PURPOSE: To evaluate the learning curve and accuracy of microsurgical operation steps achieved by young medical professionals using a microsurgery robotic simulator. The NASA-TLX score was used to assess the workload in...PURPOSE: To evaluate the learning curve and accuracy of microsurgical operation steps achieved by young medical professionals using a microsurgery robotic simulator. The NASA-TLX score was used to assess the workload in the simulation of robotic operation steps for surgical beginners. METHODS: Twenty-three students of dental medicine performed four exercises over 3 consecutive weeks. The exercises consisted of grasping and placing models, grasping and placing a needle, and performing a surgical knot. RESULTS: There was significant improvement (p < 0.05) in the operation time from the first to the second and third measurement points for all exercises. Furthermore, the range of instrument movement became more efficient as the learning curve progressed. The incidence of complications such as instrument collisions improved with each trial. The workload was reduced significantly by the training sessions. CONCLUSION: Our study showed that the young medical professionals had a significant learning curve on a microsurgery robotic simulator. The simulator provided a suitable opportunity for students and young professionals to prepare for robotic microsurgery and pique their interest in the field.
PURPOSE: To evaluate the efficacy and safety of postoperative pleurodesis using OK-432, focusing on patients with idiopathic interstitial pneumonia (IIP). METHODS: This retrospective cohort study included patients who un...PURPOSE: To evaluate the efficacy and safety of postoperative pleurodesis using OK-432, focusing on patients with idiopathic interstitial pneumonia (IIP). METHODS: This retrospective cohort study included patients who underwent OK-432 pleurodesis following pulmonary resection. We reviewed clinical characteristics, radiological evidence of IIP, operative findings, postoperative air leak volume, pleurodesis details, morbidity, and mortality; then we compared the outcomes of patients with vs. those without IIP, and analyzed the predictors of ≥Grade II complications. RESULTS: Pleurodesis was performed in 361 patients, including 67 (19%) with IIP. No significant differences were observed in the incidence of fever or in postpleurodesis parameters. The initial success rate was 58.2% for IIP patients and 70.4% for non-IIP patients. Recurrence developed in 7.5% of patients and surgical intervention was required in 4.1%. Risk factors for ≥Grade II complications included older age, IIP, pleurodesis within 3 postoperative days (PODs), and pre-pleurodesis WBC > 7000/µL. Pneumonia after pleurodesis was more frequent in the IIP patients (11.9% vs. 2.4%, p < 0.01). CONCLUSIONS: There were no treatment-related deaths following OK-432 pleurodesis in IIP patients; however, IIP remained a significant risk factor for pleurodesis-related complications, particularly pneumonia. Early intervention and elevated WBC levels may increase the complication risk. Delaying pleurodesis until the WBC count normalizes is advisable to reduce adverse events.
PURPOSE: To examine whether Japanese Society of Pediatric Surgeons (JSPS) supervisory certification is associated with intraoperative directive communication patterns, potentially explaining the previously observed short...PURPOSE: To examine whether Japanese Society of Pediatric Surgeons (JSPS) supervisory certification is associated with intraoperative directive communication patterns, potentially explaining the previously observed shorter manipulation times in pediatric single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC). METHODS: We conducted a single-center, audio-based observational study focusing on male patients who underwent SILPEC between December 2024 and September 2025. Attending-to-operator statements during hernial suturing were transcribed and coded. Directive statements (commanding/advising) were counted per minute and compared between the groups. A multivariate linear regression analysis with cluster-robust standard errors for the attending surgeons was performed to identify the factors associated with directive statement frequency. RESULTS: Forty procedures were performed in total. Directive frequency was higher in the certified group (median, 1.3 vs. 0.59 per minute). A multivariate analysis revealed that supervisory certification increased directive frequency (B = 0.69; 95% confidence interval [CI], 0.60–0.77), while the operating surgeon’s postgraduate year decreased it (B = − 0.22; 95% CI, − 0.31 to − 0.12). A history of hernia incarceration was also negatively associated with directive frequency (B = − 0.62; 95% CI, − 1.12 to − 0.12). CONCLUSIONS: JSPS-certified supervisors delivered directive statements more frequently, whereas guidance decreased with operator seniority and incarceration. These exploratory findings require validation through further studies involving a larger cohort of certified supervisors.
PURPOSE: To investigate the prognostic value of the CALLY index for colorectal cancer. METHODS: The subjects if this retrospective analysis were patients who underwent laparoscopic or robot-assisted surgery for pathologi...PURPOSE: To investigate the prognostic value of the CALLY index for colorectal cancer. METHODS: The subjects if this retrospective analysis were patients who underwent laparoscopic or robot-assisted surgery for pathological stage II–III colorectal cancer between 2009 and 2023 at a single center. The relationship between the CALLY index and prognosis was compared with the prognostic nutritional index and the modified Glasgow prognostic score, and its association with clinicopathological features and perioperative treatment was assessed. Subgroup analyses were performed based on pathological stage. A meta-analysis of published studies was performed to establish a harmonized cutoff value for the CALLY index. RESULTS: A total of 338 patients were enrolled. The optimal CALLY cutoff was 3.67. A CALLY index of < 3.67 was an independent predictor of poor outcomes in multivariate Cox regression analyses. The 3-year-overall survival rates were 97.3% and 88.3% in the high- and low-CALLY groups, respectively (P = 0.005). The subgroup analyses revealed that patients with stage III colorectal cancer and a low-CALLY index had poorer survival and were less likely to receive oxaliplatin-based adjuvant chemotherapy. The meta-analysis yielded a pooled cutoff value of 3.18 (95% CI, 1.48–4.88). CONCLUSIONS: The CALLY index outperforms existing biomarkers and is valuable for prognostic stratification and treatment decision-making in patients with resectable colorectal cancer.
PURPOSE: We evaluated the long-term outcomes of children undergoing thoracotomy lung resection for congenital lung malformations in terms of lung function, complications, and health-related quality of life (HRQOL). METHO...PURPOSE: We evaluated the long-term outcomes of children undergoing thoracotomy lung resection for congenital lung malformations in terms of lung function, complications, and health-related quality of life (HRQOL). METHODS: We retrospectively reviewed 27 children who underwent thoracotomy at Osaka University Hospital (1992-2017) with at least five years of follow-up and postoperative lung function testing after six years of age. We compared the percent predicted vital capacity (%VC), percent predicted forced expiratory volume in 1 s (%FEV), and FEV to FVC ratio (FEV/FVC) as indicators of the lung function. Longitudinal changes in the lung function, pulmonary and musculoskeletal morbidities, and HRQOL were assessed using the Pediatric Quality of Life Inventory. RESULTS: %VC and FEV/FVC remained within the normal range but were significantly lower than the controls; %FEV was below the normal range. No significant longitudinal changes in the lung function were observed. Asthma‑like symptoms appeared in 37.0% of the patients and persisted beyond adolescence. Musculoskeletal morbidities occurred in 33.3% of the patients, with five pectus excavatum cases requiring correction. HRQOL did not differ from that of the healthy controls. CONCLUSIONS: In our study, children undergoing thoracotomy lung resection for congenital lung malformations exhibited a significantly lower lung function than the healthy controls, and these impairments persisted over an extended follow-up period. Long-term complications and a reduced lung function were not reflected in the subjective HRQOL.
PURPOSE: This study compared short- and mid-term outcomes between robot-assisted surgery (Robot) and laparoscopic surgery (Lap) for splenic flexure colon cancer. METHODS: We analyzed patients who underwent minimally inva...PURPOSE: This study compared short- and mid-term outcomes between robot-assisted surgery (Robot) and laparoscopic surgery (Lap) for splenic flexure colon cancer. METHODS: We analyzed patients who underwent minimally invasive surgery for splenic flexure colon cancer between April 2018 and November 2024. The patients were divided into the Robot and Lap groups. The perioperative outcomes, postoperative complications, and survival data were also evaluated. The overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. RESULTS: In total, 32 and 20 patients underwent Robot and Lap, respectively. The Robot group had a significantly higher rate of lymph node dissection with division of the left branch of the middle colic artery (43.8% vs. 15.0%, p = 0.038), less intraoperative blood loss (0 mL vs. 28 mL, p = 0.008), and more frequent intracorporeal anastomosis (34.4% vs. 0.0%, p = 0.004). The postoperative complications and pathological outcomes were similar. The 3-year DFS rates were comparable (Robot: 80.7% vs. Lap: 91.7%, p = 0.629). CONCLUSION: Robot-assisted surgery for splenic flexure colon cancer resulted in reduced blood loss and similar short- and mid-term outcomes compared with laparoscopic surgery. Robotic systems may offer enhanced precision for complex procedures and thereby improve the safety and technical performance.
PURPOSE: Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pa...PURPOSE: Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection. METHODS: We retrospectively reviewed 272 patients (1990-2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (n = 8) and a hepatectomy alone group (DMpos-HA, n = 10). RESULTS: A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 > 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (n = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (p < 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, p = 0.396), although the difference was not statistically significant. Major complications (Clavien-Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (p = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups. CONCLUSION: In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.
PURPOSE: Metabolic and bariatric surgery (MBS) alters the gut microbiota (GM). Changes in oral microbiota (OM) after MBS have not yet been thoroughly investigated. In this study, we evaluated the changes in GM and OM bef...PURPOSE: Metabolic and bariatric surgery (MBS) alters the gut microbiota (GM). Changes in oral microbiota (OM) after MBS have not yet been thoroughly investigated. In this study, we evaluated the changes in GM and OM before and after laparoscopic sleeve gastrectomy (LSG) in patients with severe obesity and investigated the relationship between improvements in GM/OM, weight loss, and the metabolic effects. METHODS: Thirty-seven severely obese patients who underwent LSG were enrolled in this study. We retrieved samples from the feces and oral mucosa from baseline to 1-year after LSG. These samples were subjected to a 16 S rRNA metagenomic analysis using a next-generation sequencer. We evaluated the significant changes in GM/OM and compared the results with clinical outcomes. RESULTS: Regarding OM diversity, g_Actinomyces (p = 0.003), o_Rothia (p = 0.020), and g_Streptococcus (p = 0.004) increased. With regard to GM, g_Slackia (p = 0.039), g_Bacillus (p = 0.030), g_Roseburia (p = 0.027), and g_Faecalibacterium (P = 0.003) increased, the proportion of p_ Firmicutes increased, and p_Bacteroidetes decreased in both groups. Changes in g_Akkermansia did not contribute to GM/OM diversity. The weight loss and remission rates of type 2 diabetes were higher in patients with increased normal oral flora and a recovery of g_Faecalibacterium in GM. CONCLUSIONS: We clarified that the LSG reconstructs GM/OM as weight loss and the metabolic effects are enhanced.
INTRODUCTION: As the global population ages, older patients undergo pancreatoduodenectomy (PD). This study aimed to evaluate the safety and postoperative outcomes of PD in patients > 85 years of age. METHODS: We reviewed...INTRODUCTION: As the global population ages, older patients undergo pancreatoduodenectomy (PD). This study aimed to evaluate the safety and postoperative outcomes of PD in patients > 85 years of age. METHODS: We reviewed 200 consecutive PDs and compared the postoperative outcomes in patients aged ≥ 85 years using propensity score matching (PSM). RESULTS: After PSM, no differences in the clinical characteristics were observed between the two cohorts (n = 16 each). Those aged ≥ 85 years had a significantly lower induction rate of adjuvant chemotherapy (p < 0.0001) and a higher rate of best supportive care selection at recurrence (BSC) (p = 0.033) than those aged < 85 years. There was no significant difference in the rate of non-cancer-related deaths (p = 0.18). Although there were no significant differences in the -free survival rates (p = 0.89), the overall survival rate of those ≥ 85 years was significantly worse (p = 0.023). The risk factors for death after surgery were tumor-related factors and BSC (p = 0.0012). An age ≥ 85 years was not a risk factor for major postoperative complications or death after surgery. CONCLUSIONS: PD can be safely performed in patients aged ≥ 85 years without increasing postoperative complications and recurrences in the cases with appropriate patient selection.
Tominaga T, Noda K, Takamura Y
… +15 more, Katayama H, Hashimoto S, Yamashita M, Tei S, Ono R, Ishii M, Hisanaga M, Oishi K, Moriyama M, Uchida F, Shiraishi T, Kunizaki M, Fukuda A, Nonaka T, Matsumoto K
PURPOSE: To evaluate how surgeons' experience and qualifications in laparoscopic surgery influence safe implementation of robotic surgery. METHODS: We retrospectively reviewed 652 patients with colorectal cancer who unde...PURPOSE: To evaluate how surgeons' experience and qualifications in laparoscopic surgery influence safe implementation of robotic surgery. METHODS: We retrospectively reviewed 652 patients with colorectal cancer who underwent robotic surgery between 2016 and 2024 years. The patients were divided into two groups: those who underwent surgery performed by an expert surgeon (expert group, n = 571) and a non-expert surgeon (non-expert group, n = 81). Following propensity score matching (PSM) to minimize the possibility of any selection bias, 81 patients in each group were matched, and the clinical and perioperative features were compared between the two groups. RESULTS: The number of procedures performed by non-experts has gradually increased over time, and surgeons have become progressively younger. Before matching, the non-expert group had a higher American Society of Anesthesiologists physical status (expert vs. non-expert: 13.6% vs. 4.6%, p < 0.001) and included a higher proportion of colon tumors (36.4% vs. 54.3%, p = 0.002). However, after matching, no differences were observed between the groups. Furthermore, there were no significant differences in the operative time, blood loss, or postoperative complications. CONCLUSIONS: Proctored robotic surgery is considered to be safe. However, when non-expert surgeons perform robotic surgery, expert supervision is desirable.
PURPOSE: Long-term data on the risk factors for fistulizing disease (FD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis are limited. This study aimed to identify the predictors of FD after ileostomy clo...PURPOSE: Long-term data on the risk factors for fistulizing disease (FD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis are limited. This study aimed to identify the predictors of FD after ileostomy closure and evaluate the impact of FD on pouch failure. METHODS: We reviewed 374 patients who underwent mucosal restorative proctocolectomy with handsewn IPAA between 2004 and 2022. Cox proportional hazards regression and log-rank tests were used to assess the FD-free survival and risk factors. RESULTS: After excluding 59 patients, 315 patients were analyzed. FD developed in 20 (6.3%) of these patients. Multivariate analysis showed that a monthly prednisolone (PSL) dose ≥ 450 mg before IPAA and chronic pouchitis were independent risk factors for FD (odds ratio [OR] 2.96, 95% CI: 1.15-7.64, p = 0.025; OR 3.85, 95% CI: 1.52-9.78, p = 0.0045). Patients with PSL ≥ 450 mg or chronic pouchitis had significantly poorer FD-free survival (p = 0.0004 and p = 0.0002, respectively). Pouch failure occurred more frequently in patients with FD than in those without FD (30.0% vs. 1.0%; p < 0.0001). CONCLUSIONS: High steroid exposure before IPAA and chronic pouchitis were significant predictors of FD, which strongly increased the risk of pouch failure.
PURPOSE: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortalities. Although hepatic resection provides favorable outcomes for resectable HCC (R-HCC), its recurrence rate remains high. This study aime...PURPOSE: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortalities. Although hepatic resection provides favorable outcomes for resectable HCC (R-HCC), its recurrence rate remains high. This study aimed to evaluate the prognostic significance and clinical applicability of the Mac-2 binding protein glycosylation isomer (M2BPGi), lectin-reactive α-fetoprotein fraction (AFP-L3), and protein induced by vitamin K absence-II (PIVKA-II), together with tumor characteristics, in patients with R-HCC who underwent hepatic resection. METHODS: We retrospectively analyzed 250 R-HCC patients who underwent hepatic resection between 2015 and 2025 at a single institution. Preoperative biomarkers including M2BPGi, AFP-L3, and PIVKA-II, were evaluated. The primary endpoint was the disease-free survival (DFS). RESULTS: A multivariate analysis identified M2BPGi ≥ 1.0 (hazard ratio (HR) 2.01, p < 0.001), AFP-L3 ≥ 15% (HR, 1.84, p = 0.03), and PIVKA-II ≥ 500 mAU/mL (HR 2.44, p < 0.001) were independent predictors of recurrence. A scoring system based on the number of positive biomarkers significantly stratified DFS (P < 0.001). Patients positive for all three markers had the poorest prognoses. CONCLUSIONS: M2BPGi, AFP-L3, and PIVKA-II are independent risk factors for recurrent HCC. A simple biomarker-based scoring system offers practical guidance to hepatobiliary surgeons for tailoring postoperative surveillance and evaluating candidates for adjuvant strategies.
AIM: To discuss the implementation challenges and future perspectives of digital prehabilitation for hepatobiliary-pancreatic (HBP) surgery in Japan, following the study by Nagaya et al. FINDINGS: Key considerations incl...AIM: To discuss the implementation challenges and future perspectives of digital prehabilitation for hepatobiliary-pancreatic (HBP) surgery in Japan, following the study by Nagaya et al. FINDINGS: Key considerations include addressing the digital divide in aging populations and recognizing that monitoring multifaceted adherence remains dependent on self-reported data, regardless of digital tracking. Furthermore, resource barriers and the lack of medical reimbursement in busy clinical settings hinder scalability. To clarify the multidimensional impact of digital tools, objective clinical outcomes such as the Comprehensive Complication Index (CCI) and patient-reported outcomes (PROs) remain vital. CONCLUSION: Beyond feasibility, the successful integration of digital prehabilitation requires addressing eHealth literacy, validating self-reported adherence against clinical quality, and ensuring seamless workflow integration alongside medical reimbursement.
PURPOSES: The classical totally extraperitoneal approach to inguinal hernia repair is considered to be more complex and less widely adopted than the minimally invasive transabdominal technique. This study aimed to presen...PURPOSES: The classical totally extraperitoneal approach to inguinal hernia repair is considered to be more complex and less widely adopted than the minimally invasive transabdominal technique. This study aimed to present the Comfortable-Totally ExtraPeritoneal inguinal hernia repair (cTEP) technique and evaluate its outcomes. This involves a new approach to trocar positioning in extraperitoneal inguinal hernia repairs. METHODS: The standardized procedure comprises five steps, and it is accompanied by an explanatory video. The trocars were positioned in the same manner as in the transabdominal technique. All the patients who underwent laparoscopic inguinal hernia repair using the cTEP technique between January 2022 and June 2024 were included in this study. Data on patient demographics, hernia type, operative time, complications, recurrence rate, and hospital stay were retrospectively analyzed. RESULTS: A total of 84 inguinal hernia repairs were performed in 48 patients using cTEP. The follow-up of the patients who underwent cTEP was performed at 1 week, 1 month, and annually thereafter. There were no recurrences at the mean follow-up of 18 months. CONCLUSIONS: cTEP combines the benefits of the two most common minimally invasive approaches to inguinal hernia repair: an extraperitoneal approach with the surgical field, ergonomics, and reproducibility of the transabdominal technique.
PURPOSE: To evaluate our step-by-step e-learning program incorporating flipped learning, to help inexperienced surgeons acquire laparoscopic suturing and ligation skills. METHODS: Fourteen postgraduate year 3 (PGY3) surg...PURPOSE: To evaluate our step-by-step e-learning program incorporating flipped learning, to help inexperienced surgeons acquire laparoscopic suturing and ligation skills. METHODS: Fourteen postgraduate year 3 (PGY3) surgeons utilized “G-SURGEON,” Gunma University’s e-learning system, to train in three steps: using short needle holders under direct vision, using long endoscopic needle holders under direct vision, and using long endoscopic needle holders while viewing endoscopic images. Test videos were recorded before and after a 1-month training period for each step, and then evaluated using a modified Global Rating Scale. Trainee satisfaction was assessed through a questionnaire. RESULTS: Thirteen trainees completed the program and the pass rates for each step improved after training. The pass rate for STEP 3 (using the same tools as in STEP 2, through training by watching a video) increased from 30.8% to 69.2%. The test time decreased significantly for STEP 2 (using a long endoscopic needle holder under direct vision) (p < 0.01) and STEP 3 (p = 0.04) after training. Moreover, 84.6% of trainees expressed high satisfaction with the program and would recommend it. CONCLUSION: The incorporation of flipped learning into a step-by-step e-learning curriculum may help trainees acquire laparoscopic suturing and ligation skills, enabling them to learn at their own pace, regardless of time or location, and making it a work-in-life conscious training approach.
Cervical anastomosis following subtotal esophagectomy (McKeown esophagectomy) is a standard reconstruction technique in Japan; however, it remains challenging because of its high anastomotic leakage rate. We herein repor...Cervical anastomosis following subtotal esophagectomy (McKeown esophagectomy) is a standard reconstruction technique in Japan; however, it remains challenging because of its high anastomotic leakage rate. We herein report a simplified, time-saving, and reproducible method for performing McKeown esophagectomy. In the supine position, the stomach roll is elevated toward the anastomotic site through either the retrosternal or retromediastinal routes. After transecting the esophagus, nine single-layer interrupted sutures were made using the in-out and out-in technique for the posterior wall. In-out and out-in sutures were placed on both sides of the anterior wall to ensure inversion of the mucosal layer of the stomach roll. The last three stitches were placed using the out-in and in-out stitch techniques to close the central side of the anterior wall. This simplified single-layer interrupted suture technique does not require complex maneuvers and enables surgeons to perform it easily, even within a narrow working space, after McKeown esophagectomy.
PURPOSE: The benefits of interval appendectomy (IA) in complicated appendicitis are well known. However, these remain unclear in uncomplicated appendicitis (UA) despite patients with UA often receiving IA in actual clini...PURPOSE: The benefits of interval appendectomy (IA) in complicated appendicitis are well known. However, these remain unclear in uncomplicated appendicitis (UA) despite patients with UA often receiving IA in actual clinical situations. This study investigated whether IA is an effective strategy for the treatment of UA. METHODS: We included Patients diagnosed with UA who underwent laparoscopic surgery between January 2017 and December 2023 were included. We compared the surgical outcomes between the emergency surgery (ES) and IA groups and analyzed 12 factors to identify risk factors for postoperative complications. RESULTS: 263 patients (ES group, N = 161; IA group, N = 102) were enrolled. The rates of any complication, Clavien-Dindo (C-D) grade ≥ I, and severe complication, C-D grade ≥ III, were similar (P = 0.38, P = 0.26) in both groups. In contrast, the total length of hospital stay was shorter in the ES group (P < 0.001). Among the 263 patients, postoperative complications of any type were observed in 14 (5.3%). A multivariate analysis identified no independent risk factors for postoperative complications including ES. CONCLUSION: The surgical outcomes of ES in patients with UA were favorable. Therefore, the benefits of IA are minimal and it may not be the first therapeutic choice for UA.
PURPOSE: Persistent descending mesocolon (PDM) is a rare congenital anomaly that may complicate minimally invasive surgery (MIS) for colorectal cancer (CRC). This systematic review and meta-analysis evaluated the periope...PURPOSE: Persistent descending mesocolon (PDM) is a rare congenital anomaly that may complicate minimally invasive surgery (MIS) for colorectal cancer (CRC). This systematic review and meta-analysis evaluated the perioperative impact of PDM on MIS for CRC. METHODS: This study followed the PRISMA guidelines and was registered in PROSPERO (CRD420251055757). A systematic search was performed in PubMed, Cochrane, and Scopus (January, 2000 to April, 2025). Observational studies (OBSs) compared MIS for CRC in patients with and patients without PDM. The primary outcome was operative time and the secondary outcomes included intraoperative blood loss, open conversion rate, complications, and vascular anatomy. Meta-analyses used a random-effects model. RESULTS: Seven OBSs (4,255 patients) were included in the analysis. PDM patients had significantly longer operative times (Mean difference [MD]:26.4; 95%CI:11.3-41.4) and greater intraoperative blood loss (MD:15.9; 95%CI:3.3-28.4). The rates of conversion to open surgery (Odds rate [OR]:9.6; 95%CI: 3.3-27.8) and anastomotic leakage (OR:2.49; 95%CI:1.2-5.1) were higher in PDM patients. The IMV-colon distance was significantly shorter in PDM patients, potentially increasing the marginal vessel injury risk. CONCLUSION: PDM increases the intraoperative complexity of MIS for CRC. Thus, preoperative recognition of vascular variations is critical and such procedures should be performed at expert centers.
PURPOSE: Conversion surgery (CS) is performed for locally advanced pancreatic cancer (LAPC); however, the criteria for CS varies among institutions. This study aimed to evaluate the clinical outcomes of CS for LAPC based...PURPOSE: Conversion surgery (CS) is performed for locally advanced pancreatic cancer (LAPC); however, the criteria for CS varies among institutions. This study aimed to evaluate the clinical outcomes of CS for LAPC based on strict indications at our center. METHODS: This study included patients diagnosed with and treated for LAPC between 2011 and 2021. The CS criteria indicated that the tumors shrunk to the same status as resectable pancreatic cancer (RPC) on imaging and were maintained for > 3 months. Additionally, tumors that had shrunk to a size corresponding to borderline resectable pancreatic cancer (BRPC) were observed on CT. RESULTS: Twenty-two patients underwent CS with a morbidity rate of 40.9% and no mortality. Overall survival after surgery in the LAPC group tended better than that in the BR and R groups (MST, LAPC, 59.7 months; BR, 38.6 months; R, 39.1 months; LAPC vs. BR, p = 0.085, vs. R, p = 0.065). Disease-free survival was similar across all resectability statuses: LAPC, 21.1 months; BR, 16.6 months; and R, 19.6 months (LAPC vs. BR, p = 1.000, vs. R, p = 1.000). CONCLUSION: CS in patients with LAPC under strict criteria showed promising outcomes, demonstrating the potential benefit of this approach in carefully selected patients.