BACKGROUND: Patterns of work loss in patients with gastrointestinal (GI) cancer remain relatively unknown, particularly regarding the effect of neoadjuvant therapy (NAT). We sought to assess employment disruption and mis...BACKGROUND: Patterns of work loss in patients with gastrointestinal (GI) cancer remain relatively unknown, particularly regarding the effect of neoadjuvant therapy (NAT). We sought to assess employment disruption and missed workdays in patients with esophageal, pancreatic, and rectal cancers with a particular focus on the role of NAT. METHODS: Adult patients with esophageal, pancreatic, or rectal cancer were identified from the IBM MarketScan Commercial Claims and Encounters Database (2013-2020). Full- or part-time employed patients were matched to cancer-free individuals with benign GI conditions using entropy balancing. The outcomes included employment disruption within 12 months and number of missed workdays. Multivariate Cox and negative binomial regression models were used to estimate the adjusted hazard ratios (aHRs) and incidence rate ratios (IRRs). RESULTS: Among 40,008 patients, 2314 (5.8%) were diagnosed with GI cancer. Overall, 333 patients (14.4%) with GI cancer experienced employment disruption compared with 1963 controls (5.2%) (P <.001). Among patients with cancer, 1017 (43.9%) received NAT before surgery. Patients who underwent NAT were mostly male (NAT plus surgery: 67.5% vs upfront surgery: 62.1%) and were less likely to have a Charlson Comorbidity Index of >2 (NAT plus surgery: 3.4% vs upfront surgery: 6.2%) than individuals who underwent upfront surgery (both P <.001). Compared with patients who underwent upfront surgery, patients who received NAT more frequently experienced employment disruption (11.6% vs 17.9%) and missed more workdays (58 vs 76 days, respectively). On multivariate analysis, NAT was associated with greater hazards of employment disruption (aHR, 4.01 [95% CI, 3.44-4.68]) and more missed workdays (IRR, 9.16 [95% CI, 8.65-9.70]). CONCLUSION: A GI cancer diagnosis was associated with employment disruption, with a higher incidence of disruption among patients treated with NAT. Tailored occupational and socioeconomic interventions are needed to improve the employment stability of patients with cancer.
BACKGROUND: The survival differences between splenic flexure cancer (SFC) and descending colon cancer (DCC) are unclear owing to their distinct anatomic and molecular features. This study compares their survival outcomes...BACKGROUND: The survival differences between splenic flexure cancer (SFC) and descending colon cancer (DCC) are unclear owing to their distinct anatomic and molecular features. This study compares their survival outcomes and genetic differences using data from the Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas (TCGA) databases. METHODS: This study used SEER data (2000-2022) to compare postoperative patients with SFC and DCC. Propensity score matching (PSM) was performed to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method, and competing-risk analysis with a multivariable Fine-Gray model was used to evaluate cancer-specific death (CSD). TCGA transcriptomic data were analyzed to identify differentially expressed genes and enriched pathways between SFC and DCC. RESULTS: A total of 7579 patients were identified from SEER, including 2636 with SFC and 4943 with DCC. After PSM, DCC remained associated with significantly better OS and CSS than SFC. Competing-risk analysis showed that SFC had higher cumulative incidences of both CSD and other-cause death, and multivariable Fine-Gray analysis further demonstrated that DCC was independently associated with a lower risk of CSD than SFC (subdistribution hazard ratio, 0.73; P =.019). Younger age and adequate nodal evaluation were protective, whereas advanced tumor burden, particularly T4 and N2 disease, remained strongly adverse. TCGA analysis further demonstrated distinct transcriptional profiles between the 2 subsites, with SNHG4 upregulated and AHCYL2 downregulated in SFC, alongside subsite-associated differences in fatty-acid metabolism, spliceosome-related signaling, and ribosome-associated processes. CONCLUSION: SFC is associated with worse survival than DCC, and transcriptomic profiles are distinct between the 2 subsites in TCGA.
BACKGROUND: Minimally invasive surgery has been associated with reduced postoperative morbidity compared with traditional open approaches, suggesting that it may be advantageous for patients with frailty. However, its ef...BACKGROUND: Minimally invasive surgery has been associated with reduced postoperative morbidity compared with traditional open approaches, suggesting that it may be advantageous for patients with frailty. However, its effect on individuals with frailty with intraductal papillary mucinous neoplasms (IPMNs) undergoing distal pancreatectomy (DP) remains unclear. This study aimed to evaluate the association between surgical approach and postoperative outcomes in the context of patient frailty. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, 1120 patients with nonmalignant IPMN who underwent DP between 2019 and 2023 were identified. Frailty was defined as a modified frailty index (mFI) of ≥2, calculated using 5 variables: diabetes mellitus, hypertension, functional dependency, chronic obstructive pulmonary disease, and congestive heart failure. Patients were categorized according to their frailty status and surgical approach (minimally invasive surgery [MIS] vs open surgery). Postoperative outcomes, including complications, major complications, readmission, reoperation, and mortality, were compared between the groups using univariate and multivariate analyses. RESULTS: Patients with frailty consisted of 27.7% of the cohort (n = 310) and were more likely to experience complications (35.1% in patients with frailty vs 28.4% in patients without frailty; P =.042) and longer hospital stay (mean: 5.9 days in patients with frailty vs 5.3 days in patients without frailty; P =.009). In the overall cohort, frailty independently predicted higher odds of complications (odds ratio [OR], 1.44 [95% CI, 1.05-1.97]) and readmission (OR, 1.68 [95% CI, 1.16-2.45]), whereas male sex and older age were associated with increased mortality. MIS was not associated with reduced odds of complications, readmission, reoperation, or mortality in populations with or without frailty. CONCLUSION: Frailty is an independent predictor of complications and readmission after DP for IPMN. However, MIS does not seem to confer benefits over open surgery in patients with or without frailty.
BACKGROUND: To explore the effect of the whole individualized comprehensive nursing program on the incidence of anastomotic leakage and prognosis of patients after esophageal cancer surgery. METHODS: A total of 120 patie...BACKGROUND: To explore the effect of the whole individualized comprehensive nursing program on the incidence of anastomotic leakage and prognosis of patients after esophageal cancer surgery. METHODS: A total of 120 patients who planned to undergo radical resection of esophageal cancer between March 2022 and March 2025 were randomly divided into an experimental group (n = 60) and a control group (n = 60). The experimental group received whole-course individualized comprehensive nursing, including preoperative nutritional risk screening and intervention, precise management of basic diseases, psychological intervention, perioperative preparation under the concept of enhanced recovery after surgery, postoperative fistula targeted nursing, multichannel fine management, and complication prevention. The control group received routine nursing. The incidence of anastomotic leakage, healing time, hospitalization days, medical expenses, total incidence of postoperative complications, short form (SF)-36 quality of life score, and nursing satisfaction were compared between the 2 groups. RESULTS: The incidence of anastomotic leakage in the experimental group (3.33%) was significantly lower than that in the control group (11.67%). The healing time of fistula and length of hospital stay in the experimental group were shorter than those in the control group, and the medical cost was lower than that in the control group (P <.05). The total incidence of postoperative complications in the experimental group (8.33%) was lower than that in the control group (20.00%), and the physical health general score, mental health general score, and nursing satisfaction score on the SF-36 scale at 1 month after operation were significantly higher than those in the control group (P <.05). CONCLUSION: The whole course individualized comprehensive nursing program can effectively reduce the incidence of anastomotic leakage after esophageal cancer surgery, reduce the risk of complications, and improve the quality of life of patients after surgery; this has important clinical application value.
Kobayashi T, Kojima H, Suda R
… +16 more, Yamaguchi H, Iida S, Iwama K, Seichi T, Nagae Y, Higuchi H, Ando A, Koganezawa I, Nakagawa M, Yokozuka K, Ochiai S, Gunji T, Sano T, Tabuchi S, Chiba N, Kawachi S
BACKGROUND: This study aimed to evaluate the association between preoperative antithrombin (AT) activity levels and postoperative outcomes in patients with nonocclusive mesenteric ischemia (NOMI) who underwent emergency...BACKGROUND: This study aimed to evaluate the association between preoperative antithrombin (AT) activity levels and postoperative outcomes in patients with nonocclusive mesenteric ischemia (NOMI) who underwent emergency surgery. METHODS: This study retrospectively analyzed the preoperative AT activity level measurements of 35 patients with NOMI who underwent emergency surgery between January 2012 and December 2025. The primary outcome was 30-day postoperative mortality. Receiver operating characteristic analysis determined the optimal AT activity level cutoff, and the outcomes were compared between patients with a preoperative AT activity level of <75% and those with a preoperative AT activity level of ≥75%, with further stratification by preoperative Sequential Organ Failure Assessment (SOFA) score. RESULTS: Preoperative AT activity level was significantly lower in 30-day postoperative nonsurvivors than survivors (54% vs 77%, respectively; P =.009). A preoperative AT activity level of <75% was associated with higher rates of postoperative disseminated intravascular coagulation, greater organ dysfunction, and increased 30-day and in-hospital mortality. The prognostic value was most evident in patients with SOFA scores of <10. All patients with SOFA scores ≥10 had AT activity levels of <75% and poor outcomes. CONCLUSION: Lower preoperative AT activity level may be associated with 30-day postoperative mortality in NOMI. Preoperative AT activity level measurement may help facilitate early risk stratification before the development of advanced multiorgan dysfunction.
Di Martino M, Ministrini S, Tiberio G
… +15 more, Conci S, Ruzzenente A, Maekawa A, Perri G, Marchegiani G, Libia A, Spampinato MG, Romano F, Garancini M, Famularo S, De Rose A, Giuliante F, Zucchini V, Ercolani G, Donadon M
BACKGROUND: Noncolorectal liver metastases (NONCOLMETs) are composed of a heterogeneous group historically associated with poor outcomes. Advances in systemic therapy and liver interventions have renewed interest in live...BACKGROUND: Noncolorectal liver metastases (NONCOLMETs) are composed of a heterogeneous group historically associated with poor outcomes. Advances in systemic therapy and liver interventions have renewed interest in liver resection (LR) for selected patients. However, evidence remains inconsistent, and indications vary across tumor types. METHODS: A comprehensive MEDLINE and Embase search up to February 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified studies assessing the outcomes of liver interventions for NONCOLMETs. The studies were grouped by primary tumor. The extracted and summarized data included overall survival (OS), prognostic determinants, and comparisons with nonsurgical management. RESULTS: From 899 screened records, survival after LR varied markedly. The most favorable outcomes were seen in neuroendocrine tumors (median OS, 84-120 months) and gastrointestinal stromal tumors (GISTs) responding to tyrosine kinase inhibitors (TKIs; median OS, 70-90 months). Breast and selected urogynecologic cancers showed a median OS of >36 months. However, esophageal, gastric, and pancreatic cancers showed benefit only in exceptionally selected, chemoresponsive liver-only disease. Across tumor types, specific favorable prognostic factors included oligometastatic and liver-only disease; longer disease-free interval; radiologic or biomarker response to systemic therapy, such as carbohydrate antigen 19-9 decline in pancreatic cancer, estrogen receptor/progesterone receptor positivity in breast cancer, human epidermal growth factor receptor 2 or programmed death-ligand 1 expression in gastroesophageal cancer, and TKI response in GIST; and well-differentiated histology. Comparative and propensity-matched analyses consistently suggested a survival benefit from LR in favorable subsets of patients with NONCOLMETs. CONCLUSION: LR may provide meaningful survival benefit in carefully selected patients with biologically favorable, liver-dominant NONCOLMETs. Multidisciplinary evaluation and tumor-specific selection criteria remain essential. Prospective studies are needed to refine the indications.
Thyen AJ, Maatman TK, Roch AM
… +5 more, Ellis RJ, Ceppa EP, House MG, Schmidt CM, Zyromski NJ
J Gastrointest Surg
· 2026 May · PMID 41796851
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BACKGROUND: Postpancreatectomy acute pancreatitis (PPAP) is an increasingly recognized but still disputed clinical entity. Defined by the International Study Group for Pancreatic Surgery in 2022 as a 48-hour postoperativ...BACKGROUND: Postpancreatectomy acute pancreatitis (PPAP) is an increasingly recognized but still disputed clinical entity. Defined by the International Study Group for Pancreatic Surgery in 2022 as a 48-hour postoperative elevation of serum amylase level and radiographic confirmation of pancreatitis. PPAP is graded as postoperative hyperamylasemia (POH), grade B, and grade C. The 2023 National Surgical Quality Improvement Program's (NSQIP) pancreatectomy-targeted Participant Use Data File included for the first time PPAP variables. This study aimed to determine whether the NSQIP data will reflect the incidence of PPAP in a national sample. METHODS: Patients who underwent a pancreatectomy at 168 participating institutions between January 1, 2023, and December 31, 2023, were included in the NSQIP pancreatectomy-targeted dataset. Cases were identified using Current Procedural Terminology codes. The variables were captured retrospectively. Data were amassed and managed by the American College of Surgeons NSQIP. RESULTS: Of 8015 patients included in the analysis, 1273 (17%) had amylase values. Among these patients, 782 (61%) had normal serum amylase level, 430 (34%) had POH, 53 (4.1%) had grade B PPAP, and 8 (0.01%) had grade C PPAP. Multivariable logistic regression found a small pancreatic duct and soft pancreatic texture to be significantly associated with POH and clinically relevant PPAP (CR-PPAP) for head resections. Patients with POH and CR-PPAP were significantly more likely to have any-cause morbidity and complications, such as Clavien-Dindo grade ≥ 3 (P <.05 and P <.05, respectively). CONCLUSION: This is the first national survey of patients who underwent pancreatectomy that confirmed a high incidence of POH and PPAP. The low rate of amylase level measurement suggests that general education about this disease process will be important. Normal pancreatic texture is the most significant risk factor for developing POH/PPAP, and mitigation strategies and more liberal use of early postoperative imaging should be considered for patients.
BACKGROUND: The incidence of appendiceal cancer has increased over the last two decades. The current study aims to investigate the overall survival and prognostic factors of appendiceal cancer using the National Cancer D...BACKGROUND: The incidence of appendiceal cancer has increased over the last two decades. The current study aims to investigate the overall survival and prognostic factors of appendiceal cancer using the National Cancer Data Bank (NCDB) database. METHODS: We used the NCDB (2004-2020) in the current retrospective analysis to include patients with appendiceal cancer. We meticulously selected histologies that corresponded to goblet cell adenocarcinoma (GCA), neuroendocrine neoplasm (NEN), non-mucinous adenocarcinoma (NMA), and mucinous adenocarcinoma (MA). RESULTS: The GCA, MA, NEN, and NMA groups consist of 6,111, 16,471, 19,199, and 11,065 patients, respectively. The NMA group had significantly lower overall survival (101.40 months, 95% CI (99.13-103.67)) compared to the other groups (p<0.001). The NEN group had significantly higher overall survival (170.88 months, 95% CI (168.56-173.20)) compared to the other groups (p<0.001). Importantly, NMA type of appendiceal tumor (HR: 1.37, reference: GCA), intraoperative chemotherapy (HR: 0.60, reference: neoadjuvant therapy), and laparoscopic approach surgery (HR: 0.74, reference: open approach) were independent predictors of overall survival in patients with appendiceal cancer. CONCLUSION: Our study revealed that NMA and NEN types had the poorest and best overall survival rates, respectively, compared to other types. In addition, intraoperative systemic therapy and laparoscopic approach surgery were independently associated with better survival in patients with appendiceal cancer.
BACKGROUND: Esophageal fistula is a severe clinical condition associated with high mortality rates. Currently, there is no standardized treatment of esophageal fistula. This study aimed to investigate the therapeutic out...BACKGROUND: Esophageal fistula is a severe clinical condition associated with high mortality rates. Currently, there is no standardized treatment of esophageal fistula. This study aimed to investigate the therapeutic outcomes between the conventional treatment group and the transnasal fistula drainage group while analyzing relevant factors influencing fistula healing. METHODS: This single-center retrospective study analyzed patients who were diagnosed with benign esophageal fistula and treated at Nanchong Central Hospital between September 2019 and November 2024. Treatment allocation was primarily based on fistula size: patients with small fistulas received conventional therapy (conventional treatment group), whereas those with large fistulas received conventional therapy combined with endoscopic transnasal fistula drainage (transnasal fistula drainage group). RESULTS: The conventional treatment group achieved a healing rate of 88.6%, whereas the transnasal fistula drainage group showed a healing rate of 85.0%, demonstrating comparable ultimate healing rates between the 2 approaches. Multivariate analysis identified fistula size and albumin level as 2 independent prognostic factors affecting patient recovery. CONCLUSION: For patients with small fistulas, conventional therapy alone achieves satisfactory healing outcomes. In cases of larger fistulas, the combination of conventional treatment with endoscopic transnasal fistula drainage yields comparable therapeutic efficacy to that observed in small fistulas.
BACKGROUND: Uni-port mediastinoscopic-assisted transhiatal esophagectomy (UMATHE) is increasingly applied in minimally invasive esophageal cancer surgery, particularly for patients unsuitable for transthoracic procedures...BACKGROUND: Uni-port mediastinoscopic-assisted transhiatal esophagectomy (UMATHE) is increasingly applied in minimally invasive esophageal cancer surgery, particularly for patients unsuitable for transthoracic procedures. This study aimed to quantitatively assess the independent impact of first-assistant experience on surgical efficiency and outcomes in UMATHE. METHODS: We retrospectively analyzed 179 consecutive UMATHE procedures performed by a single surgeon with 2 fixed assistants. Joinpoint regression identified the learning-curve inflection point. To explore temporal synchrony between assistant experience and surgical performance, we applied Seasonal-Trend decomposition using LOESS (STL) and cross-correlation analysis. Assistant experience (cumulative case count), identity, and surgeon learning phase were then incorporated into linear mixed-effects models (LMMs) and robust linear regression models (RLMs) to evaluate their effects on operative time and blood loss. RESULTS: Joinpoint regression identified a learning curve inflection at case 42. STL and cross-correlation analyses demonstrated synchronized improvement between assistant experience and operative performance. Assistant experience consistently predicted shorter operative time, with significance emerging in the basic model (P =.012) and strengthening after adjustment for learning phase and clinical covariates (P <.001). The association with blood loss was marginally significant in basic models (P =.043) but lost significance with full adjustment. RLMs confirmed these patterns. CONCLUSION: First-assistant experience independently enhances operative efficiency once the surgeon has reached procedural proficiency, whereas its influence on blood loss is modest and more team-dependent. Targeted assistant training may unlock further efficiency in complex minimally invasive esophagectomy.
BACKGROUND: Isolated extrapancreatic metastatic disease within the pancreas is uncommon. This study aimed to examine the indications and outcomes of pancreatic resection for metastatic disease in nonpancreatic, nonneuroe...BACKGROUND: Isolated extrapancreatic metastatic disease within the pancreas is uncommon. This study aimed to examine the indications and outcomes of pancreatic resection for metastatic disease in nonpancreatic, nonneuroendocrine malignancy at a high-volume center. METHODS: This was a retrospective analysis of a prospectively managed database of pancreatic resections for metastatic disease for primary nonpancreatic, nonneuroendocrine tumors at the University Hospital Southampton. The collected and analyzed data included patient demographics, operative and perioperative outcomes, survival, and recurrence. RESULTS: A total of 844 patients who underwent pancreatic resection were examined. Of note, 26 consecutive patients met the inclusion criteria, representing 3.3% of the unit's throughput. The median disease-free interval was 65 months. Most resections were performed for renal cell carcinoma, followed by melanoma, breast cancer, and colorectal cancer. The perioperative morbidity was 42.9%, with 12 cases of postoperative complications. There were no perioperative deaths. The median overall survival was 41 months, whereas the median disease-free survival was 17 months for the entire cohort. CONCLUSION: When coupled with the low morbidity and mortality rates of a high-volume pancreatic surgery center using careful patient selection, pancreatic metastectomy has the potential to result in good long-term survival.
BACKGROUND: Although several postoperative adjuvant therapies for hepatocellular carcinoma (HCC) have shown efficacy in reducing recurrence, no globally accepted guidelines exist for patients with vascular invasion after...BACKGROUND: Although several postoperative adjuvant therapies for hepatocellular carcinoma (HCC) have shown efficacy in reducing recurrence, no globally accepted guidelines exist for patients with vascular invasion after curative resection. This study aimed to evaluate the efficacy and safety of lenvatinib (Len) as adjuvant therapy for patients with HCC with vascular invasion after curative liver resection (LR). METHODS: Patients with HCC with vascular invasion, including microvascular invasion (MVI) and portal vein tumor thrombus (PVTT), who underwent curative resection at 2 hospitals were retrospectively reviewed. Overall survival (OS), recurrence-free survival (RFS), and recurrence patterns were compared between patients treated with LR alone and those receiving postoperative Len (LR + Len) using propensity score matching (PSM). RESULTS: A total of 326 patients with HCC with vascular invasion were enrolled. Among them, 248 (76.1%) had MVI; 79 patients were allocated to the LR + Len group, and the others to the LR group. After PSM (1:3), 73 patients were included in the LR + Len group and 172 patients in the LR group. In the matched cohort, patients in the LR + Len group had significantly longer RFS (hazard ratio [HR], 1.54; 95% CI, 1.03-2.29; P =.032) and OS (HR, 2.11; 95% CI, 1.08-4.10; P =.025) than those undergoing LR alone. Subgroup analysis revealed that adjuvant Len significantly improved both RFS and OS in patients with MVI, but it conferred no benefit to those with PVTT. CONCLUSION: Postoperative adjuvant Len therapy was associated with longer OS and RFS for patients with HCC with vascular invasion, particularly for those with MVI.
BACKGROUND: This study aimed to investigate the usefulness of preoperative assessment of grip strength and frailty in predicting surgical outcomes and loss of independence (LOI) after hepatobiliary-pancreatic (HBP) surge...BACKGROUND: This study aimed to investigate the usefulness of preoperative assessment of grip strength and frailty in predicting surgical outcomes and loss of independence (LOI) after hepatobiliary-pancreatic (HBP) surgery among older adult patients. METHODS: This was a retrospective study that analyzed data of 224 older adults (≥70 years) who underwent HBP surgery for malignancies between June 2020 and May 2023. Grip strength and frailty assessment using a frailty checkup were assessed preoperatively at the first visit. LOI was defined as postoperative transfer for rehabilitation, readmission or mortality, new need for long-term health care, or an increase in the level of care within 6 months postoperatively. RESULTS: Overall, 49 patients had reduced grip strength, and those with low grip strength were older and had poor nutritional status. Patients with low grip strength had a significantly longer postoperative hospital stay and higher complication and transfer rates than those with normal grip strength. The postoperative LOI was significantly high in patients with low grip strength (P <.001). According to the frailty checkup, low grip strength was significantly associated with falling and decreased frequency of going out. Multivariate analysis revealed that low grip strength was an independent risk factor for postoperative LOI (odds ratio, 7.24; P <.001). Exploratory risk factors for postoperative LOI included a low prognostic nutritional index, pancreatectomy, and low grip strength, and the LOI rate increased significantly as the number of risk factors increased. CONCLUSION: Low grip strength may be a useful screening tool for predicting postoperative LOI in older adults undergoing HBP surgery.