Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. Machine learning (ML) may enable the noninvasive prediction of histopathological features using clinical and imaging data. This study evaluat...Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. Machine learning (ML) may enable the noninvasive prediction of histopathological features using clinical and imaging data. This study evaluated the utility of ML in predicting vessels that encapsulate tumor clusters (VETC) and tumor differentiation in HCC. We retrospectively analyzed 232 patients who underwent hepatic resection for solitary HCC (≤ 5 cm). Histological assessment was used to determine the VETC status and tumor differentiation. Contrast-enhanced CT images were processed using BiomedCLIP to extract 512-dimensional image feature vectors, which were combined with clinical data and analyzed using a support vector machine classifier. The model performance was evaluated using five-fold cross-validation with precision, recall, and F1-score. VETC-positive tumors were significantly associated with a poor survival. Models using clinical data alone demonstrated limited predictive performance (F1 = 0.469 for VETC; F1 = 0.473 for differentiation). The incorporation of image features modestly improved VETC prediction (F1 = 0.599) but did not enhance the prediction of tumor differentiation. Image-based models did not outperform the clinical models. VETC is a histopathological marker associated with a poor prognosis in HCC. While ML models showed limited predictive accuracy, further optimization of imaging analysis and data integration may improve noninvasive histological prediction.
PURPOSE: To evaluate the intra-aneurysm pressure (IAP) after the implantation of various off-the-shelf endovascular aneurysm repair (EVAR) devices and examine its clinical implications. METHODS: A retrospective review of...PURPOSE: To evaluate the intra-aneurysm pressure (IAP) after the implantation of various off-the-shelf endovascular aneurysm repair (EVAR) devices and examine its clinical implications. METHODS: A retrospective review of 153 EVAR cases for infrarenal abdominal aortic aneurysm (AAA) with bilateral common iliac landings and no residual type I/III endoleaks was conducted. During EVAR, the IAP and abdominal aortic pressure (AAP) were measured, and the aorta-aneurysm systolic pressure gradient (AASPG = systolic AAP - systolic IAP) was compared among the devices and between the graft fabric materials. The associations between the AASPG and postoperative AAA shrinkage were also assessed. RESULTS: The AASPGs (mmHg) for the devices were as follows: Aorfix (34 cases), 17.8 ± 12.9; Endurant (32 cases), 22.3 ± 16.9; AFX (26 cases), 17.5 ± 18.0; Zenith Alpha (20 cases), 25.7 ± 16.3; Excluder (16 cases), 26.4 ± 19.7; TREO (13 cases), 30.5 ± 11.8; and Alto (12 cases), 37.7 ± 14.5 (p = 0.002). Polytetrafluoroethylene grafts showed a higher AASPG than woven polyester grafts (31.3 vs. 22.5 mmHg, p = 0.009). No significant association was observed between the AASPG and AAA shrinkage. CONCLUSION: The degree of IAP reduction differs according to the EVAR device and graft fabric material. These findings provide baseline data on the device-specific effects of IAP.
Breast-conserving surgery with radiotherapy offers outcomes comparable to those of mastectomy. However, margin control and cosmetic results remain challenging, especially for deep or unfavorably located tumors. This stud...Breast-conserving surgery with radiotherapy offers outcomes comparable to those of mastectomy. However, margin control and cosmetic results remain challenging, especially for deep or unfavorably located tumors. This study evaluated the S-SMARTS technique (suture-based marking, scar minimizing, and axillary-lateral thoracic fat flap reconstruction with tissue sliding), a hidden-scar, volume displacement method using axillary and lateral thoracic fat flaps. In this single-center retrospective study (Osaka University, Jan 2020-Apr 2025), 44 patients underwent breast-conserving surgery using S-SMARTS. The margin status and cosmetic outcomes (via BCCT.core) were analyzed. Negative margins were achieved in 95.5% of cases on the initial excision and 100% after intraoperative frozen section. The BCCT.core assessment demonstrated that 76.2% of the cases had "Good/Excellent" and 23.8% had "Fair" outcomes. Multivariate analyses were performed to explore any potential predictors of margin positivity. However, no statistically robust predictors were identified. S-SMARTS demonstrates technical feasibility and acceptable early oncologic and aesthetic outcomes in a single-surgeon cohort. Further comparative and multi-institutional studies are warranted to validate its oncologic impact, reproducibility, and patient-reported aesthetic benefits.
Kawakubo N, Maniwa J, Yamaguchi Y
… +13 more, Ueda M, Hino Y, Kamouchi A, Ishimoto K, Fukuhara M, Takahashi Y, Toriigahara Y, Fukuta A, Yoshimaru K, Nagata K, Miyata J, Matsuura T, Tajiri T
Neuroblastoma is the most common extracranial solid tumor in children. The prognosis for high-risk disease remains poor despite multimodal therapy, including chemotherapy, surgical resection, radiotherapy, and autologous...Neuroblastoma is the most common extracranial solid tumor in children. The prognosis for high-risk disease remains poor despite multimodal therapy, including chemotherapy, surgical resection, radiotherapy, and autologous stem-cell transplantation. Immunotherapy has improved outcomes remarkably, particularly using anti-GD2 monoclonal antibodies, which are now established as standard maintenance therapy. Combination regimens of cytokines and isotretinoin have enhanced survival, and chemo-immunotherapy has demonstrated superior response rates in relapsed/refractory settings. The aim of treatment with next-generation antibodies, such as humanized or Fc-engineered formats, is to reduce toxicity and improve efficacy. GD2-based vaccines and cellular therapies, including CAR-T cells, NK/NKT cell therapy, and bispecific antibody-armed T cells, have shown promising activity, particularly for minimal residual disease. However, challenges such as GD2 downregulation, an immunosuppressive tumor microenvironment, and manufacturing constraints persist. Future strategies may involve multimodal immunotherapy integrating antibodies, vaccines, and cellular platforms with precise patient selection and microenvironment modulation. Immunotherapy is reshaping neuroblastoma treatment, with the potential to achieve both deeper remission and long-term disease control.
Pancreaticoduodenectomy (PD) is one of the most technically demanding gastrointestinal surgical procedures. Among its various components, pancreaticojejunostomy (PJ) is particularly complex. We developed a simple and eas...Pancreaticoduodenectomy (PD) is one of the most technically demanding gastrointestinal surgical procedures. Among its various components, pancreaticojejunostomy (PJ) is particularly complex. We developed a simple and easy-to-perform pancreaticojejunostomy technique, termed Horizontal Hexagonal Six-stitch Pancreaticojejunostomy (HEXA-PJ). After placing U-shaped sutures on the jejunal seromuscular layers and pancreas, the HEXA-PJ technique begins with the placement of two anterior traction sutures on the pancreatic duct, followed by suturing at the 3- and 9-o'clock positions. Owing to the improved visualization achieved through this sequence, the remaining posterior sutures can be easily placed. After completing the anterior sutures, the duct-to-mucosa anastomosis is finalized in a controlled manner. Finally, modified Blumgart sutures were placed and ligated. This structured approach can be easily learned and can shorten the anastomotic time of the PJ without increasing the risk of significant postoperative complications.
Sahin N, Donmez T, Degerli MS
… +12 more, Hocaoglu E, Sakiz D, Ozyalvac FT, Sahin EA, Bulut S, Kabuli HA, Sahin MY, Sari A, Gumusoglu AY, Celik EY, Aga O, Surek A
PURPOSE: Appendiceal diverticular disease (ADD) is an uncommon condition that may clinically and radiologically mimic acute appendicitis and it is associated with a high risk of perforation. Limited awareness and diagnos...PURPOSE: Appendiceal diverticular disease (ADD) is an uncommon condition that may clinically and radiologically mimic acute appendicitis and it is associated with a high risk of perforation. Limited awareness and diagnostic challenges frequently result in a diagnosis only after histopathological examination. METHODS: Among 6,853 emergency appendectomies performed between January 2015 and June 2024, 153 patients with histopathologically confirmed ADD were retrospectively analyzed in this study. The demographic data, clinical presentation, imaging findings, operative outcomes, and pathological characteristics were reviewed. All CT scans and pathology slides were re-evaluated by gastrointestinal radiologists and a gastrointestinal pathologist. The diverticula were classified according to the Lipton system. RESULTS: The frequency of ADD detection in histopathological reports was 2.23%. The mean age was 40.5 ± 15.0 years, and 60.8% of the patients were male. Acquired diverticula predominated (99.3%), with type 2 being the most common subtype (68.6% of cases). Perforation was identified intraoperatively in 32.7% and histologically in 40.5% of the cases, occurring almost exclusively in type 1 and type 2 diverticula. ADD was not diagnosed on initial emergency CT reports. However, a retrospective review identified diverticula in 59.1% of cases, most commonly cystic and located at the appendiceal apex. No malignancies were detected. CONCLUSION: ADD is a rare but clinically important entity with high perforation rates and substantial diagnostic limitations in routine imaging. Multidisciplinary reassessment improves the diagnostic accuracy and it may support optimized management strategies.
PURPOSE: Stoma-site incisional hernia is a concerning complication following ileostomy closure. We conducted this study to investigate the effectiveness of a three-layer closure technique for preventing stoma-site incisi...PURPOSE: Stoma-site incisional hernia is a concerning complication following ileostomy closure. We conducted this study to investigate the effectiveness of a three-layer closure technique for preventing stoma-site incisional hernia after ileostomy closure in patients with rectal cancer. METHODS: This single-center pre-post comparative study included 169 patients who underwent diverting loop ileostomy closure after rectal cancer surgery between April 2016 and May 2025. The three-layer closure technique replaced the single-layer technique in July 2020, and the outcomes before and after this change were compared. Firth-corrected multivariate analysis was performed to identify independent risk factors for stoma-site incisional hernia. RESULTS: Stoma-site incisional hernias developed in 12 patients (7.1%). The incidence of stoma-site incisional hernia was significantly lower in the three-layer closure group than in the single-layer closure group (1.1% vs. 13%, P = 0.002). The Firth-corrected multivariate analysis identified that the three-layer closure technique (odds ratio 0.12, 95% confidence interval 0.01-0.55, P = 0.004) was an independent protective factor. CONCLUSIONS: The three-layer closure technique reduced stoma-site incisional hernia significantly after ileostomy closure in patients with rectal cancer, suggesting that anatomically layered reconstruction provides superior abdominal wall integrity to single-layer closure.
PURPOSE: Spleen-preserving distal pancreatectomy (SPDP) is performed for benign or low-grade malignant tumors of the pancreatic body and tail. The Warshaw technique (WT), involving the division of the splenic artery and...PURPOSE: Spleen-preserving distal pancreatectomy (SPDP) is performed for benign or low-grade malignant tumors of the pancreatic body and tail. The Warshaw technique (WT), involving the division of the splenic artery and vein, is associated with splenic infarction and gastric varices. Recently, SPDP with splenic artery resection and splenic vein preservation (SVP) has been introduced. However, its safety and feasibility remain unclear. This study compared the perioperative outcomes between the SVP and WT approaches. METHODS: We retrospectively reviewed the data on patients who underwent laparoscopic or robot-assisted SPDP between January 2019 and December 2024. Of these, seven patients underwent SVP and 24 underwent WT. The clinical outcomes, complications, and postoperative imaging findings were evaluated. RESULTS: The baseline characteristics were comparable between the groups. The operative time, blood loss, postoperative inflammatory markers, and clinically relevant postoperative pancreatic fistula showed no significant differences. Contrast-enhanced CT on postoperative day 7 demonstrated splenic infarction in 2 of 4 SVP patients (50%) and 14 of 22 WT patients (63.6%, p = 0.625). Gastric varices were observed only in the WT group (22.7%, p = 0.555). Splenic vein thrombosis did not occur in the SVP group. CONCLUSIONS: The SVP approach is thus considered to be safe and feasible, with perioperative outcomes comparable to WT. Larger studies with long-term follow-up are warranted.
PURPOSE: We modified the Pfannenstiel (PS) incision by relocating it to the left lower abdomen, to combine the advantages of the PS incision with those of intracorporeal anastomosis in colorectal cancer surgery. We condu...PURPOSE: We modified the Pfannenstiel (PS) incision by relocating it to the left lower abdomen, to combine the advantages of the PS incision with those of intracorporeal anastomosis in colorectal cancer surgery. We conducted this study to evaluate the safety and utility of our modified Pfannenstiel incision (mPS) incision in laparoscopic and robotic surgery. METHODS: We reviewed, retrospectively, 357 colorectal cancer patients who underwent laparoscopic and robotic surgery between 2022 and 2025. The patients were divided into two groups based on the surgical incision used: those with the mPS incision (mPS group, n = 92) and those with a median incision (MED group, n = 265). After propensity score matching, 71 patients were matched in each group, and their clinicopathological and surgical features were compared. RESULTS: After matching, the rates of robotic surgery (90.0% vs. 40.0%, p < 0.001) and intracorporeal anastomosis were higher (61.1% vs. 25.6%, p < 0.001), while the rates of wound infection (1.1% vs. 8.9%, p = 0.034) and incisional hernia were lower (2.2% vs. 22.2%, p < 0.001) in the mPS group than in the MED group. CONCLUSIONS: The mPS incision resulted in favorable outcomes, comparable to those previously reported for conventional PS. Thus, the mPS is considered a useful incision method for intracorporeal anastomosis in robotic surgery.
PURPOSE: Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative re...PURPOSE: Locally advanced non-small cell lung cancer (LA-NSCLC) is a heterogeneous disease that requires tailored treatment strategies. This study investigates the correlation between T and N factors and postoperative recurrence patterns to refine therapeutic approaches. METHODS: The subjects of this retrospective cohort study were 193 patients with LA-NSCLC, who underwent trimodality therapy between 1999 and 2021. Tumors were categorized as Nodal-Dominant (ND) LA-NSCLC (T1-2 with advanced nodal involvement) or Tumor-Dominant (TD) LA-NSCLC (T3-4 with limited nodal involvement). We compared recurrence patterns and survival outcomes between the two groups. RESULTS: The 193 patients comprised 83 with ND-LA-NSCLC and 110 with TD-LA-NSCLC. The patients with ND-LA-NSCLC had a significantly higher rate of distant metastasis than those with TD-LA-NSCLC (50.6% vs. 26.4%, P = 0.001). The patients with TD-LA-NSCLC had significantly better 5-year disease-free survival (DFS) than those with ND-LA-NSCLC (62.4% vs. 37.2%, P < 0.001). CONCLUSIONS: ND-LA-NSCLC is associated with a higher risk of distant metastatic recurrence, underscoring the need for more effective systemic therapies before surgery. Conversely, TD-LA-NSCLC exhibits superior local disease control, reinforcing the role of intensive local therapies. These findings emphasize the importance of tumor classification based on T and N factors for optimizing perioperative treatment strategies for LA-NSCLC.
The surgical care infrastructure faces a critical dual crisis: acute access shortages in low- and middle-income countries and systemic instability in high-income countries. This dysfunction stems from a global surgical w...The surgical care infrastructure faces a critical dual crisis: acute access shortages in low- and middle-income countries and systemic instability in high-income countries. This dysfunction stems from a global surgical workforce crisis defined by dual failures: failure in workforce development in low- and middle-income countries and failure in workforce retention in high-income countries. At the individual level, these failures are driven by distinct "vicious triads" centered on surgeon burnout. In low- and middle-income countries, the triad of burnout, professional isolation, and rational exodus arises from systemic fragility. Conversely, in high-income countries, the convergence of burnout, diminishing aspiration for surgery, and aging of surgeons destabilizes retention. Beyond work-hour limits, durable retention requires improved working conditions and incentives aligned with clinical responsibility. Relying on migration to mitigate shortages is self-defeating; instead, essential countermeasures demand bilateral international partnerships and a fundamental cultural transformation, moving away from reliance on individual self-sacrifice toward a sustainable model. This requires developing surgical educators, empowering female surgeons, and enhancing working environments. Integrating these human-centric reforms with technological innovations to alleviate administrative burdens allows surgeons to focus primarily on specialized care-the art of surgery. Ultimately, protecting workforce well-being is vital for securing the future of the surgical care infrastructure.
PURPOSE: Obstructive colorectal cancer has a poor prognosis. Self-expanding metallic stents (SEMSs) and transanal colorectal tubes (TCTs) are used as a bridge to surgery (BTS). However, comparative evidence is limited. T...PURPOSE: Obstructive colorectal cancer has a poor prognosis. Self-expanding metallic stents (SEMSs) and transanal colorectal tubes (TCTs) are used as a bridge to surgery (BTS). However, comparative evidence is limited. This study compared the short-term outcomes of SEMS and TCT placement using a nationwide database. METHODS: We identified 19,564 patients who underwent colectomy after SEMS or TCT placement for cT3-4N0-2M0 colon cancer between 2012 and 2022 using the Diagnosis Procedure Combination database. After exclusion, 16,033 patients were analyzed. Propensity score matching generated 5,203 matched pairs for analysis. Outcomes were compared using conditional logistic regression and linear fixed-effect models. RESULTS: The overall stoma rate was significantly lower in the SEMS group than in the TCT group (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.23-0.35). SEMS placement was associated with reduced postoperative abdominal drainage (OR, 0.31; 95% CI, 0.28-0.35) and reoperation (OR, 0.25; 95% CI, 0.20-0.31) rates. The total hospital stay was shorter in the SEMS group (regression coefficient, - 3.5 days; 95%CI, - 4.3 to - 2.6). CONCLUSIONS: This nationwide cohort study showed that SEMS placement significantly reduced perioperative stoma construction compared with TCT placement. A lower frequency of stoma construction, postoperative abdominal drainage, and reoperation was associated with shorter total hospital stays.
Chyle leakage is a recognized complication of pancreatic surgery. However, the risk factors for this condition have not been fully elucidated. This study aimed to evaluate whether the postoperative drain lymphocyte count...Chyle leakage is a recognized complication of pancreatic surgery. However, the risk factors for this condition have not been fully elucidated. This study aimed to evaluate whether the postoperative drain lymphocyte count can serve as a predictor of chyle leakage after pancreatic surgery. A total of 132 patients who underwent pancreatic resection, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, between November 2021 and March 2025 were retrospectively analyzed. Patient characteristics and perioperative factors, including drain lymphocyte count, were examined in relation to the occurrence of chyle leakage, which were defined according to the 2017 International Study Group of Pancreatic Surgery criteria. Chyle leakage occurred in 17 patients (12.9%), all of whom were classified as Grade B. A univariate analysis demonstrated significant associations between chyle leakage and PD procedure (p = 0.03), open surgery (p = 0.04), vascular resection (p < 0.01), D2 lymph node dissection (p < 0.01), and a drain lymphocyte count ≥ 308/µL on postoperative day 3 (p < 0.01). A multivariate analysis identified a drain lymphocyte count ≥ 308/µL on postoperative day 3 as an independent risk factor for chyle leakage (p < 0.01). The postoperative drain lymphocyte count is a reliable and independent predictor of chyle leakage following pancreatic surgery.
Esophagogastric junction adenocarcinoma (EGJAC) is a distinct and increasingly prevalent malignancy associated with a poor survival. Among EGJACs, Siewert type II tumors pose particular challenges because of their hetero...Esophagogastric junction adenocarcinoma (EGJAC) is a distinct and increasingly prevalent malignancy associated with a poor survival. Among EGJACs, Siewert type II tumors pose particular challenges because of their heterogeneous origins, molecular diversity, and the absence of consensus regarding classification and management. Although anatomical classifications remain clinically useful, they inadequately reflect the biological complexity of these tumors. Recent molecular and omics advances have clarified esophagogastric junction tumorigenesis by revealing the interactions between reflux-related conditions and intrinsic and environmental risk factors. Accumulating evidence suggests that Siewert II tumors may originate from multiple cellular populations within the junctional zone, including Barrett's metaplasia, cardiac-type epithelium, and gastric mucosa, each associated with distinct pathogenetic pathways. Genomic and transcriptomic studies have identified key oncogenic drivers and pathways, supporting biologically driven subclassification and potentially explaining variability in the therapeutic response. Currently, surgical and systemic treatment strategies for Siewert II tumors are largely extrapolated from esophageal and gastric cancer paradigms. Integrating molecular profiling with anatomical classification may improve clinical trial stratification and enable more personalized therapeutic approaches. This review summarizes the current evidence on the epidemiology, risk factors, histopathology, and molecular landscape of Siewert II adenocarcinomas, emphasizing the need for integrative classification frameworks to advance precision oncology and improve the patient outcomes.
PURPOSE: To evaluate the safety and efficacy of sleeve lobectomy for patients with non-small cell lung cancer (NSCLC) and assess the prognostic impact of preoperative chemoradiotherapy. METHODS: The subjects of this retr...PURPOSE: To evaluate the safety and efficacy of sleeve lobectomy for patients with non-small cell lung cancer (NSCLC) and assess the prognostic impact of preoperative chemoradiotherapy. METHODS: The subjects of this retrospective study were 103 consecutive patients who underwent sleeve lobectomy at our institution between 2006 and 2021. RESULTS: Sixty patients had squamous cell carcinoma (Sq), 33 had adenocarcinoma (Ad), and 10 had other types of NSCLC. Four anastomotic complications occurred, but there was no perioperative mortality. Downstaging was observed after preoperative treatment in 74% of 19 patients with Sq, and 56% of 9 patients with Ad. The pathologic response was greater in the patients with Sq than in those with Ad (- 91% vs. -32%). The 5-year overall survival (OS) and disease-free survival (DFS) rates were 62.3% and 58.1%, respectively. The patients with Sq had better DFS (73.5% vs. 21.6%) and OS (70.5% vs. 46.7%) than those with Ad. Multivariate analysis identified Ad histology (HR, 3.042; p = 0.0026) as a prognostic factor for DFS, and incomplete resection (HR, 2.940; p = 0.048) as a prognostic factor for OS. Among the 39 patients with recurrence, distant metastases were more frequent in those with Ad (72.7%) than in those with Sq (33.3%). CONCLUSION: Sleeve lobectomy is safe and effective for locally advanced NSCLC. Preoperative chemoradiotherapy was more effective for patients with locally advanced Sq than for those with Ad.
PURPOSE: To improve the handling characteristics of suture needles, two novel needle designs, the Bi-curve and the G-curve, were developed by modifying conventional curvature designs. METHODS: Ten surgeons with varying l...PURPOSE: To improve the handling characteristics of suture needles, two novel needle designs, the Bi-curve and the G-curve, were developed by modifying conventional curvature designs. METHODS: Ten surgeons with varying levels of experience performed standardized open and robotic suturing tasks using half-circle, Bi-curve, and G-curve needles in a simulation environment. Suturing times were evaluated under both conditions. Moreover, advanced laparoscopic suturing tasks were performed using a robotic system. Needle trajectory parameters, burst pressure resistance, and subjective assessments of manipulability were analyzed to assess technical performance and potential tissue impact. RESULTS: During open forward suturing, both the Bi-curve and G-curve needles reduced suturing time significantly from that required with the half-circle needle, whereas no significant differences were observed among needle types in robotic suturing tasks. In advanced laparoscopic tasks, needle-passage quality scores were significantly higher for the Bi-curve and G-curve needles. Needle trajectory metrics and burst pressure resistance were comparable for all needle designs. Subjective evaluations revealed that no surgeon rated the novel needles as inferior to the conventional needle in terms of manipulability. CONCLUSIONS: In this exploratory study, the Bi-curve and G-curve needles demonstrated handling performance comparable to, and in some aspects favorable to, that of the conventional half-circle needle, without causing more tissue damage.
PURPOSE: Venous thromboembolism (VTE) is a potentially serious complication after surgery for gastrointestinal cancer; however, its risk factors following laparoscopic surgery remain unclear. This study aimed to identify...PURPOSE: Venous thromboembolism (VTE) is a potentially serious complication after surgery for gastrointestinal cancer; however, its risk factors following laparoscopic surgery remain unclear. This study aimed to identify the risk factors for postoperative VTE in patients undergoing laparoscopic gastrectomy or colectomy. METHODS: We analyzed data, retrospectively, from patients enrolled in the multicenter randomized EnoLap-CG trial, who underwent laparoscopic gastrectomy or colectomy. All patients underwent protocol-mandated contrast-enhanced computed tomography (CT) on postoperative day (POD) 7 to screen for VTE. RESULTS: Postoperative VTE was identified in 19 (4.6%) of 410 patients. The preoperative D-dimer level was significantly higher in the VTE group than in the no- VTE group (1.40 µg/mL vs. 0.76 µg/mL; p < 0.01). The incidence of VTE was higher in women than in men (7.2% vs. 2.9%; p = 0.05). Multivariate logistic regression analysis demonstrated that an elevated preoperative D-dimer level (OR, 1.89; 95% CI, 1.28-2.80; p < 0.01) and female sex (OR, 2.64; 95% CI, 1.02-6.85; p < 0.01) were independent risk factors for VTE. CONCLUSIONS: An elevated preoperative D-dimer level and female sex are independent risk factors for postoperative VTE after laparoscopic gastric and colorectal cancer surgery.
PURPOSE: To evaluate the oncological outcomes of breast cancer patients with sentinel lymph node (SLN) micrometastases, who underwent mastectomy without axillary lymph node dissection (ALND) or post-mastectomy radiothera...PURPOSE: To evaluate the oncological outcomes of breast cancer patients with sentinel lymph node (SLN) micrometastases, who underwent mastectomy without axillary lymph node dissection (ALND) or post-mastectomy radiotherapy (PMRT). METHODS: This retrospective single-center study included 79 breast cancer patients with SLN micrometastases who underwent mastectomy, but not completion ALND or PMRT, between 2007 and 2020. We reviewed clinicopathological characteristics, adjuvant systemic therapies, and oncological outcomes. The primary outcome was loco-regional recurrence-free survival (LRFS), and the secondary outcomes included distant disease-free survival (DDFS) and breast cancer-specific survival (BCSS). RESULTS: The median age at surgery was 56 years. Most tumors (79%) were estrogen receptor-positive/human epidermal growth factor receptor 2-negative, and approximately 49% were classified as cT1. The median number of removed SLNs was two, and the median number of positive nodes was one. After a median follow-up of 4.8 years, the estimated 5-year LRFS, DDFS, and BCSS were 97.1%, 94.6%, and 95.5%, respectively. CONCLUSION: Low rates of loco-regional recurrence were observed in this retrospective cohort of breast cancer patients with SLN micrometastases, who underwent mastectomy without ALND or PMRT.
Liver transplantation (LT) is a potentially curative treatment option for patients with unresectable colorectal liver metastases (CRLM). Despite numerous reports of favorable overall survival following LT for CRLM by sev...Liver transplantation (LT) is a potentially curative treatment option for patients with unresectable colorectal liver metastases (CRLM). Despite numerous reports of favorable overall survival following LT for CRLM by several high-volume transplant centers, recurrence-free survival remains far from satisfactory. Given the invasiveness of the procedure, the scarcity of deceased-donor organs, and the potential risks to living donors, optimal patient selection is crucial. Currently, several prognostic factors are used for selecting good candidates for LT for CRLM, including tumor burden, extrahepatic metastases, gene mutation profile, and response to chemotherapy. To this end, several scoring systems based on traditional prognostic factors have been proposed. This review also discusses the prognostic factors that are not incorporated into standard LT program criteria but may serve as novel eligibility markers to improve patient selection, including metabolic tumor volume assessed by PET/CT, ctDNA, and the presence of perihepatic lymph node metastases. Routine pathological assessment of perihepatic lymph nodes prior to LT may be especially warranted because a high liver tumor burden is correlated with an increased incidence of perihepatic lymph node metastases. Further clinical studies and results from ongoing LT trials are needed to validate the clinical utility of these proposed prognostic factors.
PURPOSES: Owing to the lack of a standardized surgical approach, surgical treatment of patients with chronic postoperative inguinal pain remains challenging. The aim of the present study was to evaluate the safety and lo...PURPOSES: Owing to the lack of a standardized surgical approach, surgical treatment of patients with chronic postoperative inguinal pain remains challenging. The aim of the present study was to evaluate the safety and long-term efficacy of surgical intervention in patients with chronic postoperative inguinal pain based on the patient-reported outcome measures. METHODS: Fifty-four patients who underwent surgery for chronic postoperative inguinal pain at two institutions between March 2013 and July 2024 were retrospectively evaluated. The surgical procedure was selected according to the type of pain and primary hernia repair procedure. Safety was assessed by early postoperative morbidity, and long-term efficacy was evaluated by a questionnaire survey regarding postsurgical satisfaction (excellent/good/moderate/poor), hernia recurrence, and change in the pain scale score. RESULTS: At a median follow-up of 35.3 months, 92% of patients reported “excellent” or “good” satisfaction with the results. The mean NRS score significantly decreased from 7.7 before surgery to 2.5 after surgery (P < 0.001). Severe morbidity and hernia recurrence occurred in 5.6% (3/54) and 3.7% (2/54) of patients, respectively. CONCLUSIONS: This study proposes a surgical strategy for patients with CPIP based on the primary repair method and pain type. Although further validation is needed, our algorithm yielded a high degree of patient satisfaction.