PURPOSE: Esophageal reconstruction using substitutes other than the stomach is technically demanding and it is often associated with postoperative complications. This study aimed to compare the short- and long-term outco...PURPOSE: Esophageal reconstruction using substitutes other than the stomach is technically demanding and it is often associated with postoperative complications. This study aimed to compare the short- and long-term outcomes of ileal and colonic reconstruction (IC) and pedicled jejunum reconstruction (PJ) after esophagectomy. METHODS: This study included 84 patients who underwent esophagectomy without gastric tube reconstruction (13 patients underwent IC and 71 underwent PJ). The clinicopathological characteristics, perioperative outcomes, and long-term nutritional status were compared between the two groups. RESULTS: The reconstruction procedure time was significantly shorter in the PJ group than in the IC group (P = 0.042), and blood loss during one-stage operations was lower in the PJ group (P = 0.010). Postoperative diarrhea occurred less frequently in the PJ group (P = 0.001). At 12 months after surgery, the decreases in the body mass index, psoas muscle area, psoas muscle volume, and psoas muscle index were significantly smaller in the PJ group (P = 0.022, 0.002, 0.003, and 0.042, respectively). Blood-based nutritional indicators were also more favorable in the PJ group. No significant differences were observed in the survival outcomes between the two groups. CONCLUSION: PJ is considered to be the preferred reconstruction method when gastric tube reconstruction cannot be performed after esophagectomy.
PURPOSE: We evaluated ultrasound-guided manual reduction as an initial management strategy for incarcerated obturator hernia, both as a bridge to elective surgery and as a pragmatic non-operative option in severely frail...PURPOSE: We evaluated ultrasound-guided manual reduction as an initial management strategy for incarcerated obturator hernia, both as a bridge to elective surgery and as a pragmatic non-operative option in severely frail patients. METHODS: We retrospectively analyzed consecutive patients who underwent attempted manual reduction for incarcerated obturator hernia between 2012 and 2025, excluding those with suspected bowel necrosis. The reduction success, associated factors, and subsequent outcomes were assessed. RESULTS: Manual reduction was successful in 39/46 lesions (84.8%) without procedure-related complications. Early presentation tended to be associated with successful reduction (median 12 vs. 48 h, p = 0.057). Compared with emergency surgery after failed reduction (n = 7), elective surgery following successful reduction (n = 24) was associated with lower bowel resection rates (0% vs. 42.9%, p = 0.008), higher mesh use (100% vs. 57.1%, p = 0.008), and a shorter postoperative stay (4 vs. 12 days, p = 0.002). Among the eight severely frail patients managed non-operatively, seven (87.5%) met the predefined clinical endpoints. CONCLUSION: Ultrasound-guided manual reduction appears to be feasible in selected patients with incarcerated obturator hernia, serving as a bridge to elective mesh repair under favorable conditions. In carefully selected severely frail individuals, it may also represent a pragmatic non-operative management option.
PURPOSE: To identify the prognostic factors in preoperatively treated rectal cancer and select patients who could be treated with neoadjuvant chemotherapy (NAC) alone. METHODS: A total of 78 patients, 58 in the NAC group...PURPOSE: To identify the prognostic factors in preoperatively treated rectal cancer and select patients who could be treated with neoadjuvant chemotherapy (NAC) alone. METHODS: A total of 78 patients, 58 in the NAC group and 20 in the radiation therapy (RT) group, with rectal cancer deeper than cT3 or N+ were studied from 2016 to 2022. The survival outcomes after neoadjuvant therapy and poor prognostic factors were analyzed. RESULTS: The median follow-up period was 63 months in the NAC group and 52 months in the RT group. In the multivariate analyses of all patients, a posttreatment mesorectal fascia (MRF)-positive status yielded a poor prognosis for the disease-free survival (HR, 5.051; 95% CI; 1.198-21.30, P = 0.027) and local recurrence (HR, 9.937; 95% CI; 1.282-77.05, P = 0.028). In posttreatment MRF-negative cases, the 3-year disease-free survival was 85.7% in both the NAC and RT groups (P = 0.950). The 3-year local recurrence rate was 14.3% in the RT group and 0% in the NAC group (P = 0.173). CONCLUSIONS: Posttreatment MRF positivity is an independent risk factor for a poor disease-free survival and local recurrence. However, posttreatment MRF negative cases that respond to NAC have comparable survival outcomes to those who undergo RT.
PURPOSE: To quantify colonic lengthening achieved by complete splenic flexure mobilization (SFM) and high inferior mesenteric vein (IMV) ligation while preserving the left colic artery (LCA) in laparoscopic low rectal ca...PURPOSE: To quantify colonic lengthening achieved by complete splenic flexure mobilization (SFM) and high inferior mesenteric vein (IMV) ligation while preserving the left colic artery (LCA) in laparoscopic low rectal cancer surgery. METHODS: Standardized LCA-preserving anterior resection was performed on 18 fresh cadavers. The additional colonic length gained after each maneuver was measured under tension-free conditions. High inferior mesenteric artery (IMA) ligation, which sacrifices the LCA, was also measured as a reference comparator. RESULTS: The mean baseline resection length was 10.4 ± 6.9 cm. Additional gains: 6.3 ± 1.7 cm after SFM and 14.4 ± 2.1 cm after high IMV ligation (maximum gain under LCA preservation). As a reference, high IMA ligation (without LCA preservation) provided a lengthening of 18.4 ± 1.7 cm. In malrotation (n = 2), IMV ligation yielded only 10.2-12.3 cm of mesenteric length. BMI correlated positively with the baseline length (r = 0.529, p = 0.023). CONCLUSIONS: Under LCA preservation, high IMV ligation provides the greatest lengthening (14.4 cm), although efficacy is reduced with malrotation. These data guide preoperative planning for tension-free anastomosis and adequate margin placement.
Ono R, Tominaga T, Takamura Y
… +13 more, Katayama H, Hashimoto S, Yamashita M, Maruta H, Noda K, Hisanaga M, Oishi K, Moriyama M, Uchida F, Shiraishi T, Kunizaki M, Nonaka T, Matsumoto K
PURPOSE: The risk factors and prognostic implications of retrieving fewer than 12 lymph nodes in patients undergoing laparoscopic/robot-assisted right colectomy remain unclear. METHODS: A total of 993 patients with Stage...PURPOSE: The risk factors and prognostic implications of retrieving fewer than 12 lymph nodes in patients undergoing laparoscopic/robot-assisted right colectomy remain unclear. METHODS: A total of 993 patients with Stage II/III right-sided colon cancer who underwent minimally invasive surgery between 2016 and 2024 were reviewed. Patients were divided into two groups: those with < 12 retrieved lymph nodes (low lymph node [L-LN] group, n = 139) and those with ≥ 12 retrieved lymph nodes (high lymph node [H-LN] group, n = 854). The clinicopathological characteristics and prognosis were compared between the groups. RESULTS: A multivariate analysis revealed that BMI > 25 kg/m (odds ratio [OR] 1.508; 95% confidence interval [CI] 1.004-2.266; p = 0.047), no colonic stent insertion (OR 3.500; 95%CI 1.077-11.378: p = 0.037), and a clinical node-negative status (OR 1.535 95%CI 1.050-2.242: p = 0.026) were independent predictors of retrieval of < 12 lymph nodes. In both Stage II (100% vs. 79.5%, p < 0.05) and Stage III (100% vs. 63.6%, p = 0.07) patients, adjuvant chemotherapy resulted in better outcomes than no adjuvant chemotherapy. CONCLUSION: In minimally invasive right colectomy, a high BMI and clinically node-negative disease were associated with a reduced number of dissected lymph nodes. As potentially inadequate dissection may contribute to a poor prognosis, adjuvant therapy should be considered in selected patients.
Postoperative pneumonia is a critical problem after esophagectomy. This systematic review examined overall risk factors for pneumonia after esophagectomy comprehensively and compared their relative impact on patients wit...Postoperative pneumonia is a critical problem after esophagectomy. This systematic review examined overall risk factors for pneumonia after esophagectomy comprehensively and compared their relative impact on patients with esophageal cancer. We searched MEDLINE, Embase, CENTRAL, and Web of Science in November, 2024, and included cohort studies on esophageal neoplasms, esophagectomy, pneumonia, and risk factors in this review. Study quality was assessed with the Newcastle-Ottawa Scale. The search yielded 3,323 records, among which 60 studies were eligible. The mean patient age ranged from 60.3 years to 73.9 years and the pneumonia incidence ranged from 2.0% to 61.5%. Thirty-seven risk factors were reported. By predefined levels of significance, age and smoking status were very strong (≥10 significant studies and >50% of all studies), and sarcopenia, forced expiratory volume (FEV), oral status, and physical frailty were strong (6-9 significant studies and >50% of all studies). Regarding the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework, age, smoking status, sarcopenia, FEV, and physical frailty were rated as having moderate certainty, and oral status was rated as having low certainty. Based on pooled odds ratios (random-effects models) the highest-ranked factors were physical frailty (OR: 5.170, 95% CI: 2.430-11.020), sarcopenia (OR: 2.790, 95% CI: 1.600-4.860), and FEV (OR: 2.730, 95% CI: 1.500-4.960).
PURPOSE: Resectability in pancreatic cancer (PC) is determined by anatomical, biological, and conditional (ABC) criteria. However, the pretreatment prognostic markers for unresectable locally advanced (UR-LA) PC are insu...PURPOSE: Resectability in pancreatic cancer (PC) is determined by anatomical, biological, and conditional (ABC) criteria. However, the pretreatment prognostic markers for unresectable locally advanced (UR-LA) PC are insufficient. This study aimed to identify the baseline predictors of survival and establish an inflammation-nutrition-based prognostic score. METHODS: Thirty-nine patients with UR-LA PC who received chemotherapy or chemoradiotherapy were retrospectively evaluated. Pretreatment biomarkers, including systemic immune-inflammation index (SIII) and body mass index (BMI), were analyzed using Cox proportional hazards models. RESULTS: Multivariable analysis identified BMI < 18.5 kg/m² (PFS: HR 3.79, p = 0.003; OS: HR 2.88, p = 0.03) and SIII > 900/µL (PFS: HR 3.71, p = 0.002; OS: HR 4.25, p = 0.02) as independent predictors of worse outcomes. High SIII was correlated with elevated neutrophil-to-lymphocyte ratio and lower prognostic nutritional index, whereas low BMI was associated with sarcopenia and reduced feasibility of conversion surgery. A pretreatment SIII/BMI score (0-2 points) effectively stratified survival: median PFS was 16.4, 7.3, and 4.3 months, and median OS was 31.1, 18.0, and 7.1 months for scores 0, 1, and 2, respectively. CONCLUSIONS: Pretreatment SIII and BMI are strong independent prognostic markers for UR-LA PC. The SIII/BMI score is a practical pretreatment tool aligned with the ABC framework to support individualized treatment planning.
PURPOSE: The optimal surgical approach for upper gastric cancer remains controversial, particularly regarding the postoperative quality of life (QOL) and nutritional outcomes. This study compared the outcomes of subtotal...PURPOSE: The optimal surgical approach for upper gastric cancer remains controversial, particularly regarding the postoperative quality of life (QOL) and nutritional outcomes. This study compared the outcomes of subtotal gastrectomy (STG), proximal gastrectomy (PG), and distal gastrectomy (DG). METHODS: We retrospectively analyzed 94 patients who underwent gastrectomy for upper gastric cancer (DG: n = 39, PG: n = 33, STG: n = 22). The quality of life (QOL) was assessed using the Postgastrectomy Syndrome Assessment Scale (PGSAS-45) 12 months postoperatively. The nutritional status was evaluated based on changes in body weight. RESULTS: The baseline clinicopathological factors and TNM stages were comparable among the three cohorts. PG was associated with significantly worse reflux, dyspepsia, and meal-related complaints than STG and DG. The STG showed fewer dumping-related symptoms than the PG. No significant differences in overall nutritional status were observed between the STG and DG groups, whereas the PG group tended to be associated with less favorable nutritional outcomes. These findings were consistent with the responder analyses. CONCLUSIONS: In this retrospective cohort study, STG was associated with a more favorable postoperative symptom profile than PG and showed postoperative outcomes comparable to those of DG.
Mise M, Ozawa H, Kobayashi H
… +11 more, Kawasaki M, Kanemitsu Y, Kinugasa Y, Ueno H, Suto T, Itabashi M, Funahashi K, Ishida H, Kotake K, Sugihara K, Ajioka Y
PURPOSE: We previously identified T4, an undifferentiated histological type, and positive lymph node (LN) metastasis as risk factors for positive intraperitoneal lavage cytology (IPLC) in colorectal cancer (CRC) surgery....PURPOSE: We previously identified T4, an undifferentiated histological type, and positive lymph node (LN) metastasis as risk factors for positive intraperitoneal lavage cytology (IPLC) in colorectal cancer (CRC) surgery. However, the number of LN metastases influencing IPLC positivity remains unknown. We conducted a multicenter, prospective, observational study to determine the threshold number of LN metastases associated with IPLC positivity and identify patients with CRC who should undergo IPLC. METHODS: Patients with clinical stage II and III CRC who underwent tumor resection and IPLC between 2013 and 2017 were included. IPLC was performed once during laparotomy and once after tumor resection. Patients with a T4 stage, ascites, or undifferentiated types were excluded, as these factors affected IPLC. The number of LNs that influenced IPLC positivity was examined using a logistic regression analysis and the Akaike information criterion (AIC). RESULTS: The IPLC positivity rate was 2.0%. The rate increased significantly in patients with ≥ 2 LN metastases, and stratification by five LN metastases yielded the lowest AIC value (156.9). The positivity rate was 8.9-fold higher in patients with ≥ 5 LN metastases than in those with < 5 metastases. CONCLUSION: IPLC is recommended for patients with clinical stage III CRC and multiple LN metastases.
PURPOSE: The Laboratory Frailty Index (FI-lab), derived from routine preoperative laboratory parameters, offers a simple and objective alternative to conventional frailty assessment. However, its clinical relevance in el...PURPOSE: The Laboratory Frailty Index (FI-lab), derived from routine preoperative laboratory parameters, offers a simple and objective alternative to conventional frailty assessment. However, its clinical relevance in elderly patients undergoing pancreaticoduodenectomy (PD), particularly those with pancreatic ductal adenocarcinoma (PDAC), remains unclear. METHODS: We retrospectively analyzed 350 patients aged ≥ 65 years who underwent PD between 2012 and 2021. Frailty was defined as FI-lab ≥ 0.40. Short-term outcomes, including major postoperative complications (Clavien-Dindo grade ≥IIIa) and in-hospital mortality, were compared between frail and non-frail patients. The long-term outcomes (overall survival [OS] and disease-free survival [DFS]) were evaluated in 166 patients with PDAC. RESULTS: Ninety-seven patients (27.7%) were classified as frail. Frail patients had a lower body mass index, greater intraoperative blood loss, and higher transfusion rates, whereas major complications and mortality rates were comparable between the groups. In patients with PDAC, frailty was associated with shorter OS (27.5 vs. 42.2 months; p = 0.043) and DFS (16.7 vs. 23.4 months; p = 0.046), although it was not an independent prognostic factor. CONCLUSIONS: FI-lab-defined frailty was not associated with perioperative morbidity or mortality after PD. In patients with PDAC, FI-lab may serve as a supplementary tool for preoperative risk stratification by reflecting their physiological vulnerability.
PURPOSE: Low anterior resection syndrome (LARS) is a common complication of rectal resections. This study aimed to identify the symptoms that patients perceive as most bothersome, compare the symptom patterns between the...PURPOSE: Low anterior resection syndrome (LARS) is a common complication of rectal resections. This study aimed to identify the symptoms that patients perceive as most bothersome, compare the symptom patterns between the early and late postoperative phases, and assess the limitations of existing scoring systems in reflecting patient distress. METHODS: A cross-sectional study was conducted with 82 patients who underwent sphincter-preserving rectal resection at the Aichi Medical University Hospital (2016-2024). A questionnaire including the LARS score, Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), and original questions on bothersome symptoms and subjective severity (0-10 scale) were administered. The patients were classified into the early (≤ 2 years, n = 28) and late (> 2 years, n = 54) postoperative groups. RESULTS: Clustering was the most frequently reported symptom in both the early (67.9%) and late (51.9%) phases. The median CCFIS was lower in the late group (6 [0-18] vs. 3.5 [0-17], p = 0.045), while no significant differences were observed in LARS scores (33 [12-39] vs. 29.5 [0-36], p = 0.127) or subjective severity (4 [0-9] vs. 3 [0-10], p = 0.588). One-third of the patients with severe clustering were not classified as having "major LARS." CONCLUSIONS: Clustering, which is often underestimated by composite scores, remained the most distressing and persistent symptom, emphasizing the need for symptom-specific evaluation in LARS.
BACKGROUND: The benefit of neoadjuvant chemoradiotherapy (NACRT) for elderly patients with locally advanced rectal cancer (LARC) remains unclear because these patients are often excluded from trials. We evaluated the saf...BACKGROUND: The benefit of neoadjuvant chemoradiotherapy (NACRT) for elderly patients with locally advanced rectal cancer (LARC) remains unclear because these patients are often excluded from trials. We evaluated the safety and oncologic outcomes of NACRT in elderly LARC patients. METHODS: The subjects of this retrospective analysis were 98 LARC patients who underwent radical resection after NACRT. We compared patients aged ≥ 75 years (Elderly group) with non-elderly patients (non-Elderly group), assessing treatment completion, adverse events, pathological response, and survival outcomes. Prognostic factors for relapse-free survival (RFS) were examined using Cox regression. RESULTS: The Elderly group patients had poorer performance status and more frequent chemotherapy dose reductions. The median relative dose intensity of chemotherapy did not differ significantly between the Elderly and non-Elderly groups, and the median relative dose intensity of radiotherapy was 100% in both groups. The incidence of grade ≥ 3 adverse events was comparable between the groups. RFS (P = 0.313) and cancer-specific survival (P = 0.408) did not differ significantly. Multivariate analysis identified the American Society of Anesthesiologists-performance status score 3 (HR: 4.64, P = 0.002), Clavien-Dindo grade ≥ 3 complications (HR: 2.72, P = 0.008), and ypN3 (HR: 2.96, P = 0.036), but not age, as independent predictors of RFS. CONCLUSIONS: Chronological age did not affect toxicity, pathological response, or survival outcomes adversely. Thus, NACRT can be offered safely to elderly LARC patients with appropriate performance status, suggesting that age alone should not preclude curative treatment.
Mori M, Hirano S, Hakamada K
… +29 more, Oki E, Ito T, Urushidani S, Uyama I, Eto M, Ebihara Y, Kanemitsu Y, Kawashima K, Kanno T, Kitsuregawa M, Kinugasa Y, Kitatsuji H, Sato T, Sato F, Shimokawa T, Shimamoto H, Takiguchi S, Takemasa I, Tokunaga M, Nakauchi M, Noshiro H, Masaki Mandai, Koshi Mimori, Morohashi H, Yoshizumi T, Watanabe G, Sakai Y, Ikeda N, Taketomi A
Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinic...Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.
Hamaji M, Miyamoto S, Sozu T
… +11 more, Ohsumi A, Kobayashi M, Nakagawa T, Sonobe M, Aoyama A, Ishikawa M, Sakai H, Miyahara R, Menju T, Date H, Chen-Yoshikawa TF
PURPOSE: Surgeries performed on Fridays may be associated with an increased risk of postoperative complications. However, data on pulmonary resection for non-small cell lung cancer (NSCLC) are lacking. This study aimed t...PURPOSE: Surgeries performed on Fridays may be associated with an increased risk of postoperative complications. However, data on pulmonary resection for non-small cell lung cancer (NSCLC) are lacking. This study aimed to evaluate the outcomes of pulmonary resection for NSCLC performed on Fridays or before holidays. METHODS: We performed a retrospective chart review to identify patients with NSCLC who underwent pulmonary resection between 2014 and 2016. Patients were classified into two groups: those undergoing surgery on Fridays or the day before a public holiday (pre-weekend group) and those undergoing surgery on other weekdays (control group). Propensity score matching (1:1 ratio) was performed to compare intraoperative injury, any postoperative complication, grade ≥ 3 complications, overall survival (OS), and recurrence-free survival (RFS). RESULTS: The risk ratios were 0.70 (95% confidence interval [CI]: 0.27-1.82) for intraoperative injuries, 0.93 (95%CI: 0.70-1.22) for any postoperative complications, and 0.54 (95%CI: 0.32-0.93) for grade ≥ 3 complications. The hazard ratio was 0.91 (95%CI: 0.64-1.29) for OS and 0.99 (95%CI: 0.75-1.30) for RFS. CONCLUSIONS: Elective pulmonary resection for NSCLC performed on Fridays or before holidays may not be associated with increased postoperative complications or worse long-term outcomes.
PURPOSE: This study aimed to determine the risk factors for new-onset hepatic steatosis after total pancreatectomy (TP), focusing on muscle loss and sex. METHODS: We retrospectively analyzed 100 patients who underwent TP...PURPOSE: This study aimed to determine the risk factors for new-onset hepatic steatosis after total pancreatectomy (TP), focusing on muscle loss and sex. METHODS: We retrospectively analyzed 100 patients who underwent TP between 2005 and 2024. Nutritional parameters, BMI, muscle volume, and liver status were evaluated. Logistic regression and subgroup analyses were performed to identify the risk factors for hepatic steatosis. RESULTS: The prevalence of hepatic steatosis increased from 3.0% preoperatively to 24.0% at 3-6 months after TP. Female patients showed a significantly higher incidence of hepatic steatosis than male patients (37.8% vs. 12.7%, respectively). A multivariate analysis identified female sex (odds ratio: 7.77, 95% confidence interval: 2.03-29.8, p = 0.009), younger age (0.93, 0.88-0.98, 0.011), and higher preoperative BMI (1.28, 1.05-1.63, 0.015) as independent risk factors. Among the female patients, a younger age, one-stage TP, greater reductions in SMI, portal vein resection, longer operative time, greater blood loss, and diarrhea at discharge were associated with new-onset hepatic steatosis. However, a lower intraoperative blood loss potentially contributes to recovery from hepatic steatosis after TP. CONCLUSIONS: A female sex is a high risk factor for hepatic steatosis after TP. Reducing operative stress and preserving muscle volume may facilitate the prevention and recovery from hepatic steatosis.
Shiraishi T, Hashimoto S, Tominaga T
… +13 more, Takamura Y, Katayama H, Yamashita M, Noda K, Tei S, Ono R, Hisanaga M, Oishi K, Moriyama M, Uchida F, Kunizaki M, Nonaka T, Matsumoto K
PURPOSE: Studies evaluating the occurrence, risk factors, and prognostic impact of surgical site infection (SSI) after minimally invasive surgery (MIS) for colorectal cancer are limited. METHODS: This multicenter retrosp...PURPOSE: Studies evaluating the occurrence, risk factors, and prognostic impact of surgical site infection (SSI) after minimally invasive surgery (MIS) for colorectal cancer are limited. METHODS: This multicenter retrospective study reviewed 3276 consecutive patients who underwent curative MIS for colorectal cancer between 2016 and 2024. Patients were divided into those who experienced incisional/deep SSI (n = 71), organ/space SSI (n = 67), and no SSI (no-SSI, n = 3138). This cohort was further subdivided into colon and rectum groups, and we examined the clinicopathological background and risk factors using a logistic regression analysis and prognosis using a Cox proportional hazards analysis. RESULTS: In colon cancer, blood loss was an independent predictor of incisional/deep SSI (odds ratio (OR) 1.745, p = 0.042) and organ/space SSI (OR 6.087, 95% CI, 1.319-28.087; p = 0.020). In rectal cancer, preoperative treatment was an independent predictor of incisional/deep SSI (OR 5.619, p < 0.001) and organ/space SSI (OR 2.552, p = 0.021). In pathological node-negative patients with colon cancer, RFS (5-year RFS; 76.4% vs. 27.2% vs. 82.6%, p < 0.001) and OS (5-year OS; 80.0% vs. 56.0% vs. 86.4%, p = 0.013) were worse in the organ/space SSI group. CONCLUSIONS: Preoperative treatment and blood loss are risk factors for SSI. Even after SSI, administering appropriate adjuvant chemotherapy may be important for improving the prognosis.
PURPOSE: Nurse practitioners (NPs) were introduced in Japan to reduce physicians' workloads through task shifting. Three cardiac surgical NPs (CSNPs) were employed in our department. This study aimed to describe their cl...PURPOSE: Nurse practitioners (NPs) were introduced in Japan to reduce physicians' workloads through task shifting. Three cardiac surgical NPs (CSNPs) were employed in our department. This study aimed to describe their clinical practices and evaluate their contributions to task shifting. METHODS: We reviewed the medical records of patients treated between January 2019 and December 2024. Three analyses were conducted: (I) quantification of medical procedures performed by CSNPs, (II) assessment of CSNP participation as surgical assistants, and (III) evaluation of delegated medical order entries. RESULTS: (I) Among 1,822 patients, the most frequently performed CSNP procedures were ventilator setting adjustments, peripherally inserted central catheter placement, and arterial blood sampling. (II) The median annual number of surgeries involving CSNPs was 191 (44%), with a median cumulative operative time of 1,137 h. (III) CSNP-delegated orders accounted for 19.2% of outpatient and 36.6% of inpatient entries. Increased CSNP order entries were significantly correlated with decreased surgeon entries in both outpatient (r = 0.67, p < 0.001) and inpatient (r = 0.59, p < 0.001) settings. CONCLUSIONS: The inverse correlation between CSNP and surgeon order entries indicates that CSNPs substantially support task shifting and help reduce surgeons' workloads in cardiac surgery.
PURPOSE: Early distinction between perforated and non-perforated acute appendicitis (AA) in children remains challenging. Conventional inflammatory markers have limited accuracy, highlighting the potential value of compo...PURPOSE: Early distinction between perforated and non-perforated acute appendicitis (AA) in children remains challenging. Conventional inflammatory markers have limited accuracy, highlighting the potential value of composite inflammatory indices. METHODS: Pediatric patients were categorized as having non-perforated or perforated appendicitis based on intraoperative findings and histopathologic confirmation. Laboratory data obtained on hospital admission included C-reactive protein (CRP), white blood cell count, and differential leukocyte percentages. RESULTS: The subjects of this retrospective study were 338 pediatric patients, 48 (14.2%) of whom had perforated AA. The CRP to lymphocyte ratio (CRP/LR) was significantly higher in the patients with perforated AA (p < 0.001). ROC analysis demonstrated good discriminative performance of CRP/LR for predicting appendiceal perforation, with an area under the curve of 0.84 (95% CI 0.78-0.90). A CRP/LR cut-off value of ≥ 7.2 yielded a sensitivity of 83.3% and a specificity of 78.6%. After adjustment for age, symptom duration, and body temperature on admission, CRP/LR remained an independent predictor of appendiceal perforation in the multivariate regression analysis. CONCLUSION: The CRP/LR showed good diagnostic performance in differentiating perforated from non-perforated AA and may serve as a simple, readily available tool for early risk stratification in pediatric patients.
PURPOSE: Robotic distal pancreatectomy (RDP) is being adopted increasingly, but its impact on clinically relevant postoperative pancreatic fistula (CR-POPF) compared with that of open distal pancreatectomy (ODP) remains...PURPOSE: Robotic distal pancreatectomy (RDP) is being adopted increasingly, but its impact on clinically relevant postoperative pancreatic fistula (CR-POPF) compared with that of open distal pancreatectomy (ODP) remains unclear. We compared the incidences of CR-POPF after RDP vs. ODP, focusing on postoperative inflammation and drain bacterial contamination. METHODS: The subjects of this retrospective analysis were 125 patients who underwent stapler-based distal pancreatectomy at a single center between 2013 and 2025 (RDP, n = 50; ODP, n = 75). Propensity score matching yielded 32 matched patients in each group. Outcomes included CR-POPF, postoperative C-reactive protein, drain amylase levels, and drain fluid cultures on postoperative days (PODs) 1 and 3. Multivariable analysis was performed to identify the factors associated with CR-POPF. RESULTS: After matching, it was evident that the RDP group had less blood loss (median 95 vs. 573 mL, p < 0.001) and fewer transfusions (3% vs. 19%, p = 0.045). Positive POD-3 drain cultures were less frequent after RDP (6% vs. 25%, p = 0.039). CR-POPF occurred less often after RDP than ODP (6% vs. 41%, p = 0.001). Exploratory analysis revealed that RDP was associated with a lower incidence of CR-POPF, whereas positive POD 3 drain culture was associated with increased risk. CONCLUSIONS: RDP was associated with a lower incidence of CR-POPF, which may be related to differences in postoperative inflammation and bacterial contamination.
PURPOSE: The diagnostic accuracy of conventional size-based evaluation on computed tomography (CT) is limited. We conducted this study to develop and validate a novel CT-based scoring system, integrating lymph node morph...PURPOSE: The diagnostic accuracy of conventional size-based evaluation on computed tomography (CT) is limited. We conducted this study to develop and validate a novel CT-based scoring system, integrating lymph node morphology, enhancement, size, and tumor laterality for the accurate preoperative assessment of lymph node metastasis in colorectal cancer patients. METHODS: We analyzed a retrospective cohort of 145 patients who underwent curative colorectal cancer surgery with D3 lymph node dissection. Short-axis diameter, contrast enhancement, and margin irregularity of evaluable lymph nodes were assessed on preoperative CT images, and the largest lymph node in each patient was analyzed. Diameter-based and composite-based approaches were developed and validated using temporally separate cohorts. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve and other accuracy measures. RESULTS: In the derivation cohort, the composite-based approach showed superior performance to the diameter-based approach across all tumor locations (AUC 0.80 vs. 0.73), including right-sided (0.80 vs. 0.70) and left-sided colon cancers (0.84 vs. 0.77). Sensitivity and specificity further improved with laterality-adjusted scoring. These findings were confirmed in the validation cohort. CONCLUSIONS: A laterality-specific scoring system integrating lymph node morphology, enhancement, and size may improve the preoperative diagnostic accuracy for identifying lymph node metastasis in colorectal cancer patients.