Annals of Gastroenterological Surgery最新文献_第5页

Transanal minimally invasive proctectomy for ulcerative colitis is beneficial in terms of short-term outcomes and defecation function 经肛门微创直肠切除术治疗溃疡性结肠炎对短期疗效和排便功能有益

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-14 DOI: 10.1002/ags3.12844

Marie Hanaoka, Yusuke Kinugasa, Kenta Yao, Ayumi Takaoka, Megumi Sasaki, Shinichi Yamauchi, Masanori Tokunaga

Objective

Despite being reported safety, the advantages of transanal minimally invasive proctocolectomy (TAMIP) are controversial, and comparative studies on postoperative defecation function between ileal pouch-anal anastomosis (IPAA) using laparoscopic transanal manipulation (TAMIP-IPAA) and without this technique (traditional IPAA) are lacking. This study analyzed TAMIP's impact on short-term and postoperative defecation function in patients with ulcerative colitis (UC) to evaluate its safety and feasibility.

Methods

Inclusion criteria comprised patients with UC undergoing minimally invasive proctocolectomy at our hospital from May 2014 to May 2023. The TAMIP-IPAA approach involved precise rectal mucosa removal while preserving the sphincter muscle during laparoscopic transanal manipulation.

Results

In the evaluation of short-term outcomes for 71 patients undergoing proctocolectomy, the TAMIP group (37 patients) outperformed the non-TAMIP group in operative time (395 vs. 289 min, p < 0.001) and postoperative hospital stay (12 vs. 8 days, p < 0.001). Additionally, TAMIP-IPAA demonstrated advantages over traditional IPAA (seven patients), in operative time (443 vs. 289 min, p = 0.006), intraoperative blood loss (392 vs. 130 mL, p = 0.001), postoperative hospital stay (18 vs. 8 days, p = 0.003), anastomotic leakage (42.9% vs. 8.1%, p = 0.041), and re-admission within 30 days (57.1% vs. 8.1%, p = 0.009). Wexner scores were significantly superior in the TAMIP-IPAA group at 6 months (14.5 vs. 8.0 points, p = 0.029) and 1 year post stoma closure (14.0 vs. 7.0 points, p = 0.020), indicating enhanced short-term outcomes and defecation function compared to traditional IPAA.

Conclusions

TAMIP-IPAA for UC has the potential to offer promising benefits, including the enhancement of short-term outcomes and the improvement of defecation function.

尽管经肛门微创直肠切除术（TAMIP）的安全性已得到报道，但其优势仍存在争议，而且目前还缺乏对使用腹腔镜经肛门操作的回肠袋-肛门吻合术（IPAA）（TAMIP-IPAA）和不使用该技术的回肠袋-肛门吻合术（传统IPAA）术后排便功能的比较研究。本研究分析了TAMIP对溃疡性结肠炎（UC）患者短期和术后排便功能的影响，以评估其安全性和可行性。纳入标准包括2014年5月至2023年5月在我院接受微创直肠结肠切除术的UC患者。TAMIP-IPAA方法包括在腹腔镜经肛门操作中精确切除直肠粘膜，同时保留括约肌。在对71名接受直肠切除术的患者进行短期疗效评估时，TAMIP组（37名患者）在手术时间（395分钟对289分钟，P＜0.001）和术后住院时间（12天对8天，P＜0.001）方面优于非TAMIP组。此外，TAMIP-IPAA 在手术时间（443 分钟对 289 分钟，p = 0.006）、术中失血（392 毫升对 130 毫升，p = 0.001）、术后住院时间（18 天对 8 天，p = 0.003）、吻合口漏（42.9% 对 8.1%，p = 0.041）和 30 天内再次入院（57.1% 对 8.1%，p = 0.009）方面均优于传统的 IPAA（7 例患者）。TAMIP-IPAA组在造口关闭后6个月（14.5分 vs. 8.0分，p = 0.029）和1年（14.0分 vs. 7.0分，p = 0.020）的Wexner评分明显优于传统IPAA组，表明短期疗效和排便功能均优于传统IPAA组。

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引用次数: 0

Risk factors for serious postoperative complications following gastrectomy in super-elderly patients ≥85-years-old with gastric cancer: A National Clinical Database study in Japan 年龄≥85 岁的超高龄胃癌患者胃切除术后出现严重术后并发症的风险因素：日本国家临床数据库研究

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-10 DOI: 10.1002/ags3.12843

Yoshitake Ueda, Shiori Nishimura, Masafumi Inomata, Tomonori Akagi, Hidefumi Shiroshita, Tsuyoshi Etoh, Shuji Takiguchi, Yoshiharu Sakai, Hiraku Kumamaru, Hideki Ueno, Yuko Kitagawa

Aim

This study aimed to evaluate the technical safety and feasibility of gastrectomy for super-elderly patients ≥85-y-old with gastric cancer and to clarify the risk factors for serious postoperative complications in these patients.

Methods

Between 2017 and 2020, 10,203 patients who underwent distal gastrectomy (DG) and 2580 patients who underwent total gastrectomy (TG) were reviewed from the Japanese National Clinical Database. All possible preoperative factors were used to explore the risk factors for serious postoperative complications in the super-elderly patients with gastric cancer.

Results

For DG, the operative mortality rate was 1.6% (162 patients), and the rate of serious postoperative complications was 7.8% (796 patients). Similarly, the mortality rate was 2.6% (67 patients), and the rate of serious complications was 11.3% (292 patients) for TG. Based on multivariate analysis, body mass index (≥25 kg/m²), activities of daily living (ADL) (partially dependent), ASA-PS (Grade ≥3), dyspnea, ascites, history of cerebrovascular disease, serum albumin (<4 g/dL), and creatinine (>1.2 mg/dL) in DG, and ADL (partially dependent), ASA-PS (Grade ≥3), previous percutaneous coronary intervention, dialysis, WBC (>9000 μL), and AST (>35 IU/L) in TG were strong risk factors for serious postoperative complications.

Conclusions

The study findings suggest that gastrectomy for super-elderly gastric cancer patients is relatively safe and feasible. Surgeons need to pay special attention to physical status and past medical history than tumor factors for preventing serious postoperative complications in super-elderly gastric cancer patients.

这项研究旨在评估≥85岁超高龄胃癌患者胃切除术的技术安全性和可行性，并明确这些患者术后出现严重并发症的风险因素。2017年至2020年间，日本国家临床数据库对10203例接受远端胃切除术（DG）的患者和2580例接受全胃切除术（TG）的患者进行了回顾性研究。在 DG 中，手术死亡率为 1.6%（162 名患者），术后严重并发症发生率为 7.8%（796 名患者）。同样，TG 的死亡率为 2.6%（67 名患者），严重并发症发生率为 11.3%（292 名患者）。根据多变量分析，体重指数（≥25 kg/m2）、日常生活活动能力（ADL）（部分依赖）、ASA-PS（等级≥3）、呼吸困难、腹水、脑血管病史、血清白蛋白（1.研究结果表明，超高龄胃癌患者胃切除术相对安全可行。研究结果表明，超高龄胃癌患者进行胃切除术相对安全可行，但外科医生需要特别注意超高龄胃癌患者的身体状况和既往病史，而非肿瘤因素，以预防术后严重并发症的发生。

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引用次数: 0

Impact of Endoscopic Surgical Skill Qualification System-certified surgeons as operators in laparoscopic rectal cancer surgery in Japan: A propensity score-matched analysis (subanalysis of the EnSSURE study) 日本腹腔镜直肠癌手术中内镜手术技能资格系统认证外科医生作为操作者的影响：倾向评分匹配分析（EnSSURE 研究的子分析）

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-09 DOI: 10.1002/ags3.12841

Ken Kojo, Takahiro Yamanashi, Shigenori Homma, Manabu Yamamoto, Takuya Miura, Yoshiyuki Ishii, Atsushi Ishibe, Hiroomi Ogawa, Nobuki Ichikawa, Hiroaki Iijima, Masafumi Inomata, Akinobu Taketomi, Takeshi Naitoh, EnSSURE study group collaboratives in Japan Society of Laparoscopic Colorectal Surgery

Background

In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) is used to evaluate surgical skills essential for laparoscopic surgery, but whether surgeons with this certification as operators improve the short-term outcomes and prognosis after rectal cancer surgery is unclear. This cohort study was designed to compare the short-term and long-term outcomes of laparoscopic surgery for advanced rectal cancer performed by an ESSQS-certified surgeon versus a surgeon without ESSQS certification.

Methods

The outcomes of cStage II and III rectal cancer surgery cases performed at 56 Japanese hospitals between 2014 and 2016 were retrospectively reviewed. To examine the impact of ESSQS-certified surgeons as surgeons, the outcomes of cases with only ESSQS-certified surgeons as operators were compared with those without involvement of ESSQS-certified surgeons.

Results

A total of 3197 cases were enrolled, with 1015 in which surgery was performed by ESSQS-certified surgeons, and 544 in which there was no involvement of ESSQS-certified surgeons. After propensity score matching, the ESSQS group had significantly shorter operative time (p < 0.001), a lower conversion rate to open surgery (p < 0.001), and more dissected lymph nodes (p = 0.002).

Conclusion

Laparoscopic rectal surgery performed by ESSQS-certified surgeons was significantly associated with improved short-term outcomes. This demonstrates the utility of the ESSQS certification system.

在日本，内窥镜手术技能资格认证系统（ESSQS）被用于评估腹腔镜手术所必需的手术技能，但获得该认证的外科医生是否能改善直肠癌手术后的短期疗效和预后尚不清楚。这项队列研究旨在比较获得ESSQS认证的外科医生与未获得ESSQS认证的外科医生进行晚期直肠癌腹腔镜手术的短期和长期疗效。为了研究获得ESSQS认证的外科医生作为手术医生的影响，研究人员将仅由获得ESSQS认证的外科医生作为手术医生的病例与没有获得ESSQS认证的外科医生参与手术的病例的结果进行了比较。共纳入3197例病例，其中1015例由获得ESSQS认证的外科医生实施手术，544例没有获得ESSQS认证的外科医生参与手术。经过倾向评分匹配后，ESSQS 组的手术时间明显更短（p < 0.001），转为开放手术的比例更低（p < 0.001），切除的淋巴结更多（p = 0.002）。这证明了ESSQS认证系统的实用性。

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引用次数: 0

Feasibility and predictive factors on the completion of docetaxel plus S-1 adjuvant chemotherapy in pathological stage III gastric cancer 多西他赛+S-1辅助化疗在病理III期胃癌中的可行性及预测因素

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-07-03 DOI: 10.1002/ags3.12840

Masayoshi Terayama, Manabu Ohashi, Kensei Yamaguchi, Daisuke Takahari, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Koshi Kumagai, Takeshi Sano, Souya Nunobe

Background

The standard adjuvant chemotherapy regimen for stage III gastric cancer is docetaxel plus S-1 (DS) based on the results of the START-II trials. However, in clinical practice some patients could not continue this intensive doublet chemotherapy because of limited tolerability. This study aimed to assess the practical feasibility of DS and elucidate the predictive factors for the completion of adjuvant DS therapy.

Methods

Data from consecutive patients who underwent radical gastrectomy between 2018 and 2021 and were diagnosed with histopathologically confirmed stage III gastric cancer were retrospectively collected. First, the completion rate and adverse effects of DS were assessed. Second, the association between DS incompletion and patient backgrounds including body weight, skeletal muscle index (SMI), and intramuscular adipose content (IMAC) were examined.

Results

Of 87 patients, 59 patients (67.8%) completed DS and dose reduction was required in 18 patients (20.6%). Neutropenia of grade 3 or higher was the most common hematological toxicity observed (17.2%). The most frequent nonhematological toxicity of grade 3 or higher was fatigue (6.9%), followed by diarrhea (5.7%), nausea (4.5%), and anorexia (4.5%). In a multivariate analysis, low SMI (p = 0.005) and high IMAC (p = 0.004) were significant risk factors for DS incompletion.

Conclusions

DS adjuvant chemotherapy after radical gastrectomy for pathological stage III gastric cancer is acceptable, even in clinical practice, with respect to completion and toxicity. Additionally, the body composition factors such as SMI and IMAC might be useful in predicting incompletion of DS. These findings will help us to preoperatively select patients for DS.

根据 START-II 试验的结果，III 期胃癌的标准辅助化疗方案是多西他赛联合 S-1（DS）。然而，在临床实践中，由于耐受性有限，一些患者无法继续接受这种高强度的双药化疗。本研究旨在评估DS的实际可行性，并阐明完成DS辅助治疗的预测因素。研究人员回顾性收集了2018年至2021年间接受根治性胃切除术并经组织病理学确诊为III期胃癌的连续患者数据。首先，评估了DS的完成率和不良反应。其次，研究了DS未完成率与患者背景（包括体重、骨骼肌指数（SMI）和肌肉内脂肪含量（IMAC））之间的关联。87名患者中，59名患者（67.8%）完成了DS，18名患者（20.6%）需要减少剂量。3级或以上的中性粒细胞减少是最常见的血液学毒性（17.2%）。最常见的 3 级或以上非血液学毒性是疲劳（6.9%），其次是腹泻（5.7%）、恶心（4.5%）和厌食（4.5%）。在多变量分析中，低SMI（p = 0.005）和高IMAC（p = 0.004）是DS无法完成的重要风险因素。此外，SMI和IMAC等身体成分因素可能有助于预测DS未完成情况。这些发现将有助于我们在术前选择接受 DS 的患者。

{"title":"Feasibility and predictive factors on the completion of docetaxel plus S-1 adjuvant chemotherapy in pathological stage III gastric cancer","authors":"Masayoshi Terayama, Manabu Ohashi, Kensei Yamaguchi, Daisuke Takahari, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Koshi Kumagai, Takeshi Sano, Souya Nunobe","doi":"10.1002/ags3.12840","DOIUrl":"10.1002/ags3.12840","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The standard adjuvant chemotherapy regimen for stage III gastric cancer is docetaxel plus S-1 (DS) based on the results of the START-II trials. However, in clinical practice some patients could not continue this intensive doublet chemotherapy because of limited tolerability. This study aimed to assess the practical feasibility of DS and elucidate the predictive factors for the completion of adjuvant DS therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from consecutive patients who underwent radical gastrectomy between 2018 and 2021 and were diagnosed with histopathologically confirmed stage III gastric cancer were retrospectively collected. First, the completion rate and adverse effects of DS were assessed. Second, the association between DS incompletion and patient backgrounds including body weight, skeletal muscle index (SMI), and intramuscular adipose content (IMAC) were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 87 patients, 59 patients (67.8%) completed DS and dose reduction was required in 18 patients (20.6%). Neutropenia of grade 3 or higher was the most common hematological toxicity observed (17.2%). The most frequent nonhematological toxicity of grade 3 or higher was fatigue (6.9%), followed by diarrhea (5.7%), nausea (4.5%), and anorexia (4.5%). In a multivariate analysis, low SMI (<i>p</i> = 0.005) and high IMAC (<i>p</i> = 0.004) were significant risk factors for DS incompletion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DS adjuvant chemotherapy after radical gastrectomy for pathological stage III gastric cancer is acceptable, even in clinical practice, with respect to completion and toxicity. Additionally, the body composition factors such as SMI and IMAC might be useful in predicting incompletion of DS. These findings will help us to preoperatively select patients for DS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 1","pages":"60-68"},"PeriodicalIF":2.9,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683389","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

Preoperative geniohyoid muscle mass in esophageal cancer patients is associated with swallowing function after esophagectomy 食管癌患者术前的舌根肌肉质量与食管切除术后的吞咽功能有关。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-26 DOI: 10.1002/ags3.12839

Sanshiro Kawata, Yoshihiro Hiramatsu, Junko Honke, Tomohiro Murakami, Eisuke Booka, Tomohiro Matsumoto, Yoshifumi Morita, Hirotoshi Kikuchi, Katsuya Yamauchi, Hiroya Takeuchi

Aim

Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post-esophagectomy swallowing function.

Methods

We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross-sectional areas (cm²) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration–Aspiration Scale (PAS) during video-fluoroscopic swallowing studies performed 7–10 days postoperatively.

Results

The cross-sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p < 0.01: median in males: 3.2 cm², and in females: 2.3 cm²). These values were used to define high and low cross-sectional area groups. The cross-sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, p = 0.03) and cross-sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, p < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, p = 0.03). In the multivariate analysis, low cross-sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, p = 0.03 and odds ratio = 6.6, p = 0.02, respectively).

Conclusion

Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy.

目的：食管切除术后经常会出现吞咽困难。舌根肌参与吞咽动作，但其在食管切除术患者中的意义仍不明确。我们研究了术前舌骨后肌质量与食管切除术后吞咽功能的关系：我们对 114 例因食管恶性肿瘤接受食管切除术和胃导管重建术的患者进行了回顾性分析。我们使用计算机断层扫描评估了术前舌骨后肌矢状横截面积（平方厘米）。每个性别的中位值被视为临界值。在术后7-10天进行的视频荧光吞咽检查中，我们使用吞咽困难量表（PAS）对吞咽困难的严重程度进行了评估：男性的横截面积明显大于女性（3.2 ± 0.7 vs. 2.4 ± 0.5，P 2；女性：2.3 cm2）。这些数值被用来定义高横截面积组和低横截面积组。横截面积与握力（相关系数 (CC) = 0.530）和骨骼肌指数（CC = 0.541）呈正相关。转甲状腺素水平（22.4 ± 6.8 vs. 25.4 ± 5.5，P = 0.03）和横截面积（2.6 ± 0.7 vs. 3.2 ± 0.8，P = 0.03）。在多变量分析中，低横截面积和喉返神经麻痹都是吞咽研究中发生误吸的独立风险因素（几率比分别为 3.6，p = 0.03 和 6.6，p = 0.02）：结论：使用颈部计算机断层扫描评估术前舌骨后肌肉质量可预测食管切除术后的吞咽困难。

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引用次数: 0

Effect of abdominal aortic calcification on long-term outcomes after the first liver resection in very old patients with hepatocellular carcinoma 高龄肝癌患者首次肝切除术后腹主动脉钙化对远期预后的影响。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-22 DOI: 10.1002/ags3.12838

Yosuke Namba, Masahiro Ohira, Yuki Imaoka, Michinori Hamaoka, Masakazu Hashimoto, Takashi Onoe, Daisuke Takei, Koichi Oishi, Megumi Yamaguchi, Tomoyuki Abe, Takeshi Tadokoro, Sotaro Fukuhara, Ko Oshita, Keiso Matsubara, Naruhiko Honmyo, Shintaro Kuroda, Hiroyuki Tahara, Tsuyoshi Kobayashi, Kentaro Ide, Hideki Ohdan

Aim

We previously reported that abdominal aortic calcification is associated with poor overall and recurrence-free survival after hepatectomy for hepatocellular carcinoma (HCC). However, the effect of abdominal aortic calcification on cancer-specific prognosis in very old patients with several comorbidities remains unknown. This multicenter study aimed to evaluate the impact of abdominal aortic calcification on the cumulative recurrence rate and recurrence-free survival in patients with HCC aged >80 years.

Methods

We retrospectively analyzed the data of 128 patients (aged ≥80 years) who underwent liver resection for hepatocellular carcinoma at seven hospitals belonging to Hiroshima Surgical Study Group of Clinical Oncology between January 2014 and December 2018. Patients were divided into two groups: high and low abdominal aortic calcification groups. The primary endpoints were cumulative recurrence rate and recurrence-free survival.

Results

Kaplan–Meier survival curve analysis demonstrated that the cumulative recurrence rate in the high abdominal aortic calcification group was significantly higher than that in the low abdominal aortic calcification group, and the high abdominal aortic calcification group had a significantly lower recurrence-free survival rate. In the multivariate analysis, high abdominal aortic calcification (p = 0.03), high des-gamma-carboxyprothrombin score (p = 0.04), and multiple tumors (p < 0.01) were independent predictive factors for recurrent HCC, and high abdominal aortic calcification (p = 0.01) and high des-gamma-carboxyprothrombin (p = 0.01) were independent predictive factors for poor cancer-specific survival.

Conclusions

Our results indicate that the abdominal aortic calcification score is associated with cumulative recurrence rate and recurrence-free survival in very old patients with HCC.

目的：我们之前报道过腹主动脉钙化与肝细胞癌（HCC）肝切除术后总生存率和无复发生存率差有关。然而，腹主动脉钙化对具有多种合并症的高龄患者癌症特异性预后的影响尚不清楚。本多中心研究旨在评估腹主动脉钙化对bb0 ~ 80岁HCC患者累积复发率和无复发生存率的影响。方法：回顾性分析2014年1月至2018年12月在广岛临床肿瘤外科研究组所属的7家医院接受肝细胞癌切除术的128例患者（年龄≥80岁）的资料。患者分为腹主动脉高、低钙化组。主要终点是累积复发率和无复发生存期。结果：Kaplan-Meier生存曲线分析显示，腹主动脉高钙化组累积复发率显著高于低钙化组，且高钙化组无复发生存率显著低于低钙化组。在多因素分析中，腹主动脉高钙化（p = 0.03）、高des-羧基凝血酶原评分（p = 0.04）、多发性肿瘤（p = 0.01）和高des-羧基凝血酶原评分（p = 0.01）是癌症特异性生存率差的独立预测因素。结论：我们的研究结果表明，腹主动脉钙化评分与高龄HCC患者的累积复发率和无复发生存率相关。

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引用次数: 0

Essential updates 2022/2023: A review of current topics in robotic hepatectomy 2022/2023 年基本更新：机器人肝切除术当前主题回顾。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-21 DOI: 10.1002/ags3.12817

Tomohiko Adachi, Takanobu Hara, Hajime Matsushima, Akihiko Soyama, Susumu Eguchi

The liver requires careful handling intra-operatively owing to its vital functions and complexity. Traditional open hepatectomy, while standard, is invasive and requires long recovery periods. Laparoscopic hepatectomy is a less invasive option, with its own challenges. The rise of robotic surgery, such as the da Vinci® system, improves precision and control, addressing the limitations of conventional methods, but brings new concerns, such as costs and training. This review focuses on the latest advancements in robotic hepatectomy from 2022/23 articles, delving into topics like “robotic surgery in liver transplantation,” “robotic hepatectomy for hilar cholangiocarcinoma,” “robotic vascular reconstruction following hepatectomy,” “robotic repeat hepatectomy,” and “prospective trials in robotic hepatectomy.” To retrieve articles, a focused literature search was conducted using PubMed for articles from 2022/23 with a 5-year filter, excluding reviews. Initially, abstracts were screened, and relevant articles on robotic surgery were examined in full for inclusion in this review. Although all the above items are cutting-edge, and many of the references are necessarily at the level of case reports, recent articles are still accompanied by surgical videos, which are useful to readers, especially surgeons who are considering imitating the procedures. In summary, we examined the recent advancements in robotic liver resection. The inclusion of videos that present new techniques aids in knowledge transfer. We anticipate the continued growth of this field of research.

由于肝脏的重要功能和复杂性，术中需要小心处理。传统的开腹肝切除术虽然标准，但创伤大，恢复期长。腹腔镜肝切除术是一种创伤较小的选择，但也有其自身的挑战。达芬奇®系统等机器人手术的兴起提高了手术的精确度和控制能力，解决了传统方法的局限性，但也带来了新的问题，如成本和培训。本综述重点关注2022/23篇文章中机器人肝切除术的最新进展，深入探讨 "肝移植中的机器人手术"、"机器人肝切除术治疗肝门胆管癌"、"肝切除术后的机器人血管重建"、"机器人重复肝切除术 "和 "机器人肝切除术的前瞻性试验 "等主题。为了检索文章，我们使用 PubMed 对 2022/23 年以来的文章进行了重点文献检索，并进行了 5 年筛选，但不包括综述。首先对摘要进行筛选，然后对机器人手术的相关文章进行全文检索，以纳入本综述。虽然上述所有项目都是前沿项目，而且许多参考文献必然是病例报告级别的，但近期的文章仍附有手术视频，这对读者，尤其是考虑模仿手术的外科医生很有帮助。总之，我们研究了机器人肝脏切除术的最新进展。加入介绍新技术的视频有助于知识的传播。我们期待着这一研究领域的持续发展。

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引用次数: 0

Modified oral antibiotics and mechanical bowel preparation (OAMBP) versus conventional OAMBP for sigmoid colon and rectal surgery: A multicenter randomized non-inferiority trial 乙状结肠和直肠手术中的改良口服抗生素和机械肠道准备（OAMBP）与传统 OAMBP：多中心随机非劣效性试验。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-20 DOI: 10.1002/ags3.12837

Sodai Arai, Marie Hanaoka, Shinichi Yamauchi, Hironobu Baba, Ryoichi Hanazawa, Hiroyuki Sato, Akihiro Hirakawa, Masanori Tokunaga, Yusuke Kinugasa

Aim

To evaluate whether the use of a laxative with reduced patient burden in oral antibiotics and mechanical bowel preparation (OAMBP) could prevent surgical site infection (SSI) in left-sided colon and rectal cancers.

Methods

This multicenter, non-blinded, randomized, non-inferiority trial included patients who underwent elective colorectal surgery for colorectal cancer in a university and community hospital in Japan from April 1, 2021 to March 31, 2023. We compared conventional OAMBP (polyethylene glycol, metronidazole, and kanamycin) (cOAMBP group) with modified OAMBP (sodium picosulfate hydrate, metronidazole, and kanamycin) (mOAMBP group). The primary outcome was overall incidence of SSI. Secondary outcomes were postoperative complications, degree of patient burden, and intraoperative bowel dilatation.

Results

Among 119 patients, 112 were randomly assigned to the two groups, with 56 patients in each group. SSI occurred in three (5.4%) and five patients (8.3%) in the mOAMBP and cOAMBP groups, respectively (90% confidence interval [CI]: −12.8–5.3), with a 15% margin of non-inferiority. Anastomotic leakage occurred in no patient in the mOAMBP group and three patients (5.4%) in the cOAMBP group (p = 0.24). The cOAMBP group reported significantly more pain than the mOAMBP group (50 [90.9%] vs. 7 [12.5%] participants). The mOAMBP group showed significantly lesser bowel dilatation than the cOAMBP group (1 [1.8%] vs. 21 [37.5%] participants).

Conclusion

mOAMBP is safe and less burdensome, can reduce intraoperative bowel dilatation, and is non-inferior compared with cOAMBP in preventing SSI. Therefore, mOAMBP may be more suitable for sigmoid colon and rectal cancer.

Trial Registration

UMIN000043162 (http://www.umin.ac.jp/ctr/). Registered on January 28, 2021.

目的：评估在口服抗生素和机械肠道准备（OAMBP）中使用可减轻患者负担的泻药能否预防左侧结肠癌和直肠癌手术部位感染（SSI）：这项多中心、非盲、随机、非劣效试验纳入了 2021 年 4 月 1 日至 2023 年 3 月 31 日期间在日本一所大学和社区医院接受结直肠癌择期手术的患者。我们比较了传统 OAMBP（聚乙二醇、甲硝唑和卡那霉素）（cOAMBP 组）和改良 OAMBP（皮磷酸钠水合物、甲硝唑和卡那霉素）（mOAMBP 组）。主要结果是 SSI 的总发生率。次要结果是术后并发症、患者负担程度和术中肠管扩张：在 119 名患者中，112 人被随机分配到两组，每组 56 人。mOAMBP组和cOAMBP组分别有3名（5.4%）和5名（8.3%）患者发生SSI（90%置信区间[CI]：-12.8-5.3），非劣效差为15%。mOAMBP 组无患者发生吻合口漏，cOAMBP 组有 3 名患者（5.4%）发生吻合口漏（p = 0.24）。cOAMBP 组报告的疼痛明显多于 mOAMBP 组（50 [90.9%] 对 7 [12.5%]）。结论：mOAMBP 安全且负担较轻，可减少术中肠管扩张，在预防 SSI 方面与 cOAMBP 相比并无劣势。因此，mOAMBP 可能更适合乙状结肠和直肠癌：umin000043162 (http://www.umin.ac.jp/ctr/)。注册日期：2021 年 1 月 28 日。

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引用次数: 0

Patterns of venous collateral development after splenic vein occlusion associated with surgical and oncological outcomes after distal pancreatectomy 脾静脉闭塞后静脉侧支发展模式与胰腺远端切除术后的手术和肿瘤预后相关。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-17 DOI: 10.1002/ags3.12830

Keishi Sugimachi, Tomonari Shimagaki, Takahiro Tomino, Emi Onishi, Yohei Mano, Tomohiro Iguchi, Masahiko Sugiyama, Yasue Kimura, Masaru Morita, Yasushi Toh

Aims

Splenic vein occlusion (SpVO) due to a pancreatic tumor may result in the development of collateral circulation and left-sided portal hypertension. This study aimed to investigate the impact of SpVO on distal pancreatectomy (DP) and provide insights about the management of such cases.

Methods

This retrospective analysis included 124 patients who underwent DP from 2014 to 2022. A subgroup analysis was performed on 88 patients who underwent DP for pancreatic ductal adenocarcinoma (PDAC).

Results

SpVO was found in 26 (20.8%) patients. The patients with SpVO had significantly larger splenic volumes and lower platelet counts. Compared to the patients with patent splenic veins (SpVs), the patients with SpVO underwent significantly longer operations (p = 0.006), with a higher incidence of postoperative complications (p = 0.002). We classified the collateral routes associated with SpVO into five patterns. The most common pattern was the left gastroepiploic vein type, which was associated with a tumor of the pancreatic body. In patients with PDAC, SpVO was associated with larger tumors, microscopic vascular permeation, and peritoneal recurrence. However, the differences between overall and recurrence-free survival rates in the patients with SpVO vs those with patent SpVs were not significant.

Conclusions

SpVO causes left-sided portal hypertension, which can be a risk for perioperative complications in DP. Operative planning based on the classification of collateral flow patterns may help prevent intraoperative congestion and perioperative complications.

目的：胰腺肿瘤引起的脾静脉闭塞（SpVO）可能导致侧支循环和左侧门静脉高压。本研究旨在探讨脾静脉闭塞对胰腺远端切除术（DP）的影响，并为此类病例的治疗提供见解：这项回顾性分析纳入了2014年至2022年期间接受胰腺切除术的124例患者。对88例因胰腺导管腺癌（PDAC）接受胰腺切除术的患者进行了亚组分析：26例（20.8%）患者发现了SpVO。SpVO患者的脾脏体积明显增大，血小板计数明显降低。与脾静脉（SpVs）通畅的患者相比，SpVO患者的手术时间明显更长（P = 0.006），术后并发症的发生率更高（P = 0.002）。我们将与 SpVO 相关的侧支途径分为五种模式。最常见的模式是左胃十二指肠静脉型，这与胰腺体肿瘤有关。在 PDAC 患者中，SpVO 与肿瘤较大、微血管渗透和腹膜复发有关。然而，SpVO患者与SpV通畅患者的总生存率和无复发生存率之间的差异并不显著：结论：SpVO 会导致左侧门静脉高压，可能成为 DP 围手术期并发症的风险因素。结论：SpVO 会导致左侧门静脉高压，可能成为 DP 围手术期并发症的风险因素。根据侧支血流模式分类制定手术计划有助于防止术中充血和围手术期并发症。

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引用次数: 0

Incidence, mortality, survival, and treatment statistics of cancers in digestive organs—Japanese cancer statistics 2024 消化器官癌症的发病率、死亡率、存活率和治疗统计--2024 年日本癌症统计。

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery

Pub Date : 2024-06-17 DOI: 10.1002/ags3.12835

Takahiro Higashi, Yukinori Kurokawa

Access to accurate statistical data is paramount in the pursuit of effective cancer control activities, including research, policy development, and clinical care. This paper presents a comprehensive statistical report on the incidence, mortality, survival, and treatment of major digestive organ cancers, including those of the esophagus, stomach, colon, rectum, liver, extrahepatic biliary tract, and pancreas, in Japan. We compiled data from the National Cancer Center's “Cancer Information Services” and government “e-Stat” websites and offered a succinct overview of basic statistics by using tables and graphical presentations. Our findings underscore the critical role of the National Cancer Registry introduced by the Cancer Registry Act of 2016, which mandates hospitals across Japan to report cancer cases. This system ensures more accurate incidence statistics. Mortality data sourced from the National Vital Statistics System and survival rates derived from hospital-based cancer registries offer insights into the outcomes and efficacy of treatment modalities. These data indicate a downward trend in mortality for stomach and liver cancers and stable or declining rates for other cancers except pancreatic cancer, which has the lowest survival rate. Treatment patterns indicate an increase in endoscopic procedures for esophageal and stomach cancers, with stable treatment approaches for colorectal cancer. This statistical overview aims to improve the understanding and inform research, policy, and clinical decisions in the field of digestive organ cancers.

获取准确的统计数据对于开展有效的癌症控制活动（包括研究、政策制定和临床治疗）至关重要。本文介绍了日本主要消化器官癌症（包括食道癌、胃癌、结肠癌、直肠癌、肝癌、肝外胆道癌和胰腺癌）的发病率、死亡率、存活率和治疗情况的综合统计报告。我们从国立癌症中心的 "癌症信息服务 "和政府的 "e-Stat "网站上收集了数据，并通过表格和图表的形式简明扼要地概述了基本统计数据。我们的研究结果强调了 2016 年《癌症登记法》引入的国家癌症登记系统的关键作用，该系统要求日本全国的医院报告癌症病例。该系统确保了更准确的发病率统计数据。国家生命统计系统提供的死亡率数据和医院癌症登记处提供的存活率有助于了解治疗方法的结果和疗效。这些数据表明，胃癌和肝癌的死亡率呈下降趋势，除存活率最低的胰腺癌外，其他癌症的死亡率稳定或下降。治疗模式表明，食管癌和胃癌的内窥镜手术有所增加，结直肠癌的治疗方法保持稳定。本统计综述旨在加深人们对消化器官癌症的了解，并为研究、政策和临床决策提供参考。

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引用次数: 0