PURPOSE: Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is useful for resident training. However, the association between the operative interval and skill acquisition remains unclear. We evaluate...PURPOSE: Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is useful for resident training. However, the association between the operative interval and skill acquisition remains unclear. We evaluated the learning curve of resident-performed TAPP and explored the association between the operative interval and operative time changes. METHODS: We retrospectively analyzed 67 consecutive TAPP cases performed by a single surgical resident. A cumulative sum (CUSUM) analysis was based on the adjusted operative time, with bilateral cases weighted by 0.6. Breakpoints were estimated using segmented regression, and the relationship between the operative interval and the change in adjusted operative time between consecutive cases (ΔTime) was assessed using exploratory analyses. RESULTS: A CUSUM analysis estimated breakpoints at 16.0 (95% CI, 13.7-18.3) and 38.1 (95% CI, 36.5-39.7) cases. BMI showed a weak negative correlation with operative duration. The adjusted operative time decreased across the learning, proficiency, and competency phases. Exploratory LOESS curves suggested a possible non-linear relationship between operative interval and ΔTime, with 8-14-day intervals showing a tendency toward a greater reduction during early phases. However, the differences among the interval groups were not significant. CONCLUSION: Resident-performed TAPP exhibited a three-phase learning curve. Case selection and operative interval may be associated with operative time changes, although these findings remain exploratory.
Breast-conserving surgery (BCS) is widely accepted as a standard treatment for early breast cancer, providing local control with favorable cosmetic outcomes. However, the resection of tumors in the lower pole of the brea...Breast-conserving surgery (BCS) is widely accepted as a standard treatment for early breast cancer, providing local control with favorable cosmetic outcomes. However, the resection of tumors in the lower pole of the breast often results in unsatisfactory deformities, particularly in women with small, non-ptotic breasts. We describe a simple oncoplastic technique using an anchor-shaped cutaneous flap that combines volume displacement of breast tissue with volume replacement using adjacent extra-breast tissue as a new oncoplastic breast-conserving surgery (OPBCS) technique. Three Japanese patients with early breast cancer involving the lower breast underwent this procedure. After complete tumor resection with adequate margins, an anchor-shaped cutaneous flap was designed along the inframammary fold. The de-epithelialized flap was elevated, rolled cranially, and sutured to fill the defect while simultaneously recreating the inframammary line. Both patients showed excellent breast symmetry, and there were no postoperative complications. This anchor-shaped flap is a practical option for patients with small, non-ptotic breasts who are not suitable candidates for reduction mammoplasty. It minimizes the volume deficit by removing redundant skin and effectively utilizes both intra- and extra-mammary tissue.
PURPOSE: We aimed to explore whether the admission serum amylase levels may help inform the selection of medical management in patients with AAST Grade I pancreatic injuries. METHODS: We retrospectively reviewed the reco...PURPOSE: We aimed to explore whether the admission serum amylase levels may help inform the selection of medical management in patients with AAST Grade I pancreatic injuries. METHODS: We retrospectively reviewed the records of 20 patients treated for pancreatic trauma between 2010 and 2024. They were categorized into medical management or intervention groups according to the initial treatment strategy. We used a receiver operating characteristic (ROC) analysis to evaluate the predictive value of the admission serum amylase levels for successful medical management. RESULTS: Eight patients were treated with strict medical management, whereas 12 required additional interventions. All patients in the medical management group had AAST Grade I injuries, and none required conversion to interventional treatment. The admission serum amylase levels were significantly lower in the medical management group (median 106 vs. 350 IU/L; p = 0.0228), whereas there were no significant intergroup differences in inflammatory markers. The ROC analysis yielded an area under the curve of 0.83 (95% CI, 0.59- 1.00). The cutoff value was 158 IU/L, with a sensitivity of 87.5% and a negative predictive value of 90.9%. CONCLUSION: Lower admission serum amylase levels in patients with AAST Grade I pancreatic injury may be associated with suitability for strict medical management; however, these findings are exploratory and require validation in larger multicenter studies.
Fukumoto M, Poudel S, Korai T
… +11 more, Koike D, Kiyasu Y, Watanabe J, Yamaoka-Fujikawa Y, Tanikawa A, Kohmura T, Ishida S, Suda C, Saito M, Ikeda N, Taketomi A
PURPOSE: To assess the prevalence of self-reported harassment during surgical residency in Japan, identify independent risk factors, and examine its impact on early career intentions among newly board-certified surgeons....PURPOSE: To assess the prevalence of self-reported harassment during surgical residency in Japan, identify independent risk factors, and examine its impact on early career intentions among newly board-certified surgeons. METHODS: We conducted a prespecified secondary analysis of a 2023 nationwide survey of surgeons certified between 2021 and 2022 (N = 1410). Respondents answering "Yes" to the perceived harassment item were assigned to the harassment group, while those answering "No" constituted the control; respondents selecting "Prefer not to answer" were excluded from this prespecified secondary analysis to avoid interpretive ambiguity. Complete‑case multivariable logistic regression produced adjusted odds ratios (aORs) for trainee, program, and workload level correlates. RESULTS: Among the respondents, 304 (41.5%) reported harassment by instructors. In the multivariable model, low instructor teaching ability (adjusted odds ratio [aOR] 2.75; 95% CI] 1.72-4.41) and overtime > 80 h/month (aOR 2.28; 95% CI 1.57-3.30) were the primary factors independently associated with self-reported harassment. Furthermore, experiencing harassment was significantly associated with overall program dissatisfaction, lack of intention to return to the training institution, and a higher likelihood of dropping out (p < 0.001). CONCLUSIONS: Self-reported harassment experiences are associated with an excessive workload and unsatisfactory surgical instruction, threatening trainee retention. Duty hour limits, instructor education, and confidential reporting systems should therefore be prioritized.
PURPOSE: The increased use of artificial intelligence (AI)-based writing tools may influence academic writing styles. This study aimed to evaluate changes in writing styles in Japanese surgical journals using quantitativ...PURPOSE: The increased use of artificial intelligence (AI)-based writing tools may influence academic writing styles. This study aimed to evaluate changes in writing styles in Japanese surgical journals using quantitative time-series analysis. METHODS: We analyzed articles published between 2015 and 2025 in Surgery Today and Surgical Case Reports. The writing style was quantified using predefined lexical sets for rare and common AI-related words and promotional words. The word density was calculated for each article separately. We conducted interrupted time-series analyses with 2023 as the intervention year. Observed post-2023 values were compared with the expected values based on pre-2023 trends. RESULTS: Rare-word density showed a marked post-2023 increase, with a significant change in slope (β = 1.05 per year, 95% CI: 1.01-1.10, p < 0.001). The common-word density also increased after 2023 (β = 0.48, 95% CI: 0.46-0.51; p < 0.001). Promotional word density showed a smaller but statistically significant increase in the post-2023 slope (β = 0.34, 95% CI: 0.24-0.44; p < 0.001). For all three measures, the observed post-2023 values exceeded the expected values that were extrapolated from the pre-2023 trends. CONCLUSION: Post-2023, the increase in AI-associated lexical marker use in Japanese surgical journals showed accelerated growth compared to the expected long-term trends.
Sato Y, Tanaka Y, Hatanaka Y
… +10 more, Fujibayashi S, Mitsui N, Yokoi R, Horaguchi T, Matsumoto K, Fukada M, Yasufuku I, Asai R, Tajima JY, Matsuhashi N
PURPOSE: Delayed gastric conduit emptying (DGCE) is a functional complication after esophagectomy that can cause nutritional and respiratory issues, but its risk factors remain unclear. METHODS: We retrospectively analyz...PURPOSE: Delayed gastric conduit emptying (DGCE) is a functional complication after esophagectomy that can cause nutritional and respiratory issues, but its risk factors remain unclear. METHODS: We retrospectively analyzed 166 patients after esophagectomy at Gifu University Hospital (2020-2024). DGCE was diagnosed per International Society for Diseases of the Esophagus criteria and graded using a novel radiographic classification (Grade 1-3). Clinical and postoperative outcomes were compared, and risk factors analyzed by logistic regression. RESULTS: DGCE occurred in 29 patients (17.5%). Early DGCE patients were more often female (p = 0.005), had greater gastric conduit-mediastinum length difference (p < 0.001), and fewer fixation sutures (p < 0.001). No independent predictors were identified, though female sex and higher body mass index (BMI) showed trends. Pneumonia and late DGCE were more frequent (both p < 0.001). Severe DGCE (Grade 3) caused greater weight loss at 6 months and 1 year (p = 0.013, p < 0.001). CONCLUSIONS: Post-esophagectomy DGCE was linked to excessive conduit length and insufficient fixation. Careful intraoperative handling and structured long-term follow-up are crucial.
Hashimoto S, Tominaga T, Noda K
… +18 more, Shiraishi T, Yamashita M, Katayama H, Tei S, Hida T, Maruta H, Takamura Y, Ono R, Hisanaga M, Ishii M, Moriyama M, Fukuoka H, To K, Oishi K, Takeshita H, Sawai T, Nonaka T, Matsumoto K
PURPOSE: Postoperative complications may affect the long-term outcomes after colorectal cancer (CRC) surgery. This multicenter study compared prognostic factors for overall survival (OS) in younger (≤ 74 years) and older...PURPOSE: Postoperative complications may affect the long-term outcomes after colorectal cancer (CRC) surgery. This multicenter study compared prognostic factors for overall survival (OS) in younger (≤ 74 years) and older (≥ 75 years) patients after curative resection for CRC, focusing on the 1-year and post-1-year outcomes. METHODS: We analyzed data from 1582 patients who underwent curative surgery for CRC at six hospitals between April 2016 and December 2019. Kaplan-Meier and Cox models were used to identify the risk factors for complications and survival. RESULTS: Older patients had a significantly worse overall survival (OS) and survival beyond the 1-year landmark. Postoperative complications were associated with increased 1-year mortality in both age groups. In younger patients, survival beyond 1 year was associated with a positive N status and a low BMI. In contrast, in older patients, postoperative complications remained associated with survival beyond the 1-year landmark, along with a male sex, positive N status, and poor ASA-PS. CONCLUSIONS: The prolonged impact of complications on survival in older patients with CRC underscores the need for age-specific surgical strategies and proactive complication management.
PURPOSE: Osteosarcopenia (OSP) is a predictor of adverse outcomes after colorectal cancer (CRC) surgery. However, the prognostic impact of postoperative evolution remains unknown. This study evaluated the effect of dynam...PURPOSE: Osteosarcopenia (OSP) is a predictor of adverse outcomes after colorectal cancer (CRC) surgery. However, the prognostic impact of postoperative evolution remains unknown. This study evaluated the effect of dynamic changes in the OSP status between baseline and one year post-curative resection on the long-term prognosis. METHODS: This retrospective study analyzed 641 patients who were recurrence-free one year after post-resection. The OSP status was assessed using CT at baseline and one year postoperatively. A 1-year landmark analysis was performed to adjust for any immortal time bias. Patients were categorized according to their OSP trajectory as follows: Maintained non-OSP, Improved, Worsened, or Non-improved. The outcomes were analyzed using Kaplan-Meier curves and multivariate Cox regression models. RESULTS: The prevalence at one year was 10%. Overall survival (OS) showed significant hierarchical disparities across the groups (P < 0.0001). The 5-year OS from the 1-year landmark was highest in the Improved group (96.7%) and lowest in the Non-improved group (43.3%). A multivariate analysis identified the postoperative OSP trajectory as the strongest independent risk factor for poor recurrence-free survival (HR 9.82; p < 0.0001) and a significant independent prognostic factor for overall survival (OS) (HR 3.39; p < 0.0001). CONCLUSION: The postoperative OSP dynamics are significantly associated with the prognosis after CRC surgery and serve as useful prognostic indicators for cancer survivors.
PURPOSES: The Kirsten rat sarcoma viral oncogene homolog (KRAS) is defined as frequently mutated oncogenes in colorectal cancer. We aimed to clarify the clinical impact of KRAS mutation status on recurrence patterns, the...PURPOSES: The Kirsten rat sarcoma viral oncogene homolog (KRAS) is defined as frequently mutated oncogenes in colorectal cancer. We aimed to clarify the clinical impact of KRAS mutation status on recurrence patterns, the surgical management of recurrent lesions, and prognostic outcomes after curative hepatectomy for colorectal liver metastases (CRLM). METHODS: The subjects of this retrospective study were 190 patients who underwent curative (macroscopic R0 resection) hepatectomy for CRLM and had wild-type (62.1%) or mutant (37.9%) KRAS status. RESULTS: KRAS mutations were associated with significantly worse overall survival (OS) and recurrence-free survival (RFS), as well as more aggressive recurrence patterns. Multivariate analysis identified KRAS mutation as an independent predictor of poor OS and RFS, whereas CEA ≥ 5 ng/mL was independently associated with OS but not RFS. Notably, patients from the mutant KRAS and wild-type KRAS groups who underwent local therapy (as repeat resection or ablation) for local recurrence had comparable OS. Conversely, among the patients who did not receive local therapy, those from the mutant KRAS group had significantly worse OS than those from the wild-type KRAS group. CONCLUSIONS: KRAS mutations are associated with aggressive recurrence patterns and a poor prognosis for patients with CRLM. However, survival following local therapy for recurrence appeared less pronounced regardless of KRAS status.
PURPOSE: To analyze the data on groin hernia repair practice in Japan in 2024 and present the recent changes in open repair technique selection. METHODS: We performed a retrospective descriptive analysis of groin hernia...PURPOSE: To analyze the data on groin hernia repair practice in Japan in 2024 and present the recent changes in open repair technique selection. METHODS: We performed a retrospective descriptive analysis of groin hernia repairs registered in the National Clinical Database (NCD) of Japan in 2024, using nationwide data and a Japanese Hernia Society-registered subset with detailed procedure variables for 2021-2024. RESULTS: In the nationwide dataset, inguinal laparo-endoscopic and open repairs accounted for 58.2% and 38.2% of all groin hernia repairs, respectively. Among open repairs in the Japanese Hernia Society-registered dataset, underlay mesh repair was the most common subtype of primary repair until 2023, but decreased over time. The proportion of anterior onlay mesh repairs increased from 21.8% in 2021 to 32.0% in 2024, while the proportion of plug-and-patch repairs remained stable at approximately 24%. For recurrent open repairs, plug-and-patch repair remained the most common subtype, accounting for approximately 37%-39%, whereas underlay mesh repair decreased from 28.4% in 2021 to 21.0% in 2024, and anterior onlay mesh repair increased from 17.7% in 2021 to 26.0% in 2024. CONCLUSIONS: Open groin hernia repair remains common in Japan, and its composition is shifting toward the use of anterior onlay mesh repair, although plug-and-patch and underlay mesh repairs are still performed widely.
PURPOSE: Open-window thoracostomy remains a traditional yet important option for treating empyema. This study aimed to evaluate the clinical outcomes after open-window thoracostomy and identify any prognostic factors bas...PURPOSE: Open-window thoracostomy remains a traditional yet important option for treating empyema. This study aimed to evaluate the clinical outcomes after open-window thoracostomy and identify any prognostic factors based on our institutional experience. METHODS: We retrospectively reviewed the medical records of 40 consecutive patients who underwent open-window thoracostomy at our institution between January 2010 and December 2020. RESULTS: The mean age of the patients was 68.3 years, and twenty-five were male. Thirty-five patients had empyema with a fistula and five had empyema without a fistula. The overall survival rates at one, three, and five years were 92.5 percent, 72.9 percent, and 55.9 percent, respectively. A univariate Cox regression analysis followed by a multivariate Cox regression analysis identified three independent prognostic factors for overall survival: preoperative contralateral aspiration pneumonia, prognostic nutritional index < 37.4 (area under the curve 0.742 by receiver operating characteristic analyses), and an elevated white blood cell count. CONCLUSIONS: The preoperative nutritional status, systemic inflammation, and the presence of contralateral aspiration pneumonia were strongly associated with survival after open-window thoracostomy. This study highlights the importance of these factors in the management of empyema.
Douchi D, Ando M, Umino Y
… +13 more, Sato H, Shimura M, Inoue K, Iseki M, Aoki S, Murakami K, Miura T, Maeda S, Ishida M, Mizuma M, Masamune A, Furukawa T, Unno M
PURPOSE: To validate the prognostic value of histological treatment response, assessed using the Japan Pancreas Society (JPS) grading system, in patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated wi...PURPOSE: To validate the prognostic value of histological treatment response, assessed using the Japan Pancreas Society (JPS) grading system, in patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant chemotherapy (NAC) followed by surgical resection. METHODS: We analyzed, retrospectively, data from 117 consecutive patients who underwent NAC and curative-intent PDAC resection at Tohoku University Hospital between January 2010 and December 2022. Histological responses were graded using the JPS system. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards modeling. RESULTS: Histological Grade 1a, 1b, 2, 3, and 4 responses were observed in 47 (40.2%), 42 (35.9%), 21 (17.9%), 6 (5.1%), and 1 (0.9%) patients, respectively. Patients with a Grade ≥ 2 response had significantly longer overall survival (OS) and significantly higher R0 resection rates than those with Grade 1a or 1b responses (median OS: 118.7 vs. 46.6 months, p = 0.037; 100% vs. 82.0%, p = 0.01). In a multivariable Cox regression model including RECIST progression status and baseline covariates, JPS Grade ≥ 2 remained significantly associated with better OS (adjusted HR 0.48; 95% CI 0.24-0.96; p = 0.039). CONCLUSION: Substantial histological response (JPS Grade ≥ 2) after NAC is strongly associated with improved OS and higher R0 resection rates in patients with resectable PDAC. The JPS grading system provides a basis for clinically meaningful prognostic stratification.
Hasuda H, Nakanishi R, Nagai T
… +11 more, Tajiri H, Ota M, Sakaguchi Y, Ando K, Sugiyama M, Uehara H, Fujinaka Y, Yoshida D, Edahiro K, Oki E, Yoshizumi T
PURPOSE: To identify the perioperative risk factors for postoperative complications in patients aged ≥ 80 years. METHODS: We retrospectively analyzed 2,072 consecutive patients who underwent colorectal surgery at seven i...PURPOSE: To identify the perioperative risk factors for postoperative complications in patients aged ≥ 80 years. METHODS: We retrospectively analyzed 2,072 consecutive patients who underwent colorectal surgery at seven institutions between January 2021 and December 2023 and compared the perioperative outcomes between patients aged ≥ 80 (n = 464) and ≤ 79 years (n = 1,608). RESULTS: Patients aged ≥ 80 years had an American Society of Anesthesiologists Physical Status (ASA-PS) score of ≥ 3 (P < 0.0001) and more comorbidities. Minimally invasive surgery was performed less frequently (P < 0.0001), with a shorter surgical duration (P = 0.0003) and greater intraoperative bleeding (P = 0.04). Postoperative pneumonia (P = 0.0005) and urinary disorder complications after rectal surgery (P = 0.03) were more frequent in patients aged ≥ 80 years. A multivariate analysis identified male sex (P = 0.02), ASA-PS ≥ 3 (P = 0.005), and intraoperative bleeding (P = 0.02) as independent risk factors for pneumonia. Intraoperative bleeding (P = 0.002) and anastomosis (P = 0.03) were significant risk factors for urinary disorders after rectal surgery. Minimally invasive surgery in older adults resulted in a longer surgical duration (P < 0.0001), less bleeding (P < 0.0001), and fewer complications than conventional surgery. CONCLUSION: Postoperative pneumonia and urinary complications after rectal surgery are common in older adult patients. Minimally invasive approaches may reduce the risk of complications.
PURPOSE: This study aimed to investigate the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and long-term prognosis and postoperative complications in older patients with colorectal cancer (C...PURPOSE: This study aimed to investigate the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and long-term prognosis and postoperative complications in older patients with colorectal cancer (CRC). METHODS: Three hundred three patients with pathological stage (pStage) I-III CRC who underwent curative surgery at our institution between 2015 and 2022 were retrospectively analyzed. Patients aged ≥ 75 years were defined as older. RESULTS: In the overall cohort, a low CALLY index was an independent prognostic factor (hazard ratio (HR) = 2.42, 95% confidence interval (CI): 1.31-4.47, p = 0.004). The age-stratified analysis revealed that a low CALLY index was associated with a worse prognosis and was an independent prognostic factor in older patients (HR = 3.46, 95% CI: 1.44-8.30, p = 0.005), whereas no independent prognostic significance was observed in non-older patients. Moreover, although the CALLY index was not associated with postoperative complications in non-older patients, a low CALLY index was an independent risk factor for postoperative complications in older patients (odds ratio = 3.93, 95% CI 1.49-10.3, p = 0.005). CONCLUSION: The CALLY index is a valuable predictor of both short- and long-term outcomes in patients with pStage I-III CRC, with a particularly strong impact on older patients aged ≥ 75 years.
Omori M, Komatsu S, Hamanaka M
… +13 more, Kido M, Gon H, Fukushima K, Urade T, Yoshida T, Arai K, Lee D, Akita M, Mizumoto T, Ishida J, Nanno Y, Yanagimoto H, Fukumoto T
PURPOSE: Hepatectomy is a curative treatment for hepatocellular carcinoma (HCC) but deteriorating postoperative liver function can limit its benefits, especially for patients with borderline resectable (BR) HCC. We evalu...PURPOSE: Hepatectomy is a curative treatment for hepatocellular carcinoma (HCC) but deteriorating postoperative liver function can limit its benefits, especially for patients with borderline resectable (BR) HCC. We evaluated postoperative liver function trajectories and their impact on long-term survival. METHODS: The subjects of this retrospective analysis were 790 patients who underwent initial curative hepatectomy, stratified by resectability (R, BR1, BR2) and modified albumin-bilirubin (mALBI) grade. Liver function was assessed via ALBI scores pre- and postoperatively. Deterioration was defined as an ALBI score ratio < 0.9. RESULTS: Median overall survival (OS) differed significantly, being 109.9, 54.4, and 40.4 months for the R, BR1, and BR2 groups, respectively (p < 0.001). While functional status at POD 90 influenced recurrence-free survival, deterioration at POD 180 was identified as a robust independent predictor of OS (HR 1.53, p = 0.005). Notably, no single preoperative or perioperative factor was a significant predictor of this long-term functional decline at POD 180. Postoperative recovery was heterogeneous, with 47.5% of patients with mALBI grade 2a improving to grade 1 by POD 180. CONCLUSIONS: Post-hepatectomy liver function at POD 180 is a key determinant of long-term survival. As this late deterioration is difficult to predict perioperatively, continuous monitoring of hepatic reserve is essential to maintain eligibility for subsequent multidisciplinary therapies.
PURPOSE: This study aimed to evaluate the effectiveness of "GEKA-Navi," a collaborative online recruitment event organized by eight surgical departments, and analyze the participant feedback and residency entry data from...PURPOSE: This study aimed to evaluate the effectiveness of "GEKA-Navi," a collaborative online recruitment event organized by eight surgical departments, and analyze the participant feedback and residency entry data from 2021 to 2025. METHODS: GEKA-Navi targeted medical students and residents and featured plenary sessions on surgical careers, as well as departmental breakout sessions. The primary outcome was the proportion of newly recruited surgical residents from 2021 to 2025 who had participated in GEKA-Navi. The secondary outcomes were questionnaire-based participant evaluations, including satisfaction and motivation toward surgical careers. RESULTS: Five events were conducted, with annual participation ranging from 82 to 150 individuals. A total of 151 new surgical residents entered the participating departments from 2021 to 2025, of whom 90 (59.6%) had previously attended GEKA-Navi. Secondary outcome analyses revealed consistently high participant satisfaction, with 98% of participants reporting increased interest in joining surgical departments and over 80% reporting increased motivation to become surgeons. CONCLUSIONS: GEKA-Navi was associated with high participant satisfaction and increased interest in surgical careers. These findings provide descriptive insights into participants' perceptions and recruitment patterns within a structured multidepartmental recruitment initiative. Such approaches may help inform the design of future recruitment strategies for clinical trials.
PURPOSE: The presence of a soft tissue mass (STM) around the arteries is often observed after pancreatectomy. Although a STM frequently represents local recurrence, it can also reflect benign postoperative changes. Howev...PURPOSE: The presence of a soft tissue mass (STM) around the arteries is often observed after pancreatectomy. Although a STM frequently represents local recurrence, it can also reflect benign postoperative changes. However, the frequency of STMs and the factors determining whether its presence leads to local recurrence or remains benign have not been studied. This study aimed to determine the frequency of STM after pancreatectomy and to identify the clinical factors associated with the development of local recurrence. METHODS: A total of 246 patients who underwent pancreatectomy at a single institution were analyzed retrospectively. The presence of a STM was assessed by follow-up computed tomography, and its association with local recurrence was evaluated. RESULTS: Among the 246 patients, 33 (13.4%) developed STM after pancreatectomy, and all cases occurred in patients with pancreatic ductal adenocarcinoma (PDAC). Among the 133 patients who underwent pancreatectomy for PDAC, 33 (24.8%) developed STM, 23 (69.7%) of which progressed to local recurrence. No significant predictive factors for STM occurrence were identified in the PDAC patients. However, among the PDAC patients with STM, those who had received neoadjuvant radiotherapy were significantly less likely to develop local recurrence than those who had not (P = 0.0259). CONCLUSION: STMs occurred after pancreatectomy only in patients with PDAC, and neoadjuvant radiotherapy may influence whether the STM progresses to local recurrence, although the sample size was limited. No predictive factors associated with the development of STMs in patients with PDAC were identified.
PURPOSE: The current guidelines recommend cisplatin-based adjuvant chemotherapy for patients with completely resected stage II-III non-small cell lung cancer (NSCLC). Carboplatin-based chemotherapy is occasionally select...PURPOSE: The current guidelines recommend cisplatin-based adjuvant chemotherapy for patients with completely resected stage II-III non-small cell lung cancer (NSCLC). Carboplatin-based chemotherapy is occasionally selected, although there is limited evidence of its long-term outcomes. We conducted this study to compare the long-term outcomes of cisplatin- based chemotherapy with those of carboplatin-based chemotherapy. METHODS: A retrospective chart review was performed to identify patients aged ≥ 18 years with performance status 0-1, complete resection, and pathological stage II-IIIA NSCLC (7th edition) between 2014 and 2016 in our multi-institutional database. Patients were classified into two groups: the cisplatin-based adjuvant chemotherapy group and the carboplatin-based adjuvant chemotherapy group. To adjust for baseline differences, inverse probability of treatment weighting (IPTW) based on propensity scores was applied. The primary outcome was recurrence-free survival (RFS) and the secondary outcomes were cancer-specific survival (CSS) and overall survival (OS). RESULTS: A total 342 patients were included, of whom 195 received cisplatin-based adjuvant chemotherapy and 147 received carboplatin-based chemotherapy. After IPTW adjustment, the hazard ratios for RFS, CSS, and OS were 1.10 (95% confidence interval [CI]: 0.82-1.49, p = 0.526), 1.11 (95% CI: 0.68-1.82, p = 0.675), and 1.46 (95% CI: 0.96-2.22, p = 0.08), respectively. CONCLUSIONS: Carboplatin-based adjuvant chemotherapy may be considered for selected patients deemed unfit to receive cisplatin.
PURPOSES: Robotic gastrectomy (RG) offers superior dexterity and visualization compared with laparoscopic gastrectomy (LG). However, its high cost requires careful patient selection. This study aimed to evaluate whether...PURPOSES: Robotic gastrectomy (RG) offers superior dexterity and visualization compared with laparoscopic gastrectomy (LG). However, its high cost requires careful patient selection. This study aimed to evaluate whether these advantages provide clinical benefits for elderly patients who are vulnerable to surgical stress. METHODS: This retrospective study included 656 patients with gastric or esophagogastric junction cancer who underwent R0 RG or LG. The patients were stratified into elderly (≥ 75 years, n = 300) and non-elderly (< 75 years, n = 356). Propensity score matching was performed within each group to adjust baseline differences, and the outcomes were compared. RESULTS: In elderly patients, RG caused fewer postoperative complications (grade ≥ III) (3.0% vs. 11.0%, P = 0.03) and lower postoperative C-reactive protein (P = 0.03) and drain amylase levels (P = 0.02). In non-elderly patients, RG led to lower drain amylase levels (P = 0.002). However, the complication rates did not differ significantly (3.8% vs. 7.6%, P = 0.29). No significant differences in the recurrence-free survival or overall survival were observed. CONCLUSIONS: RG may reduce postoperative complications in elderly patients, thus supporting a potential benefit in this population.