PURPOSE: Coexisting inflammation should be assessed following the diagnosis of malnutrition. This study aimed to determine the effect of low prealbumin levels on the overall survival (OS) of patients with gastric cancer...PURPOSE: Coexisting inflammation should be assessed following the diagnosis of malnutrition. This study aimed to determine the effect of low prealbumin levels on the overall survival (OS) of patients with gastric cancer following gastrectomy according to the intensity of inflammation. METHODS: This retrospective study included consecutive patients who underwent radical gastrectomy for pStages I-III gastric cancer between 2006 and 2020. Preoperative inflammation severity was classified according to the guidance of the Global Leadership Initiative on Malnutrition criteria as normal (C-reactive protein (CRP) < 0.3 mg/dL), mild (0.3-0.99 mg/dL), moderate (1.0-5.0 mg/dL), or severe (> 5.0 mg/dL). Prealbumin levels were categorized as high (≥ 22 mg/dL), moderate (15-22 mg/dL), or low (< 15 mg/dL). RESULTS: Among 5303 patients, 4583 were categorized into the normal group, 483 into the mild CRP group, 204 into the moderate CRP group, and 33 into the severe CRP group. A comparison of OS revealed that low prealbumin levels were associated with poorer OS, regardless of the severity of inflammation. Multivariate analyses confirmed that a low prealbumin level was an independent poor prognostic factor for OS in patients with or without inflammation (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: Prealbumin levels can be used as a predictor of OS in patients with gastric cancer after gastrectomy, regardless of preoperative inflammation.
AIM: This study aimed to describe the clinical characteristics, surgical selection patterns, and postoperative outcomes of patients who underwent either primary tumor resection (PTR) or ostomy for symptomatic unresectabl...AIM: This study aimed to describe the clinical characteristics, surgical selection patterns, and postoperative outcomes of patients who underwent either primary tumor resection (PTR) or ostomy for symptomatic unresectable stage IV rectal cancer in a real-world clinical setting. METHODS: We retrospectively reviewed 63 patients who underwent palliative surgery at Aichi Cancer Center Hospital between 2005 and 2023: PTR (n = 39) or ostomy (n = 24). The outcomes included postoperative complications, time to chemotherapy, and overall survival. RESULTS: Liver metastases were observed in 89.7% of the PTR group and 50.0% of the ostomy groups (p < 0.001), whereas distant lymph node metastases were more frequent in the ostomy group (p = 0.007). Postoperative complications were observed in 15.4% of the PTR group and 8.3% of the ostomy groups. The median interval to chemotherapy was 41 days in the PTR group and 15 days in the ostomy group (p < 0.001). Four patients (16.7%) in the ostomy group experienced tumor-related issues during chemotherapy. The five-year overall survival was 10.3% in the PTR group and 4.1% in the ostomy group (p = 0.390). CONCLUSIONS: PTR may delay chemotherapy owing to postoperative complications. These findings suggest the need for careful consideration of the risks and benefits when selecting surgical options for symptom control in patients with unresectable stage IV rectal cancer.
PURPOSE: To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy. METHODS: This multicenter retrospecti...PURPOSE: To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy. METHODS: This multicenter retrospective study included 327 patients aged ≥ 80 years who underwent curative gastrectomy for gastric cancer. The patients were classified into urban (n = 118) and rural (n = 209) groups. The baseline characteristics, surgical outcomes, and long-term outcomes were compared. RESULTS: Patients in rural areas had poorer performance statuses, more comorbidities, worse nutritional and inflammatory profiles, and longer distances to the hospital. However, no differences were observed between the urban and rural groups in terms of the surgical approach, postoperative complication rates, or the administration of adjuvant chemotherapy. The 5-year overall survival rates in the rural and urban groups were 66.6% and 59.8%, respectively (p = 0.197). A multivariate Cox regression analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio: 2.02), carcinoembryonic antigen ≥ 5 ng/mL (hazard ratio: 1.92), pathological stage III (hazard ratio: 3.72), and Clavien-Dindo grade ≥ III complications (hazard ratio: 2.51) as independent predictors of overall survival. CONCLUSION: The comparable surgical and long-term survival outcomes between patients treated in rural and urban areas suggest that equitable surgical care may be achievable across different geographic settings.
PURPOSE: To assess whether frailty in older adults undergoing colorectal cancer surgery correlates with perioperative complication risks predicted by the Japanese National Clinical Database (NCD) Risk Calculator. METHODS...PURPOSE: To assess whether frailty in older adults undergoing colorectal cancer surgery correlates with perioperative complication risks predicted by the Japanese National Clinical Database (NCD) Risk Calculator. METHODS: The subjects of this retrospective study were 143 patients aged ≥ 75 years, who underwent comprehensive geriatric assessment (CGA) before elective colorectal tumor resection at the NHO Kyushu Cancer Center (2018-2023). Frailty was evaluated using the 10-item CGA Frailty Index (FI-CGA-10) and the Robinson Frailty Score (RFS). Correlation and receiver operating characteristic (ROC) analyses were performed, with validation using descriptive statistics based on cutoff values derived from the ROC analysis. RESULTS: The median age of the patients was 80 years and frailty (FI-CGA-10 > 0.35 or RFS > 4) was identified in 29%. Both FI-CGA-10 (r = 0.8086) and RFS (r = 0.7362) showed strong correlations with the predicted postoperative fall risk. ROC analysis identified 52.0% and 46.1% of the patients as having optimal fall risk thresholds for detecting frailty, using FI-CGA-10 and RFS, respectively. Validation showed that patients with a predicted fall risk ≥ 52% had significantly higher rates of receiving palliative treatment, suffering postoperative complications, and not being discharged home. CONCLUSION: The NCD Risk Calculator may serve as a practical surrogate for frailty assessment in older patients undergoing colorectal cancer surgery, particularly in resource-limited settings.
PURPOSE: Colovesical fistula, a serious complication of colonic diverticulitis, often requires surgical intervention. As the epidemiological data for colovesical fistula associated with colonic diverticulitis in Japan ar...PURPOSE: Colovesical fistula, a serious complication of colonic diverticulitis, often requires surgical intervention. As the epidemiological data for colovesical fistula associated with colonic diverticulitis in Japan are limited, this study investigated its incidence and characteristics using a claims database. METHODS: This retrospective study analyzed the JMDC Claims Database (January, 2005 to August, 2023). Patients with colonic diverticulitis were identified based on diagnosis codes and concurrent antibiotic treatment. Patients diagnosed with colovesical fistulas who underwent surgery were included in the analysis. Patients with fistulas associated with cancer or inflammatory bowel disease such as ulcerative colitis and Crohn’s disease were excluded. RESULTS: In total, 42,825 patients with colonic diverticulitis were identified and colovesical fistula developed in 185 (0.43%) of these patients (0.63% in men and 0.07% in women). The median duration from diverticulitis to fistula diagnosis was 0 days, with 73.2% of patients diagnosed simultaneously with, or prior to, diverticulitis. Surgery was performed a median of 49 days after diagnosis. CONCLUSION: This first Japanese epidemiological study on colovesical fistulas highlights its low incidence, sex differences, and frequent diagnosis before or with colonic diverticulitis. These findings emphasize the importance of recognizing the diverse clinical presentations for a timely diagnosis and better management.
Nukada S, Shiozawa M, Izukawa S
… +12 more, Atsumi Y, Asari M, Kazama K, Katayama Y, Numata K, Numata M, Mikayama Y, Higuchi A, Sugano N, Godai T, Mushiake H, Saito A
PURPOSE: This prospective study evaluated the lymph node (LN) yield following CRM-oriented specimen processing, whilw paying particular attention to the proportion of cases with fewer than 12 examined LNs. METHODS: The K...PURPOSE: This prospective study evaluated the lymph node (LN) yield following CRM-oriented specimen processing, whilw paying particular attention to the proportion of cases with fewer than 12 examined LNs. METHODS: The Kanagawa Yokohama Colorectal Cancer Study Group conducted a multicenter prospective cohort study between 2021 and 2024. Patients with clinical stage II or III lower rectal cancer who underwent surgery without neoadjuvant therapy were enrolled in this study. This study reports a single-arm analysis of the short-term outcomes. Surgical specimens were processed using modified methods that preserved the mesentery adjacent to the tumor. The primary endpoint was the number of retrieved lymph nodes. RESULTS: The median number of retrieved LNs was 19 (range, 2–98), and ≥ 12 LNs were identified in 81.6% of patients. CRM was assessable in 96.1% of the cases. Despite partial preservation of the mesorectum, the LN yield was not inferior to that reported in major clinical trials, and no systematic reduction attributable to the CRM-oriented methods was observed. Exploratory analyses suggested that patients with < 12 examined LNs were more frequently associated with patient- or procedure-related factors. CONCLUSION: CRM-oriented specimen processing enables accurate CRM evaluation, while maintaining LN retrieval within a feasible range and preserving the clinically important threshold of ≥ 12 LNs.
Yamashita M, Noda K, Tominaga T
… +14 more, Takamura Y, Katayama H, Hashimoto S, Tei S, Ono R, Ishii M, Hisanaga M, Oishi K, Moriyama M, Uchida F, Shiraishi T, Kunizaki M, Nonaka T, Matsumoto K
PURPOSE: Few reports have so far compared cases of Stage IV colorectal cancer in which primary tumor resection or stoma creation was performed prior to systemic chemotherapy. METHODS: We retrospectively reviewed 246 pati...PURPOSE: Few reports have so far compared cases of Stage IV colorectal cancer in which primary tumor resection or stoma creation was performed prior to systemic chemotherapy. METHODS: We retrospectively reviewed 246 patients with clinical Stage IV colorectal cancer who underwent surgery followed by systemic chemotherapy. The patients were divided into two groups: those who underwent only stoma creation (stoma group, n = 62) and those who underwent primary tumor resection (resection group, n = 164). RESULTS: The stoma group had more male patients (stoma group vs. resection group, 74.2% vs. 54.8%; p = 0.009), more comorbidities (88.7% vs. 73.2%, p = 0.012), and more rectal tumors (38.7% vs. 11.0%; p < 0.001); after propensity score matching, no differences were seen, but shorter operation time (110 vs. 174 min; p < 0.001), less blood loss (5 vs. 11 mL; p < 0.001), longer hospital stay (19 vs. 14 days; p = 0.003), and a shorter duration from surgery to first chemotherapy (27 vs. 35 days; p < 0.001) were seen in the stoma group, with a better overall survival in the resection group (p = 0.036). CONCLUSION: Primary resection of stage IV colorectal cancer is associated with a better prognosis. However, highly invasive surgery may cause postoperative complications and a poor prognosis; therefore, careful consideration of its appropriateness is necessary.
PURPOSE: The Tokyo Guidelines of 2018 recommend performing an intraoperative bile culture for acute cholecystitis. However, their clinical significance remains unclear. We evaluated the impact of performing a bile cultur...PURPOSE: The Tokyo Guidelines of 2018 recommend performing an intraoperative bile culture for acute cholecystitis. However, their clinical significance remains unclear. We evaluated the impact of performing a bile culture on the perioperative outcomes. METHODS: We retrospectively analyzed 344 patients who underwent cholecystectomy for acute cholecystitis between 2015 and 2024. The patients were classified into a culture group (n = 248) and a non-culture group (n = 96). The inverse probability of treatment weighting was applied to adjust for baseline differences. The perioperative outcomes were compared and the influence of performing a bile culture on antibiotic management was assessed. RESULTS: The culture group had more Grade II/III tumors (p < 0.05). After adjustment, drain placement was more frequent (73.2% vs. 58.9%; p = 0.01). No significant differences were observed in the operative time (100 vs. 87 min, p = 0.10), gallbladder perforation (32.9% vs. 30.0%, p = 0.85), hospital stay (5 vs. 4 days, p = 0.30), or complications (24.0% vs. 18.0%, p = 0.273). In the culture group, 71.8% of the patients completed antibiotics before the culture results. Therapy was changed in only 2.0% of the patients. CONCLUSIONS: Although a bile culture is often performed in severe cases, it rarely influences the antibiotic strategy or improves the outcomes. Therefore, performing a routine intraoperative bile culture, as recommended by the Tokyo Guidelines 2018, may have limited utility.
PURPOSE: To identify the high-risk subgroup of outcomes following upfront surgery for clinical (c)-N1 stage II non-small cell lung cancer (NSCLC). METHODS: Between 2009 and 2022, 140 patients underwent upfront lung resec...PURPOSE: To identify the high-risk subgroup of outcomes following upfront surgery for clinical (c)-N1 stage II non-small cell lung cancer (NSCLC). METHODS: Between 2009 and 2022, 140 patients underwent upfront lung resection of more than one lobe with mediastinal lymphadenectomy for cN1 stage II NSCLC. The subjects of this retrospective study were 129 of these patients, whose cN1 node was confirmed pathologically as metastasis after surgery. “Continuous cN1” was an N1 node directly involving the primary tumor. Disease-free survival (DFS) and overall survival (OS) were estimated using log-rank tests. RESULTS: Continuous cN1 was detected in 55 patients (43%). Lobectomy, bilobectomy, and pneumonectomy were performed in 95 (74%), 20 (16%), and 14 (11%) patients, respectively. Bronchoplasty and vascular plasty were performed in 43 patients (33%) and 25 patients (19%), respectively. The pathological nodal status was pN1 only in 92 patients (71%) and pN2 with pN1 in 37 patients (29%). Multivariate analysis identified that a solid component size > 40 mm was an independent predictor of poor DFS (p = 0.020) and OS (p = 0.001). CONCLUSIONS: A solid component size of > 40 mm was a poor prognostic factor for the DFS and OS of patients with cN1 stage II NSCLC, suggesting that induction therapy should be considered for this subgroup.
PURPOSE: To investigate the amount of overtime hours in relation to surgical training outcomes in Japan. METHODS: Data from a nationwide online questionnaire survey of newly certified surgical trainees were analyzed base...PURPOSE: To investigate the amount of overtime hours in relation to surgical training outcomes in Japan. METHODS: Data from a nationwide online questionnaire survey of newly certified surgical trainees were analyzed based on the amount of overtime. Respondents were divided into 2 groups: Group L had worked > 80 h per month, and Group S had worked ≤ 80 h per month. Differences in training outcomes, workplace environments, and challenges were analyzed. RESULTS: Among 1410 surgical trainees, 694 respondents who gave valid answers were classified into Group L (n = 462, 67%) and Group S (n = 232, 33%). No significant differences were observed in terms of the number of surgeries (p = 0.95), scientific papers (p = 0.38) or annual income (9.11 vs. 9.46 million JPY, p = 0.94). The proportion of respondents who considered dropping out, felt harassed, or dissatisfied was significantly higher in Group L than in Group S (p = 0.0001, p < 0.0001, and p = 0.0076, respectively). CONCLUSION: Increased overtime hours did not correlate with positive outcomes such as the number of surgeries performed, scientific publications, or annual income. In contrast, negative outcomes, such as dropout thoughts and feelings of harassment, increased. These findings imply that less overtime and improved overtime management could make surgery more appealing to future applicants.
PURPOSE: This study aimed to identify the risk factors for 30-day mortality following neonatal surgery for major thoracic and abdominal conditions. METHODS: We conducted a retrospective cohort study of neonates who under...PURPOSE: This study aimed to identify the risk factors for 30-day mortality following neonatal surgery for major thoracic and abdominal conditions. METHODS: We conducted a retrospective cohort study of neonates who underwent major noncardiac abdominal or thoracic surgery in a tertiary pediatric surgery center in Tunisia between April 2015 and March 2025. RESULTS: A total of 361 neonates underwent major abdominal or thoracic surgeries during the study period. The male-to-female ratio was 1.3:1. The most common surgical conditions were esophageal atresia (n = 105), duodenal atresia (n = 42), and anorectal malformation (n = 39). A total of 85 neonates (23.5%) died within 30 days of surgery. According to a multivariate logistic regression analysis, five variables were independently associated with 30-day mortality. CONCLUSION: This study demonstrated that an outborn status, prematurity, congenital heart disease, low 5-minute Apgar score, and prolonged operative time predict 30-day mortality after major neonatal surgery. These factors could serve as valuable tools for identifying patients at increased risk and enhancing the quality of their management.
Takahashi S, Takano Y, Kubota A
… +11 more, Kodera K, Tsukihara S, Kamada T, Kobayashi Y, Hashizume R, Imakita T, Ishiyama M, Kanno H, Hanyu N, Ogawa M, Eto K
PURPOSE: We developed an albumin-C-reactive protein-tumor marker (ACTM) score and assessed its prognostic significance in elderly patients undergoing curative resection for colorectal cancer. METHODS: We retrospectively...PURPOSE: We developed an albumin-C-reactive protein-tumor marker (ACTM) score and assessed its prognostic significance in elderly patients undergoing curative resection for colorectal cancer. METHODS: We retrospectively analyzed data from 232 patients > 80 years old who underwent surgery for Stage I–III colorectal cancer. The ACTM score was calculated by assigning 1 point each for the following factors: C-reactive protein > 0.5 mg/dL, albumin < 3.5 g/dL, and either carcinoembryonic antigen ≥ 5.0 ng/mL or carbohydrate antigen 19 − 9 ≥ 37 U/mL. We examined the association between ACTM score and survival outcomes. RESULTS: Higher ACTM scores were significantly associated with a worse relapse-free (P < 0.01) and overall survival (P < 0.01). In a multivariate analysis, an American Society of Anesthesiologists physical status ≥ 2 (P < 0.01), lymph node metastasis (P < 0.01), and ACTM score ≥ 2 (P < 0.01) were independent predictors of the 5-year relapse-free survival, whereas male sex (P < 0.01), neutrophil-to-lymphocyte ratio ≥ 3.5 (P < 0.01), and ACTM score ≥ 2 (P < 0.01) were independent predictors of the 5-year overall survival. CONCLUSIONS: The ACTM score, which combines nutritional and inflammatory response indices with tumor markers, may predict the prognosis of very elderly patients with colorectal cancer.
PURPOSE: To evaluate the clinical characteristics and short-term outcomes of minimally invasive surgery (MIS) for right-sided colon cancer with superior mesenteric artery rotation (SMAR) when the SMA is found, intraopera...PURPOSE: To evaluate the clinical characteristics and short-term outcomes of minimally invasive surgery (MIS) for right-sided colon cancer with superior mesenteric artery rotation (SMAR) when the SMA is found, intraoperatively, to run anterior to the superior mesenteric vein (SMV) in the ileocolic root area. METHODS: The subjects of this retrospective analysis were patients with right-sided colon cancer, who underwent MIS with D3 lymph node dissection between 2018 and 2024. We compared the clinical characteristics and short-term outcomes of MIS in patients with and those without SMAR. The findings of SMAR were defined on preoperative computed tomography as ct-SMAR. RESULTS: Among the 523 patients included in this analysis, there were 513 (98.1%) without SMAR and 10 (1.9%) with SMAR. It was identified that 60.0% of the patients with SMAR had cecum cancer vs.25.1% of those without SMAR. The sensitivity and specificity of the findings of ct-SMAR were 80.0% and 97.5%, respectively. Both operative time (183 min vs. 231 min, p = 0.004) and blood loss (0 mL vs. 27 mL, p = 0.012) were significantly higher in the patients with SMAR. CONCLUSION: The vascular course in patients with SMAR differs from the usual pattern and this may increase the risk of unexpected vascular injury, potentially leading to intraoperative bleeding and prolonged operative time.
PURPOSE: Portal hypertension (PoH) after liver transplantation is a severe complication that results in graft loss. We investigated the characteristics and evaluated the treatment outcomes of PoH after living donor liver...PURPOSE: Portal hypertension (PoH) after liver transplantation is a severe complication that results in graft loss. We investigated the characteristics and evaluated the treatment outcomes of PoH after living donor liver transplantation (LDLT). METHODS: This single-center, retrospective cohort study included 325 LDLT recipients. RESULTS: Of the subjects, 37 (11.4%) had a PoH. The 10- and 20-year graft survival rates were significantly lower in patients with PoH than in those without PoH (69.1% vs. 90.8% and 42.1% vs. 84.7%, respectively; p < 0.0001). The types of PoH were pre-hepatic, hepatic, and post-hepatic in 16, 13, and 8 patients, respectively. Interventional radiology was performed for PoH in all post-hepatic PoH patients and in 62.5% of pre-hepatic PoH patients. Notably, 46.2% of the patients with hepatic PoH required re-transplantation. The 10-year graft survival rate was significantly worse in patients with hepatic PoH than in those with pre- and post-hepatic PoH (46.2% vs. 86.7% and 75.0%, respectively; P < 0.05). Post-transplant PoH was an independent predictor of graft loss after LDLT (hazard ratio, 5.73; 95% confidence interval: 2.43-13.55, P < 0.0005). CONCLUSIONS: Post-transplant PoH negatively affected the graft survival in LDLT recipients. Pre-hepatic, hepatic, and post-hepatic PoH cases had different characteristics, requiring different treatments. Therefore, an appropriate diagnosis and treatment are important.
PURPOSE: Anastomotic leakage (AL) after low anterior resection (LAR) for rectal cancer leads to significant postoperative morbidity and mortality. No studies have specifically addressed the impact of the Preoperative Sto...PURPOSE: Anastomotic leakage (AL) after low anterior resection (LAR) for rectal cancer leads to significant postoperative morbidity and mortality. No studies have specifically addressed the impact of the Preoperative Stool Scale (PSS) for AL in rectal cancer surgery. The aim of this study was to assess the impact of PSS on AL in a cohort who underwent elective minimally invasive low anterior resection (mi-LAR) for rectal cancer. METHODS: We retrospectively reviewed 204 consecutive patients who underwent mi-LAR for rectal cancer from January 2018 and December 2024. The main outcomes measured were Grade ≥III AL and major morbidity. RESULTS: AL was identified in 4.4% of patients. Patients with a poor PSS were observed to have higher incidence of AL (22.7% vs. 2.3%), higher morbidity (36.3% vs. 8.2%) and longer hospital stay (22 vs. 15 days) in comparison to those with a good or excellent PSS. Univariate analyses showed that tumor stenosis, poor PSS, lower prognostic nutrition index, and larger tumor size were significantly associated with AL. A multivariate analysis revealed that a poor PSS was significantly correlated with AL (odds ratio [OR] 7.364, 95% confidence interval [95% CI] 1.532–35.391; p = 0.013). CONCLUSIONS: A poor PSS was found to significantly increase the risk of AL.
PURPOSE: Perineal wound complications after abdominoperineal resection (APR) remain a major concern, often leading to poor patient outcomes. Prophylactic negative-pressure wound therapy (pNPWT) and oral antibiotics (OA)...PURPOSE: Perineal wound complications after abdominoperineal resection (APR) remain a major concern, often leading to poor patient outcomes. Prophylactic negative-pressure wound therapy (pNPWT) and oral antibiotics (OA) administration have individually shown promise in reducing surgical site infections (SSIs). The present study investigated their combined effect for the prevention of perineal wound complications after APR. METHODS: This retrospective study included patients who underwent APR for lower rectal cancer between April 2016 and March 2025. Patients were divided into two groups: conventional treatment (CT) and those receiving a combination of pNPWT and preoperative OA (pNPWT + OA). Postoperative complications were compared. RESULTS: Sixteen patients were included in the pNPWT + OA group and 14 in the CT group. The incidence of superficial perineal SSIs was significantly lower in the pNPWT + OA group than in the CT group (6.3% vs. 42.9%, p = 0.030), with no cases of wound dehiscence (0% vs. 28.6%, p = 0.036). Furthermore, preoperative albumin < 3.0 g/dL correlated with the incidence of perineal SSIs and wound dehiscence. CONCLUSION: The combined use of pNPWT and OA was associated with a reduction in perineal wound infections and dehiscence following APR. This approach may improve postoperative outcomes; however, these findings are hypothesis-generating and should be validated in large-scale, prospective studies, including cost-effectiveness analyses.
PURPOSE: This study evaluated the clinical impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with different stages of colorectal cancer. METHODS: We retrospectively included patients diagnosed with colon and...PURPOSE: This study evaluated the clinical impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with different stages of colorectal cancer. METHODS: We retrospectively included patients diagnosed with colon and rectal cancer who underwent colectomy or proctectomy at a single institute between 2017 and 2018. The primary outcome was to investigate the cutoff value of the NLR for 5-year recurrence and survival. The secondary outcome was to evaluate the clinical impact of the NLR according to stage. RESULTS: In this cohort of 192 patients, the optimal NLR cutoff value was 4.0. Univariate analyses showed that carcinoembryonic antigen (CEA) level, white blood cell (WBC) count, lymphocyte count, stage, and high NLR were associated with 5-year overall survival (p < 0.001, p = 0.01, p = 0.008, p < 0.001, and p < 0.001, respectively), and multivariate analyses showed that NLR was independently associated with 5-year overall survival (p = 0.013). When stratified by cancer stage, NLR influenced survival outcomes in patients with stage III and IV disease (p < 0.001 and 0.047, respectively). CONCLUSION: A cutoff value of NLR 4.0 is strongly associated with 5-year overall survival in patients with stage III and IV colorectal cancer.
Matsumoto M, Itoh S, Tsunematsu M
… +13 more, Yugawa K, Furukawa K, Haruki K, Shirai Y, Taniai T, Yanagaki M, Hamura R, Uwagawa T, Okui N, Tanji Y, Akaoka M, Yoshizumi T, Ikegami T
PURPOSE: To investigate the independent predictors of progression-free survival (PFS) after gemcitabine, cisplatin, and durvalumab (GCD) therapy for advanced biliary tract cancer (BTC), including the thyroid-stimulating...PURPOSE: To investigate the independent predictors of progression-free survival (PFS) after gemcitabine, cisplatin, and durvalumab (GCD) therapy for advanced biliary tract cancer (BTC), including the thyroid-stimulating hormone (TSH) ratio pre- and post-GCD. METHODS: The subjects of this retrospective analysis were 29 patients receiving GCD for advanced BTC. The cutoff TSH ratios were determined by a receiver operating characteristic (ROC) curve for PFS. The independent predictors of PFS after GCD were determined by univariate and multivariate analyses. RESULTS: The median PFS was 4.9 (range, 0.9-16.8) months. The objective response and disease control rates were 13.0% and 52.2%, respectively. The cutoff values of the TSH ratio after one and two cycles were 0.97 [area under the ROC curve (AUROC): 0.86, 95% confidence interval (CI): 0.70-1.00], p = 0.02] and 1.2 (AUROC: 0.820, 95% CI: 0.664-0.976), respectively. Multivariate analysis identified pretreatment neutrophil-to-lymphocyte ratio (NLR) ≥ 5 [hazard ratio (HR): 6.27, 95% CI: 1.83-21.5, p = 0.004] and TSH ratio after two cycles of < 1.2 (HR: 3.25, 95% CI: 1.25-8.46, p = 0.02) as independent predictors of PFS. CONCLUSION: The TSH ratio after two GCD cycles of < 1.2 and a pretreatment NLR ≥ 5 are potential prognostic factors for poor PFS.
PURPOSE: Postoperative pneumonia (POP) is a major complication of hepatobiliary and pancreatic surgery that significantly affects patient outcomes. However, the necessity of routine preoperative spirometry to assess the...PURPOSE: Postoperative pneumonia (POP) is a major complication of hepatobiliary and pancreatic surgery that significantly affects patient outcomes. However, the necessity of routine preoperative spirometry to assess the risk of POP remains uncertain. We therefore evaluated whether or not omitting routine preoperative spirometry affects the postoperative outcomes, particularly the incidence of POP. METHODS: This retrospective study included 691 patients who underwent hepatobiliary and pancreatic surgeries at our institution. Patients were categorized into two groups: the pre-COVID-19 group (April 2018 to March 2020), wherein all patients underwent spirometry, and the COVID-19 group (April 2020 to March 2022), with limited spirometry. This study evaluated postoperative outcomes and risk factors for POP in both groups. RESULTS: No significant differences were observed in the incidence of POP between the pre-COVID-19 and COVID-19 era groups (2.9% vs. 2.3%, p = 0.6197) or between patients with and without spirometry during the COVID-19 period (2.1% vs. 2.5%, p = 1.0000). Abnormal spirometry results were independent risk factors for POP and were significantly associated with male sex, a history of lung disease, and abnormal chest imaging findings. CONCLUSIONS: In patients undergoing hepatobiliary and pancreatic surgery, omitting routine preoperative spirometry did not adversely affect postoperative outcomes, including POP incidence. Therefore, targeted spirometry may be acceptable.