PURPOSES: Robotic staplers offer several advantages in rectal surgery owing to their wide range of articulation and ergonomic manipulation. These benefits are evident during mobilization of the mesentery from the surroun...PURPOSES: Robotic staplers offer several advantages in rectal surgery owing to their wide range of articulation and ergonomic manipulation. These benefits are evident during mobilization of the mesentery from the surrounding tissue and dissection of the rectum. However, no study has quantitatively evaluated the robotic stapler articulation in rectal surgery. METHODS: We retrospectively enrolled 110 patients who underwent robotic anterior resection and double-stapling anastomosis. Stapling-related variables, including the type of cartridge, number of firings, time for initial stapling, and pitch/yaw of the stapling arm joint, were collated, and their association with patient background variables was analyzed. RESULTS: The pitch ranged from - 56° to - 0.2° (median, - 36.3°), and the yaw ranged from - 57.9° to 54.2° (median, - 7.5°). A multivariate analysis showed that a more negative pitch value was independently associated with surgery for cT3/4 cancers (p = 0.042). Moreover, the pitch decreased as the distance from the anus to the staple line increased (p < 0.001). Female sex was the only factor independently associated with yaw (p = 0.029). Univariate analyses revealed that age ≥ 70 years, preoperative treatment, short cartridge selection, and multiple firings were correlated with a high anastomotic leakage rate. CONCLUSIONS: This study clearly demonstrates how surgeons utilize the unique functions of robotic staplers during rectal transection.
Miyata R, Hamaji M, Kurakami H
… +12 more, Nakanobo R, Kobayashi M, Sumitomo R, Ikeda M, Ishikawa M, Fukada T, Sakai H, Oda H, Ohsumi A, Moriya T, Yamagishi H, Date H
The clinical benefits of anaplastic lymphoma kinase (ALK) inhibitors in patients with recurrent ALK-rearranged lung adenocarcinoma after surgical resection remain poorly understood. We retrospectively reviewed the medica...The clinical benefits of anaplastic lymphoma kinase (ALK) inhibitors in patients with recurrent ALK-rearranged lung adenocarcinoma after surgical resection remain poorly understood. We retrospectively reviewed the medical records of 10 patients who received alectinib as first-line therapy for postoperative recurrence between 2014 and 2018, following complete resection at multiple institutions in Japan. Clinical outcomes, including the progression-free survival (PFS) and overall survival (OS), were analyzed. The median follow-up duration was 93.6 months from surgery. The median OS was 96.8 months after surgery and 82.8 months from recurrence. The median PFS from recurrence was not reached, with a 5-year PFS rate of 58.3%. One patient discontinued treatment because of adverse events. Alectinib, as a first-line therapy for recurrent ALK-rearranged lung adenocarcinoma, demonstrated durable efficacy and acceptable safety. These findings suggest that targeted therapy for recurrence is a valuable treatment strategy. Prospective studies are warranted to determine the optimal timing for ALK-TKI initiation.
PURPOSE: The robotic approach improves the safety and effectiveness of gastric cancer surgery; however, it increases operative time. This study evaluated the effect of individualized adjustment of camera port positioning...PURPOSE: The robotic approach improves the safety and effectiveness of gastric cancer surgery; however, it increases operative time. This study evaluated the effect of individualized adjustment of camera port positioning on short-term outcomes of robotic gastrectomy (RG). METHODS: This study included consecutive patients who underwent RG for gastric cancer at our department between August 2019 and April 2025. Short-term outcomes were compared between RG with adjustment for camera port positioning at the height of the angle of Treitz using computed tomography images (A group, n = 30) and those without adjustment (NA group, n = 89). RESULTS: No significant differences were observed in patient characteristics between the groups; however, both operative and console times were significantly shorter in group A (both P < 0.001). The estimated blood loss and duration of postoperative stay were also lower in Group A, whereas the incidence of postoperative morbidity was similar. In a multivariate analysis, adjustment of the camera port was identified as an independent predictor of shortened operative time (odds ratio 0.039, P < 0.001). CONCLUSIONS: Individualized adjustment of camera port positioning could be useful for improving the short-term outcomes of RG, including reduction in operative time.
PURPOSE: Most cases of postoperative non-small-cell lung cancer (NSCLC) recurrence occur within 5 years of curative resection, with rare cases of late recurrence occurring after 5 years. However, the unique characteristi...PURPOSE: Most cases of postoperative non-small-cell lung cancer (NSCLC) recurrence occur within 5 years of curative resection, with rare cases of late recurrence occurring after 5 years. However, the unique characteristics of late recurrence remain unclear. This study aimed to elucidate the characteristics and risk factors for late recurrence in patients with NSCLC. METHODS: We retrospectively analyzed 693 patients who underwent curative resection for NSCLC between 2004 and 2013. The primary endpoint was the identification of risk factors for late recurrence, that is, recurrence 5 years after resection. RESULTS: The 5- and 10-year overall survival (OS) rates were 80.6% and 63.7%, respectively. Among the 435 patients who were recurrence-free for 5 years postoperatively, late recurrence occurred in 24(5.5%). A multivariate analysis identified age at resection (≥ 75 years) as a significant risk factor for late recurrence. Post-recurrence survival did not differ between patients with recurrence within five years and those with late recurrence. CONCLUSIONS: Age at resection (≥ 75 years) was a potential risk factor for late NSCLC recurrence. These patients require long-term follow-up and monitoring for up to five years after resection.
PURPOSE: Zolbetuximab, a monoclonal antibody against claudin18.2 (CLDN18.2), shows promise in the treatment of advanced gastric cancer. However, as treatment relies on CLDN18.2 expression in primary tumors, concordance w...PURPOSE: Zolbetuximab, a monoclonal antibody against claudin18.2 (CLDN18.2), shows promise in the treatment of advanced gastric cancer. However, as treatment relies on CLDN18.2 expression in primary tumors, concordance with metastatic lesions remains unclear. METHODS: We retrospectively analyzed 50 patients with advanced gastric cancer. CLDN18.2 expression was assessed immunohistochemically in paired primary and metastatic lesions, being defined as positive when ≥ 75% of tumor cells showed moderate to strong membranous staining. Clinicopathological factors associated with the discordance were also evaluated. RESULTS: CLDN18.2 positivity was found in 36% of primary tumors and 18% of metastatic lesions. Concordance between sites was 78%, varying by route: 100% in hematogenous lesions, 80% in lymphatic lesions, and 72% in peritoneal lesions. In discordant cases, 89% showed loss of expression in metastases despite primary positivity, particularly in peritoneal lesions. A larger tumor size and nodal involvement (≥ N2) were significantly associated with discordance (p = 0.020 and p = 0.004, respectively). A receiver operating characteristic analysis identified 90 mm as the optimal cutoff (AUC = 0.73). A flowchart of tumor size and nodal status showed an 81.8% discordance when both were present. CONCLUSIONS: CLDN18.2 expression often differs between primary and metastatic sites, particularly with peritoneal spread. Tumor size and nodal status may help identify patients who are unlikely to benefit from primary tumor-based profiling.
PURPOSE: Periodontitis is a chronic oral disease that contributes to low-grade systemic inflammation and may predispose to extraoral complications. We conducted this study to analyze its association with gallstone-relate...PURPOSE: Periodontitis is a chronic oral disease that contributes to low-grade systemic inflammation and may predispose to extraoral complications. We conducted this study to analyze its association with gallstone-related cholecystitis. METHODS: The subjects of this prospective observational study were 160 adults with acute calculous cholecystitis or symptomatic cholelithiasis. The patients were grouped according to their periodontal status as having “normal/mild” or “moderate/severe” peridontitis. We calculated the inflammatory indices: the lymphocyte-to-C-reactive protein ratio (LCR), neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and platelet-to-lymphocyte ratio (PLR); and analyzed the associations between periodontal status, inflammatory markers, and gallbladder pathology, using univariate and multivariate models. RESULTS: Moderate/severe periodontitis was found significantly more frequently in patients with cholecystitis than in those with uncomplicated gallstones (80% vs. 22.5%, p < 0.001). Patients with cholecystitis had lower LCR and higher NLR, d-NLR, and PLR values (all p < 0.05). Multivariate analysis identified periodontitis (HR = 1.797) and all inflammatory markers as independent predictors of cholecystitis. Severe periodontitis was especially prevalent in patients with active acute cholecystitis. CONCLUSION: Periodontitis is significantly associated with acute cholecystitis, potentially through systemic inflammatory mechanisms. Thus, periodontal evaluation may be important in the management and prevention of biliary tract complications.
PURPOSE: The CheckMate 577 trial revealed that adjuvant nivolumab administration following neoadjuvant chemoradiotherapy and surgery significantly improved the disease-free survival (DFS). However, evidence supporting it...PURPOSE: The CheckMate 577 trial revealed that adjuvant nivolumab administration following neoadjuvant chemoradiotherapy and surgery significantly improved the disease-free survival (DFS). However, evidence supporting its effectiveness following neoadjuvant chemotherapy and surgery for advanced esophageal cancer remains limited. This study evaluated the efficacy and safety of adjuvant nivolumab therapy in patients receiving neoadjuvant chemotherapy followed by esophagectomy. METHODS: We retrospectively analyzed 53 patients who underwent neoadjuvant chemotherapy followed by esophagectomy for advanced esophageal cancer between 2021 and 2024 years. Patients were divided into the adjuvant nivolumab and non-adjuvant groups. Clinicopathological factors, surgical outcomes, adverse events, and survival rates were compared between the groups. We also investigated the association between immune-related adverse events (irAEs) and survival outcome. RESULTS: Of the 53 patients, 15 (28%) received adjuvant nivolumab therapy. The DFS was significantly better in the adjuvant nivolumab group. In the multivariate analysis, although not significantly, adjuvant nivolumab was identified as a favorable prognostic factor. In total, 8 patients (53%) developed irAEs; those who developed irAEs and completed 1-year adjuvant nivolumab therapy showed a longer DFS than those without irAEs. CONCLUSION: Adjuvant nivolumab therapy following neoadjuvant chemotherapy and surgery may improve the DFS in patients with advanced esophageal cancer. Appropriate irAE management may support therapy completion and improve patient outcome.
Esophagectomy is the standard treatment for resectable esophageal cancer (EC). Recently, the prognosis of EC has gradually improved owing to the introduction of minimally invasive surgery, enhanced postoperative recovery...Esophagectomy is the standard treatment for resectable esophageal cancer (EC). Recently, the prognosis of EC has gradually improved owing to the introduction of minimally invasive surgery, enhanced postoperative recovery, and perioperative nutritional treatment. However, more than half of the patients who undergo esophagectomy experience recurrence, even after curative esophagectomy. Once EC recurs, the prognosis for patients with recurrent EC is limited. Tumor cell metastasis is the most common cause of recurrence. Micrometastatic cells grow in unresectable regions after curative esophagectomy. Therefore, control of micrometastasis is necessary to prevent the recurrence of EC in the perioperative period. Perioperative adjuvant treatment has been introduced for various malignancies, including EC, to prevent recurrence due to micrometastasis. Since 1990, evidence has emerged regarding postoperative adjuvant treatment, preoperative adjuvant treatment, and perioperative adjuvant treatment for resectable EC. To optimize adjuvant treatment for resectable esophageal cancer, it is necessary to understand the characteristics of each approach before the introduction of adjuvant treatment for resectable esophageal cancer. This review summarizes the background, current status, and future perspectives of adjuvant therapy for resectable esophageal cancer.
The Japan Society for Treatment of Obesity has repeated nationwide surveys on bariatric/metabolic procedures, including endoluminal procedures. We report the changes from 2021 to 2024. An e-mail survey was sent to 108 Ja...The Japan Society for Treatment of Obesity has repeated nationwide surveys on bariatric/metabolic procedures, including endoluminal procedures. We report the changes from 2021 to 2024. An e-mail survey was sent to 108 Japanese institutions that performed the bariatric/metabolic procedures. The number of laparoscopic bariatric/metabolic surgeries was as follows: 2021 (n = 890), 2022 (n = 985), 2023 (n = 936), and 2024 (n = 915). The number of laparoscopic sleeve gastrectomy (LSG) with bypass procedures increased in 2024 according to insurance coverage. Additionally, the number of LSGs for body mass index (BMI) < 35 kg/m drastically increased in 2024 according to changes in insurance coverage. The number of endoluminal bariatric/metabolic procedures was as follows: 2021 (n = 40), 2022 (n = 51), 2023 (n = 72), and 2024 (n = 80). Intragastric balloon placement and endoscopic sleeve gastroplasty were performed. The proportions reversed over four years. In Japan, the number of LSG with bypass procedures and LSGs for BMI < 35 kg/m is expected to increase in the future.
BACKGROUND/AIM: The prognostic outcome of the Naples prognostic score (NPS) in patients with colorectal liver metastases (CRLMs) who have undergone hepatectomy has not been investigated. The present study investigated th...BACKGROUND/AIM: The prognostic outcome of the Naples prognostic score (NPS) in patients with colorectal liver metastases (CRLMs) who have undergone hepatectomy has not been investigated. The present study investigated the prognostic value of the preoperative NPS score and other systemic inflammation-related biomarkers in patients who underwent hepatectomy for CRLMs. PATIENTS AND METHODS: The subjects included 179 patients with CRLMs who underwent hepatectomy and retrospectively investigated the association of preoperative NPS with the surgical failure-free survival (SFFS), disease-free survival (DFS), and overall survival (OS) using univariate and multivariate analyses. RESULTS: In this study, the cutoff NPS value was 2. In the univariate analysis, a high NPS was associated with a worse SFFS (p = 0.04) and OS (p = 0.02). The multivariate analysis showed significant and independent predictors of the OS were extrahepatic lesions (p < 0.01), serum carcinoembryonic antigen (CEA) levels (p = 0.04), and a high NPS (p = 0.04). CONCLUSION: The NPS can be useful in predicting long-term outcomes in patients with CRLMs after hepatectomy.
PURPOSES: The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreatico...PURPOSES: The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreaticoduodenectomy. METHODS: We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien-Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement. RESULTS: A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO. CONCLUSIONS: This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.
PURPOSE: Parathyroid carcinoma is an extremely rare malignancy, with an unfavorable clinical outcome and a high recurrence rate after initial surgery. Because surgical removal without tumor cells is the only curative tre...PURPOSE: Parathyroid carcinoma is an extremely rare malignancy, with an unfavorable clinical outcome and a high recurrence rate after initial surgery. Because surgical removal without tumor cells is the only curative treatment, a preoperative diagnosis is important to develop a strategy for complete removal of tumor cells. This study aimed to examine preoperative methods to differentiate parathyroid carcinoma from parathyroid adenoma. METHODS: We retrospectively analyzed the clinical and pathological features of patients with parathyroid carcinoma or parathyroid adenoma who were undergoing treatment at our hospital between 2011 and 2021. RESULTS: The statistical analysis included 7 patients with parathyroid carcinoma and 132 patients with parathyroid adenoma. For the preoperative diagnosis of parathyroid carcinoma, we found that the serum intact parathyroid hormone (iPTH) level was the most useful indicator, showing a significant positive correlation with depth to width (D/W) ratio (r = 0.6084, p = 0.0386) in parathyroid carcinoma, whereas no correlation was observed in parathyroid adenoma. Furthermore, in patients with a D/W ratio of > 0.534, iPTH levels more clearly differentiated parathyroid carcinoma from parathyroid adenoma. CONCLUSION: The combination of the serum iPTH level and D/W ratio may be useful in the differential diagnosis of parathyroid carcinoma.
PURPOSE: Minimally invasive esophagectomy (MIE) is the standard surgical procedure. Robot-assisted MIE (RAMIE) was developed to overcome the problems associated with conventional MIE. This study investigated whether or n...PURPOSE: Minimally invasive esophagectomy (MIE) is the standard surgical procedure. Robot-assisted MIE (RAMIE) was developed to overcome the problems associated with conventional MIE. This study investigated whether or not standardizing surgical procedures for RAMIE using soft coagulation scissors and Maryland bipolar forceps could improve short-term outcomes. METHODS: This study included 130 patients who underwent RAMIE. Clinicopathological characteristics and surgical outcomes were compared before and after standardization by two expert surgeons as well as between the standardized and trainee groups. A cumulative sum control chart (CUSUM) was used to evaluate changes in operative time. RESULTS: The console time during the thoracic procedure was shorter in the standardized group than in the pre-standardized group (P < 0.001). The rate of recurrent laryngeal nerve palsy was lower in the standardized group than in the pre-standardized group (P = 0.039). No significant differences were observed between the standardized and trainee groups. In the standardized and trainee groups, CUSUM clearly indicated that the console time peak occurred in the 12th and 16th cases. CONCLUSIONS: Standardization of surgical procedures using an appropriate device for each surgical step could improve surgical outcomes in RAMIE. Furthermore, it may facilitate safer and more efficient surgical training.
PURPOSE: A cloaca-like deformity following vaginal delivery is a rare obstetric complication that significantly impacts the patient's quality of life. No standard treatment protocols have yet been established, with some...PURPOSE: A cloaca-like deformity following vaginal delivery is a rare obstetric complication that significantly impacts the patient's quality of life. No standard treatment protocols have yet been established, with some centers advocating diverting colostomy. This study aimed to evaluate the efficacy and safety of primary perineal body reconstruction without colostomy. METHODS: We retrospectively analyzed seven consecutive cases of post-delivery cloaca-like deformities treated with primary perineal body reconstruction between June 2022 and September 2024. The outcome measures included operative time, blood loss, complications, functional outcomes using the Wexner incontinence scores, and the recurrence rate. RESULTS: All patients underwent a successful one-stage repair. The median operative time was 110 min (range: 85-168), and the median blood loss was 131 ml (range: 60-610). One patient (14.3%) experienced minor wound dehiscence that was conservatively managed. The postoperative hospital stay was 8 days in all cases. The Wexner incontinence scores improved significantly from a preoperative median of 12 (range: 5-17) to postoperative 4 (range: 0-14) (p < 0.0223). The sexual function improved in all cases, with two patients achieving subsequent pregnancy and delivery. No recurrence was observed during a mean follow-up of 9.7 ± 2.9 months. CONCLUSION: Primary perineal body reconstruction is a safe and effective treatment option for post-delivery cloaca-like deformities, thereby avoiding the need for diverting colostomy in appropriately selected patients. However, given the small sample size and retrospective nature of this study, our conclusions remain tentative.
PURPOSE: To compare the short-term outcomes of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP), with a particular focus on the actual completion rates of spleen and splenic vessels preser...PURPOSE: To compare the short-term outcomes of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP), with a particular focus on the actual completion rates of spleen and splenic vessels preservation preoperatively. METHODS: Fifty-two RDP and 87 LDP procedures performed between 2014 and 2024 were retrospectively analyzed. RESULTS: The operative time was significantly longer for RDP than for LDP (median 407 min vs. 320 min, p < 0.0001), whereas the intraoperative blood loss was significantly lower (median 70 mL vs. 100 mL, p = 0.011). The rate of conversion to open surgery was also lower for RDP (2% vs. 10%, p = 0.042). The spleen preservation rate, defined as the proportion of cases in which spleen preservation was achieved preoperatively, was 100% (12/12) and 92% (23/25) in the RDP and LDP groups, respectively (p = 0.203). The splenic vessels preservation rate was significantly higher with RDP (100% [10/10]) than with LDP (67% [16/24]; p = 0.011). Postoperative complication rates did not differ significantly between the two groups. CONCLUSIONS: Compared with LDP, RDP was associated with significantly reduced intraoperative blood loss, a lower conversion rate to open surgery, and a higher success rate in splenic vessels preservation, suggesting the technical advantages of RDP.
PURPOSE: Bleeding after graft reperfusion is a significant challenge in pancreas transplantation (PTx). To reduce post-reperfusion bleeding, we developed a modified bench surgery technique, combining a vessel-sealing sys...PURPOSE: Bleeding after graft reperfusion is a significant challenge in pancreas transplantation (PTx). To reduce post-reperfusion bleeding, we developed a modified bench surgery technique, combining a vessel-sealing system (LigaSure™) with indigo carmine (IC) leak testing. This study evaluates the clinical efficacy and safety of this method. METHODS: We reviewed, retrospectively, 54 consecutive PTx procedures, with (n = 25) or without (n = 29) the novel LigaSure™ plus IC (L + IC) method, performed between 2010 and 2024. Surgical outcomes, postoperative complications, graft loss, and glucose tolerance were compared between the control and L + IC groups. The safety of IC (9.0 µg/mL) for pancreatic islet cells was assessed through in vitro AO/PI staining and glucose-stimulated insulin secretion (GSIS) assays. RESULTS: The L + IC group showed significantly less post-reperfusion bleeding than the control group (715 mL vs. 360 mL; p = 0.0122). Multivariate analysis identified that L + IC was independently associated with reduced post-reperfusion bleeding (odds ratio 0.2171, p = 0.0171). IC exposure did not impair islet cell viability or function. The HbA1c and C-peptide levels were comparable between the groups. CONCLUSION: Our novel L + IC bench surgery technique proved safe and effective for reducing bleeding after pancreas graft reperfusion. Further prospective multicenter studies should be carried out to confirm its impact on long-term surgical outcomes.
PURPOSE: To compare the advantages and disadvantages of simultaneous laparoscopic hepatocolorectal resection and staged resection for colorectal cancer with synchronous liver metastasis. METHODS: Patients with colorectal...PURPOSE: To compare the advantages and disadvantages of simultaneous laparoscopic hepatocolorectal resection and staged resection for colorectal cancer with synchronous liver metastasis. METHODS: Patients with colorectal cancer and synchronous liver metastases who underwent laparoscopic surgery were divided into simultaneous (n = 38) and staged (n = 56) resection groups and their short-term outcomes and medical expenses were then retrospectively compared. RESULTS: The postoperative hospital stay was significantly shorter and the total medical costs were lower in the simultaneous group. However, the major complication rate (Clavien-Dindo classification ≥ 3a) was higher in the simultaneous group (28.9% vs. 12.5%, P = 0.047). After performing propensity score-adjusted logistic regression, simultaneous resection remained significantly associated with major complications (odds ratio, 5.11; P = 0.006). In a univariate analysis, the platelet count < 150,000/µL, liver metastasis diameter ≥ 3 cm, and difficulty score ≥ 6 were identified as potential risk factors for major complications in the simultaneous group. In a multivariate analysis, a difficulty score ≥ 6 was a significant risk factor (odds ratio, 9.63; P = 0.004). CONCLUSIONS: Simultaneous laparoscopic resection reduces the surgical burden and medical costs but carries a heightened perioperative risk. Staged resection should therefore be considered for patients with risk factors, particularly for those requiring hepatectomy with a difficulty score of ≥ 6.
Yoshiyama S, Kawabata R, Yamaguchi H
… +12 more, Fujiwara M, Matsukawa N, Kitamura M, Takeoka T, Hara H, Yoshihara T, Kitagawa A, Tomihara H, Naito A, Murakami M, Noura S, Miyamoto A
PURPOSES: Postoperative swallowing dysfunction is a complication that adversely affects elderly patients undergoing gastrointestinal cancer surgery. However, the perioperative changes in swallowing function and their pre...PURPOSES: Postoperative swallowing dysfunction is a complication that adversely affects elderly patients undergoing gastrointestinal cancer surgery. However, the perioperative changes in swallowing function and their predictive factors remain unclear. METHODS: The subjects of this retrospective analysis were 170 patients aged ≥ 65 years who underwent gastrointestinal cancer surgery and screened positively for sarcopenia and/or cognitive or swallowing concerns. Swallowing function was assessed using the Fujishima Eating and Swallowing Ability Grade (Fujishima Grade), a 10-point scale commonly used in Japan, at four perioperative time points. Dysfunction was defined as Grade ≤ 7 on postoperative day (POD) 1. Predictors were identified using univariate and multivariate logistic regression. RESULTS: Swallowing dysfunction developed in 63 patients (37.1%). The median grade declined on POD1 and improved by POD7 and on discharge. Among those with dysfunction, 21.0% remained at grade 7 on discharge. These patients had significantly lower cognitive scores (p < 0.001). Multivariate analysis identified age ≥ 75 years (OR 2.56, p = 0.034), sarcopenia (OR 2.13, p = 0.048), MMSE (Mini-Mental State Examination) ≤ 23 (OR 3.09, p = 0.007), and preoperative Fujishima Grade 8 (OR 2.48, p = 0.011) as independent predictors. CONCLUSIONS: Swallowing function declines transiently after gastrointestinal cancer surgery in elderly patients. Older age, sarcopenia, MMSE ≤ 23, and preoperative Fujishima Grade 8 are independent predictors of postoperative swallowing dysfunction.
PURPOSE: Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mF...PURPOSE: Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mFI-5) are established tools, their combined predictive value for postoperative complications remains unclear. Therefore, we investigated whether their combination improved risk prediction. METHODS: We analyzed 399 CRC ≥ 65 years of age who underwent curative surgery. Preoperative assessment included frailty (mFI-5 ≥ 2) and nutritional risk (GNRI < 98). Patients were stratified into low- (no factors), intermediate- (one factor), and high-risk (both factors) groups. Clavien-Dindo grade ≥ II complications were analyzed by multivariate logistic regression to identify predictive factors. RESULTS: Infectious complications increased significantly across the low-, intermediate-, and high-risk groups (13.3%, 14.6%, and 30.2%, respectively), with overall complication rates of 20.7%, 22.2%, and 45.3%, respectively. The median postoperative stay increased with increased risk (12, 14, and 18 days, respectively). Anastomotic leakage was more frequent, though not to a statistically significant extent, in high-risk patients. High-risk status independently predicted infectious and overall complications. CONCLUSIONS: Combined GNRI and mFI-5 assessments facilitated effective stratification of postoperative risk in older adults with CRC. These assessments may help in routine preoperative evaluations and support individualized perioperative care.