Annals of Gastroenterological Surgery最新文献_第5页

Discrepancy Between Radiographic and Pathological Response Assessment in Neoadjuvant Treatment for Pancreatic Cancer: A Comparison Between Neoadjuvant Chemotherapy and Neoadjuvant Chemoradiotherapy 胰腺癌新辅助治疗的影像学与病理反应评价差异：新辅助化疗与新辅助放化疗的比较

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-28 DOI: 10.1002/ags3.70047

Satoru Miyahara, Hidenori Takahashi, Yoshito Tomimaru, Shogo Kobayashi, Daisaku Yamada, Hirofumi Akita, Takehiro Noda, Yuichiro Doki, Hidetoshi Eguchi

Aim

Appropriate reassessment of treatment response plays a crucial role in identifying optimal candidates for resection in neoadjuvant treatment (NAT) strategy for pancreatic cancer (PC); however, radiological evaluations are associated with limitations such as discrepancies with pathological response. Radiotherapy can induce inflammatory responses, potentially leading to an overestimation of residual tumor viability. This study explored the relationship between radiographic and pathological response assessments in NAT, focusing on the difference between neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT).

Methods

Patients with resectable, borderline resectable, and initially unresectable locally advanced PC who had undergone curative resection after NAT were included in this study. The correlation between radiological assessment using RECIST criteria and pathological response according to Evans classification in the NAC and NACRT groups was assessed.

Results

No significant differences were observed between the groups in terms of the findings of the RECIST assessment; however, the rate of favorable pathologic response (Evans ≥ IIb) in the NACRT group was significantly higher (p < 0.001). Furthermore, a comparison between the Evans grade for each RECIST criteria revealed a higher favorable pathologic response rate in the NACRT group among patients categorized as “stable disease (SD)” (p < 0.001). Some patients receiving NACRT who were initially classified as SD exhibited pathological complete response (Evans IV).

Conclusions

Discrepancies between radiographic and pathological response assessments in NAT for PC may differ between NAC and NACRT. In reassessment after NAT, the specific type of therapy administered, that is, NAC or NACRT, must be considered, especially in cases wherein radiographic alterations are minimal.

目的在胰腺癌（PC）新辅助治疗（NAT）策略中，适当的重新评估治疗反应对确定最佳切除候选人起着至关重要的作用；然而，放射学评估存在局限性，如与病理反应的差异。放疗可诱发炎症反应，可能导致对残余肿瘤生存能力的高估。本研究探讨了NAT中影像学与病理反应评估的关系，重点探讨了新辅助化疗（NAC）与新辅助放化疗（NACRT）的差异。方法选取可切除、边缘可切除和最初不可切除的局部晚期PC，并在NAT术后行根治性切除。评估NAC组和NACRT组采用RECIST标准的放射学评估与依Evans分类的病理反应的相关性。结果两组间RECIST评估结果无显著差异；然而，NACRT组的良好病理反应率（Evans≥IIb）明显更高（p < 0.001）。此外，对每个RECIST标准的Evans分级的比较显示，在被归类为“稳定疾病（SD）”的患者中，NACRT组有更高的有利病理反应率（p < 0.001）。一些最初被分类为SD的接受NACRT的患者表现出病理完全缓解（Evans IV）。结论NAC和NACRT对PC的影像学和病理反应评价差异可能存在差异。在NAT后的重新评估中，必须考虑具体的治疗类型，即NAC或NACRT，特别是在放射学改变很小的情况下。

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引用次数: 0

Conditional Survival for Pancreas Graft and Its Associated Factors After Pancreas Transplantation 胰腺移植后的条件存活及其相关因素

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-27 DOI: 10.1002/ags3.70040

Yoshito Tomimaru, Toshinori Ito, Tetsuhisa Kitamura, Takashi Kenmochi, Yuichiro Doki, Hidetoshi Eguchi

Aim

Traditional actuarial graft survival estimates are useful in pancreas transplantation (PTx) cases. From the perspective of patients, however, a more accurate estimate is necessary to predict long-term prognosis with consideration of their specific circumstances. Graft conditional survival analysis after transplantation is useful, but no relevant studies have included PTx. This study addressed pancreas graft conditional survival (pCS) and associated factors in PTx recipients in Japan.

Methods

A total of 526 PTx cases (2000–2023) were analyzed from the Japan Pancreas Transplant Registry. In addition to unconditional actuarial survival, pCS was calculated with the Kaplan–Meier method based on graft survival to landmark times, and factors affecting pCS were investigated using a Cox proportional hazards regression model.

Results

Unconditional actuarial 1/3/5/10-year graft survival rates were 86.6%/80.8%/76.7%/68.3% after PTx. Donor sex (male vs. female), recipient age (≤ 49 vs. ≥ 50 years), and type of PTx procedure (simultaneous pancreas-kidney transplantation vs. pancreas after kidney transplantation + pancreas transplantation alone) were significantly associated with survival. pCS increased with landmark time, indicating that posttransplant prognosis in surviving patients was more favorable than predicted at PTx. Donor sex and type of PTx procedure affected unconditional actuarial pancreas graft survival but not pCS, and recipient age influenced both pCS and unconditional actuarial pancreas graft survival.

Conclusion

pCS provided a dynamic perspective on long-term pancreas graft survival, demonstrating improved prognosis with extended posttransplant time. Donor sex and PTx procedure type influenced unconditional actuarial survival, but their impact diminished with time, while recipient age remained a consistent determinant of pCS.

目的传统的精算移植存活估计在胰腺移植（PTx）病例中是有用的。然而，从患者的角度来看，考虑到他们的具体情况，需要更准确的估计来预测长期预后。移植后移植条件存活分析是有用的，但尚未有相关研究纳入PTx。本研究探讨了日本PTx受者胰腺移植的条件生存（pCS）和相关因素。方法对日本胰腺移植登记处2000-2023年526例PTx病例进行分析。除了无条件精算生存外，还使用基于移植生存到里程碑时间的Kaplan-Meier方法计算pc，并使用Cox比例风险回归模型研究影响pc的因素。结果PTx术后1/3/5/10年生存率分别为86.6%/80.8%/76.7%/68.3%。供体性别（男性vs女性）、受体年龄（≤49岁vs≥50岁）和PTx手术类型（同时胰肾移植vs肾移植后胰腺+单独胰腺移植）与生存率显著相关。pc随着里程碑时间的增加而增加，表明存活患者的移植后预后比PTx时预测的更有利。供体性别和PTx手术类型影响无条件精算胰腺移植存活，但不影响pCS，受者年龄影响pCS和无条件精算胰腺移植存活。结论pCS为胰腺移植术后长期生存提供了动态视角，随着移植后时间的延长，预后得到改善。供体性别和PTx手术类型影响无条件精算生存率，但其影响随着时间的推移而减弱，而受体年龄仍然是pCS的一致决定因素。

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引用次数: 0

Identification of Risk Factors in Postoperative Urinary Dysfunction for Rectal Gastrointestinal Stromal Tumors 直肠胃肠道间质瘤术后尿功能障碍的危险因素分析

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-25 DOI: 10.1002/ags3.70058

Jun Kataoka, Yuichiro Tsukada, Masashi Wakabayashi, Daichi Kitaguchi, Hiro Hasegawa, Koji Ikeda, Yuji Nishizawa, Masaaki Ito

Aim

Curative resection and organ preservation are important to manage rectal gastrointestinal stromal tumors; however, postoperative quality of life, including urinary function, remains a concern. Our prior findings suggest a high incidence of urinary dysfunction after surgical resection of rectal gastrointestinal stromal tumors. This study aimed to identify the incidence of risk factors for postoperative urinary dysfunction during surgery for rectal gastrointestinal stromal tumors.

Methods

This retrospective study, conducted at our institution, included 45 patients who underwent surgery for rectal gastrointestinal stromal tumors between January 2008 and March 2022. Tumor size was assessed as the largest diameter via magnetic resonance imaging. Postoperative urinary dysfunction was defined as requiring urethral or intermittent catheterization at discharge.

Results

Median tumor size was 50.0 mm (range, 10.0–110.0 mm). Of all 45 patients, 25 (53.3%) underwent complete autonomic preservation and 11 (24.4%) experienced urinary dysfunction at discharge. Univariable analysis identified tumor size ≥ 50.0 mm immediately before surgery (p = 0.04) and preoperative targeted therapy (p = 0.03) as risk factors. Multivariable analysis showed male sex (odds ratio = 8.2, 95% confidence interval: 1.32–50.60; p = 0.02) and tumor size ≥ 50.0 mm immediately before surgery (odds ratio = 9.0, 95% confidence interval: 1.46–55.20; p = 0.02) as independent preoperative risk factors.

Conclusions

The incidence of postoperative urinary dysfunction after surgery for rectal gastrointestinal stromal tumors was 24.4%. The preoperative risk factors of postoperative urinary dysfunction were male sex (55.6%) and tumor size ≥ 50.0 mm immediately before surgery (53.3%).

目的直肠胃肠道间质瘤的根治性切除和器官保存是治疗的重要手段；然而，术后生活质量，包括泌尿功能，仍然是一个值得关注的问题。我们先前的研究结果显示直肠胃肠道间质瘤手术切除后泌尿功能障碍的发生率很高。本研究旨在探讨直肠胃肠道间质瘤术后尿功能障碍的危险因素。方法本回顾性研究在我院进行，包括45例2008年1月至2022年3月期间接受直肠胃肠道间质瘤手术的患者。通过磁共振成像评估肿瘤大小为最大直径。术后尿功能障碍被定义为出院时需要尿道或间歇导尿。结果中位肿瘤大小为50.0 mm（范围10.0 ~ 110.0 mm）。在所有45例患者中，25例（53.3%）患者完全自主神经保存，11例（24.4%）患者出院时出现尿功能障碍。单变量分析发现术前肿瘤大小≥50.0 mm （p = 0.04）和术前靶向治疗（p = 0.03）是危险因素。多因素分析显示，男性（优势比为8.2,95%可信区间为1.32 ~ 50.60,p = 0.02）和术前肿瘤大小≥50.0 mm（优势比为9.0,95%可信区间为1.46 ~ 55.20,p = 0.02）为术前独立危险因素。结论直肠胃肠道间质瘤术后尿功能障碍发生率为24.4%。术后泌尿功能障碍的术前危险因素为男性（55.6%）和术前肿瘤大小≥50.0 mm（53.3%）。

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引用次数: 0

Impact of Ghrelin-Depleting Gastrectomy on Long-Term Endocrine and Metabolic Health With a Focus on Skeletal Muscle and Bone Mineral Content 胃促生长素消耗切除术对长期内分泌和代谢健康的影响——以骨骼肌和骨矿物质含量为重点

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-23 DOI: 10.1002/ags3.70055

Hiroki Harada, Takuya Goto, Keishi Yamashita, Hiroyuki Minoura, Kota Okuno, Shohei Fujita, Mikiko Sakuraya, Tadashi Higuchi, Koshi Kumagai, Naoki Hiki

Background

Advances in diagnostic and surgical techniques have improved survival rates for gastric cancer patients. However, gastrectomy involving ghrelin-secreting regions of the upper gastric greater curvature can lead to long-term endocrine and metabolic disturbances, including reductions in serum ghrelin and insulin-like growth factor-1 (IGF-1), potentially contributing to skeletal muscle and bone mineral loss.

Methods

This prospective observational study included 35 gastric cancer patients who underwent gastrectomy between 2016 and 2018, with follow-up for 3–5 years. Patients were categorized into ghrelin-depleted (total or proximal gastrectomy) and ghrelin-preserved (distal gastrectomy) groups. Serum desacyl-ghrelin, IGF-1, and insulin-like growth factor-binding protein-3 (IGFBP-3) levels were measured, and skeletal muscle mass and bone mineral content were assessed.

Results

The ghrelin-depleted group exhibited significantly lower serum desacyl-ghrelin (56.9 ± 27.9 vs. 111.2 ± 54.8 fmol/mL, p = 0.0006), skeletal muscle mass (87.7% ± 2.1% vs. 95.1% ± 2.4%, p = 0.0229), and bone mineral content (90.9% ± 13.0% vs. 99.5% ± 6.3%, p = 0.0249). Additionally, IGF-1 levels showed a significant positive correlation with skeletal muscle mass (r = 0.53, p = 0.020). While the correlation between IGF-1 and bone mineral content did not reach statistical significance, a positive trend was observed (r = 0.44, p = 0.062).

Conclusion

Gastrectomy involving resection of ghrelin-rich regions leads to long-term reductions in serum desacyl-ghrelin levels, adversely affecting skeletal muscle mass and bone mineral content. These findings highlight the importance of considering the endocrine consequences when selecting surgical procedures.

背景诊断和手术技术的进步提高了胃癌患者的生存率。然而，胃切除术涉及胃大弯曲上部生长素分泌区，可导致长期内分泌和代谢紊乱，包括血清生长素和胰岛素样生长因子-1 （IGF-1）的减少，可能导致骨骼肌和骨矿物质的损失。方法本前瞻性观察研究纳入了2016 - 2018年间行胃切除术的35例胃癌患者，随访3-5年。患者被分为胃饥饿素缺失组（全胃或近端胃切除术）和胃饥饿素保留组（远端胃切除术）。测定血清去酰基生长素、IGF-1和胰岛素样生长因子结合蛋白-3 （IGFBP-3）水平，评估骨骼肌质量和骨矿物质含量。结果ghrelin缺失组血清去酰基-ghrelin（56.9±27.9 vs. 111.2±54.8 fmol/mL, p = 0.0006）、骨骼肌质量（87.7%±2.1% vs. 95.1%±2.4%,p = 0.0229）、骨矿物质含量（90.9%±13.0% vs. 99.5%±6.3%,p = 0.0249）显著降低。此外，IGF-1水平与骨骼肌质量呈正相关（r = 0.53, p = 0.020）。IGF-1与骨矿物质含量的相关性不具有统计学意义，但呈正相关（r = 0.44, p = 0.062）。结论胃切除术切除胃促生长素富集区导致血清去酰基胃促生长素水平长期降低，对骨骼肌质量和骨矿物质含量产生不利影响。这些发现强调了在选择手术方式时考虑内分泌后果的重要性。

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引用次数: 0

Endoscopic Submucosal Dissection Versus Laparoscopic and Endoscopic Cooperative Surgery for Superficial Duodenal Epithelial Tumors: A Multicenter Retrospective Study 内镜下粘膜剥离与腹腔镜和内镜合作手术治疗十二指肠浅表上皮肿瘤：一项多中心回顾性研究

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-23 DOI: 10.1002/ags3.70056

Takuo Takehana, Tsuneo Oyama, Motohiko Kato, Shunsuke Yoshii, Shu Hoteya, Satoru Nonaka, Shoichi Yoshimizu, Masao Yoshida, Ken Ohata, Hironori Yamamoto, Yuko Hara, Shigetsugu Tsuji, Osamu Dohi, Yasushi Yamasaki, Hiroya Ueyama, Koichi Kurahara, Tomoaki Tashima, Nobutsugu Abe, Atsushi Nakayama, Ichiro Oda, Naohisa Yahagi

Aims

This study aimed to compare the clinicopathological features and short-term outcomes of endoscopic submucosal dissection (ESD) and laparoscopic and endoscopic cooperative surgery (LECS) for superficial duodenal epithelial tumors (SDETs) and investigate the risk factors for severe adverse events (AEs).

Methods

Overall, 1017 patients who underwent ESD and 62 who underwent LECS to treat suspected SDETs between January 2008 and December 2018 were included. After comparing surgical and postsurgical outcomes between the two groups, logistic regression analyses were performed to identify the predictors of AEs.

Results

The lesion size was significantly larger in the LECS group than in the ESD group (28.5 vs. 20.8 mm, p < 0.01). The LECS group included significantly more patients with lesions greater than half the circumference than did the ESD group (19.3% vs. 5.4%, p < 0.01). LECS achieved a significantly higher complete closure rate of the resected wounds (98.4% vs. 74.4%, p < 0.01). Delayed bleeding and perforation occurred in 49 (5.0%) and 22 (2.2%) patients in the ESD group and 3 (4.8%) and 1 (1.6%) in the LECS group, respectively. Multivariate analyses revealed that incomplete closure of the resected wounds was the only independent risk factor for delayed bleeding (odds ratio, 5.069) and delayed perforation (odds ratio, 5.413).

Conclusions

Both ESD and LECS showed similar AE rates, although LECS is likely to be indicated for larger and wider circumferential tumors. Only incomplete closure of the resected wound was an independent risk factor for severe AEs, such as delayed perforation and bleeding.

目的比较内镜下粘膜剥离术（ESD）与腹腔镜内镜下联合手术（LECS）治疗浅表十二指肠上皮肿瘤（sdet）的临床病理特征和短期预后，探讨严重不良事件（ae）的危险因素。方法共纳入2008年1月至2018年12月期间1017例接受ESD和62例接受LECS治疗疑似sdet的患者。在比较两组患者的手术和术后结果后，进行logistic回归分析以确定ae的预测因素。结果LECS组病变大小明显大于ESD组（28.5 vs. 20.8 mm, p < 0.01）。与ESD组相比，LECS组中病变大于周长一半的患者明显增多（19.3% vs. 5.4%, p < 0.01）。术中切口完全愈合率（98.4% vs. 74.4%, p < 0.01）显著高于术中切口。ESD组49例（5.0%）、22例（2.2%）、LECS组3例（4.8%）、1例（1.6%）出现迟发性出血和穿孔。多因素分析显示，切除伤口不完全闭合是延迟出血（优势比为5.069）和延迟穿孔（优势比为5.413）的唯一独立危险因素。结论ESD和LECS的AE发生率相似，但LECS可能适用于更大、更宽的肿瘤。只有切除的伤口不完全闭合是严重ae的独立危险因素，如延迟穿孔和出血。

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引用次数: 0

Postoperative Prognostic Nutritional Index as a Useful Prognostic Factor in Patients With Gastric Cancer 胃癌患者术后预后营养指数作为一个有用的预后指标

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-19 DOI: 10.1002/ags3.70057

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

Aim

To verify whether postoperative prognostic nutritional index is a useful prognostic factor in patients with gastric cancer.

Methods

This study included 1738 consecutive patients with gastric cancer who underwent radical gastrectomy at our institution from January 2004 to December 2018. The sensitivity and specificity of white blood cell, neutrophil, lymphocyte, monocyte, and platelet counts, C-reactive protein, hemoglobin, and albumin levels, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, C-reactive protein-to-albumin ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index on postoperative Days 1 and 3 in predicting recurrence were evaluated using receiver operating characteristic curves. Recurrence-free survival and overall survival were compared between the normal and high fibrinogen groups.

Results

After applying the inclusion criteria, 1635 eligible patients were included in the analysis. The prognostic nutritional index on postoperative Day 1 attained the highest area under the curve (0.699). Overall survival and recurrence-free survival in the low prognostic nutritional index on postoperative Day 1 group were significantly poorer than those in the high prognostic nutritional index on postoperative Day 1 group (log-rank test, both p < 0.001). Multivariate Cox analysis revealed that prognostic nutritional index on postoperative Day 1 was a significantly independent prognostic factor for overall survival and recurrence-free survival (p = 0.002 and p < 0.001, respectively).

Conclusion

Postoperative prognostic nutritional index was a useful prognostic factor in patients with gastric cancer.

目的探讨胃癌患者术后营养指标是否可作为判断预后的有效指标。方法本研究纳入2004年1月至2018年12月在我院连续行根治性胃切除术的1738例胃癌患者。采用受者工作特征曲线评价术后第1天和第3天白细胞、中性粒细胞、淋巴细胞、单核细胞和血小板计数、c反应蛋白、血红蛋白和白蛋白水平、中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值、c反应蛋白与白蛋白比值、血小板与淋巴细胞比值和预后营养指数预测复发的敏感性和特异性。比较正常组和高纤维蛋白原组的无复发生存率和总生存率。结果应用纳入标准后，1635例符合条件的患者被纳入分析。术后第1天预后营养指数曲线下面积最高（0.699）。术后第1天预后营养指数低组的总生存率和无复发生存率显著低于术后第1天预后营养指数高组（log-rank检验，p < 0.001）。多因素Cox分析显示，术后第1天的预后营养指数是总生存率和无复发生存率的显著独立预后因素（p = 0.002和p <； 0.001）。结论预后营养指数是胃癌患者预后的重要指标。

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引用次数: 0

Fluorescence Guided Surgery in Gastric Cancer: What Do We Have and What Can We Do? 荧光引导胃癌手术：我们有什么和我们能做什么？

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-13 DOI: 10.1002/ags3.70053

Chun Zhuang, Han-Kwang Yang

Background and Objective

Fluorescence imaging has emerged as a valuable adjunct in gastric surgery, enhancing resection precision and oncologic outcomes. However, the use of indocyanine green (ICG) remains controversial due to uncertainties in efficacy and administration. A lack of standardized protocols persists. This review summarizes current applications of fluorescence in gastric cancer surgery, outlining existing challenges and future research needs.

Methods

A systematic PubMed search (2004–2024) was conducted using keywords such as “indocyanine green,” “carbon particle,” “blue dye,” “gastric cancer,” and “gastroesophageal junction cancer” to identify and review key uses of fluorescence agents in gastrointestinal malignancies.

Key Findings

Fluorescence-guided imaging aids intraoperative tumor localization, shortens operative time, and enhances lymph node (LN) yield, improving staging accuracy. Its role in sentinel lymph node (SLN) detection is still under debate due to false negatives. ICG fluorescence angiography (ICG-FA) may lower anastomotic leak rates, though strong supporting evidence is limited. No consensus exists regarding ICG dosage, timing, or delivery method.

Conclusions

Current evidence supports the safety and efficacy of fluorescence imaging in gastrointestinal surgery, with promising outcomes in precision and staging. However, uniform protocols for fluorescence use are urgently needed. Future studies should aim to standardize administration and optimize clinical implementation to fully realize its benefits.

背景与目的荧光成像在胃手术中已成为一种有价值的辅助手段，可提高切除精度和肿瘤预后。然而，由于疗效和管理的不确定性，吲哚菁绿（ICG）的使用仍然存在争议。标准化协议的缺乏仍然存在。本文综述了荧光技术在胃癌手术中的应用现状，提出了存在的挑战和未来的研究需求。方法系统检索PubMed(2004-2024)，检索关键词为“吲哚菁绿”、“碳颗粒”、“蓝色染料”、“胃癌”、“胃食管结癌”等，识别并回顾荧光剂在胃肠道恶性肿瘤中的关键应用。荧光引导成像有助于术中肿瘤定位，缩短手术时间，提高淋巴结（LN）产出率，提高分期准确性。由于假阴性，其在前哨淋巴结（SLN）检测中的作用仍在争论中。ICG荧光血管造影（ICG- fa）可能降低吻合口漏率，尽管强有力的支持证据有限。关于ICG的剂量、时间或给药方法尚无共识。结论目前的证据支持荧光成像在胃肠道手术中的安全性和有效性，在准确性和分期方面有希望的结果。然而，迫切需要统一的荧光使用方案。今后的研究应着眼于规范用药和优化临床实施，以充分发挥其益处。

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引用次数: 0

Surgical Volume and Short-Term Outcomes After Advanced Hepatectomy in the Postpandemic Era: Analysis of the Japanese National Clinical Database (2018–2023) 大流行后时代晚期肝切除术的手术量和短期结果：日本国家临床数据库分析（2018-2023）

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-10 DOI: 10.1002/ags3.70054

Yusuke Takemura, Hideki Endo, Taizo Hibi, Ryo Seishima, Masashi Takeuchi, Hiroyuki Yamamoto, Hiromichi Maeda, Akinobu Taketomi, Yoshihiro Kakeji, Yasuyuki Seto, Hideki Ueno, Masaki Mori, Ken Shirabe, Yuko Kitagawa

Aim

Previous studies have shown that the volume and short-term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short-term outcomes following advanced hepatectomy in Japan during the postpandemic era.

Methods

Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien–Dindo grade ≥ III), 30-day and inhospital mortality rates, and failure-to-rescue rates were assessed. The standardized morbidity and mortality ratios—calculated as the observed-to-expected incidence rates using an NCD-established risk model for 30-day mortality, inhospital mortality, and major complications—were also examined.

Results

A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID-19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras.

Conclusions

Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post-COVID-19 era, despite a decreasing procedural volume.

此前的研究表明，在2019冠状病毒病（COVID-19）大流行期间，日本晚期肝切除术的数量和短期结果保持稳定。然而，这些趋势在大流行后时期是否发生了变化仍不清楚。本研究旨在评估大流行后日本晚期肝切除术后的手术量和短期结果。方法分析日本国家临床数据库（NCD） 2018年至2023年晚期肝切除术患者的数据。评估手术次数、主要并发症（Clavien-Dindo分级≥III）、30天和住院死亡率以及抢救失败率的变化。标准化发病率和死亡率——使用非传染性疾病建立的30天死亡率、住院死亡率和主要并发症的风险模型计算为观察到的与预期的发病率——也进行了检查。结果共纳入39 348例。晚期肝切除术的数量逐渐下降，与COVID-19大流行无关。然而，在整个研究期间，80岁以上患者的比例显著增加。在整个研究期间，包括大流行期间和大流行后时期，每月标准化死亡率和发病率基本保持稳定。来自日本全国数据库的数据分析表明，尽管手术量减少，但在covid -19后时代，晚期肝切除术继续安全进行。

{"title":"Surgical Volume and Short-Term Outcomes After Advanced Hepatectomy in the Postpandemic Era: Analysis of the Japanese National Clinical Database (2018–2023)","authors":"Yusuke Takemura, Hideki Endo, Taizo Hibi, Ryo Seishima, Masashi Takeuchi, Hiroyuki Yamamoto, Hiromichi Maeda, Akinobu Taketomi, Yoshihiro Kakeji, Yasuyuki Seto, Hideki Ueno, Masaki Mori, Ken Shirabe, Yuko Kitagawa","doi":"10.1002/ags3.70054","DOIUrl":"https://doi.org/10.1002/ags3.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Previous studies have shown that the volume and short-term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short-term outcomes following advanced hepatectomy in Japan during the postpandemic era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien–Dindo grade ≥ III), 30-day and inhospital mortality rates, and failure-to-rescue rates were assessed. The standardized morbidity and mortality ratios—calculated as the observed-to-expected incidence rates using an NCD-established risk model for 30-day mortality, inhospital mortality, and major complications—were also examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID-19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post-COVID-19 era, despite a decreasing procedural volume.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1343-1350"},"PeriodicalIF":3.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436117","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

Association Between the Degree of Arterial Contact Angle and Survival in Patients With Borderline Resectable Pancreatic Cancer 边缘可切除胰腺癌患者动脉接触角程度与生存率的关系

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-09 DOI: 10.1002/ags3.70052

Katsuhisa Ohgi, Ryo Ashida, Mihoko Yamada, Shimpei Otsuka, Yoshiyasu Kato, Rui Sato, Akifumi Notsu, Katsuhiko Uesaka, Teiichi Sugiura

Aim

This study aimed to evaluate the impact of arterial contact angle on survival outcomes in patients with borderline resectable pancreatic cancer (BRPC) undergoing neoadjuvant treatment (NAT) and surgical resection.

Methods

A retrospective analysis of 84 patients with BRPC with arterial contact who underwent NAT followed by surgery at the Shizuoka Cancer Center (2012–2021) was conducted. They were classified into two groups according to the arterial contact angle measured using preoperative computed tomography: < 90° (n = 34, smaller-angle group) and ≥ 90° (n = 50, larger-angle group). Surgical, pathological, and survival outcomes were compared between the groups. Multivariate analysis identified independent prognostic factors for overall survival (OS).

Results

The larger-angle group had a significantly higher R1 resection rate (28% vs. 3%, p = 0.003) and worse OS (median 38.0 vs. 72.6 months, p = 0.045) than the smaller-angle group. Recurrence-free survival was also significantly shorter in the larger-angle group (median 15.1 vs. 31.1 months, p = 0.044). Multivariate analysis identified an arterial contact angle ≥ 90° as an independent prognostic factor for the OS (hazard ratio 1.97, p = 0.035). The recurrence rate was higher in the larger-angle group (78% vs. 53%, p = 0.019), with a trend toward increased local recurrence and liver metastases.

Conclusion

An arterial contact angle of ≥ 90° was associated with higher R1 resection rates, increased recurrence, and poor survival in patients with BRPC. More aggressive multimodal treatment strategies, including extended NAT, may be necessary to improve the outcomes in these high-risk patients.

目的本研究旨在评估动脉接触角对接受新辅助治疗（NAT）和手术切除的边缘性可切除胰腺癌（BRPC）患者生存结局的影响。方法回顾性分析2012-2021年静冈县癌症中心84例动脉接触BRPC术后行NAT治疗的患者。根据术前ct测得的动脉接触角分为90°组（n = 34，小角度组）和≥90°组（n = 50，大角度组）。比较两组之间的手术、病理和生存结果。多变量分析确定了影响总生存期（OS）的独立预后因素。结果大角度组R1切除率（28%比3%，p = 0.003）显著高于小角度组，OS（中位38.0比72.6个月，p = 0.045）显著低于小角度组。大角度组的无复发生存期也明显较短（中位15.1个月比31.1个月，p = 0.044）。多因素分析发现，动脉接触角≥90°是OS的独立预后因素（风险比1.97,p = 0.035）。大角度组复发率较高（78% vs. 53%, p = 0.019），有局部复发和肝转移增加的趋势。结论动脉接触角≥90°与BRPC患者R1切除率高、复发率高、生存率差相关。更积极的多模式治疗策略，包括延长NAT，可能需要改善这些高危患者的预后。

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引用次数: 0

Association Between Distance to the Transplant Center and Survival Following Living Donor Liver Transplantation 离移植中心的距离与活体肝移植术后存活的关系

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2025-06-09 DOI: 10.1002/ags3.70051

Hajime Matsushima, Akihiko Soyama, Takanobu Hara, Ayaka Kinoshita, Takashi Hamada, Kazushige Migita, Ayaka Satoh, Hajime Imamura, Tomohiko Adachi, Susumu Eguchi

Aim

To determine whether the distance from home to our transplant center affects posttransplant survival in patients undergoing living donor liver transplantation.

Methods

Data from 301 adult patients who underwent primary living donor liver transplantation at our center between January 2000 and July 2023 were retrospectively reviewed. The patients were divided into three groups according to the distance of their homes from our center: Group 1, 0–9 miles (n = 104); Group 2, 10–40 miles (n = 121); and Group 3, > 40 miles (n = 76).

Results

Graft and patient survival rates were significantly lower in Group 3 than in Group 1 (p = 0.010 and p = 0.004, respectively). Multivariate analysis showed that living > 40 miles from our transplant center was independently associated with worse patient survival (p = 0.025). Furthermore, conditional survival analysis revealed that living > 40 miles from our transplant center was associated with impaired 3-year patient survival. Subgroup analysis of Group 3 revealed that patients living > 40 miles to the nearest transplant center or university hospital had significantly lower 3-year conditional survival rates than those of patients living < 40 miles from the nearest facility (p = 0.011).

Conclusion

Greater distances to the transplant center may negatively affect posttransplant outcomes. Therefore, patients who have undergone living donor liver transplantation and who reside in areas far from specialized medical services should be monitored with caution.

目的探讨家到移植中心的距离是否会影响活体肝移植患者的术后生存。方法回顾性分析2000年1月至2023年7月在本中心接受原发性活体肝移植的301例成人患者的资料。根据患者家离中心的距离将患者分为3组：第1组，0-9英里（n = 104）；第二组，10-40英里（n = 121）；第三组40英里（n = 76）。结果3组移植体存活率和患者生存率显著低于1组（p = 0.010和p = 0.004）。多变量分析显示，居住在离移植中心40英里的地方与较差的患者生存率独立相关（p = 0.025）。此外，条件生存分析显示，居住在离我们移植中心40英里的地方与患者3年生存受损有关。第3组的亚组分析显示，居住在距离最近的移植中心或大学医院40英里的患者的3年条件生存率明显低于居住在距离最近的移植中心或大学医院40英里的患者（p = 0.011）。结论离移植中心较远可能对移植后的预后有不利影响。因此，接受活体供肝移植的患者和居住在远离专业医疗服务地区的患者应谨慎监测。

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引用次数: 0