The clinical characteristics of colonic diverticular perforation are poorly understood. We aimed to clarify the clinical characteristics of colonic diverticular perforation.
Methods
Patients who underwent surgery for colonic diverticular perforation from 2011 to 2021 were retrospectively evaluated. The patients were divided into right- and left-sided colon cohorts according to their perforation location.
Results
Of 1129 patients with gastrointestinal perforation, 138 had colonic diverticular perforation. The sigmoid colon was the most common perforation site. The patients were categorized into right-sided (20 patients) and left-sided (118 patients) colon cohorts. The number of patients with colonic diverticular perforation increased with age, as did the proportion of left-sided perforations. The left-sided cohort had significantly higher mean age, hemoglobin, and serum albumin levels than the right-sided cohort. The blood urea nitrogen and serum creatinine levels were significantly lower in the right-sided cohort. The proportion of patients with colostomy, the proportion of patients with postoperative complications, and the length of intensive care unit stay during hospitalization were significantly longer in the left-sided cohort. The left-sided cohort also had a considerably longer mean hospital stay and higher mean hospitalization costs than the right-sided colon cohort. An age of ≥ 75 years tended to be associated with a prolonged hospital stay and high hospitalization costs in the left-sided colon cohort.
Conclusions
The patients' conditions, length of hospital stay, and hospitalization costs were significantly worse in the left- than right-sided colon cohort. The clinical characteristics differed according to the location of the diverticular perforation.
{"title":"Clinical and Economic Insights Into Surgery for Colonic Diverticular Perforation: A Long-Term Observational Cohort Study","authors":"Minoru Fujita, Noriaki Manabe, Munenori Takaoka, Masaharu Higashida, Hideo Matsumoto, Atsushi Urakami, Tomoki Yamatsuji, Tomio Ueno, Jiro Hata, Ken Haruma, Collaborators","doi":"10.1002/ags3.70033","DOIUrl":"https://doi.org/10.1002/ags3.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The clinical characteristics of colonic diverticular perforation are poorly understood. We aimed to clarify the clinical characteristics of colonic diverticular perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent surgery for colonic diverticular perforation from 2011 to 2021 were retrospectively evaluated. The patients were divided into right- and left-sided colon cohorts according to their perforation location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1129 patients with gastrointestinal perforation, 138 had colonic diverticular perforation. The sigmoid colon was the most common perforation site. The patients were categorized into right-sided (20 patients) and left-sided (118 patients) colon cohorts. The number of patients with colonic diverticular perforation increased with age, as did the proportion of left-sided perforations. The left-sided cohort had significantly higher mean age, hemoglobin, and serum albumin levels than the right-sided cohort. The blood urea nitrogen and serum creatinine levels were significantly lower in the right-sided cohort. The proportion of patients with colostomy, the proportion of patients with postoperative complications, and the length of intensive care unit stay during hospitalization were significantly longer in the left-sided cohort. The left-sided cohort also had a considerably longer mean hospital stay and higher mean hospitalization costs than the right-sided colon cohort. An age of ≥ 75 years tended to be associated with a prolonged hospital stay and high hospitalization costs in the left-sided colon cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The patients' conditions, length of hospital stay, and hospitalization costs were significantly worse in the left- than right-sided colon cohort. The clinical characteristics differed according to the location of the diverticular perforation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1036-1046"},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012826","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}
Mamoru Uemura, Jun Watanabe, Akio Shiomi, Takashi Akiyoshi, George J. Chang, Yukihide Kanemitsu, Ichiro Takemasa, Yoshiharu Sakai, Masahiko Watanabe, Itaru Endo
Lateral lymph node dissection (LLND) is recognized as an effective treatment for reducing local recurrence in patients with locally advanced lower rectal cancer. However, the lack of standardization in techniques and anatomical landmarks remains a concern, as it may complicate the assessment of treatment efficacy. To address this, the Japan Society of Gastroenterological Surgery (JSGS) held a consensus meeting during the 77th General Meeting of the JSGS to standardize LLND techniques. In this meeting, essential anatomical landmarks for LLND were confirmed. The primary regions targeted for dissection include lymph nodes in the obturator region (designated as station 283) and those in the internal iliac region (designated as station 263). The medial boundary of LLND is defined by the uretero-hypogastric fascia, whereas the vesico-hypogastric fascia constitutes the central plane of dissection and serves as the medial boundary of station 283. Indicators of successful LLND completion include exposure of the sciatic nerve (lumbosacral trunk) at the bottom of the dissection, as well as exposure of the inferior vesical vessels, internal pudendal artery, and coccygeus muscle, confirming the thoroughness of the caudal part of the dissection. The consensus reached in this meeting, along with findings from several published reports cited in this report, is expected to contribute to the standardization of LLND quality.
{"title":"Surgical Procedure of Lateral Lymph Node Dissection for Advanced Lower Rectal Cancer","authors":"Mamoru Uemura, Jun Watanabe, Akio Shiomi, Takashi Akiyoshi, George J. Chang, Yukihide Kanemitsu, Ichiro Takemasa, Yoshiharu Sakai, Masahiko Watanabe, Itaru Endo","doi":"10.1002/ags3.70039","DOIUrl":"https://doi.org/10.1002/ags3.70039","url":null,"abstract":"<p>Lateral lymph node dissection (LLND) is recognized as an effective treatment for reducing local recurrence in patients with locally advanced lower rectal cancer. However, the lack of standardization in techniques and anatomical landmarks remains a concern, as it may complicate the assessment of treatment efficacy. To address this, the Japan Society of Gastroenterological Surgery (JSGS) held a consensus meeting during the 77th General Meeting of the JSGS to standardize LLND techniques. In this meeting, essential anatomical landmarks for LLND were confirmed. The primary regions targeted for dissection include lymph nodes in the obturator region (designated as station 283) and those in the internal iliac region (designated as station 263). The medial boundary of LLND is defined by the uretero-hypogastric fascia, whereas the vesico-hypogastric fascia constitutes the central plane of dissection and serves as the medial boundary of station 283. Indicators of successful LLND completion include exposure of the sciatic nerve (lumbosacral trunk) at the bottom of the dissection, as well as exposure of the inferior vesical vessels, internal pudendal artery, and coccygeus muscle, confirming the thoroughness of the caudal part of the dissection. The consensus reached in this meeting, along with findings from several published reports cited in this report, is expected to contribute to the standardization of LLND quality.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1112-1118"},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436059","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}
Preoperative chemotherapy with cisplatin, fluorouracil, and docetaxel (DCF) is one of the neoadjuvant treatments for locally advanced esophageal squamous cell carcinoma (ESCC). However, the optimal number of DCF cycles remains unknown. This multi-institutional, randomized, phase II trial aimed to investigate the long-term survival outcomes of two versus three courses of DCF.
Methods
A total of 180 patients with locally advanced ESCC from six institutions were randomly assigned to receive either two (N = 91) or three (N = 89) courses of DCF administered every 3 weeks prior to surgery. Long-term survival outcomes were compared between the two regimens.
Results
Baseline characteristics were well balanced between the two groups. The 5-year overall survival (OS) and progression-free survival (PFS) rates for the three and two course groups were 70.7% vs. 63.8% (hazard ratio (HR) = 0.91, p = 0.717) and 63.3% vs. 60.0% (HR = 0.94, p = 0.810) respectively, with no significant differences observed. The per-protocol analysis exhibited similar results, with OS rates of 71.1% vs. 68.8% (HR = 0.90, p = 0.702) and PFS rates of 63.6% vs. 65.4% (HR = 0.92, p = 0.773). Recurrence patterns were also similar between the groups. Subgroup analysis revealed that non-responders in the three course DCF group had significantly worse long-term survival outcomes, whereas the two course DCF group exhibited minimal trends in this regard. Conversely, patients aged < 65 years or those with favorable clinical responses in the three course group demonstrated improved long-term survival outcomes.
Conclusion
Two courses of preoperative DCF followed by radical esophagectomy can be one of the potential treatment strategies for locally advanced ESCC.
Trial Registration
ClinicalTrials.gov identifier: UMIN 000015788.
背景术前顺铂、氟尿嘧啶、多西紫杉醇化疗（DCF）是局部晚期食管鳞状细胞癌（ESCC）的新辅助治疗方法之一。然而，DCF循环的最佳次数仍然未知。这项多机构、随机、II期试验旨在调查2个疗程与3个疗程DCF的长期生存结果。方法选择来自6所医院的180例局部晚期ESCC患者，随机分为2个疗程（N = 91）和3个疗程（N = 89），每3周进行一次DCF治疗。比较两种方案的长期生存结果。结果两组患者基线特征平衡良好。三个疗程组和两个疗程组的5年总生存率（OS）和无进展生存率（PFS）分别为70.7% vs. 63.8%（风险比(HR) = 0.91, p = 0.717）和63.3% vs. 60.0% (HR = 0.94, p = 0.810)，差异无统计学意义。每个方案分析显示类似的结果，OS率为71.1%比68.8% (HR = 0.90, p = 0.702)， PFS率为63.6%比65.4% （HR = 0.92, p = 0.773）。两组之间的复发模式也相似。亚组分析显示，三疗程DCF组无反应者的长期生存结果明显较差，而两疗程DCF组在这方面表现出最小的趋势。相反，65岁的患者或在三个疗程组中有良好临床反应的患者表现出改善的长期生存结果。结论术前两疗程DCF加根治性食管切除术是局部晚期ESCC的治疗策略之一。试验注册ClinicalTrials.gov标识符：UMIN 000015788。
{"title":"Long-Term Survival of Two Versus Three Courses of Preoperative Cisplatin and Fluorouracil Plus Docetaxel for Locally Advanced Esophageal Cancer: A Multicenter Randomized Phase II Trial","authors":"Takahito Sugase, Hiroshi Miyata, Takashi Kanemura, Norihiro Matsuura, Tomoki Makino, Makoto Yamasaki, Koji Tanaka, Kotaro Yamashita, Kota Momose, Osamu Shiraishi, Keijiro Sugimura, Masaaki Motoori, Kazumasa Fujitani, Atsushi Takeno, Motohiro Hirao, Yutaka Kimura, Taroh Satoh, Masahiko Yano, Yuichiro Doki, Takushi Yasuda","doi":"10.1002/ags3.70036","DOIUrl":"https://doi.org/10.1002/ags3.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preoperative chemotherapy with cisplatin, fluorouracil, and docetaxel (DCF) is one of the neoadjuvant treatments for locally advanced esophageal squamous cell carcinoma (ESCC). However, the optimal number of DCF cycles remains unknown. This multi-institutional, randomized, phase II trial aimed to investigate the long-term survival outcomes of two versus three courses of DCF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 180 patients with locally advanced ESCC from six institutions were randomly assigned to receive either two (<i>N</i> = 91) or three (<i>N</i> = 89) courses of DCF administered every 3 weeks prior to surgery. Long-term survival outcomes were compared between the two regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were well balanced between the two groups. The 5-year overall survival (OS) and progression-free survival (PFS) rates for the three and two course groups were 70.7% vs. 63.8% (hazard ratio (HR) = 0.91, <i>p</i> = 0.717) and 63.3% vs. 60.0% (HR = 0.94, <i>p</i> = 0.810) respectively, with no significant differences observed. The per-protocol analysis exhibited similar results, with OS rates of 71.1% vs. 68.8% (HR = 0.90, <i>p</i> = 0.702) and PFS rates of 63.6% vs. 65.4% (HR = 0.92, <i>p</i> = 0.773). Recurrence patterns were also similar between the groups. Subgroup analysis revealed that non-responders in the three course DCF group had significantly worse long-term survival outcomes, whereas the two course DCF group exhibited minimal trends in this regard. Conversely, patients aged < 65 years or those with favorable clinical responses in the three course group demonstrated improved long-term survival outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Two courses of preoperative DCF followed by radical esophagectomy can be one of the potential treatment strategies for locally advanced ESCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: UMIN 000015788.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1144-1154"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436025","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}
Yuji Takakura, Katsunori Shinozaki, Satoshi Ikeda, Hiroyuki Egi, Yuzo Hirata, Manabu Shimomura, Takafumi Oshiro, Takao Hinoi, Daisuke Sumitani, Masahiro Nakahara, Masanori Yoshimitsu, Naruhiko Honmyo, Tsuyoshi Kobayashi, Junko Tanaka, Hideki Ohdan, the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO)
Aim
NCCN and ESMO guidelines recommend up to 6 months of perioperative oxaliplatin-based chemotherapy for patients with resectable colorectal liver metastases (CRLM). However, the optimal sequencing and chemotherapy regimen remain unclear.
Methods
We conducted a randomized phase II trial, HiSCO-01, to compare the outcomes of preoperative (Preop-group) and postoperative chemotherapy (Postop-group) with eight cycles of CAPOX plus bevacizumab (CAPOX-Bev) in patients with resectable CRLM. The primary endpoint was the treatment compliance rate (TCR), defined as the percentage of patients who received at least six cycles of CAPOX-Bev and underwent R0 resection.
Results
Of the 81 patients enrolled, 76 patients were eligible. TCR was 89.2% in Preop-group and 71.8% in Postop-group (p = 0.06). The overall incidence of chemotherapy-related Grade 3 or higher adverse events was similar between the two groups. The postoperative complication rate was comparable except that biliary fistula developed significantly higher in Postop-group. The 3-year progression-free survival and 5-year overall survival rates were 32.2% and 60.5% in Preop-group, respectively, and 38.5% and 57.2% in Postop-group, respectively.
Conclusion
Both preoperative and postoperative CAPOX-Bev were safely administered, and preoperative chemotherapy showed numerically higher TCR than postoperative chemotherapy. This multimodal approach is highly promising for treating resectable CRLM.
{"title":"Preoperative Versus Postoperative Chemotherapy With CAPOX Plus Bevacizumab for Resectable Colorectal Liver Metastases: A Randomized Phase II Trial (HiSCO-01)","authors":"Yuji Takakura, Katsunori Shinozaki, Satoshi Ikeda, Hiroyuki Egi, Yuzo Hirata, Manabu Shimomura, Takafumi Oshiro, Takao Hinoi, Daisuke Sumitani, Masahiro Nakahara, Masanori Yoshimitsu, Naruhiko Honmyo, Tsuyoshi Kobayashi, Junko Tanaka, Hideki Ohdan, the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO)","doi":"10.1002/ags3.70035","DOIUrl":"https://doi.org/10.1002/ags3.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>NCCN and ESMO guidelines recommend up to 6 months of perioperative oxaliplatin-based chemotherapy for patients with resectable colorectal liver metastases (CRLM). However, the optimal sequencing and chemotherapy regimen remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a randomized phase II trial, HiSCO-01, to compare the outcomes of preoperative (Preop-group) and postoperative chemotherapy (Postop-group) with eight cycles of CAPOX plus bevacizumab (CAPOX-Bev) in patients with resectable CRLM. The primary endpoint was the treatment compliance rate (TCR), defined as the percentage of patients who received at least six cycles of CAPOX-Bev and underwent R0 resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 81 patients enrolled, 76 patients were eligible. TCR was 89.2% in Preop-group and 71.8% in Postop-group (<i>p</i> = 0.06). The overall incidence of chemotherapy-related Grade 3 or higher adverse events was similar between the two groups. The postoperative complication rate was comparable except that biliary fistula developed significantly higher in Postop-group. The 3-year progression-free survival and 5-year overall survival rates were 32.2% and 60.5% in Preop-group, respectively, and 38.5% and 57.2% in Postop-group, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both preoperative and postoperative CAPOX-Bev were safely administered, and preoperative chemotherapy showed numerically higher TCR than postoperative chemotherapy. This multimodal approach is highly promising for treating resectable CRLM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN Clinical Trial Registry: UMIN000003783</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1253-1262"},"PeriodicalIF":3.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436297","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 incidence of upper-third gastric cancer is rising, necessitating proximal gastrectomy or total gastrectomy in most patients. However, surgical removal of the fornix, a major site for ghrelin secretion, often results in reduced appetite and weight loss post-surgery. To address this issue, we devised a resection approach aimed at preserving ghrelin secretory sites. Here, we introduce a novel technique for treating upper-third gastric cancer near the esophagogastric junction: super subtotal gastrectomy (SSTG). During distal gastrectomy assisted by robotics, lymph node dissection was performed. Endoscopic confirmation of the tumor site guided the design of the gastrectomy line. Using a linear stapler, the stomach was dissected from the greater curvature fold to the angle of His. The specimen was then extracted through a precise incision from the angle of His to the right side of the esophagus, partially resecting the esophagogastric junction. Suturing of the open lumens of the esophagus and stomach was performed to repair the remaining stomach. Closure of the diaphragmatic crus prevented esophageal hiatal hernia. Reconstruction was achieved through Roux-en-Y reconstruction. SSTG offers the advantage of maintaining an oral margin beyond the esophageal junction while preserving the fornix. In the SSTG group, the median operative time was 333 min (range: 257–354), with a blood loss of 79.5 mL (range: 20–141). No serious intraoperative complications were observed. Our proposed SSTG technique enables the preservation of the fornix even in cases of upper-third gastric cancer located closer to the esophagogastric junction than was previously possible.
{"title":"Super Subtotal Gastrectomy: A Novel Reconstruction Concept for Upper Gastric Cancer That Preserves the Fornix","authors":"Kohei Fujita, Hiroyuki Sagawa, Sunao Ito, Ryo Ogawa, Shuji Takiguchi","doi":"10.1002/ags3.70030","DOIUrl":"https://doi.org/10.1002/ags3.70030","url":null,"abstract":"<p>The incidence of upper-third gastric cancer is rising, necessitating proximal gastrectomy or total gastrectomy in most patients. However, surgical removal of the fornix, a major site for ghrelin secretion, often results in reduced appetite and weight loss post-surgery. To address this issue, we devised a resection approach aimed at preserving ghrelin secretory sites. Here, we introduce a novel technique for treating upper-third gastric cancer near the esophagogastric junction: super subtotal gastrectomy (SSTG). During distal gastrectomy assisted by robotics, lymph node dissection was performed. Endoscopic confirmation of the tumor site guided the design of the gastrectomy line. Using a linear stapler, the stomach was dissected from the greater curvature fold to the angle of His. The specimen was then extracted through a precise incision from the angle of His to the right side of the esophagus, partially resecting the esophagogastric junction. Suturing of the open lumens of the esophagus and stomach was performed to repair the remaining stomach. Closure of the diaphragmatic crus prevented esophageal hiatal hernia. Reconstruction was achieved through Roux-en-Y reconstruction. SSTG offers the advantage of maintaining an oral margin beyond the esophageal junction while preserving the fornix. In the SSTG group, the median operative time was 333 min (range: 257–354), with a blood loss of 79.5 mL (range: 20–141). No serious intraoperative complications were observed. Our proposed SSTG technique enables the preservation of the fornix even in cases of upper-third gastric cancer located closer to the esophagogastric junction than was previously possible.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"870-875"},"PeriodicalIF":2.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520112","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}
Anal fistula is a chronic condition characterized by an abnormal tract between the anal canal and perianal skin, often leading to infection, inflammation, and impaired quality of life. Incision-thread-drawing surgery is the main treatment for anal fistula. However, the risk of poor postoperative healing remains significant. This study investigates the prognostic value of preoperative serum insulin-like growth factor-1 (IGF-1) levels in predicting wound healing after incision-thread-drawing surgery for anal fistula.
Methods
A total of 129 patients undergoing incision-thread-drawing surgery for anal fistula were enrolled. Patients were divided into a healing group (n = 87) and a non-healing group (n = 42) based on wound healing status at 1 month post-surgery. Serum IGF-1 levels were measured preoperatively, and their association with wound healing, inflammatory cytokines, and postoperative anal function was analyzed using logistic regression, receiver operating characteristic (ROC) analysis, and Wexner Incontinence Score.
Results
Preoperative serum IGF-1 levels were significantly lower in the non-healing group (p < 0.001). IGF-1 levels above 174.9 ng/mL were associated with better wound healing (OR = 0.603, p = 0.005) and lower postoperative inflammation. Higher IGF-1 levels correlated with improved anal function at 7 and 14 days post-surgery (p < 0.01).
Conclusion
Preoperative serum IGF-1 levels are a valuable prognostic biomarker for predicting wound healing and postoperative recovery in patients undergoing incision-thread-drawing surgery for anal fistula, potentially guiding clinical decision-making and patient management strategies.
{"title":"Prognostic Value of Serum Insulin-Like Growth Factor-1 in Patients With Anal Fistula Treated by Incision-Thread-Drawing Surgery","authors":"Zhijun Wu, Xuexue Yin, Jing Li","doi":"10.1002/ags3.70037","DOIUrl":"https://doi.org/10.1002/ags3.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anal fistula is a chronic condition characterized by an abnormal tract between the anal canal and perianal skin, often leading to infection, inflammation, and impaired quality of life. Incision-thread-drawing surgery is the main treatment for anal fistula. However, the risk of poor postoperative healing remains significant. This study investigates the prognostic value of preoperative serum insulin-like growth factor-1 (IGF-1) levels in predicting wound healing after incision-thread-drawing surgery for anal fistula.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 129 patients undergoing incision-thread-drawing surgery for anal fistula were enrolled. Patients were divided into a healing group (<i>n</i> = 87) and a non-healing group (<i>n</i> = 42) based on wound healing status at 1 month post-surgery. Serum IGF-1 levels were measured preoperatively, and their association with wound healing, inflammatory cytokines, and postoperative anal function was analyzed using logistic regression, receiver operating characteristic (ROC) analysis, and Wexner Incontinence Score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Preoperative serum IGF-1 levels were significantly lower in the non-healing group (<i>p</i> < 0.001). IGF-1 levels above 174.9 ng/mL were associated with better wound healing (OR = 0.603, <i>p</i> = 0.005) and lower postoperative inflammation. Higher IGF-1 levels correlated with improved anal function at 7 and 14 days post-surgery (<i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative serum IGF-1 levels are a valuable prognostic biomarker for predicting wound healing and postoperative recovery in patients undergoing incision-thread-drawing surgery for anal fistula, potentially guiding clinical decision-making and patient management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 6","pages":"1362-1368"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436246","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}
Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).
Methods
Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.
Results
We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.
Conclusions
New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.
{"title":"Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma","authors":"Yuichi Goto, Yutaro Mihara, Takashi Niizeki, Hisamune Sakai, Sachiko Ogasawara, Jun Akiba, Hirohisa Yano, Takumi Kawaguchi, Fumihiko Fujita, Toru Hisaka","doi":"10.1002/ags3.70034","DOIUrl":"https://doi.org/10.1002/ags3.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (<i>p</i> = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1075-1085"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012517","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}
Yuki Matsui, Daisuke Hashimoto, So Yamaki, Kazuki Matsumura, Hidetaka Miyazaki, Yuji Ikeda, Denys Tsybulskyi, Thanh Sang Nguyen, Sohei Satoi
Aim
The incidence of cholelithiasis after gastrectomy is higher than that in the general population; however, the incidence and risk factors for choledocholithiasis have not been well reported. We aimed to assess the association between a history of gastrectomy and choledocholithiasis.
Methods
A total of 3025 patients who underwent cholecystectomy with or without choledocholithotomy between January 2006 and December 2020 at Kansai Medical University, Japan were included in this study. Patients were divided into a gastrectomy group with a history of gastrectomy (173 patients, 5.7%) and a control group having no history of gastrectomy (2852 patients, 94.3%).
Results
The incidence of choledocholithiasis was 61.8% and 22.2% in the gastrectomy and control groups, respectively, with a significantly higher incidence in the gastrectomy group (p < 0.0001). Multivariate analysis showed that age, sex, history of gastrectomy, and previous surgery except gastrectomy were risk factors for the development of choledocholithiasis, with a history of gastrectomy being the strongest risk factor (Odds Ratio 3.78, 95% Confidence Interval 2.71–5.27). The incidence values of choledocholithiasis in the Billroth I, Billroth II, and Roux-en-Y methods were 44.7%, 70.6%, and 69.7%, respectively, and were significantly lower in the Billroth I group than in the Roux-en-Y group (p = 0.009). The median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux-en-Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II.
Conclusion
Gastrectomy is a known risk factor for choledocholithiasis. Concomitant cholecystectomy during gastrectomy may be indicated in older men.
{"title":"A history of gastrectomy is a risk factor for choledocholithiasis in patients undergoing cholecystectomy: A single center retrospective study","authors":"Yuki Matsui, Daisuke Hashimoto, So Yamaki, Kazuki Matsumura, Hidetaka Miyazaki, Yuji Ikeda, Denys Tsybulskyi, Thanh Sang Nguyen, Sohei Satoi","doi":"10.1002/ags3.70008","DOIUrl":"https://doi.org/10.1002/ags3.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The incidence of cholelithiasis after gastrectomy is higher than that in the general population; however, the incidence and risk factors for choledocholithiasis have not been well reported. We aimed to assess the association between a history of gastrectomy and choledocholithiasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 3025 patients who underwent cholecystectomy with or without choledocholithotomy between January 2006 and December 2020 at Kansai Medical University, Japan were included in this study. Patients were divided into a gastrectomy group with a history of gastrectomy (173 patients, 5.7%) and a control group having no history of gastrectomy (2852 patients, 94.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of choledocholithiasis was 61.8% and 22.2% in the gastrectomy and control groups, respectively, with a significantly higher incidence in the gastrectomy group (<i>p</i> < 0.0001). Multivariate analysis showed that age, sex, history of gastrectomy, and previous surgery except gastrectomy were risk factors for the development of choledocholithiasis, with a history of gastrectomy being the strongest risk factor (Odds Ratio 3.78, 95% Confidence Interval 2.71–5.27). The incidence values of choledocholithiasis in the Billroth I, Billroth II, and Roux-en-Y methods were 44.7%, 70.6%, and 69.7%, respectively, and were significantly lower in the Billroth I group than in the Roux-en-Y group (<i>p</i> = 0.009). The median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux-en-Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gastrectomy is a known risk factor for choledocholithiasis. Concomitant cholecystectomy during gastrectomy may be indicated in older men.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1047-1054"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012486","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}
Taro Oshikiri, Hisateru Tachimori, Hiroaki Miyata, Yoshihiro Kakeji, Ken Shirabe
Background
Conventional minimally invasive esophagectomy (C-MIE) is the mainstay for locally advanced esophageal cancer. However, the relationship among facility size, risk-adjusted mortality and morbidity in C-MIE remains unclear. This study aims to clarify whether C-MIE should be consolidated into high-volume centers in Japan.
Methods
Risk models for perioperative mortality and morbidity were created using the Japanese National Clinical Database (NCD) data. NCD data registered between January 2016 and December 2020, including 14 152 C-MIE records. The developed risk models were used to estimate the ratio of expected to observed events (perioperative deaths or complications) (O/E ratio) for each facility.
Results
Regarding the risk model performances, the C-indices of the perioperative mortality risk prediction models were 0.793. The O/E ratio and 95% confidence interval (CI) for perioperative mortality were facility size < 10 MIEs/year, O/E ratio: 1.368 and 95% CI: 1.140–1.597; facility size 10–29 MIEs/year, O/E ratio: 0.886 and 95% CI: 0.644–1.127; and facility size ≥ 30 MIEs/year, O/E ratio: 0. 61 and 95% CI: 0.342–0.892. Conversely, there were no significant differences in morbidity rate by facility size.
Conclusions
The risk of perioperative mortality from C-MIE was lower in hospitals with larger facilities than those with smaller facilities; therefore, consolidating patients for C-MIE in high-volume hospitals is necessary.
{"title":"Influence of Facility Size on Perioperative Outcomes in Minimally Invasive Esophagectomy for 14 152 Patients With Esophageal Cancer Based on the Japanese National Clinical Database: A Multicenter Cohort Study","authors":"Taro Oshikiri, Hisateru Tachimori, Hiroaki Miyata, Yoshihiro Kakeji, Ken Shirabe","doi":"10.1002/ags3.70027","DOIUrl":"https://doi.org/10.1002/ags3.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conventional minimally invasive esophagectomy (C-MIE) is the mainstay for locally advanced esophageal cancer. However, the relationship among facility size, risk-adjusted mortality and morbidity in C-MIE remains unclear. This study aims to clarify whether C-MIE should be consolidated into high-volume centers in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Risk models for perioperative mortality and morbidity were created using the Japanese National Clinical Database (NCD) data. NCD data registered between January 2016 and December 2020, including 14 152 C-MIE records. The developed risk models were used to estimate the ratio of expected to observed events (perioperative deaths or complications) (O/E ratio) for each facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Regarding the risk model performances, the C-indices of the perioperative mortality risk prediction models were 0.793. The O/E ratio and 95% confidence interval (CI) for perioperative mortality were facility size < 10 MIEs/year, O/E ratio: 1.368 and 95% CI: 1.140–1.597; facility size 10–29 MIEs/year, O/E ratio: 0.886 and 95% CI: 0.644–1.127; and facility size ≥ 30 MIEs/year, O/E ratio: 0. 61 and 95% CI: 0.342–0.892. Conversely, there were no significant differences in morbidity rate by facility size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of perioperative mortality from C-MIE was lower in hospitals with larger facilities than those with smaller facilities; therefore, consolidating patients for C-MIE in high-volume hospitals is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"942-951"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012107","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 reasons behind the high prevalence of poorly differentiated gastric cancer in young females remain unclear. Therefore, this study aimed to conduct a comprehensive genetic analysis to investigate the factors responsible for the high prevalence of poorly differentiated gastric cancer in young females.
Methods
We analyzed 299 patients who underwent gastric cancer surgery at the Gunma University Hospital between April 2015 and December 2020. Among them, we selected cases of poorly differentiated gastric cancer in females, differentiated gastric cancer in females, and poorly differentiated gastric cancer in males, aged 30–50 years. Three eligible cases of each condition were found and included in the study. RNA was isolated from dissected formalin-fixed, paraffin-embedded tissue samples, followed by RNA sequencing. The results were analyzed using ingenuity pathway analysis to elucidate the mechanisms contributing to the high incidence of poorly differentiated gastric cancer in young females.
Results
Dexamethasone, β-estradiol, and interleukin-1β were identified as significant upstream regulators associated with poorly differentiated gastric cancer in young females. The downstream target genes of β-estradiol included male germ cell-associated kinase, growth differentiation factor 6, endothelin 2, and collagen type XI alpha 1 chain.
Conclusion
Our detailed RNA-seq analysis revealed that the female sex hormone, β-estradiol, plays a role in the development of poorly differentiated gastric cancer in young females.
{"title":"Comprehensive genetic analysis of poorly differentiated gastric cancer in young females","authors":"Nobuhiro Nakazawa, Takehiko Yokobori, Yohei Morishita, Akinobu Echigo, Reika Kawabata-Iwakawa, Akiharu Kimura, Akihiko Sano, Makoto Sakai, Ken Shirabe, Hiroshi Saeki","doi":"10.1002/ags3.70020","DOIUrl":"https://doi.org/10.1002/ags3.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The reasons behind the high prevalence of poorly differentiated gastric cancer in young females remain unclear. Therefore, this study aimed to conduct a comprehensive genetic analysis to investigate the factors responsible for the high prevalence of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 299 patients who underwent gastric cancer surgery at the Gunma University Hospital between April 2015 and December 2020. Among them, we selected cases of poorly differentiated gastric cancer in females, differentiated gastric cancer in females, and poorly differentiated gastric cancer in males, aged 30–50 years. Three eligible cases of each condition were found and included in the study. RNA was isolated from dissected formalin-fixed, paraffin-embedded tissue samples, followed by RNA sequencing. The results were analyzed using ingenuity pathway analysis to elucidate the mechanisms contributing to the high incidence of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Dexamethasone, β-estradiol, and interleukin-1β were identified as significant upstream regulators associated with poorly differentiated gastric cancer in young females. The downstream target genes of β-estradiol included male germ cell-associated kinase, growth differentiation factor 6, endothelin 2, and collagen type XI alpha 1 chain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our detailed RNA-seq analysis revealed that the female sex hormone, β-estradiol, plays a role in the development of poorly differentiated gastric cancer in young females.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"926-932"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013267","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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