Surgery Today[JOURNAL]
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200 papers
Frailty assessed by comprehensive geriatric assessment and postoperative outcomes of older adults undergoing gastrectomy for gastric cancer.
Kasagi Y, Nishijima TF, Yokomizo R … +6 more , Terashi M, Iwanaga A, Koga N, Sugiyama M, Kimura Y, Morita M
Surg Today · 2026 Mar · PMID 41854741 · Publisher ↗
PURPOSE: Although surgical treatment can benefit older adults with gastric cancer (GC), the optimal surgical strategies for this population remain uncertain. We evaluated whether a 10-item frailty index based on comprehe...
PURPOSE: Although surgical treatment can benefit older adults with gastric cancer (GC), the optimal surgical strategies for this population remain uncertain. We evaluated whether a 10-item frailty index based on comprehensive geriatric assessment (FI-CGA-10) could predict the postoperative outcomes of older adults undergoing gastrectomy for GC. METHODS: The subjects of this retrospective cohort study were patients aged ≥ 75 years who underwent CGA prior to curative gastrectomy. Patients were classified as fit, pre-frail, or frail according to FI-CGA-10 scores. We analyzed the associations between frailty status (frail vs. fit/pre-frail), screening tools, postoperative complications (Clavien–Dindo grade ≥ 2), treatment patterns, and follow-up outcomes. RESULTS: Among 79 patients, 18 were classified as frail and 61, as fit or pre-frail. Despite undergoing less extensive surgery, the frail group had more postoperative complications (50% vs. 23%, P = 0.032). Multivariable analysis showed that frailty was independently associated with complications (odds ratio = 4.86; 95% CI, 1.22–19.3; P = 0.025). The frail group also had longer hospitalizations, less adjuvant chemotherapy, and more frequent discontinuation of postoperative surveillance. CONCLUSION: FI-CGA-10 was associated with postoperative complications in older adults undergoing gastrectomy for GC and may be useful for preoperative risk stratification.
Risk factors for seroma formation after ALT flap harvest: a retrospective study focused on age and the fascia harvest area.
Tsuboi K, Yamamoto K, Yoshizawa E … +2 more , Hayakawa M, Furukawa H
Surg Today · 2026 Mar · PMID 41854740 · Publisher ↗
PURPOSE: Seroma formation is a common complication following anterolateral thigh (ALT) flap harvesting. This study aimed to evaluate whether age or the fascia harvest area is more strongly associated with postoperative s...
PURPOSE: Seroma formation is a common complication following anterolateral thigh (ALT) flap harvesting. This study aimed to evaluate whether age or the fascia harvest area is more strongly associated with postoperative seroma formation. METHODS: We retrospectively reviewed 51 ALT flaps in 50 patients at Aichi Medical University between April 2021 and July 2025. One patient underwent a bilateral harvest. All donor sites were closed primarily, and cases of drain self-removal or skin graft closure were excluded. Seroma was defined as donor-site fluid collection confirmed by ultrasound, CT, or aspiration within 2 months postoperatively. Univariate analyses and Firth’s penalized logistic regression analyses were performed. RESULTS: Five flaps (9.8%) developed seroma in patients aged ≥ 70 years (5/20, 25%) compared with none in patients aged < 70 years (0/31, 0%; p = 0.0066). The median fascia harvest area (172.5 vs. 112.5 cm²; p = 0.526), BMI (22.9 vs. 22.6; p = 0.913), and drain removal timing (POD 7 vs. POD 7; p = 0.901) did not differ significantly between groups. The drain output within 24 h before removal was higher in the seroma group (21 vs. 11 mL; p = 0.0058). Firth’s penalized logistic regression confirmed age as an independent predictor (OR 1.13 per year; 95% confidence interval [CI], 1.01–1.41; p = 0.030). Bootstrap validation demonstrated that the age effect remained stable across resampled datasets despite the small number of seroma events. CONCLUSIONS: An older age was significantly associated with donor-site seroma after ALT flap harvest, whereas the fascia harvest area and BMI were not. Although drain output was higher in the seroma group, this may reflect early seroma formation rather than serve as a causal predictor. Elderly patients may require closer postoperative monitoring to reduce donor site complications.
Progress in immunological research on innate effectors in xenotransplantation.
Miyagawa S, Maeda A, Toyama C … +6 more , Kogata S, Noguchi Y, Matsuura R, Eguchi H, Ueno T, Okuyama H
Surg Today · 2026 Jul · PMID 41854739 · Full text
In xenotransplantation research, the control of innate immune cells is problematic. In this review, we focus on molecules, which are control-related findings obtained from known immune responses, and investigate whether...
In xenotransplantation research, the control of innate immune cells is problematic. In this review, we focus on molecules, which are control-related findings obtained from known immune responses, and investigate whether they can be applied to control macrophages and neutrophils. The “missing-self” is a well-known recognition system for natural killer cells, but it has been shown that human leukocyte antigen (HLA)-G1, rather than HLA- E, exerts this control effect on macrophages and neutrophils. Moreover, CD47 is known as a “don’t eat me signal,” and its action can be applied to the control not only of macrophages but also of neutrophils. However, this molecule is likely influenced strongly by thrombospondin-1. In contrast, when the pulmonary surfactant protein D is converted to a membrane-type molecule, it exerts a stronger regulatory effect on macrophages and neutrophils than CD47. Regarding “contact inhibition,” the suppression of cytotoxicity by CD31 was observed in neutrophils, but not well in macrophages. In contrast, CD177, a ligand with high affinity for CD31, showed a significant regulatory effect on macrophages and neutrophils through CD31 expression. These findings are important for the future production of genetically edited pigs.
Preoperative low C-reactive protein-albumin-lymphocyte (CALLY) index is a poor prognostic indicator for overall survival in patients undergoing surgery for pancreatic ductal adenocarcinoma.
Matsumoto Y, Otsuka Y, Hosaka H … +5 more , Kajiwara Y, Okada R, Ito Y, Tsuchiya M, Shimada H
Surg Today · 2026 Mar · PMID 41854738 · Publisher ↗
PURPOSE: This study aimed to investigate the prognostic impact of preoperative indicators that reflect systemic inflammatory, nutritional, and immune status, focusing on the C-reactive protein–albumin–lymphocyte (CALLY)...
PURPOSE: This study aimed to investigate the prognostic impact of preoperative indicators that reflect systemic inflammatory, nutritional, and immune status, focusing on the C-reactive protein–albumin–lymphocyte (CALLY) index in patients undergoing surgery for pancreatic ductal adenocarcinoma. METHODS: This retrospective study included 120 patients (stage I = 19, II = 94, III = 7) who underwent surgical resection for pancreatic ductal adenocarcinoma between 2007 and 2019. Preoperative laboratory data and the CALLY index were collected to evaluate their impact on overall survival (OS). A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff values. RESULTS: The optimal cutoff value for the preoperative CALLY index was 4.0. Patients with a low CALLY index (< 4.0) demonstrated a significantly worse OS than those with a high CALLY index (≥ 4.0) (P = 0.001). A multivariate analysis of composite indices identified low CALLY index (P = 0.001) as an independent prognostic factor, along with positive lymph node metastasis (P = 0.035) and the absence of adjuvant chemotherapy (P = 0.005). CONCLUSION: The CALLY index reflects the preoperative systemic inflammatory, nutritional, and immune status. It is a convenient and practical prognostic predictor of OS in patients undergoing surgery for pancreatic ductal adenocarcinoma.
Analysis of retrograde infection of prophylactic pelvic drains in rectal cancer surgery: a retrospective cohort study.
Nagai Y, Nozawa H, Sasaki K … +9 more , Murono K, Emoto S, Kaneko K, Yokoyama Y, Abe S, Harada Y, Shinagawa T, Tachikawa Y, Ishihara S
Surg Today · 2026 Mar · PMID 41854737 · Publisher ↗
PURPOSE: The role of prophylactic pelvic drains in rectal surgery remains controversial. This study aimed to clarify the clinical impact of one major concern: retrograde drain infection. METHODS: The subjects of this ret...
PURPOSE: The role of prophylactic pelvic drains in rectal surgery remains controversial. This study aimed to clarify the clinical impact of one major concern: retrograde drain infection. METHODS: The subjects of this retrospective study were 852 consecutive patients who underwent rectal cancer resection with bowel anastomosis and drain placement at a single referral hospital in Japan. Retrograde drain infections were categorized based on infection depth, as superficial/deep or organ/space. Patients with anastomotic leakage (n = 10) were excluded from the analysis. Outcomes included infection frequency, characteristics, risk factors, and oncological effects. RESULTS: Retrograde drain infection developed in 5.5% of the patients, with the vast majority (84.8%) diagnosed on or after postoperative day (POD) 7. Male sex was a significant risk factor (7.0% vs. 3.3%, P = 0.025). Patients with a retrograde drain infection had longer hospital stays (median 22 vs. 16 days, P < 0.001). Organ/space infections were associated with poorer recurrence-free survival for patients with Stage I–III disease. Drain placement helped early detection in 6 of 10 patients with anastomotic leakage, avoiding stoma creation in 2 patients. CONCLUSION: Retrograde drain infection occurs more frequently in male patients and prolongs the hospital stay. While prophylactic drains may aid early leakage detection, removal within 7 days is recommended to reduce infection risk.
Prognostic impact of the C-reactive protein-albumin-lymphocyte index in patients with resected lung cancer associated with interstitial pneumonia.
Konoeda C, Toyokawa G, Shimokawa M … +1 more , Sato M
Surg Today · 2026 Mar · PMID 41831004 · Publisher ↗
PURPOSE: The C-reactive protein (CRP)–albumin–lymphocyte (CALLY) index is a composite score that evaluates inflammatory and nutritional status. This study aimed to determine its prognostic significance in patients with r...
PURPOSE: The C-reactive protein (CRP)–albumin–lymphocyte (CALLY) index is a composite score that evaluates inflammatory and nutritional status. This study aimed to determine its prognostic significance in patients with resected lung cancer associated with interstitial pneumonia (IP). METHODS: Eighty-five patients with IP-associated resected lung cancers were included. The CALLY index was calculated as follows: (serum albumin × lymphocytes) / (CRP × 104). The patients were classified into low and high CALLY groups based on a cutoff value determined by the receiver operating characteristic curve for overall survival (OS). The associations between the CALLY index, patient characteristics, and postoperative survival were retrospectively investigated. RESULTS: The postoperative hospital stay was significantly longer (P = 0.015) and the incidence of postoperative pneumonia was significantly higher (P = 0.004) in the low CALLY group (n = 20, 23.5%) than in the high CALLY group (n = 65, 82.5%). The recurrence-free survival (RFS) and OS were significantly poorer in the low CALLY group (P = 0.045 and P = 0.020, respectively). A multivariate analysis identified the CALLY index as an independent prognosticator factor for RFS and OS (P = 0.013 and P = 0.004, respectively). CONCLUSION: The CALLY index is an independent prognostic factor in patients with IP-associated resected lung cancer.
Effect of the endoscopic surgical skill qualification system for laparoscopic right colectomy: a Japanese multicenter analysis.
Shiraishi T, Hashimoto S, Tominaga T … +12 more , Noda K, Ono R, Ishii M, Hisanaga M, Fukuda A, Moriyama M, Maruyama K, Tei S, Ishimaru K, Sawai T, Nonaka T, Matsumoto K
Surg Today · 2026 Mar · PMID 41831003 · Publisher ↗
PURPOSE: The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to provide an objective measure of the skills of laparoscopic surgeons. This study aimed to assess the effects of the ESSQS on...
PURPOSE: The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to provide an objective measure of the skills of laparoscopic surgeons. This study aimed to assess the effects of the ESSQS on short- and long-term outcomes of laparoscopic right colectomy. METHODS: We retrospectively reviewed the data of 671 patients with right colon cancer who underwent laparoscopic surgery between 2016 and 2023. Patients were divided into an expert group (n = 194) and a non-expert group (n = 477) based on whether surgery was performed by an ESSQS-qualified surgeon. After propensity score matching, 167 patients in each group were matched. The short- and long-term outcomes were compared between the groups. RESULTS: Before matching, the expert group showed significantly greater frequencies of preoperative treatment (3.1% vs. 0.4%, p = 0.008) and reduced port surgery (17.0% vs. 2.7%, p < 0.001). After matching, the operation time was shorter (203 min vs. 231 min, p = 0.012), postoperative severe complications were less frequent (1.8% vs. 6.0%, p = 0.045), and hospital stay was shorter (11 days vs. 12 days, p = 0.043) in the expert group. The relapse-free survival (p = 0.403) and overall survival (p = 0.785) were similar between the groups. CONCLUSIONS: The present study indicated better results, such as a shorter operation time and lower complication rate, for laparoscopic right colectomies performed by ESSQS-qualified surgeons.
Impact of intraoperative colonoscopy for anastomosis assessment after left-sided colorectal surgery: a meta-analysis.
Sathornviriyapong S, Matsuda A, Yodying H … +2 more , Boonsinsukh T, Yoshida H
Surg Today · 2026 Mar · PMID 41831002 · Publisher ↗
PURPOSE: Despite advances in surgical techniques, anastomotic leakage (AL) remains a serious complication after colorectal surgery. Intraoperative colonoscopy (IOC) has emerged as a technique to detect and potentially re...
PURPOSE: Despite advances in surgical techniques, anastomotic leakage (AL) remains a serious complication after colorectal surgery. Intraoperative colonoscopy (IOC) has emerged as a technique to detect and potentially reduce AL; however, its routine use remains controversial due to limited evidence. METHODS: We conducted a systematic literature search of MEDLINE, the Cochrane Library, and Google Scholar through April 2025 to identify studies comparing the anastomosis outcomes between IOC and non-IOC groups in left-sided colorectal surgery. The primary outcome was AL and the secondary outcomes included intraoperative air leakage and anastomotic bleeding. We used a random-effects meta-analysis to calculate the odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Ten studies involving 3,023 patients were included. IOC significantly reduced AL compared to non-IOC (OR 0.53; 95% CI 0.36–0.79; p = 0.002; number needed to treat = 27). IOC also showed a higher detection rate of intraoperative air leaks (OR, 0.32; 95% CI, 0.11–0.92; p = 0.03). Although not statistically significant, bleeding tended to be lower with IOC. Subgroup analyses showed AL reduction in cases of cancer, rectal surgery, and minimally invasive procedures. CONCLUSIONS: IOC reduces the intraoperative air leak rates and improves detection, thereby supporting its use in selected colorectal surgeries.
Alteration of PGA sheet composition improves histocompatibility and facilitates pleural repair.
Midorikawa K, Nakashima H, Ueda Y … +3 more , Miyahara S, Shiraishi T, Sato T
Surg Today · 2026 Mar · PMID 41817711 · Publisher ↗
PURPOSE: Pulmonary air leakage is a major concern in thoracic surgery, and polyglycolic acid (PGA) sheets are commonly used for pleural reinforcement. The fiber diameter and sheet flexibility may influence histocompatibi...
PURPOSE: Pulmonary air leakage is a major concern in thoracic surgery, and polyglycolic acid (PGA) sheets are commonly used for pleural reinforcement. The fiber diameter and sheet flexibility may influence histocompatibility and pleural repair. This study compared a conventional 14-µm PGA sheet (14-PGA) with a thin-fiber 2-µm PGA (2-PGA) and flexible thin-fiber prototype (2-fPGA). METHODS: Standardized pleural defects were created in beagle dogs and then were repaired using fibrin glue. The primary endpoint was histological assessment on days 3, 7, 14, 28, and 56 (n = 12 per time point), evaluating remnants of PGA fibers, inflammatory reactions, neovascularization, and foreign body granulomas. The secondary endpoints were burst pressure testing (n = 5 per group) and surgeon-reported usability. RESULTS: The thin-fiber sheets demonstrated improved histocompatibility with earlier resolution of inflammation and foreign body reactions than 14-PGA. On Day 56, granuloma scores were higher in 14-PGA (mean 1.42, 95%CI 0.91–1.93) than in 2-PGA (0.08, − 0.08–0.25) and 2-fPGA (0.00, 0.00–0.00). The burst pressure was comparable among the groups. Surgeons have reported the superior conformability of 2-fPGA. CONCLUSION: Altering the PGA sheet composition toward thin and flexible microfibers improved histocompatibility and facilitated pleural repair without compromising the sealing performance in this beagle model.
Elevated glucose metabolism via the hexosamine biosynthesis pathway: A metabolic signature of high-fluorodeoxyglucose-uptake lung adenocarcinoma.
Watanabe H, Makinoshima H, Kanauchi N … +9 more , Kabasawa T, Suzuki J, Takamori S, Sasage T, Abe K, Hoshijima K, Uchida T, Soga T, Shiono S
Surg Today · 2026 Mar · PMID 41806212 · Publisher ↗
PURPOSE: To evaluate hexosamine biosynthetic pathway (HBP) involvement in high-fluorodeoxyglucose (FDG)-uptake lung adenocarcinoma. METHODS: We conducted metabolomic analysis to evaluate the HBP in patients with lung ade...
PURPOSE: To evaluate hexosamine biosynthetic pathway (HBP) involvement in high-fluorodeoxyglucose (FDG)-uptake lung adenocarcinoma. METHODS: We conducted metabolomic analysis to evaluate the HBP in patients with lung adenocarcinoma, who underwent preoperative 18-FDG positron emission tomography. Capillary electrophoresis-time-of-flight mass spectrometry was done to obtain 511 small-molecule metabolite spectra, and a principal component analysis was performed. RESULTS: We examined 80 tissue samples: 40 tumor-adjacent non-tumor tissue samples and 40 resected lung adenocarcinomas. The principal component analysis confirmed good clustering between the tumor and non-tumor tissues. The non-tumor tissues comprised uniform materials, whereas the tumor tissues comprised a mixture of materials. Heatmaps for 50 metabolites revealed lower glucose and citrate levels and higher levels of lactate, glycolysis metabolites, succinate, fumarate, adenosine di- and -monophosphate, and all essential amino acids in the tumor tissues than the non-tumor tissues. HBP intermediate and uridine diphosphate N-acetylglucosamine levels were also higher in the tumor tissues. Both lactate and HBP intermediate levels were higher in hypermetabolic tumor tissues (standardized uptake value ≥ 3) than in non-hypermetabolic tumor tissues (standardized uptake value < 3). Low-FDG-uptake cells showed strong expression for glucose transporter SLC2A1 and weak expression for O-linked N-acetylglucosamine, whereas high-FDG-uptake cells showed strong expression for both markers. CONCLUSIONS: Hypermetabolic adenocarcinoma may be associated with intensified glycolysis and HBP activation.
Factors influencing surgical difficulty in minimally invasive right hemicolectomy.
Takashima Y, Kasai S, Shiomi A … +5 more , Manabe S, Tanaka Y, Kojima T, Igaki T, Mori Y
Surg Today · 2026 Mar · PMID 41806211 · Publisher ↗
PURPOSE: To identify the clinical factors associated with surgical difficulty in minimally invasive right hemicolectomy (RHC), including that performed with robotic surgery (RS). METHODS: The subjects of this retrospecti...
PURPOSE: To identify the clinical factors associated with surgical difficulty in minimally invasive right hemicolectomy (RHC), including that performed with robotic surgery (RS). METHODS: The subjects of this retrospective study were patients who underwent laparoscopic or robotic RHC for primary colon adenocarcinoma at Shizuoka Cancer Center between April 2014 and March 2025. Surgical difficulty was assessed comprehensively based on postoperative short-term outcomes, including operative time, conversion, blood loss, hospital stay, and complications. RESULTS: Among a total 540 patients, 70 (13.0%) were categorized as having high surgical difficulty. A total of 181 (33.5%) and 359 (66.5%) patients underwent robotic and laparoscopic RHC, respectively. Univariate analysis identified a visceral fat area ≥100 cm2, tumor size ≥5 cm, advanced clinical stage, and laparoscopic approach as significant factors associated with high surgical difficulty. Multivariate analysis identified a high visceral fat area (odds ratio [OR] = 3.89, p < 0.001) and a large tumor size (OR = 2.78, p = 0.004) as independent risk factors for increased surgical difficulty. Conversely, RS was associated with reduced surgical difficulty (OR = 0.53, p = 0.035). CONCLUSIONS: Visceral obesity and large tumor size may be associated with increased surgical difficulty, whereas RS may contribute to reducing the difficulty.
Trends in groin hernia repair in Japan: analysis of the 2023 annual report from the National Clinical Database.
Sato M, Yamamoto H, Poudel S … +8 more , Nagae I, Matsubara T, Tazaki T, Takagi T, Shirabe K, Ueno H, Hachisuka T, Miyazaki K
Surg Today · 2026 Mar · PMID 41806210 · Publisher ↗
PURPOSE: To provide a nationwide overview of groin hernia surgeries in Japan, using data from the National Clinical Database (NCD) as of 2023, with emphasis on procedure types, demographic trends, and hernia classificati...
PURPOSE: To provide a nationwide overview of groin hernia surgeries in Japan, using data from the National Clinical Database (NCD) as of 2023, with emphasis on procedure types, demographic trends, and hernia classification by sex and recurrence status. METHODS: We analyzed data on groin hernia surgeries registered in the NCD from January to December, 2023. Procedures were classified into four categories: open or endoscopic, and inguinal or femoral. Variables included age, sex, surgical urgency, anesthesiologist involvement, and admission type. Longitudinal trends (2011–2023) and sex-/recurrence-specific differences were also evaluated. RESULTS: A total of 127,139 groin hernia repairs were performed at 2,143 institutions. Inguinal hernias accounted for 96.5% of the repairs and femoral hernias accounted for 3.5%, with 56.8% of all the hernias repaired endoscopically. Emergency surgery was done more frequently for femoral hernias (44.3%) than for inguinal hernias (2.6%). Femoral hernias were more common in women, and their proportion was higher among recurrent hernias than primary hernias for both sexes. Recurrent hernia repair comprised 3.8% of the hernia surgeries for male patients and 1.9% of those for female patients. The number of endoscopic repairs increased over time, especially for bilateral hernias. CONCLUSION: This is the first large-scale hernia classification study from Asia. It highlights sex- and recurrence-specific patterns and supports clinical and international registry comparisons.
Delivery sheet method for lichtenstein with progrip surgery on inguinal hernia repair.
Kakizoe S, Kakizoe Y, Iwai T … +2 more , Kakizoe K, Kakizoe K
Surg Today · 2026 Mar · PMID 41806209 · Publisher ↗
PARIETEX™ ProGrip™ mesh (Medtronic USA) is a self-fixating synthetic mesh that is widely used in Lichtenstein inguinal hernia repair. Microgrip technology enables sutureless fixation, potentially reducing post-operative...
PARIETEX™ ProGrip™ mesh (Medtronic USA) is a self-fixating synthetic mesh that is widely used in Lichtenstein inguinal hernia repair. Microgrip technology enables sutureless fixation, potentially reducing post-operative nerve pain. However, proper deployment of the mesh can be technically difficult owing to its adhesion to the surrounding tissue. We aimed to develop and evaluate a simple and effective method using a delivery sheet to facilitate the easy and accurate deployment of the ProGrip mesh during Lichtenstein hernia repair. Since April 2023, the delivery sheet method has been applied to the Lichtenstein repairs performed at our institution. A delivery sheet fashioned from the original mesh packaging was cut slightly larger than the mesh and used to spread the ProGrip without folding. This technique allows for smooth placement over the transversalis fascia without tissue interference. The median operative time was 77 ± 19 min. The median time required to spread the ProGrip mesh on the delivery sheet was 5 ± 2 min. No intraoperative complications occurred, and no recurrences or postoperative complications were observed during the 1 to 2-year follow-up period.
Utility of establishing a unified regional database for enhancing academic output and specialist certification in Japan.
Tominaga T, Hashimoto S, Takamura Y … +15 more , Katayama H, Yamashita M, Noda K, Tei S, Ono R, Ishii M, Hisanaga M, Oishi K, Moriyama M, Uchida F, Shiraishi T, Kunizaki M, Fukuda A, Nonaka T, Matsumoto K
Surg Today · 2026 Mar · PMID 41787193 · Publisher ↗
PURPOSE: Surgical outcomes have improved remarkably through specialist experience and certification; however, regional physicians have limited opportunities to publish because of the lack of accessible databases. The aim...
PURPOSE: Surgical outcomes have improved remarkably through specialist experience and certification; however, regional physicians have limited opportunities to publish because of the lack of accessible databases. The aim of this study was to examine whether establishing a large-scale database in regional areas could enhance academic output and thus support specialist certification. METHODS: The databases of a university hospital and several regional general hospitals were unified in 2016. The period before database unification was termed the early period (E period) and that after unification was termed the late period (L period). The number of specialist certifications acquired was compared between the periods. RESULTS: The numbers of the following increased from the E period to the L period: academic presentations (86 vs. 186), publication of original articles (3 vs. 64), cases analyzed (5 vs. 20), papers written by new authors (2 vs. 20), Endoscopic Surgical Skill Qualification System-certified surgeons (2 vs. 12), and Board-certified Surgeons in Gastroenterology (2 vs. 12). Moreover, the mean number of years of clinical experience that it took for specialist qualifications to be obtained decreased from 14 years in the E period to 9 years in the L period. CONCLUSIONS: Establishing a database across regional areas promoted the presentation and publication of research by early-career clinicians, thereby supporting the development of medical specialists.
Response to "comment on effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction in open abdomen management".
Shigeta K, Nakae R, Yokobori S
Surg Today · 2026 Mar · PMID 41774198 · Publisher ↗
We appreciate the constructive comments on our recent study on vacuum-assisted wound closure with mesh‑mediated fascial traction (VAWCM) in open abdomen management (OAM). Dialogue is essential for refining surgical strat...
We appreciate the constructive comments on our recent study on vacuum-assisted wound closure with mesh‑mediated fascial traction (VAWCM) in open abdomen management (OAM). Dialogue is essential for refining surgical strategies, and we welcome the opportunity to clarify the key points. Our findings demonstrated that VAWCM achieved higher rates of primary fascial closure and lower in-hospital mortality than vacuum-assisted wound closure (VAWC) alone. We also highlighted the reproducibility of our modified technique, which facilitates broader clinical applications. Although VAWCM is effective, it is not universally indicated. Many OAM cases can achieve closure without VAWCM, and the additional setup time may be disadvantageous when rapid temporary abdominal closure is required, particularly in damage-control surgery. Our institutional review showed that initiating VAWCM within five days significantly improved rectus fascial closure rates (79% vs. 31%). Based on these results, we adopted a standardized protocol for OAM management and collected prospective data. We acknowledge the limitations of our retrospective, single-center design and the potential for some selection bias. Larger multicenter studies are needed to establish standardized criteria for patient selection and timing. Consistent protocols are critical for optimizing the outcomes across institutions.
Revisiting the anatomical relationship between the middle colic artery and the middle colic vein for complete mesocolic excision in colon cancer surgery.
Yamamoto T, Fukuda M, Okuchi Y … +10 more , Maekawa H, Hisano K, Oshimo Y, Kitano S, Yoshida Y, Okamura R, Itatani Y, Hida K, Obama K, Terajima H
Surg Today · 2026 Mar · PMID 41774197 · Publisher ↗
PURPOSES: To clarify the cranio-caudal positional relationships and inter-root distances among the key mesenteric vessels involved in lymphadenectomy around the superior mesenteric artery (SMA) and the superior mesenteri...
PURPOSES: To clarify the cranio-caudal positional relationships and inter-root distances among the key mesenteric vessels involved in lymphadenectomy around the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). These anatomical features have not been investigated systematically before, despite their critical importance for safe and precise complete mesocolic excision (CME) in colon cancer surgery. METHODS: The subjects of this retrospective study were consecutive patients who underwent dynamic contrast-enhanced abdominal computed tomography (CT) between April, 2024 and March, 2025. We evaluated the presence, branching, and vertical relationships of the artery and vein around the SMA/SMV using CT images with a thickness of 0.625 mm. Cranio-caudal distances between the roots of the middle colic artery (MCA) and vein (MCV), and the Henle trunk were measured. RESULTS: We analyzed the data for 100 patients. The ileocolic artery, MCA, and MCV were consistently present, while the right colic artery was identified in 36%. The gastro-pancreato-colic type was most common in the Henle trunk (90%). The MCV was located cranial to the MCA in all patients, with a mean inter-root distance of 9.4 mm. The typical alignment of MCV, Henle’s trunk, MCA, and cranial to caudal, was present in 85% of the patients. CONCLUSIONS: The MCV consistently lies cranial to, but with considerable distance from, the MCA. Recognizing these relationships may improve the safety and precision of lymphadenectomy and CME.
Potential bias in the clinical trial registration of patients with peripheral small-sized non-small cell lung cancer: Real-world data in the era of segmentectomy.
Nomata Y, Nakamura S, Nakanishi K … +5 more , Kadomatsu Y, Ueno H, Kato T, Mizuno T, Chen-Yoshikawa TF
Surg Today · 2026 Mar · PMID 41774196 · Publisher ↗
PURPOSE: Recent phase III trials demonstrate that survival after segmentectomy is not inferior to that after lobectomy for peripheral small-sized non-small cell lung cancer (NSCLC). However, the influence of patient sele...
PURPOSE: Recent phase III trials demonstrate that survival after segmentectomy is not inferior to that after lobectomy for peripheral small-sized non-small cell lung cancer (NSCLC). However, the influence of patient selection and registration bias remains unclear. This study analyzed real-world data to assess patients who were eligible for the JCOG0802/WJOG4607L trial, but who were not enrolled. METHODS: We analyzed data on 38 of 61 patients not enrolled in the JCOG0802/WJOG4607L trial, during its enrollment period. Surgical procedures, clinical characteristics, and outcomes of the nonregistered patients were reviewed. RESULTS: Lobectomy was performed in 31 patients and segmentectomy was performed in 7 patients. Radiological features of higher-grade malignancy were seen more frequently in the patients who underwent lobectomy. The most common reason for nonregistration in the JCOG0802/WJOG4607L trial was multiple mild comorbidities (n = 11), followed by tumor aggressiveness (n = 6), and concerns about inadequate margins with segmentectomy (n = 6). Recurrence was found in five patients. The 5-year overall and recurrence-free survival rates were 82.9% and 80.2%, respectively. CONCLUSIONS: Our analysis emphasizes the challenges posed by registration bias in clinical trials. Survival outcomes among the study population were worse than those reported in the JCOG0802/WJOG4607L trial, suggesting a high malignant potential on preoperative imaging, and that registration bias occurs even in large-scale randomized trials.
Predictors of distant recurrence and the role of selective lateral lymph node dissection after preoperative chemoradiotherapy for rectal cancer: a retrospective study.
Shiraishi T, Katayama C, Shibasaki Y … +7 more , Komine C, Okada T, Sano A, Sakai M, Ogawa H, Shirabe K, Saeki H
Surg Today · 2026 Mar · PMID 41774195 · Publisher ↗
PURPOSE: To identify when lateral lymph node dissection (LLND) can be omitted following neoadjuvant chemoradiotherapy (nCRT), for which patients it remains imperative, and the preoperative risk factors for recurrence pos...
PURPOSE: To identify when lateral lymph node dissection (LLND) can be omitted following neoadjuvant chemoradiotherapy (nCRT), for which patients it remains imperative, and the preoperative risk factors for recurrence post-nCRT. METHODS: We analyzed the clinical and pathological factors, surgical and recurrence details, and survival rates of 61 patients with lower rectal cancer, who underwent curative resection following nCRT between July, 2013 and August, 2024. RESULTS: LLND was omitted for 42 patients without suspected lateral lymph node metastasis, with no recurrence in lateral lymph node regions. Lymph node metastasis was confirmed in 8 (42.1%) of 19 patients who underwent LLND, all of whom had lateral lymph node enlargement (short-axis diameter ≥ 7 mm) identified prior to nCRT. One patient had recurrence in the LLND area. The 3-year disease-free and overall survival rates were 70.0% and 91.5%, respectively, with higher local recurrence in the LLND group (24.7%) than in the omission group (6.9%). Extramural vascular invasion was an independent prognostic factor for disease-free survival (p = 0.025), with early postoperative pulmonary metastases identified in 6 of 13 patients. CONCLUSIONS: Selectively omitting LLND may be feasible following nCRT, especially for patients without persistent lateral lymph node enlargement. Extramural vascular invasion is strongly associated with distant metastasis, potentially necessitating additional systemic treatments.
Association of preoperative ultrasonography with the bowel function at 5 years of age in low-type anorectal malformation: a retrospective cohort study.
Tsuzaka S, Deie K, Ebihara M … +10 more , Matsuda R, Tsutsuno T, Taki S, Ogawa S, Kondo Y, Takezoe T, Naya I, Mizuta K, Hosokawa T, Kawashima H
Surg Today · 2026 Feb · PMID 41746368 · Publisher ↗
PURPOSE: Low-type anorectal malformation (LARM) is commonly associated with favorable fecal continence; however, some patients experience a suboptimal bowel function during early childhood. We evaluated whether the recta...
PURPOSE: Low-type anorectal malformation (LARM) is commonly associated with favorable fecal continence; however, some patients experience a suboptimal bowel function during early childhood. We evaluated whether the rectal pouch–perineum (P–P) distance, measured using preoperative ultrasonography, is associated with the postoperative bowel function. METHODS: Forty-seven children with LARMs who underwent surgery between 2006 and 2020 were analyzed over a 5-year follow-up. We measured the P–P distance on day 0/1 of life using transperineal ultrasonography. The bowel function at five years of age was assessed using the Japan Society of ARM Study Group evacuation score (ES). We conducted simple and multiple regression analyses to examine the association between the P and P distance and postoperative outcomes. RESULTS: A shorter P–P distance correlated with higher ES (B = − 0.833, P = 0.014), less soiling (B = − 0.282, P = 0.038), and less incontinence (B = − 0.357, P = 0.049). Lumbosacral malformations were independently associated with a lower ES, worse soiling, and urgency. CONCLUSION: Ultrasonographic measurement of the P–P distance is useful for surgical planning and it is associated with the bowel function at 5 years of age in patients with LARMs. Although a shorter P–P distance was associated with a better bowel function in early childhood, a longer follow-up is required to determine whether P–P distance is associated with the ultimate long-term functional outcomes.
The transanal approach for lower rectal cancer: a propensity score-matched analysis.
Ishikawa D, Tokunaga T, Kashihara H … +5 more , Yoshimoto T, Wada Y, Takasu C, Nishi M, Shimada M
Surg Today · 2026 Feb · PMID 41746367 · Publisher ↗
PURPOSE: Transanal approaches have been developed to improve the quality of surgery for lower rectal cancer; however, international concerns have been raised about higher local recurrence rates. We investigated the short...
PURPOSE: Transanal approaches have been developed to improve the quality of surgery for lower rectal cancer; however, international concerns have been raised about higher local recurrence rates. We investigated the short- and long-term outcomes of the transanal approach. METHODS: A total of 291 patients who underwent laparoscopic or robotic surgery for rectal cancer were enrolled in this retrospective study. Clinical, pathological, surgical, and follow-up data were reviewed and patients were divided into a transanal approach group (n = 139) and a conventional total mesorectal excision group (n = 152). A propensity score-matched analysis was performed to compare surgical outcomes. RESULTS: After matching, 65 patients were included in each group. In the transanal group, intersphincteric resection was performed more frequently and abdominoperineal resection was less, resulting in a higher rate of anus preservation (72.3% vs. 53.8%). The operative time was shorter, blood loss was lower and major complications were less frequent in the transanal group. Overall survival was better in the transanal group. No significant difference was observed in the total recurrence rate, including the local recurrence rate. CONCLUSIONS: The transanal approach for lower RC can be performed safely without compromising short- and long-term outcomes, offering a higher rate of anus preservation.
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