PURPOSE: In this study, we aimed to investigate the association between preoperative oral frailty, nutritional status, and postoperative complications in patients who underwent curative gastrointestinal (GI) cancer surge...PURPOSE: In this study, we aimed to investigate the association between preoperative oral frailty, nutritional status, and postoperative complications in patients who underwent curative gastrointestinal (GI) cancer surgery. METHODS: We retrospectively analyzed 181 patients who underwent curative resection for GI malignancies between April 2022 and March 2024. Oral frailty and nutritional status were assessed using the Oral Frailty Index-8 (OFI-8) and Mini Nutritional Assessment-Short Form (MNA-SF) through structured, nurse-administered preoperative questionnaires. Complications were defined as Clavien-Dindo grade ≥ 2. Logistic regression analyses were used to identify independent risk factors. RESULTS: Complications occurred in 30.9% of the participants. Participants with both oral frailty (OFI-8 ≥ 4) and a risk of malnutrition (MNA-SF ≤ 11) had the highest complication rate (55.2%). In the multivariate analysis, the combination of these two factors was an independent predictor of postoperative complications (odds ratio: 3.16, p = 0.01). CONCLUSIONS: Preoperative oral frailty and malnutrition are significant predictors of postoperative complications in patients with GI cancers. A simple composite score combining OFI-8 and MNA-SF may improve risk stratification and inform multidisciplinary preoperative care strategies to optimize surgical outcomes.
Maruyama K, Noda K, Tominaga T
… +12 more, Hashimoto S, Tei S, Ono R, Hisanaga M, Oishi K, Inao A, Moriyama M, Uchida F, Shiraishi T, Kunizaki M, Nonaka T, Matsumoto K
PURPOSE: The efficacy of laparoscopic surgery for left-sided colon cancer requiring splenic flexure mobilization is still unknown. This study investigates the risk factors for severe postoperative complications in patien...PURPOSE: The efficacy of laparoscopic surgery for left-sided colon cancer requiring splenic flexure mobilization is still unknown. This study investigates the risk factors for severe postoperative complications in patients undergoing laparoscopic left colectomy. METHODS: The subjects of this retrospective study were 353 consecutive patients who underwent laparoscopic left colectomy across seven participating hospitals between January, 2016 and December, 2024. Patients were divided into two groups according to the development of postoperative complications (POCs): a POC group (n = 70) and a non-POC group (n = 283). Severe POCs developed in 25 patients. RESULTS: The POC group included more female patients (71.4% vs. 51.6%, p = 0.003), more patients with poor performance status (p = 0.005), more patients with combined resection of adjacent organ (14.3% vs. 4.6%, p = 0.006), and more patients with distant metastases (22.9% vs. 10.6%, p = 0.002). The hospital stay was also significantly longer for the POC group patients (18 days vs. 11 days, p < 0.001). Multivariate analysis for severe complications identified that blood loss greater than 50 mL (odds ratio [OR] 2.820, 95% confidence interval [CI] 1.195–6.654; p = 0.017) and distant metastases (OR 2.671, 95%CI 1.021–6.987; p = 0.045) were independent predictors of severe POCs. CONCLUSIONS: Blood loss and distant metastases were risk factors for severe POCs after laparoscopic left colectomy.
PURPOSE: Rituximab-based desensitization has enabled successful ABO-incompatible (ABO-I) liver transplantation (LT) by preventing antibody-mediated rejection (AMR). However, its effect on T cell-mediated rejection (TCMR)...PURPOSE: Rituximab-based desensitization has enabled successful ABO-incompatible (ABO-I) liver transplantation (LT) by preventing antibody-mediated rejection (AMR). However, its effect on T cell-mediated rejection (TCMR) remains unclear. We conducted a comparative analysis between ABO-compatible (ABO-C) and ABO-I LT to evaluate the effects of rituximab-based desensitization on TCMR. METHODS: We retrospectively analyzed 45 LT recipients (32 ABO-C and 13 ABO-I recipients) treated with basiliximab-based immunosuppression. The ABO-I group additionally received rituximab-based desensitization therapy. The lymphocyte subpopulations, rejection, adverse events, and outcomes were assessed. RESULTS: AMR was not observed in either group. TCMR occurred within 4 weeks post-transplantation in 0% of ABO-C cases and 38.5% of ABO-I cases (P = 0.0011). In ABO-C, a significant increase in B cells (CD19+) was observed within the first week, whereas in ABO-I, B cells remained depleted and an increase in T cells (CD3+) was observed. In all the ABO-I cases, TCMR occurred under suppressed CD25 + conditions. Adverse events were comparable between the groups. The 1-year survival rates for the ABO-C and ABO-I groups were 96.9% and 100%, respectively. CONCLUSION: Rituximab-based desensitization in ABO-I LT is associated with an increased incidence of early TCMR. Rituximab-induced B-cell depletion may promote T-cell activation through an IL-2-independent pathway, potentially contributing to increased TCMR.
PURPOSE: Textbook outcome (TO) reflects ideal surgical and postoperative quality measures from the patient's perspective. Non-achievement of a TO has been linked to a poor prognosis after colorectal cancer surgery. Minim...PURPOSE: Textbook outcome (TO) reflects ideal surgical and postoperative quality measures from the patient's perspective. Non-achievement of a TO has been linked to a poor prognosis after colorectal cancer surgery. Minimally invasive colectomy (MIC), being considerably less invasive than open colectomy (OC) may improve prognosis; however, its effect on the long-term prognosis of patients with non-achievement of a TO remains unclear. This study investigated the impact of TO achievement on prognosis after OC and MIC. METHODS: The subjects of this retrospective analysis were 256 patients who underwent OC and 472 patients who underwent MIC for colorectal cancer at Miyazaki Prefectural Nobeoka Hospital or Kumamoto University. TO was defined by five criteria: surgery within 6 weeks of diagnosis, radical resection, lymph node (LN) yield ≥ 12, no stoma, and no adverse outcomes. TO was achieved when all criteria were met; otherwise, the result was defined as non-TO (nTO). Both OC and MIC groups were stratified by TO status. RESULTS: TO achievement was significantly higher after MIC than after OC (39.0%, and 31.6%, respectively; p = 0.049). After OC, nTO patients had significantly worse 5-year overall survival than TO patients (log-rank p = 0.011). Multivariate analysis identified nTO as an independent risk factor for poor prognosis after OC [hazard ratio: 2.81; 95% confidence intervals (CI): 1.330-6.428; p = 0.0060]. In contrast, nTO had no significant impact on prognosis after MIC (log-rank p = 0.14). CONCLUSIONS: Non-achievement of a TO predicted poorer prognosis after OC but not MIC. The lower invasiveness of MIC may promote better long-term outcomes, even if a TO is not achieved.
PURPOSE: To clarify the characteristics of patients who received systemic therapy for recurrent hepatocellular carcinoma after liver resection and evaluate the associated prognostic factors. METHODS: We retrospectively a...PURPOSE: To clarify the characteristics of patients who received systemic therapy for recurrent hepatocellular carcinoma after liver resection and evaluate the associated prognostic factors. METHODS: We retrospectively analyzed data from 177 hepatocellular carcinoma patients with recurrence after liver resection; 79 received tyrosine kinase inhibitors or immune checkpoint inhibitors. Prognostic factors were analyzed in the patients who received systemic therapy. RESULTS: The median survival time after the initiation of systemic therapy was 23.3 months among the patients who received such therapy. These patients had more advanced disease at recurrence than those who did not receive systemic therapy. In the systemic therapy group, a deterioration of liver function relative to the preoperative status, expressed as the change in the albumin-bilirubin score (≥ 0.469 vs. <0.469), was independently associated with a poorer survival (9.5 vs. 25.2 months, respectively; P = 0.022). Receiving multiple regimens was associated with a longer survival than receiving a single regimen (36.6 vs. 17.7 months, respectively; P = 0.023). Four patients (5.1%) achieved complete remission, two with systemic therapy alone and two after conversion therapy; all achieved a long-term overall survival. CONCLUSIONS: A preserved liver function and multiple systemic therapy regimens are favorable prognostic factors. Achieving complete remission results in an improved long-term survival.
PURPOSE: Lynch syndrome (LS), the most common hereditary colorectal cancer (CRC), is caused by germline mutations in mismatch repair (MMR) genes, resulting in microsatellite instability-high (MSI-H) tumors. Lynch-like sy...PURPOSE: Lynch syndrome (LS), the most common hereditary colorectal cancer (CRC), is caused by germline mutations in mismatch repair (MMR) genes, resulting in microsatellite instability-high (MSI-H) tumors. Lynch-like syndrome (LL) exhibits MSI-H and MMR deficiency, but lacks identifiable germline MMR mutations. Although LS/LL CRCs share clinical and molecular features, they are distinct from sporadic MSI-H (SM) CRCs, emphasizing the need for refined molecular classification. This study investigated the somatic alterations that distinguish LS/LL CRC from SM CRC. METHODS: Whole-exome sequencing (WES) was performed on 49 LS/LL CRC and 96 SM CRC samples. Tumor-normal paired data were analyzed using GATK and MuTect2 to detect somatic variants. Mutation frequencies were compared using Fisher's exact test (p < 0.005). Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the discriminatory performance. RESULTS: We identified 11 gene regions that were significantly enriched in LS/LL CRC, including KRAS, ITGB3BP, CLEC16A, ARHGEF28, PIK3CA, and RBM26. A variant panel based on these alterations showed an area under the curve (AUC) of 0.85 and an Akaike information criterion of 129.81. CONCLUSIONS: These findings support the utility of LS/LL-specific somatic variants in stratifying MSI-H CRCs and identifying hereditary cases for personalized management.
PURPOSE: This study aimed to explore the value of neutrophil-to-platelet ratio (NPR) in predicting postoperative prognosis of distal cholangiocarcinoma(dCCA). METHODS: The optimal cutoff value of NPR was determined using...PURPOSE: This study aimed to explore the value of neutrophil-to-platelet ratio (NPR) in predicting postoperative prognosis of distal cholangiocarcinoma(dCCA). METHODS: The optimal cutoff value of NPR was determined using a receiver operator characteristic curve (ROC) analysis. Patients were divided into low- and high-NPR groups, and perioperative data and long-term survival were compared. Independent risk factors for postoperative tumor recurrence and long-term survival were identified using univariate and multivariate analyses. An NPR-based prediction model was established and verified using ROC, calibration curve, and decision curve analyses. RESULTS: A total of 168 patients were included. The area under the ROC curve of preoperative NPR was 0.617, and the optimal cutoff value was 0.014. Postoperative disease-free survival and overall survival were significantly longer in the low-NPR group. Univariate and multivariate analyses indicated that NPR > 0.014 was an independent risk factor for postoperative recurrence (RR = 1.745, 95%CI: 1.027-2.965) and long-term survival (RR = 1.837, 95%CI: 1.127-2.993). The NPR-based prediction model could improve the predictive ability for the postoperative prognosis. Patients with a high preoperative NPR may have an advanced TNM stage and portal vein invasion. CONCLUSION: Elevated NPR is an independent risk factor for postoperative tumor recurrence and a poor long-term prognosis in patients with dCCA.
Yonemura Y, Ofuchi T, Nakano T
… +12 more, Higuchi S, Kawata K, Ikehara T, Omachi K, Tsujimoto A, Hirose K, Shibuta S, Ando Y, Hu Q, Otsu H, Yoshizumi T, Mimori K
BACKGROUND: Feasible therapeutic targets need to be identified to overcome tumor heterogeneity and ameliorate therapeutic resistance. We explored the identification of oncogenes on Ch.7q, which is amplified ubiquitously...BACKGROUND: Feasible therapeutic targets need to be identified to overcome tumor heterogeneity and ameliorate therapeutic resistance. We explored the identification of oncogenes on Ch.7q, which is amplified ubiquitously in colorectal cancer (CRC). In this study, we focused on SLC12A9, which encodes a channel protein that regulates ion concentration inside and outside of the cell. MATERIALS AND METHODS: Expression and survival analyses of SLC12A9 were performed using reverse transcription quantitative polymerase chain reaction, The Cancer Genome Atlas dataset, and immunohistochemistry. A gene set enrichment analysis (GSEA) was performed to elucidate the correlation between SLC12A9 and gene sets associated with tumor progression. Subsequently, an in vitro proliferation assay was performed using SLC12A9-knockdown CRC cells. RESULTS: SLC12A9 was highly expressed in tumor cells, and its high expression was associated with a poor prognosis. The GSEA revealed an association with mTORC1 signaling. In the colony formation assay, SLC12A9 knockdown by siRNA suppressed the proliferative capacity of CRC cells. Public single-cell RNA sequencing data have revealed that SLC12A9 is derived from malignant epithelial cells in CRC tissues. CONCLUSION: Our results suggest that abundant SLC12A9 expression is associated with a poor prognosis due to the devastating growth of CRC cells, in part via the mTORC1 signaling pathway.
PURPOSE: This study aimed to investigate the impact of an intraoperative external biliary drainage (EBD) tube on late benign biliary anastomotic strictures (BAS) after pancreaticoduodenectomy (PD). METHODS: Between 2011...PURPOSE: This study aimed to investigate the impact of an intraoperative external biliary drainage (EBD) tube on late benign biliary anastomotic strictures (BAS) after pancreaticoduodenectomy (PD). METHODS: Between 2011 and 2020, 209 patients who underwent PD, including 39 patients with an EBD tube placed in a hepaticojejunostomy (H-J) during surgery (EBD group) and 170 patients without EBD (no-EBD group), were enrolled. Clinical data and the incidence of BAS were compared between the groups. RESULTS: Thirty-four patients (16%) developed BAS, with a median interval of 5.6 months. Although the incidence of BAS was not significantly different, that of bile leakage (BL) was significantly lower in the EBD group (0% vs. 5%, p = 0.05). On multivariate analysis, a common hepatic duct (CHD) diameter < 7 mm and alkaline phosphatase (ALP) > 500 IU/L three months after surgery were independent risk factors for BAS. In patients with CHD diameter < 7 mm, the incidence of BL, BAS, and after PD was significantly lower in the EBD group, whereas there was no difference between the two groups in patients with CHD diameter ≥ 7 mm. CONCLUSION: In patients with CHD diameter < 7 mm, an EBD tube should be placed in the H-J during PD.
Stem cell transplantation has emerged as a promising therapeutic modality for the treatment of anal fistulas, showing significant potential in addressing this challenging condition. This review aims to summarize the late...Stem cell transplantation has emerged as a promising therapeutic modality for the treatment of anal fistulas, showing significant potential in addressing this challenging condition. This review aims to summarize the latest research advancements in the field of stem cell therapy for anal fistula, focusing on the underlying mechanisms that contribute to healing, the clinical applications that have been explored in various studies, and the assessment of therapeutic efficacy. Despite these encouraging results, several issues remain, including the optimal source of stem cells, methods of administration, and long-term outcomes. The review will also discuss future research directions, emphasizing the need for standardized protocols and larger-scale clinical trials to establish the safety and effectiveness of stem cell transplantation in routine clinical practice.
PURPOSE: Robotic total mesorectal excision (R-TME) is widely used to treat rectal cancer; however, data on robotic beyond TME (R-bTME) remain limited. The present study compared the short-term outcomes between robotic st...PURPOSE: Robotic total mesorectal excision (R-TME) is widely used to treat rectal cancer; however, data on robotic beyond TME (R-bTME) remain limited. The present study compared the short-term outcomes between robotic standard TME (R-sTME) and R-bTME in patients with primary rectal cancer. METHODS: This retrospective multicenter study included patients with mid-to-low rectal cancer who underwent robotic surgery between 2017 and 2024. The primary endpoint was postoperative morbidity, defined as Clavien-Dindo grade ≥ II. RESULTS: Of the 462 patients, 391 underwent R-sTME, and 71 underwent R-bTME. In the R-bTME group, the resected sites most commonly involved the lateral compartment (72%), particularly lateral lymph nodes (63%), followed by the anterior compartment (18%), where uterine resection was most frequent, and the posterior compartment (11%), predominantly involving the hypogastric nerve. Overall morbidity was higher in the R-bTME group than in the R-sTME group (26.8% vs. 16.4%), primarily due to increased urinary dysfunction. However, the rates of severe complications (Clavien-Dindo grade ≥ III), infectious complications, anastomotic leakage, and conversion were comparable between the groups. The rate of positive radial margin (RM) was higher in the R-bTME group than in the R-sTME group (8.5% vs. 1.0%), reflecting more advanced local disease. CONCLUSIONS: R-bTME is feasible for advanced primary rectal cancer when performed in select patients at experienced centers.
To contribute to the evolving evidence guiding the optimal management of perforated choledochal cyst (PCC), a rare but serious complication of choledochal cyst. We reviewed data from 10 patients with PCC treated at our i...To contribute to the evolving evidence guiding the optimal management of perforated choledochal cyst (PCC), a rare but serious complication of choledochal cyst. We reviewed data from 10 patients with PCC treated at our institution between 2004 and 2024. The patients were categorized into a two-stage (n = 5) group and a one-stage group (n = 5). Surgical outcomes, postoperative complications, and length of hospital stay were compared. The operative time was significantly longer in the one-stage group than in the two-stage group (353 min vs. 282 min, respectively; p = 0.006), whereas blood loss was comparable between the groups. Open surgery was more frequent in the two-stage group than the one-stage group (80% vs. 0%; p = 0.048). Early complications occurred in 40% and 20% of the patients in the two-stage and one-stage groups, respectively (p = 1.000). Anastomotic leakage occurred in one patient from each group. The hospital stay was significantly longer in the two-stage group than in the one-stage group. The late complication incidence did not differ significantly between the groups. Our findings suggest that one-stage surgery is a safe and effective option for PCC in patients who are clinically stable and when performed by experienced surgeons. These findings may assist in the management of PCC.
PURPOSE: Lactate dehydrogenase (LDH) is an enzyme involved in the cellular energy metabolism of cancer cells. We conducted this study to evaluate serum LDH as a prognostic marker for predicting the outcomes of colorectal...PURPOSE: Lactate dehydrogenase (LDH) is an enzyme involved in the cellular energy metabolism of cancer cells. We conducted this study to evaluate serum LDH as a prognostic marker for predicting the outcomes of colorectal cancer (CRC) patients with negative carcinoembryonic antigen (CEA) and carbohydrate antigen 19 - 9 (CA19-9) levels. METHODS: The subjects of this retrospective study were 369 patients with stage II/III CRC and negative preoperative CEA and CA19-9 levels. Serum LDH levels were measured within 4 weeks before surgery and the association between serum LDH levels and survival outcomes was investigated. RESULTS: Fifty-five (15%) of the 369 patients had a high LDH of ≥ 212 U/L (high LDH group). Multivariate analysis identified that N stages 1‒3 (P = 0.019), serum LDH levels ≥ 212 U/L (P = 0.038), and a modified Glasgow Prognostic Score of 2 (P = 0.031) were independent predictors of disease-free survival (DFS). American Society of Anesthesiologists physical status ≥ 3 (P = 0.019), N stages 1‒3 (P = 0.009), and serum LDH levels ≥ 212 U/L (P < 0.001) were also independent predictors of overall survival (OS). CONCLUSION: The serum LDH level is a valuable prognostic marker for predicting the outcomes of CRC patients, even those with negative CEA and CA19-9 levels.
PURPOSE: We compared the long-term outcomes of open (OKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for children with biliary atresia (BA) who ultimately progressed to liver transplantation (LT). METHODS: The su...PURPOSE: We compared the long-term outcomes of open (OKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for children with biliary atresia (BA) who ultimately progressed to liver transplantation (LT). METHODS: The subjects of this retrospective multicenter analysis were 276 BA patients (OKPE:225, LKPE:51) undergoing living donor liver transplantation (LDLT) between 2021 and 2023. Propensity score matching (PSM, 51 pairs) and inverse probability treatment weighting (IPTW) balanced the confounders. The time from KPE to LDLT was assessed using Kaplan-Meier curves and Cox regression analysis. RESULTS: There were no significant differences in the median time from KPE to LDLT between the OKPE and LKPE groups (228 days vs. 203 days, p = 0.756). Multivariable Cox regression identified patient age at KPE (HR = 1.002, p < 0.01), but not the surgical approach, as a factor influencing the timing of transplantation. No significant differences were observed in postoperative complications, LDLT-free survival rates, or intraoperative transplant metrics between the groups. CONCLUSIONS: For BA infants who progress to LT after KPE, OKPE and LKPE have comparable impact on post-KPE complications, survival time, and outcomes following LT. Thus, the emphasis should be on optimal surgical timing and standardized postoperative management.
PURPOSES: The enhanced view totally extraperitoneal (eTEP) technique offers the advantage of preserving peritoneal integrity by utilizing an extraperitoneal dissection plane, thereby avoiding visceral-mesh contact and re...PURPOSES: The enhanced view totally extraperitoneal (eTEP) technique offers the advantage of preserving peritoneal integrity by utilizing an extraperitoneal dissection plane, thereby avoiding visceral-mesh contact and reducing the risk of complications. This study presents our initial experience and outcomes of using the eTEP technique to repair various ventral and incisional hernias. METHODS: This prospective cohort study included adult patients with abdominal wall hernias classified according to the European Hernia Society (EHS) system. The eTEP approach was used for the hernia repair. Trocar placement was tailored to the size and location of the hernia defect. The surgical techniques are described in detail, and the outcomes that were assessed included both intraoperative and postoperative complications. RESULTS: This prospective study included 72 patients who underwent an eTEP hernia repair between 2023 and 2024. Intraoperative conversion was required in 10 (13.9%) patients. The mean operative time was 156.6 ± 80.6 min. The overall postoperative complication rate was 12.9% and the average hospitalization length was 3.2 days. The postoperative pain scores decreased from 3.6 to 0.1 at 3 months, and no recurrence was observed. CONCLUSION: The eTEP technique offers a minimally invasive extraperitoneal approach for abdominal wall hernia repair. Our findings demonstrated its feasibility, efficacy, and safety profile.
PURPOSE: Determining the optimal timing of surgery for Crohn disease (CD) is challenging. The C-reactive protein-to-albumin ratio (CAR) is inexpensive and widely available; however, its utility in determining surgical ti...PURPOSE: Determining the optimal timing of surgery for Crohn disease (CD) is challenging. The C-reactive protein-to-albumin ratio (CAR) is inexpensive and widely available; however, its utility in determining surgical timing remains unclear. METHODS: We retrospectively analyzed 112 cases of penetrating-type CD resection (screened 2010-2024). Preoperative CAR was measured within 7 days of surgery. A receiver operating characteristic analysis defined the CAR threshold to maximize the negative predictive value (NPV) for 30-day complications. Patients were categorized as having a low or high CAR and were matched 1:1 using propensity scores. The early morbidity and 5-year re-operation-free survival rates were compared. RESULTS: A CAR cutoff value of 0.102 yielded the highest NPV. A high CAR was associated with increased overall morbidity (55% vs. 20%) and increased wound infection (21% vs. 5%). After matching (25 pairs), a high CAR was correlated with more complications (52% vs. 24%; P = 0.04) and prolonged stay (median 17 vs. 11 days; P = 0.02). The five-year reoperation risk was higher with a high CAR (14.6% vs. 4.0%; P = 0.03). CONCLUSIONS: Preoperative CAR < 0.102 indicates a candidate rule-out threshold for elective CD surgery, predicting fewer early complications and a lower 5-year re-operation rate. Because CAR is rapidly available and treatment-agnostic, serial monitoring could support a testable preoperative timing framework. Further prospective validation is required.
This study evaluated a novel detachable purse-string suture instrument-assisted esophagojejunostomy technique using a circular stapler for minimally invasive surgery. The detachable purse-string suture instrument facilit...This study evaluated a novel detachable purse-string suture instrument-assisted esophagojejunostomy technique using a circular stapler for minimally invasive surgery. The detachable purse-string suture instrument facilitated simplified anvil placement, enhanced visualization, and allowed flexible manipulation without the addition or extension of an incision. A total of 22 patients with gastric or esophagogastric junction cancer underwent this procedure at our institution between January 2023 and December 2024. The median intracorporeal anastomosis time for esophagojejunostomy (excluding the time required for extracorporeal jejunal limb creation and jejunojejunostomy) was 54.5 min, with no cases of anastomotic leakage. Conversion to hand-sewn methods was required in two cases due to technical difficulties. Two patients required endoscopic dilation for stenosis within one year. This method demonstrated favorable short-term outcomes and may be a safe and effective alternative to esophagojejunostomy in minimally invasive surgeries. Large-scale studies are warranted to validate the long-term efficacy and broad applicability of this method.
Atsumi Y, Numata M, Numata K
… +14 more, Shiozawa M, Kazama K, Sawazaki S, Sugiyama A, Mushiake H, Sugano N, Godai T, Katayama Y, Higuchi A, Uchiyama M, Mikayama Y, Saito K, Komura T, Saito A
PURPOSES: The symptoms of low anterior resection syndrome (LARS) are diverse, and its ambiguous definition has made estimating its prevalence difficult. In 2018, an international consensus proposed a new LARS definition...PURPOSES: The symptoms of low anterior resection syndrome (LARS) are diverse, and its ambiguous definition has made estimating its prevalence difficult. In 2018, an international consensus proposed a new LARS definition based on eight symptoms and consequences. We conducted this study to evaluate the prevalence of LARS, using this new definition (LARS-ND), and to identify its risk factors. METHODS: This multicenter, cross-sectional study surveyed patients who underwent curative resection for rectal tumors between 2020 and 2022 at 10 institutions. A one-time questionnaire based on the new LARS definition was distributed. Outcomes included LARS-ND prevalence and risk factors. RESULTS: A total of 343 patients responded (response rate: 86.6%). The prevalence of LARS-ND was 72.5%, with no significant differences across groups with different follow-up durations. The most frequent symptom and consequence were "emptying difficulties" (93.3%) and "the need for strategies and compromises" (47.5%). Among patients categorized as having "no LARS" by the conventional score, 25% were diagnosed with LARS-ND. Multivariate analysis identified younger age (< 70 years; OR = 2.28) and short anastomosis distance (≤ 5 cm; OR = 1.96) as risk factors. CONCLUSIONS: The prevalence of LARS-ND was high, and the new LARS definition identified patients with symptoms previously missed by the conventional score. Younger age and a lower anastomosis level appear to be risk factors for LARS-ND.
PURPOSE: This study aimed to assess whether the pancreatic extracellular volume (ECV) fraction on multiphasic contrast-enhanced computed tomography (CE-CT) can estimate histological pancreatic fibrosis and predict clinic...PURPOSE: This study aimed to assess whether the pancreatic extracellular volume (ECV) fraction on multiphasic contrast-enhanced computed tomography (CE-CT) can estimate histological pancreatic fibrosis and predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). METHODS: This single-center retrospective study included 106 patients who underwent multiphasic CE-CT and PD. ECV fractions were calculated based on absolute enhancements of the pancreas and aorta between the pre-contrast and equilibrium-phase images, followed by a comparison between different fibrosis grades. Multivariate logistic regression analyses were used to evaluate the association between the risk of CR-POPF development and perioperative factors. RESULTS: Of 106 patients, 45 (42.5%) developed POPF (biochemical leak, n = 8; grades B and C, n = 37). The ECV fraction (median, 40.1%; range, 20.0–87.7%) showed a moderate positive correlation with pancreatic fibrosis grade (r = 0.549, P < 0.001). In the multivariate analysis, the ECV fraction (< 40%; odds ratio, 10.1; 95% confidence interval, 3.32–36.3; P < 0.001) was identified as the only independent risk factor for CR-POPF. The area under the receiver operating characteristic curve was 0.824 for the correlation between ECV fraction and CR-POPF prediction, with a cutoff value of 40.9%. CONCLUSION: The pancreatic ECV fraction provides quantitative information for assessing pancreatic fibrosis and predicting CR-POPF after PD.