Annals of Gastroenterological Surgery最新文献

Pelvic exenteration (PE) is a radical and extreme surgical procedure for en bloc removal of pelvic organs and tissues contiguously involved by cancer. PE has long been the mainstay, and often the only option to potentially provide cure, or long term control, in the management of patients with locally advanced and recurrent abdomino-pelvic malignancies. The concept focusses on attaining an R0 cancer resection margin (most commonly defined as ≥ 1 mm), by surgically removing margin-involved or margin-threatened organs and structures, as this is consistently demonstrated as the most important predictor of outcome [1]. Naturally, however, such radicality comes with significant risks of complications; of loss of function and quality of life; as well as substantial healthcare resource utilisation and health economic impact. Consequently, the deployment of PE as a surgical solution has in the past been correctly cautious, but at times also overly pessimistic, informed by historically poor outcomes.

In more recent times, the PE landscape has undergone a paradigm shift. Incremental developments in multiple disciplines have helped pave the way for substantially improved outcomes in carefully selected patients. These include but are not limited to advances in diagnostic radiology; oncology; anaesthesia and peri-operative medicine; intensive care; surgical devices and techniques; understanding of the pelvic anatomy; management and control of haemorrhage; reconstructive options; and interventional radiology [2]. As a result, the field of PE has evolved, with broadening indications and applications, and greater radicality, manifested by the fact that pelvic bones are increasingly resected as one of the most outermost tissues in a margin of concern, and reflecting the “higher and wider” approaches achievable [3].

The increasing application of PE has also emphasised some of the glaring unmet needs in the field. Examples of these are highlighted below but are not exhaustive. A lack of standardisation and differing protocols in MRI imaging techniques is one such unmet need. Poorly designed multidisciplinary team (MDT) models for the discussion of some of the most complex and heavily pre-treated patients an MDT may receive is another such unmet need. A further concern has been in the use of surgical terminology. Contemporary PE represents an umbrella term that in the modern era encompasses a diversity of resections, and to date a confusing array of terminology has been used to describe the different surgical interventions possible. Pathological handling of specimens, for example the method of specimen orientation and marking, the number of sections taken, and management of specimens with bone, is a further area of unmet need requiring a standardisation of reporting and minimum pathological datasets. Nevertheless to date no formal international system has been described. Importantly, as a result of the lack

Patent ductus venosus is a congenital portosystemic shunt that may cause progressive portal hypertension, hepatic encephalopathy, and focal nodular hyperplasia of the liver. Embolization of the Arantius' duct is the first choice of treatment in infants and children. However, it carries the risk of coil migration into the systemic circulation in adult patients with larger Arantius ducts. Additionally, the primary closure of the Arantius' duct may result in acute portal hypertension. Herein, we present a two-stage treatment for adult patent large ductus venosus (Arantius' duct). A 23-year-old female patient with hypoalbuminemia showed a patent large Arantius' duct (diameter = 45 mm), intrahepatic portal venous hypoplasia, and multiple hepatic nodules with dynamic computed tomography (CT). Preoperative angiography showed the absence of the intrahepatic portal vein, and tentative occlusion of the Arantius' duct increased the portal pressure from 9 to 15 mmHg with visualization of only a few portal branches. Therefore, we conducted a two-stage treatment for the Arantius' duct. In the first stage, we used an open approach to perform angioplasty of the Arantius' duct to reduce the size from 45 to 8 mm in diameter, which gradually increased the intrahepatic portal blood flow in the follow-up CT scan. The second-stage embolization of the Arantius' duct was performed using an interventional procedure via the internal jugular vein 4 months after the first stage. The patient's recovery was uneventful, and post-treatment CT showed increased intrahepatic portal flow. Serum albumin value increased from 2.7 to 3.7 g/dL 2 weeks post-treatment.

Gastric cancer remains a major global health burden, especially in East Asia. Recent years have brought significant advances in multimodal management, including surgery, perioperative chemotherapy, immunotherapy, and supportive care. This review summarizes key updates from 2023 to 2024, focusing on surgical innovations, perioperative systemic therapy, treatment strategies for stage IV disease, and nutritional interventions. In early and locally advanced disease, laparoscopic and robotic gastrectomy have become widely accepted in Asia, supported by large, randomized trials such as JCOG0912 and KLASS-02. Perioperative chemotherapy has become a global standard, with the FLOT regimen leading in the West and SOX, XELOX, or DOS emerging in Asia. Immunotherapy is increasingly incorporated into perioperative settings, with trials like KEYNOTE-585 and NEONIPIGA suggesting potential benefit in selected patients. For stage IV gastric cancer, systemic chemotherapy remains the mainstay, but conversion surgery and treatment of oligometastasis have shown promising results in selected cases. Trials such as JCOG1704 and AIO-FLOT5 are investigating optimal strategies. Perioperative nutrition has also gained attention, with oral nutritional supplements, ERAS protocols, and digital tools like continuous glucose monitoring (CGM) and AI-driven platforms enhancing outcomes. Looking ahead, integration of molecular biomarkers (e.g., HER2, PD-L1, MSI, ctDNA), precise staging, and multidisciplinary collaboration will be essential for personalized treatment. Ongoing trials and international cooperation are expected to further refine evidence-based approaches to gastric cancer care.