PURPOSE: Treatment-related muscle loss is common in esophageal squamous cell carcinoma (ESCC). The masseter reflects chewing–swallowing musculature; therefore, we evaluated whether preserving the masseter muscle index (Δ...PURPOSE: Treatment-related muscle loss is common in esophageal squamous cell carcinoma (ESCC). The masseter reflects chewing–swallowing musculature; therefore, we evaluated whether preserving the masseter muscle index (ΔMMI) during preoperative chemoradiotherapy (CRT) relates more to survival and immunonutritional change, than preserving the psoas muscle index (ΔPMI). METHODS: The subjects of this retrospective analysis were 78 ESCC patients who underwent CRT followed by esophagectomy. MMI and PMI were measured on contrast-enhanced CT at baseline (TP0) and post-CRT (TP1). Immunonutritional markers were assessed at TP0–TP2 (3 months postoperatively, ± 14 days) based on percent change (Δ). Associations with interval changes were tested with ANCOVA, adjusted for baseline, age, and sex. Overall survival (OS) and recurrence-free survival (RFS) were evaluated by Kaplan–Meier using median-split Δ over TP0→TP1. RESULTS: Better maintenance of ΔMMI during CRT was related to better OS (borderline) and favorable profiles; namely, improved BMI maintenance and lower Glasgow Prognostic Score (GPS), over TP0→TP1. In contrast, greater ΔPMI loss did not separate OS, but was associated with worse RFS and consistent deterioration in the indices of BMI, geriatric nutritional risk index (GNRI), and albumin, through TP0→TP2. CONCLUSIONS: Preserving ΔMMI during CRT relates to survival and immunonutritional stability, complementing ΔPMI as a systemic marker of decline. Incorporating masseter imaging into routine assessment and testing MMI-guided perioperative support warrants prospective evaluation.
PURPOSE: To address our hypothesis that increased surgical costs for robotic liver resection would be compensated by reduced postoperative care expenses, we compared the economic outcomes of robotic, laparoscopic, and op...PURPOSE: To address our hypothesis that increased surgical costs for robotic liver resection would be compensated by reduced postoperative care expenses, we compared the economic outcomes of robotic, laparoscopic, and open liver resection under the Japanese national health insurance system. METHODS: Patients who underwent liver resection between 2022 and 2024 were included in this study. The perioperative and economic outcomes were compared among the patients who underwent robotic, laparoscopic, and open liver resection using inverse probability of treatment weighting. Subgroup analyses were conducted for single partial resection, mono-segmentectomy, and the resection of two contiguous sections. RESULTS: Of 402 patients, 302 met the inclusion criteria: robotic (n = 45), laparoscopic (n = 75), and open (n = 182). The hospital revenue per admission did not differ significantly among the three groups (P = 0.427). The overall hospital profit per day was significantly higher in the robotic group than in the laparoscopic and open groups (P < 0.001). The hospital profit per day was more favorable in patients undergoing robotic liver resection for mono-segmentectomy than in those undergoing laparoscopic and open liver resection, and for the resection of two contiguous sections than for open liver resection. CONCLUSION: Although the hospital revenue and profit per admission did not differ significantly among the groups, robotic LRR may offer economic advantages regarding hospital profit per day.
PURPOSE: This study aimed to evaluate the predictive performance of the established risk scores for postoperative pulmonary complications and develop a novel integrated score derived from these assessments in older adult...PURPOSE: This study aimed to evaluate the predictive performance of the established risk scores for postoperative pulmonary complications and develop a novel integrated score derived from these assessments in older adults undergoing laparoscopic right-sided colectomy. The secondary endpoints included the incidence of pulmonary complications and the factors related to their severity. METHODS: This dual-center retrospective study included 342 patients (≥ 75 years) who underwent laparoscopic right-sided colectomy for colon cancer between 2009 and 2023. The Estimation of Physiologic Ability and Surgical Stress system and the Prognostic Nutritional Index were evaluated as predictors of pulmonary complications (Clavien–Dindo grade ≥ 2). The risk factors were analyzed using logistic regression, from which a novel integrated score was developed, and the predictive performance was evaluated using a receiver operating characteristic curve analysis. RESULTS: Pulmonary complications occurred in 13 (3.8%) patients. Multivariate analyses identified the Preoperative Risk Score and Prognostic Nutritional Index as independent predictors. A combination score (Nutritional And Multisystem–Based Assessment [NAMBA] score) incorporating both preoperative assessments accurately identified high-risk patients (area under the curve, 0.801). Pulmonary complications occurring after abdominal complications were associated with their severity. CONCLUSIONS: The NAMBA score effectively identifies older adults at high risk of pulmonary complications after laparoscopic right-sided colectomy and it may improve perioperative management.
PURPOSE: To evaluate the prognostic significance of platelet count abnormalities, specifically thrombocytosis and thrombocytopenia, across diverse liver disease etiologies and fibrosis stages in patients undergoing curat...PURPOSE: To evaluate the prognostic significance of platelet count abnormalities, specifically thrombocytosis and thrombocytopenia, across diverse liver disease etiologies and fibrosis stages in patients undergoing curative resection for hepatocellular carcinoma (HCC). METHODS: We retrospectively analyzed 1,215 patients who underwent initial curative HCC resection. The patients were stratified by platelet count (thrombocytopenia < 100 × 10⁹/L; thrombocytosis ≥ 200 or ≥ 300 × 10⁹/L). We assessed the prognostic impact on the overall survival (OS) and recurrence-free survival (RFS) across etiologies (HBV, HCV, non-B/non-C), fibrosis stages, and specific subgroups (MASLD, SVR-HCV), alongside an aspirin use analysis. RESULTS: Both thrombocytopenia and thrombocytosis independently predicted a poor OS, whereas only thrombocytosis was a significant independent predictor of a poor RFS. Thrombocytosis adversely affected the OS across all etiologies except HBV, whereas it predicted a poor RFS specifically in patients with HBV infection. Notably, patients with MASLD and thrombocytosis exhibited the highest risk of a poor OS (HR: 3.54). Aspirin use significantly improved the RFS in the non-B/non-C, MASLD, and non-cirrhotic cohorts, but it provided no survival benefit in patients with thrombocytosis. CONCLUSION: Thrombocytopenia and thrombocytosis are independent predictors of a poor prognosis after HCC resection, with distinct etiology-specific impacts. MASLD-related HCC is particularly vulnerable to platelet-mediated tumor promotion. While aspirin may benefit selected subgroups, it has shown limited efficacy in patients with thrombocytosis.
PURPOSE: Internal pancreatic stents are commonly used during pancreaticoduodenectomy (PD) to support pancreatojejunostomy. However, stent-related complications, including rare, but severe jejunal penetration, remain a co...PURPOSE: Internal pancreatic stents are commonly used during pancreaticoduodenectomy (PD) to support pancreatojejunostomy. However, stent-related complications, including rare, but severe jejunal penetration, remain a concern. The stent–jejunum angle has not been well studied, despite its potential contribution to mechanical injury. METHODS: We retrospectively reviewed 98 patients who underwent PD with internal stent placement between 2010 and 2023. Stent characteristics, including the angle, length, and positioning, were measured using postoperative CT. Outcomes were compared among complication types, stent indwelling time groups, and two insertion techniques: conventional and a modified method designed to reduce the stent angulation. RESULTS: Jejunal penetration occurred in three patients (3.1%) and it was associated with a significantly more perpendicular stent–jejunum angle than that in the other groups. A longer stent indwelling time was correlated with a greater intrapancreatic duct length but not with postoperative complications. The modified insertion technique resulted in a less perpendicular angle, and no penetration events occurred after its implementation. CONCLUSIONS: A near-perpendicular stent–jejunum angle may be associated with jejunal penetration after PD. Although the number of events was small, this geometric parameter represents a potentially modifiable technical factor. Prospective studies are therefore warranted.
Shiraishi T, Hashimoto S, Tominaga T
… +12 more, Takamura Y, Katayama H, Yamashita M, Noda K, Tei S, Ono R, Ishii M, Oishi K, Moriyama M, Onoda T, Nonaka T, Matsumoto K
PURPOSE: The impact of the number of lymph nodes removed on prognosis in patients with pathological node-positive disease is still unclear. METHODS: We retrospectively reviewed 672 colorectal cancer patients who underwen...PURPOSE: The impact of the number of lymph nodes removed on prognosis in patients with pathological node-positive disease is still unclear. METHODS: We retrospectively reviewed 672 colorectal cancer patients who underwent curative surgery and were diagnosed as node-positive pathologically. Patients were divided into two groups: those with a low number of retrieved lymph nodes (Group L, n = 127); and those with a high number (Group H, n = 545). Propensity score matching was applied to minimize the possibility of selection bias. Finally, 120 patients in each group were matched. RESULTS: Before matching, Group L showed lower frequencies of comorbidities (Group L vs Group R: 65.4% vs 77.1%, p = 0.008), involvement of the right-side colon (25.1% vs 35.0%, p = 0.036), and clinical T4 status (15.0% vs 25.1%, p = 0.014), and a higher frequency of clinical node-negative status (47.2% vs 29.0%, p < 0.001). After matching, operation time was shorter (203 min vs 239 min, p = 0.005) and 5-year recurrence-free survival rate was poorer in Group L (57.8% vs 71.4%, p = 0.047). CONCLUSIONS: In patients with Stage III colorectal cancer, lymph node dissection yielding ≤ 12 nodes may be associated with poor prognosis. Implementation of appropriate adjuvant therapy and consideration of optimal treatment content and duration are necessary.
BACKGROUND: Neoadjuvant chemotherapy (NAC) is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC). However, larger ESCCs leading to cancerous esophageal stenosis show a poor response to NAC. The...BACKGROUND: Neoadjuvant chemotherapy (NAC) is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC). However, larger ESCCs leading to cancerous esophageal stenosis show a poor response to NAC. Therefore, this study aimed to evaluate the efficacy of NAC in patients with cancerous esophageal stenosis. METHODS: Between April 2011 and March 2022, 71 patients with ESCC and esophageal stenosis underwent minimally invasive esophagectomy (MIE) at Kobe University Hospital and Hyogo Cancer Center. In the NAC followed by surgery (NAC) group (n = 30), patients received cisplatin plus 5-fluorouracil (CF). Enteral nutrition was administered via a nasogastric tube during NAC. In the Upfront Surgery group (n = 41), patients in a good condition after surgery received CF therapy. Propensity score matching was used to identify 24 matched patients in each group. RESULTS: After propensity score matching, no significant differences were observed in the background factors; however, patients in the NAC group tended to have a slightly worse overall survival than those in the Upfront Surgery group (p = 0.056). CONCLUSION: No improvement in the overall survival was reported after preoperative CF therapy and enteral nutrition. Therefore, upfront surgery and postoperative chemotherapy may provide a better alternative treatment for these patients.
PURPOSE: The clinical value of the C-reactive protein–albumin–lymphocyte (CALLY) index, an inflammation- and nutrition-based biomarker, in unresectable or recurrent gastric cancer (URGC) remains unclear. This study evalu...PURPOSE: The clinical value of the C-reactive protein–albumin–lymphocyte (CALLY) index, an inflammation- and nutrition-based biomarker, in unresectable or recurrent gastric cancer (URGC) remains unclear. This study evaluated its prognostic significance in patients receiving first-line fluoropyrimidine-based chemotherapy. METHODS: This multicenter retrospective study included 201 URGC patients treated with fluoropyrimidine-based combination chemotherapy between 2017 and 2023. Patients with HER2-positive tumors, monotherapy, or non-fluoropyrimidine regimens were excluded from the analysis. The CALLY index was calculated using pretreatment laboratory values, and the optimal cutoff was calculated by receiver operating characteristic (ROC) analysis. We compared the survival outcomes and clinical characteristics between the high- and low-CALLY groups. RESULTS: The optimal CALLY index cutoff was 1.7, indicating the highest prognostic performance. The low-CALLY group had higher rates of unresectable primary tumors and Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 1. Despite a comparable incidence of grade ≥ 3 adverse events, third-line therapy was administered more frequently in the high-CALLY group. Median overall survival was significantly shorter in the low-CALLY group (11.4 vs. 20.5 months, respectively; p < 0.001). On multivariate analysis, a low CALLY index (hazard ratio [HR] 1.591, p = 0.004), ECOG PS ≥ 1 (HR 1.648, p = 0.002), and peritoneal dissemination (HR 1.530, p = 0.042) were independent predictors of poor survival. CONCLUSIONS: The CALLY index is a strong independent prognostic biomarker for URGC patients treated with first-line fluoropyrimidine–based chemotherapy. It reflects tumor-induced inflammation and host immune–nutritional status, providing a simple, objective tool for pretreatment risk stratification.
Sekino N, Kurata Y, Hayano K
… +11 more, Matsumoto Y, Otsuka R, Hirano S, Uesato M, Toyozumi T, Nakano A, Shiraishi T, Matsusaka K, Ikeda JI, Hayashi H, Matsubara H
PURPOSE: Microsatellite instability caused by impaired mismatch repair (MMR) is referred to as MSI-high, and gastric cancers with this feature are classified as MSI-high gastric cancer. The loss-of-function of mutL homol...PURPOSE: Microsatellite instability caused by impaired mismatch repair (MMR) is referred to as MSI-high, and gastric cancers with this feature are classified as MSI-high gastric cancer. The loss-of-function of mutL homolog 1 (MLH1) is a major cause of MSI-high gastric cancer. This study aimed to investigate the role of MLH1 in the gastric cancer pathogenesis and to characterize MLH1-deficient cases compared with MLH1-preserved cases, focusing on tumor-related factors and patient background. We also aimed to identify the genes potentially associated with phenotypic differences. METHODS: Patients who underwent gastrectomy for gastric cancer between June 2019 and December 2023 and had histopathological diagnoses indicating MLH1 expression were included in this study. Clinicopathological correlations were examined in 85 patients, including 14 MLH1-deficient and 71 MLH1-preserved cases. Finally, the gene characteristics of MLH1 deficiency were analyzed for correlations with MLH1 expression using cBioPortal. RESULTS: The MLH1-deficient group showed significant tumor depth progression, reduced alcohol consumption, fewer Helicobacter pylori infections, and low lymphocyte percentages in preoperative blood tests. Aldehyde dehydrogenase 1A1, nuclear factor kappa B1, and programmed death-ligand 1 were identified as candidate genes associated with this phenotype. CONCLUSION: We observed differences in the gastric adenocarcinoma properties according to MLH1 expression and identified important candidate genes to elucidate the pathological mechanisms.
Yamamoto T, Takahashi A, Yoshizumi T
… +29 more, Ishihara S, Inomata M, Imoto S, Eguchi H, Ebata T, Otsuka M, Okuyama H, Kakeji Y, Kato T, Kamei T, Saiki Y, Saito A, Shimizu H, Soga Y, Tajiri T, Nogi H, Hatano E, Hara H, Bitoh Y, Mizushima T, Minatoya K, Miyagawa S, Yamauchi H, Yoshino I, Baba H, Matsubara H, Ohki T, Hasegawa K, Taketomi A
PURPOSES: Minimally invasive endoscopic mitral valve repair (MVr) has been widely applied. However, the safety of performing additional procedures concomitantly with MVr has not been adequately evaluated. This study aime...PURPOSES: Minimally invasive endoscopic mitral valve repair (MVr) has been widely applied. However, the safety of performing additional procedures concomitantly with MVr has not been adequately evaluated. This study aimed to evaluate the incremental risk of endoscopic MVr by adding concomitant procedures. METHODS: We retrospectively analyzed the data of 629 patients who underwent totally endoscopic mitral valve repair (MVr) at our hospital between September 2011 and March 2024. We used a linear regression analysis to calculate the additional time required for each concomitant procedure as a surrogate marker of operative risk. RESULTS: The analysis showed that the operation time and aortic cross-clamp time (ACC) for isolated mitral valve repair as Y intercepts were 193 and 98 min, respectively. The addition of aortic valve replacement significantly increased ACC time by 50 min (95% confidence interval [CI], 38–62 min), tricuspid annuloplasty added 35 min (95% CI, 28–41 min), and the Maze procedure added 15 min (95% CI, 8–22 min). However, obesity and a low left ventricular ejection fraction did not significantly influence the procedure times. CONCLUSIONS: We quantified the additional procedure time necessary for each concomitant procedure as surrogate markers of incremental operative risk. Our findings may be useful for calculating the anticipated procedure time when concomitant procedures are planned for minimally invasive MVr.
PURPOSE: This study aimed to evaluate the impact of concomitant prophylactic cholecystectomy during gastrectomy for gastric cancer on the postoperative quality of life (QOL) and nutritional outcomes. METHODS: A retrospec...PURPOSE: This study aimed to evaluate the impact of concomitant prophylactic cholecystectomy during gastrectomy for gastric cancer on the postoperative quality of life (QOL) and nutritional outcomes. METHODS: A retrospective analysis was conducted on 318 patients who underwent curative gastrectomy for gastric cancer between 2010 and 2023. Twenty-eight patients underwent prophylactic cholecystectomy, while 290 underwent gastrectomy alone. The postoperative QOL at one year was assessed using the Postgastrectomy Syndrome Assessment Scale-45, and the nutritional status was evaluated using body weight change. RESULTS: The operative time was significantly longer in the cholecystectomy group. However, blood loss and major complications were comparable. There was no significant difference between the two groups in the postoperative cholelithiasis-free rate or cholecystitis/cholangitis-free rate. One year postoperatively, the body weight loss was similar; however, diarrhea-related symptom scores were significantly higher in the cholecystectomy group (3.0 vs. 1.7, p = 0.01). A multivariate analysis identified male sex and concomitant cholecystectomy as independent risk factors for postoperative diarrhea. CONCLUSION: Prophylactic cholecystectomy during gastrectomy did not increase major complications, but it was associated with worse diarrhea-related symptoms and a lower QOL. Its indications should therefore be carefully considered, while balancing the potential benefits against the long-term functional outcomes.
Telesurgery, once considered an experimental concept, is rapidly transitioning to a feasible clinical reality. The growing need for equitable access to surgical expertise across geographical boundaries has driven the dev...Telesurgery, once considered an experimental concept, is rapidly transitioning to a feasible clinical reality. The growing need for equitable access to surgical expertise across geographical boundaries has driven the development of remote robotic surgery. This review outlines the key enablers and limitations of current telesurgical systems, emphasizing the importance of hybrid infrastructure that integrates low-latency networks, surgical robotics, and reliable data security frameworks. While next-generation connectivity technologies such as 5G and 6G promise improved performance, overreliance on communication bandwidth alone may compromise attention to essential factors, such as system redundancy and fail-safe design. Non-technical barriers, such as ethical accountability, patient safety, data governance, and professional regulation, are equally vital in determining the long-term viability of telesurgery in clinical practice. A balanced approach to both technical robustness and governance frameworks is essential to transition telesurgery from feasibility studies to routine clinical practices.
PURPOSE: Acute appendicitis is among the most common causes of emergency department visits requiring urgent surgery, with an annual incidence of approximately 100 cases per 100,000 people. This high incidence substantial...PURPOSE: Acute appendicitis is among the most common causes of emergency department visits requiring urgent surgery, with an annual incidence of approximately 100 cases per 100,000 people. This high incidence substantially increases the hospital workload and healthcare costs, prompting the investigation of alternative management strategies. This study aimed to evaluate the clinical reliability of same-day discharge after laparoscopic appendectomy by analyzing the postoperative complications, rehospitalization, and economic outcomes. METHODS: Patients with uncomplicated acute appendicitis treated between January 2023 and October 2024 were included. The patients discharged within the first 12 h after surgery were assigned to Group 1, whereas those discharged after 24 h were assigned to Group 2. RESULTS: Post-discharge complications occurred in two (1.8%) patients in Group 1 and four (3.6%) in Group 2. No significant difference was observed between the groups in terms of post-discharge emergency department visits, which occurred in 6.3% (n = 7) of Group 1 and 9.8% (n = 11) of Group 2. The non-surgical costs were significantly lower in the same-day discharge group, with a median cost of $87.50 (44–213), compared with $256.50 (82–1,260) in the control group (p < 0.001). CONCLUSIONS: Same-day discharge after laparoscopic appendectomy does not increase postoperative complications, emergency department visits, or hospital readmissions. This approach is safe, cost-effective, and feasible in routine clinical practice. Additionally, same-day discharge enables postoperative management and discharge of up to three patients with acute appendicitis within 24 h using a single service bed.
Yoshida M, Yanagimoto H, Tsugawa D
… +12 more, Akita M, Okazoe Y, Konaka R, Takahashi T, Ishida J, Urade T, Nanno Y, Fukushima K, Komatsu S, Asari S, Kido M, Fukumoto T
PURPOSE: Perihilar cholangiocarcinoma (PHCC) accounts for 50–60% of cholangiocarcinoma and it has a poor prognosis, with low survival rates after surgery. The albumin–bilirubin (ALBI) score, based on serum albumin and bi...PURPOSE: Perihilar cholangiocarcinoma (PHCC) accounts for 50–60% of cholangiocarcinoma and it has a poor prognosis, with low survival rates after surgery. The albumin–bilirubin (ALBI) score, based on serum albumin and bilirubin levels, has been reported to predict survival more accurately than the Child–Pugh score. This study aimed to evaluate the prognostic value of the modified ALBI score (mALBI) in patients with PHCC following radical resection. METHODS: We retrospectively analyzed the medical records of patients with PHCC who underwent major hepatectomy with extrahepatic bile duct resection between January 2001 and December 2023 at Kobe University. RESULTS: We included 100 patients with PHCC in the analysis. Patients in the low mALBI group (grades 1 and 2a; n = 44) had a significantly better overall and recurrence-free survival than those in the high mALBI group (grades 2b and 3; n = 56). The high mALBI group was associated with higher preoperative CA19-9 levels, a higher incidence of preoperative cholangitis, and recurrent venous and perineural invasion. Postoperatively, the patients in the high mALBI group showed a delayed recovery of serum albumin levels and persistently elevated bilirubin levels. Furthermore, liver regeneration after right hepatectomy was significantly greater in the low mALBI group, whereas no significant difference was observed after left hepatectomy. CONCLUSIONS: The mALBI grade is a promising prognostic biomarker for both overall and recurrence-free survival in patients with PHCC following curative resection.
Kinoshita Y, Ishikawa K, Akita S
… +114 more, Koh K, Sasaki S, Jinnin M, Mimura H, Osuga K, Ozeki M, Nagahama M, Fujino A, Aoki Y, Asai A, Aramaki-Hattori N, Ishiura R, Inoue M, Iwashina Y, Ohshiro T, Ogawa K, Ozaki M, Ochi J, Onozawa S, Kato M, Kaneko T, Kawakami T, Kitagawa A, Kurita M, Kuwano Y, Kono T, Seike S, Takagi S, Takakura N, Tachibana T, Tanoue S, Chuman K, Nakaoka H, Nakamura Y, Nagai F, Niimi Y, Nosaka S, Nozaki T, Nomura T, Hashimoto K, Hayashi A, Hirakawa S, Hirabayashi T, Furukawa T, Furukawa H, Hori Y, Maekawa T, Matsuoka K, Mori H, Morii E, Morimoto A, Moriwaki Y, Yuzuriha S, Rikihisa N, Fujita M, Yamahana Y, Deie K, Tozawa A, Hasegawa D, Higashiyama A, Maeda D, Asayama S, Arai Y, Iwata Y, Uka M, Usui H, Uchiyama M, Endo S, Endo H, Ono R, Oshima N, Otsuka T, Ohara K, Kagami S, Kakihara T, Kato M, Kanamori H, Kamata M, Kawaguchi A, Kishi A, Kitagawa H, Kim K, Kobayashi T, Saito T, Shikano Y, Shimada S, Suzuki K, Takahashi M, Takami S, Takeda R, Tanaka A, Tanaka K, Tamura S, Tamura M, Danno K, Tsuboi K, Nakajima Y, Nakatani R, Noguchi M, Nozawa A, Hashizume N, Hayakawa M, Hayashi D, Fukumoto T, Honda M, Matsuda N, Maruguchi H, Murakami N, Yaguchi K, Yasue S, Yoshihara H, Yoshimatsu R, Yamamoto K, Wada S
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatm...The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR) is a minimally invasive alternative for thoracoabdominal aortic aneurysms, offering anatomical adaptability via inner branches and fe...Physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR) is a minimally invasive alternative for thoracoabdominal aortic aneurysms, offering anatomical adaptability via inner branches and fenestrations. This stepwise protocol details stent-graft modification, preloaded wires, and diameter-reducing ties, enhancing cannulation and procedural control. Inner branches facilitate the cannulation of the target vessels by providing increased clearance from the aneurysmal wall, while greater overlap with bridging stents may help reduce the risk of type III endoleaks. Despite promising outcomes, significant variations in technique and the lack of standardized protocols among institutions underscore the need for further refinement and data from ongoing multicenter studies. PM-F/iBEVAR offers a feasible and effective alternative to open surgical repair in selected patients. Wider adoption may be facilitated by the standardization of techniques and the development of evidence-based clinical guidelines.
PURPOSE: Early recovery from intestinal dysfunction after surgery reduces the risk of complications. In this study, we used radiopaque markers (SITZ MARKS® [SM] ) to objectively evaluate intestinal motility and identify...PURPOSE: Early recovery from intestinal dysfunction after surgery reduces the risk of complications. In this study, we used radiopaque markers (SITZ MARKS® [SM] ) to objectively evaluate intestinal motility and identify the factors that hinder intestinal motility recovery. METHODS: We included patients who underwent elective colon cancer surgery between January 2009 and December 2014. The exclusion criteria were as follows: (i) more than two anastomoses; (ii) intestinal obstruction; (iii) having undergone colostomy or ileostomy; (iv) having undergone additional resection of other organs; and (v) admission to the intensive care unit after surgery. All patients ingested SM 2 h before surgery. We assessed the residual number of SM to evaluate postoperative intestinal motility. We defined a delayed recovery as the presence of residual SM in the small intestine 3 days after surgery. We used a multivariate analysis to extract the factors associated with a delayed recovery of intestinal motility. RESULTS: Three hundred and thirty-seven patients were included. Mechanical bowel preparation (MBP) with polyethylene glycol (odds ratio [OR]: 2.6, P < 0.001), open surgery (odds ratio [OR]: 1.8, P = 0.048), and excessive intraoperative fluid administration (> 10 mL/kg/hour) (odds ratio [OR]: 1.8, P = 0.009) were significant factors for a delayed recovery of intestinal motility. CONCLUSION: The omission of MBP, laparoscopic surgery, and appropriate intraoperative fluid administration can facilitate an early recovery of intestinal motility.
PURPOSE: Abdominal aortic aneurysm (AAA) is a progressive, age-associated vascular disorder characterized by dilation of the abdominal aorta and a high risk of rupture. RNA-binding motif protein 10 (RBM10), a key regulat...PURPOSE: Abdominal aortic aneurysm (AAA) is a progressive, age-associated vascular disorder characterized by dilation of the abdominal aorta and a high risk of rupture. RNA-binding motif protein 10 (RBM10), a key regulator of mRNA alternative splicing involved in cell cycle control and apoptosis, has not previously been investigated in AAA. This study aimed to characterize the expression and functional role of RBM10 in AAA pathogenesis. METHODS: RBM10 expression in human AAA tissues was assessed by immunofluorescence. To explore its functional relevance, genome-wide transcriptomic profiling was performed in human aortic smooth muscle cells (HASMCs) transfected with RBM10 adenovirus or negative control for 24 h. The effects of RBM10 on HASMC proliferation and migration were evaluated using MTT and transwell assays, respectively. Apoptosis was quantified by flow cytometry. RESULTS: RBM10 expression was significantly elevated in human AAA tissues and in an established animal model. RBM10 overexpression markedly suppressed HASMC proliferation and migration while promoting apoptosis. Flow cytometry confirmed enhanced apoptotic rates, consistent with transcriptomic analysis demonstrating activation of the p53 pathway. Upregulation and activation of p53 were validated at the protein level. CONCLUSIONS: These findings indicate that RBM10 contributes to AAA progression by promoting smooth muscle cell apoptosis, likely through a p53-dependent mechanism. RBM10 may represent a promising therapeutic target for preventing or slowing AAA development.
PURPOSE: To assess the safety and efficacy of combining laparoscopic hepatectomy (LH) with splenic artery ligation (SAL) for patients with hepatocellular carcinoma (HCC) and concomitant portal hypertension. METHODS: We c...PURPOSE: To assess the safety and efficacy of combining laparoscopic hepatectomy (LH) with splenic artery ligation (SAL) for patients with hepatocellular carcinoma (HCC) and concomitant portal hypertension. METHODS: We conducted a multicenter, retrospective cohort analysis of 174 patients: 85 treated with LH + SAL (study group) and 89 treated with LH alone (control group). The key metrics evaluated included operative duration, blood loss, postoperative hospital stay, hematological parameters such as platelet count and white/red blood cell counts, immunological markers (CD4+/CD8 + ratio), complication rates, and survival outcomes. Statistical comparisons were made using t-tests, chi-squared tests, and Kaplan-Meier analysis. To mitigate potential biases and adjust for baseline characteristics, propensity score matching (PSM) was performed. RESULTS: The LH + SAL group had a significantly longer operative time (101.59 ± 12.51 vs. 92.73 ± 15.29 min, P < 0.05) but a shorter postoperative hospital stay (P < 0.05). Hematological and immunological improvements were observed in the study group 1 week, 1 month, 3 months, and 6 months postoperatively, with higher platelet counts and CD4+/CD8 + ratios (P < 0.05). Complication rates were comparable between the groups (P > 0.05). Notably, the 3-year overall survival rate was significantly higher in the study group (P < 0.001). CONCLUSION: The integration of LH and SAL enhances hematological status and immune function safely, reduces hospitalization duration, and improves the long-term survival of HCC patients with portal hypertension, without increasing surgical risks.