of pneumonia after minimally invasive esophagectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1199-1206"},"PeriodicalIF":3.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436457","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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