Digestive Surgery[JOURNAL]
Sun
200 papers
Surgical Management of Colorectal Cancer Peritoneal Metastases: Current Indications, Controversies, and Future Directions.
Horowitz M, Aquina CT
Dig Surg · 2026 Jul · PMID 42400921 · Publisher ↗
BACKGROUND: Isolated peritoneal metastases occur in approximately 4-8% of patients with colorectal cancer and are associated with a very poor prognosis with systemic therapy alone. While cytoreductive surgery (CRS) and h...
BACKGROUND: Isolated peritoneal metastases occur in approximately 4-8% of patients with colorectal cancer and are associated with a very poor prognosis with systemic therapy alone. While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has traditionally been a controversial treatment regimen for colorectal cancer peritoneal metastases due to a high rate of morbidity and a perceived limited efficacy, recent studies have confirmed its safety and have demonstrated the ability to achieve long-term survival in carefully selected patients. SUMMARY: This narrative review presents the current indications, controversies, and future directions of CRS, HIPEC, and additional emerging treatment modalities in the surgical management of colorectal cancer peritoneal metastases. KEY MESSAGES: Peritoneal metastases in colorectal cancer signify a poor prognosis. Management of peritoneal disease includes CRS with or without HIPEC. The use of CRS has been established as an effective treatment modality with acceptable morbidity and long-term quality of life. However, the efficacy of HIPEC continues to be debated. Patient functional status, tumor biology, degree of disease burden, and the feasibility of achieving complete cytoreduction are central to the success of the operation. Emerging treatment options, such as pressurized intraperitoneal aerosolized chemotherapy (PIPAC), represent promising alternative treatment options for patients.
Development of a basic robotic training course for residents in general surgery in the Netherlands.
Voskens FJ, Burbach JPM, Amelung FJ … +10 more , Lips D, van der Schelling G, van Det MJ, Aufenacker TJ, Draaisma WA, Hagendoorn J, Hartemink KJ, Witteman BPL, Broeders I, Ruurda JP
Dig Surg · 2026 Jun · PMID 42287672 · Publisher ↗
Introduction The continued adoption of robotic-assisted surgery (RAS) in digestive surgery has created an increasing demand for structured training of surgical residents. However, standardized basic RAS training programs...
Introduction The continued adoption of robotic-assisted surgery (RAS) in digestive surgery has created an increasing demand for structured training of surgical residents. However, standardized basic RAS training programs specifically designed for residents remain limited, resulting in variable exposure and skill acquisition. This study describes the development and evaluation of a structured basic RAS training course, to standardize education and improve residents' robotic surgery skills. Methods A two day, on-site basic RAS training course was developed by the Dutch Robotic Surgery Working Group and implemented at the OLV Robotic Surgery Institute (ORSI) academy between June 2021 and October 2023. The curriculum included lectures, interactive didactic sessions, simulation-based training, and both dry and wet lab exercises. The impact of the course on skill enhancement was assessed using pre- and post course assessments. Results Seventy-five senior surgical residents with a specific interest in RAS participated. Simulator assessments showed significant improvements in overall score, task completion time and economy of motion across all three exercises following course completion: exercise 1 (p<0.001), exercise 2 (p<0.001), exercise 3 (p<0.001). Conclusion This two-day basic robot training course significantly improved basic robotic skills of general surgery residents. The program provides essential preparation for safe clinical utilization of robotic surgery and may serve as a scalable model for future basic robotic training courses within surgical residency programs.
Bacterial Colonization in Resected Lymph Nodes During Pancreatic Surgery - A Pilot Study.
Coşkun Gürçınar S, Gürçınar IH, Rothe K … +12 more , Muckenhuber A, Jäger C, Göß R, Pergolini I, Mota Reyes C, Safak O, Erkan M, Friess H, Istvanffy R, Ceyhan GO, Demir IE, Demir E
Dig Surg · 2026 Jun · PMID 42284242 · Publisher ↗
BACKGROUND: The detection of bacterial colonization in postoperative pancreatic fistula (POPF) fluid has renewed interest in the role of bacterial translocation during pancreatic surgery. In this context, we hypothesized...
BACKGROUND: The detection of bacterial colonization in postoperative pancreatic fistula (POPF) fluid has renewed interest in the role of bacterial translocation during pancreatic surgery. In this context, we hypothesized that peripancreatic lymph nodes might similarly harbor bacterial colonization. This study aimed to investigate the presence of bacteria in these lymph nodes, identify factors potentially contributing to their colonization, and assess the clinical significance of these findings. METHODS: In this observational pilot study, peripancreatic lymph nodes (station 8a) resected during pancreatic surgery were analyzed for bacterial DNA using 16S rDNA-PCR, and the microbiological findings were correlated with detailed perioperative and postoperative clinical data. RESULTS: We analyzed the bacterial colonization of the lymph node station 8a in 37 patients undergoing pancreatic surgery between 2019 and 2026. Bacterial colonization was found in 3 patients (8.1%). No significant association was observed between lymph node colonization and the type of surgical procedure, histopathological diagnosis, or the development of clinically relevant postoperative pancreatic fistula or other major postoperative complications. All cases with bacterial colonization had undergone preoperative ERCP (p = 0.230). CONCLUSION: In this pilot study, bacterial colonization of peripancreatic lymph nodes was uncommon and was observed only in patients with a history of ERCP. Although no association with postoperative pancreatic fistula was identified, a potential relationship with overall postoperative morbidity cannot be ruled out. Further studies with larger patient cohorts are needed to better define the clinical relevance and underlying mechanisms of lymphatic bacterial translocation.
Prognostic Significance of Nutritional and Inflammatory Factors in Gastric Cancer Surgery.
Fujiwara Y, Endo S, Higashida M … +7 more , Endo Y, Makieda R, Kubota H, Hori M, Okada T, Yoshimatsu K, Ueno T
Dig Surg · 2026 May · PMID 42160221 · Publisher ↗
INTRODUCTION: Various nutritional and inflammatory biomarkers have been proposed to predict prognosis in cancer patients. This study aimed to identify the most significant of these, along with clinical features, in gastr...
INTRODUCTION: Various nutritional and inflammatory biomarkers have been proposed to predict prognosis in cancer patients. This study aimed to identify the most significant of these, along with clinical features, in gastric cancer patients who underwent gastrectomy. METHODS: We retrospectively analyzed gastric cancer patients who underwent gastrectomy. Preoperative markers included mGPS(Modified Glasgow Prognostic Score), NLR(Neutrophil-to-Lymphocyte Ratio), CAR(CRP to Albumin ratio), PNI( Prognostic Nutritional Index), and CONUT (Controlling Nutrition Status)score. Postoperative markers were CRPmax, postoperative complications, and operative procedures. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Survival was analyzed with the Kaplan-Meier method. Key prognostic factors were identified using stepwise univariate and multivariable Cox regression. RESULTS: 360 patients were analyzed. Stepwise Cox analysis showed mGPS as the strongest preoperative predictor of OS and RFS. When including both pre- and postoperative variables, age, pathological stage, and surgical procedure were independent prognostic factors. In a model limited to modifiable factors, mGPS and postoperative complications independently predicted both OS and RFS, while surgical procedure independently predicted RFS only. CONCLUSIONS: Improving preoperative mGPS and minimizing postoperative complications may enhance survival after gastrectomy. When appropriate, stomach-preserving procedures (e.g., subtotal distal gastrectomy) should be favored over total gastrectomy.
PIPAC for Malignant Peritoneal Mesothelioma: Current Insights and Future Directions.
Castagna A, Fotiadou A, Ramouz A … +4 more , Gesheva P, Brindl N, Solass W, Brandl A
Dig Surg · 2026 May · PMID 42118694 · Publisher ↗
Malignant peritoneal mesothelioma (MPM) is a rare and aggressive tumour with poor prognosis, often diagnosed late due to nonspecific symptoms. Current standard treatment involves systemic chemotherapy and cytoreductive s...
Malignant peritoneal mesothelioma (MPM) is a rare and aggressive tumour with poor prognosis, often diagnosed late due to nonspecific symptoms. Current standard treatment involves systemic chemotherapy and cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), but this approach is limited to selected patients. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) has emerged as a novel technique improving drug delivery and penetration in the peritoneal cavity. This narrative review evaluates the role of PIPAC in the treatment of MPM, analysing data from clinical studies on its feasibility, safety, and efficacy. Evidence suggests that PIPAC is a well-tolerated procedure, with a manageable safety profile and potential to improve survival and tumour response in patients with unresectable or recurrent disease. Limitations in current studies include small cohorts and heterogeneous patient populations, underscoring the need for further research. PIPAC represents a promising therapeutic option, offering enhanced intraperitoneal chemotherapy (IPC) delivery with minimal systemic toxicity. Future investigations should focus on optimizing treatment protocols and evaluating long-term benefits to better define PIPAC's role in clinical practice.
Low Preoperative Haemoglobin Is a Risk Factor for Clavien-Dindo Grade IV-V and Non-Surgical Complications in Colorectal Cancer Surgery.
Peroja P, Huhta H, Rautio T … +1 more , Rintala J
Dig Surg · 2026 Apr · PMID 42060555 · Publisher ↗
INTRODUCTION: Preoperative anaemia is common in patients undergoing colorectal cancer surgery, but the association between preoperative haemoglobin (Hb) and postoperative morbidity remains unclear. METHODS: This retrospe...
INTRODUCTION: Preoperative anaemia is common in patients undergoing colorectal cancer surgery, but the association between preoperative haemoglobin (Hb) and postoperative morbidity remains unclear. METHODS: This retrospective cohort study included all 2,374 patients who underwent elective colorectal segmental resection for colorectal cancer at Oulu University Hospital between 2014 and 2024. After exclusions for missing Hb data (n = 49), procedures other than primary curative resection (n = 735), missing complication data (n = 117), and age under 18 years (n = 1), 1,472 patients were analysed. Receiver operating characteristic analysis was used to determine the optimal Hb cut-off, and logistic regression was used to identify factors associated with Clavien-Dindo classification (CDC) grade IV-V complications. RESULTS: Preoperative anaemia was present in 444/859 (51.7%) men and 208/613 (33.9%) women. Overall, 758/1,472 (51.5%) patients developed a postoperative complication. Compared with non-anaemic patients, anaemic patients had higher rates of CDC grade IV-V complications (7.4% vs. 2.6%, p < 0.001) and non-surgical complications (31.4% vs. 20.4%, p < 0.001). The optimal Hb cut-off for CDC grade IV-V complications was 117.5 g/L. Low Hb was associated with severe complications in univariable (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.79-5.10) and multivariable analyses (OR 1.76, 95% CI 1.01-3.05). CONCLUSION: Low preoperative Hb is an independent risk factor for severe postoperative complications, particularly non-surgical events, after colorectal cancer surgery. Data-driven Hb thresholds may improve preoperative risk stratification.
Interval Appendicectomy after Conservative Management of Complicated Appendicitis: Balancing Recurrence, Neoplasm Risk, and Surveillance Strategies.
Gosavi R, McMurrick P, Teoh W … +2 more , Ooi G, Narasimhan V
Dig Surg · 2026 Apr · PMID 42048268 · Full text
BACKGROUND: Non-operative management (NOM) of complicated appendicitis is increasingly accepted, but the role of interval appendicectomy (IA) remains contentious. Contemporary evidence has shifted decision-making from re...
BACKGROUND: Non-operative management (NOM) of complicated appendicitis is increasingly accepted, but the role of interval appendicectomy (IA) remains contentious. Contemporary evidence has shifted decision-making from recurrence risk alone toward age-linked neoplasm risk and radiological features. SUMMARY: Recurrence after successful NOM is commonly reported at 12-24% and is concentrated within the first 6 months. In adults presenting with periappendiceal abscess, appendiceal tumour prevalence rises with age, reaching approximately 5-10% in patients aged 35-39 years and 14-20% in cohorts aged ≥40 years. Interval CT or MRI findings, including dilated or cystic morphology, mural abnormalities, calcification, mucin, or a base mass, identify higher risk patients in whom IA should be prioritised. Colonoscopy is best used selectively, particularly when caecal pathology is suspected, imaging is equivocal, or IA is not planned in older patients. KEY MESSAGES: IA should generally be considered in patients aged ≥40 years and in those with persistent symptoms or concerning radiological findings, while recognising that decisions must be individualised and made through shared decision-making. Younger patients with complete radiological resolution and no red-flag features can usually be observed with structured imaging follow-up. A risk-stratified clinical algorithm is proposed to guide post-NOM management.
Erratum.
Dig Surg · 2026 · PMID 41855301 · Publisher ↗
The article "Are There Any Differences in Clinical Outcome after the Surgical Management of Patients with Stomach versus Duodenal Perforation?" [Dig Surg 2025;42:220-228; https://doi.org/10.1159/000547869] by Lahes et al...
The article "Are There Any Differences in Clinical Outcome after the Surgical Management of Patients with Stomach versus Duodenal Perforation?" [Dig Surg 2025;42:220-228; https://doi.org/10.1159/000547869] by Lahes et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.
Tube Enteral Feeding-Associated Non-Occlusive Mesenteric Ischemia following Gastric Cancer Surgery: A Retrospective Case Series Analysis.
Patnaik SC, Rao TS, Narsimha Raju KVV … +7 more , Shukla SS, Reddy P, Reddy A, Suryanarayana P, Komandur A, Vashist Y, Nusrath S
Dig Surg · 2026 Mar · PMID 41824640 · Publisher ↗
INTRODUCTION: Non-occlusive mesenteric ischemia (NOMI) is a rare but lethal complication after gastric cancer (GC) surgery, marked by intestinal hypoperfusion without arterial occlusion. Nonspecific symptoms and rapid de...
INTRODUCTION: Non-occlusive mesenteric ischemia (NOMI) is a rare but lethal complication after gastric cancer (GC) surgery, marked by intestinal hypoperfusion without arterial occlusion. Nonspecific symptoms and rapid deterioration hinder timely diagnosis. This study evaluated outcomes, diagnostic pathways, and management. METHODS: We retrospectively reviewed 8 GC patients who developed NOMI (February 2022-January 2024). Collected variables included demographics, surgical details, feeding practices, presentation, imaging, treatment, and outcomes. The primary endpoint was 30-day mortality. RESULTS: NOMI presented a median of 3 days postoperatively (range 2-5). The median age was 63.5 years; 75% were male; all had advanced GC; and 62.5% had gastric outlet obstruction. Common signs were abdominal distension (75%), hypotension (50%), and peritonitis (25%). CT consistently showed small-bowel dilatation, pneumatosis intestinalis, and portal venous gas, mainly in distal jejunum/ileum. Seven patients underwent re-exploration: five required resection. After implementing a modified feeding protocol, cases reduced from seven to one. Thirty-day mortality was 50%, largely from sepsis and multiorgan dysfunction syndrome. CONCLUSION: In GC patients with feeding jejunostomy, NOMI remains a serious complication. A cautious feeding strategy - deferring feeds during vasopressor support, initiating low-strength kitchen feeds, slow escalation, and early oral intake - was associated with fewer cases. High clinical suspicion, rapid CT, and timely surgery are critical to improve outcomes.
Risk Factors for Conversion in Laparoscopic Appendicectomy: A Cross-Sectional Study in a Middle-Income Country.
Rodriguez-Prado E, Rioja-Torres F, De La Cruz-Ku G … +1 more , Razuri-Bustamante C
Dig Surg · 2026 · PMID 41824615 · Publisher ↗
INTRODUCTION: Acute appendicitis is a common surgical emergency. Laparoscopic appendicectomy is preferred for faster recovery and less pain, but conversion to open surgery remains necessary in some cases. Most evidence o...
INTRODUCTION: Acute appendicitis is a common surgical emergency. Laparoscopic appendicectomy is preferred for faster recovery and less pain, but conversion to open surgery remains necessary in some cases. Most evidence on conversion comes from high-income countries, while data from low- and middle-income settings (LMIC), where resource limitations may influence surgical decisions, are scarce. This study aimed to identify factors associated with conversion in a public, resource-limited Peruvian hospital. METHODS: We conducted a retrospective cross-sectional study of patients undergoing laparoscopic appendicectomy at a public hospital in Lima, Peru, between 2022 and 2023. Variables were compared between patients requiring conversion and those completing the procedure laparoscopically. Multivariate analyses were performed to identify risk factors. RESULTS: A total of 523 patients were included. Conversion to open appendicectomy occurred in 4 patients (0.76%), primarily due to difficult dissection from severe adhesions, intraoperative hemorrhage associated with equipment malfunction. Multivariate analysis identified adhesions (OR = 8.91, 95% CI: 1.48-53.42, p = 0.017), appendicolith (OR = 11.49, 95% CI: 1.74-75.69, p = 0.001), and intraoperative complications (OR = 45.74, 95% CI: 6.71-311.55, p < 0.001) as significant factors of conversion. CONCLUSIONS: Laparoscopic appendicectomy is safe and effective in public hospitals, even in low-resource settings. Conversion was rare and mainly driven by adhesions, appendicoliths, or intraoperative complications. These findings reinforce that laparoscopic appendicectomy can be reliably performed in LMIC.
The Optimal Technique to Remove Visible Lesions in Barrett's Esophagus: When to Use Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection?
Munters K, Pouw RE, Weusten BLAM … +1 more , van Munster SN
Dig Surg · 2026 · PMID 41706616 · Publisher ↗
<p>Background: The incidence of esophageal adenocarcinoma (EAC) has risen significantly in recent decades, with Barrett's esophagus (BE) as the most important precursor. When a visible lesion is identified within BE, end...
<p>Background: The incidence of esophageal adenocarcinoma (EAC) has risen significantly in recent decades, with Barrett's esophagus (BE) as the most important precursor. When a visible lesion is identified within BE, endoscopic resection (ER) is the preferred treatment, providing both histologic staging and curative therapy for dysplasia and low-risk EAC. Summary: Two ER techniques are commonly used: cap-based endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is an extensively studied technique considered safe, effective, and easy to learn. However, due to the cap-based approach, lesions larger than 15-20 mm need to be removed by multiple adjacent resections, so-called piecemeal resection. This may result in remnant tissue in the resection field and may compromise histopathological assessment. In contrast, ESD enables en bloc removal regardless of lesion size. While ESD has also demonstrated safety and efficacy, it is technically more demanding and associated with longer procedure times. For some lesions, there is general agreement on treatment, with ESD preferred for lesions with suspected submucosal invasion, bulky morphology, or fibrosis. Conversely, EMR remains the standard for smaller, superficial lesions without these features. Key Message: A significant grey zone persists, clinical scenarios for which comparative evidence is lacking and consensus on the optimal treatment approach remains unclear. </p>.
The Usefulness of the Serum Fibrinogen-to-Albumin Ratio as a Preoperative Predictor of High-Grade Dysplasia or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm of the Pancreas.
Ochiai S, Chiba N, Yamaguchi H … +11 more , Suda R, Nagae Y, Seichi T, Nakagawa M, Gunji T, Kobayashi T, Sano T, Kikuchi Y, Tabuchi S, Ishizaki T, Kawachi S
Dig Surg · 2026 · PMID 41610059 · Publisher ↗
INTRODUCTION: The indications for resection of intraductal papillary mucinous neoplasms (IPMNs) have been optimized according to the high-risk stigmata (HRS) and worrisome features (WFs). However, the proportion of resec...
INTRODUCTION: The indications for resection of intraductal papillary mucinous neoplasms (IPMNs) have been optimized according to the high-risk stigmata (HRS) and worrisome features (WFs). However, the proportion of resected IPMNs diagnosed as low grade is not insignificant. This study aimed to investigate whether fibrinogen-to-albumin ratio (FAR) improves the diagnostic ability of high-grade dysplasia (HGD) or invasive carcinoma (IC) in IPMN. METHODS: This study included 47 patients who underwent surgery between April 2008 and July 2024. Clinical factors were examined to determine HGD or IC. We also compared the accuracy of predicting HGD or IC between HRS alone and HRS plus FAR. RESULTS: A total of 23 were diagnosed with HGD or IC based on pathological diagnosis. On multivariable analysis, contrasted walled nodules ≥5 mm and FAR ≥0.0833 were significant predictors of HGD or IC. Moreover, the HRS and high FAR (≥0.0833) group had better the positive predictive value and diagnostic accuracy rate. CONCLUSIONS: FAR may be a significant predictor of HGD or IC in IPMN. In addition, when combined with HRS, its diagnostic ability as a predictor of HGD or IC may be further improved.
Accuracy and Methodological Considerations of Steep Ramp Test-Estimated Oxygen Uptake at Peak Exercise in Preoperative Risk Assessment for Esophagectomy.
Lotz J, Bongers BC, Janssen-Heijnen M … +1 more , Franssen R
Dig Surg · 2026 · PMID 41587140 · Publisher ↗
Abstract loading — click title to view on PubMed.
Laparoscopic Anatomical S7 Segmentectomy: A Standardized Combined Dorsal and Ventral Method.
Chen W, Hou Y, Jiang Y … +4 more , He Y, Xiang W, Liu Y, Jin C
Dig Surg · 2026 · PMID 41538364 · Publisher ↗
INTRODUCTION: Anatomical resection of tumor in liver segment S7 is the most technically challenging procedure in laparoscopic liver hepatectomy due to its deep location and complex vascular structures, which results in a...
INTRODUCTION: Anatomical resection of tumor in liver segment S7 is the most technically challenging procedure in laparoscopic liver hepatectomy due to its deep location and complex vascular structures, which results in a steep learning curve for beginners. We explored a simple and feasible approach: a dorsal approach combined with a dorsoventral method for liver segment S7 resection. METHODS: The key innovations we propose through the dorsal approach combined with a dorsoventral method include the following: (1) systematic dissection of the S7 hepatic pedicle through Rouviere's sulcus; (2) parenchymal transection guided by the dorsal ischemic demarcation line of segment S7; (3) advance along the right hepatic vein toward the ventral aspect of segment S7. By decomposing complex maneuvers into three standardized steps (steps 1-3), this protocol significantly reduces technical barriers. The procedural details are meticulously demonstrated in this report to enhance reproducibility. RESULTS: In the preliminary phase of this study, 20 patients were included. All patients underwent surgery smoothly, with no conversion to open surgery and no deaths, and all patients achieved R0 resection. The operation time was 190.0 (178.0-210.0) min, and intraoperative blood loss was 200.0 (150.0-280.0) mL. CONCLUSIONS: This method standardizes the laparoscopic S7 segment resection, which, while ensuring precise removal, is expected to reduce the learning curve for surgeons.
Surgery for Locally Advanced Pancreatic Ductal Adenocarcinoma: Selection of Patients and Surgical Technique.
Barreto SG, Loveday B, Mittal A … +2 more , Pandanaboyana S, Windsor JA
Dig Surg · 2026 · PMID 41518632 · Full text
<p>Background: The management of locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) now relies on an integrated, multidimensional assessment that goes beyond just the relationship of the tumour to vascular anato...
<p>Background: The management of locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) now relies on an integrated, multidimensional assessment that goes beyond just the relationship of the tumour to vascular anatomy. Summary: By combining dynamic imaging, biomarker monitoring, genetic profiling, and thorough physiological evaluation, clinicians can more accurately select patients who are most likely to benefit from aggressive surgical intervention. These patients can then be offered NAT, singly or in combination, and preferably within the context of a clinical trial. The re-staging of patients post-NAT remains a challenge, but in patients who have shown no evidence of tumour growth or metastases and preferably with evidence of biochemical, metabolic, or radiological response and are fit enough, a trial dissection may be indicated. This evolving strategy transforms a disease once considered palliative into one with curative potential in selected patients. In this setting, surgical techniques have also evolved to include artery-first approaches to the SMA and CA, arterial divestment as an alternative to arterial resection, and the triangle operation. Patients with LA-PDAC should be managed in a high-volume centre with experience in treating this type of patient. There is no established role for minimally invasive techniques, including laparoscopic or robotic surgery, with LA-PDAC. Key Messages: Determining the role of surgery for locally advanced pancreatic cancer requires more than just an assessment of the tumour-vasculature relationship. The multidisciplinary selection integrates dynamic imaging, biomarker monitoring, genetic profiling, and physiological evaluation. For some patients, a previous palliative strategy is transformed to a potentially curative one. In this setting, new surgical techniques include an artery-first approach to avoid futile resection, periadventitial dissection instead of arterial resection, and the triangle operation for complete nodal clearance. </p>.
Perioperative Blood Product Transfusions in Gastric Cancer Surgery in Finland.
Lammi JP, Ukkonen M, Eskelinen M … +3 more , Saarnio J, Käkelä P, Rantanen T
Dig Surg · 2026 · PMID 41452788 · Publisher ↗
INTRODUCTION: Preoperative anaemia is common in gastric cancer patients. Although restrictive blood product transfusion strategies have been introduced, their use in standard practice is not well known. This national reg...
INTRODUCTION: Preoperative anaemia is common in gastric cancer patients. Although restrictive blood product transfusion strategies have been introduced, their use in standard practice is not well known. This national register study investigated the perioperative haemoglobin and platelet levels and the use of blood product transfusions in gastric cancer surgery. METHODS: In order to improve and unify blood transfusion policies, the Finnish Red Cross Blood Service carried out a project concerning the optimal use of blood products (VOK project). These register data were used to form the patient population containing 70% of blood product transfusions in Finland. Patients undergoing open surgery for gastric cancers were included. RESULTS: A total of 500 patients were included. Perioperative anaemia was observed in 75% of males and 52% of females. Fifty-one percent of patients received blood transfusions, with a median transfusion trigger point of 91 g/L [IQR 84-98 g/L] and a median 3 units transfused [IQR 2-4 units]. Seven percent received platelet transfusion (median trigger 77, IQR 15-146; median 4 units, IQR 2-8), and 6.5% received either fresh frozen plasma or pooled human plasma products. At discharge, the median haemoglobin level was 109 g/L in non-transfused patients and 114 g/L in transfused patients. If restrictive strategies had been applied, only 1.7% (n = 9) had required blood and 0.5% (n = 3) had a platelet transfusion. CONCLUSION: Anaemia is common among patients undergoing gastric cancer surgery. We encourage clinicians to follow restrictive transfusion policies in gastric cancer patients as Hb levels seem to recover after gastric surgery without blood transfusions.
Response Rate Correlates with the Conversion Rate in Patients with Advanced Hepatocellular Carcinoma Treated with Systemic or Hepatic Artery Infusion Chemotherapy: A Systematic Review.
Okuno M, Nishino H, Okura K … +3 more , Ishii T, Hashida H, Hatano E
Dig Surg · 2026 · PMID 41433214 · Full text
UNLABELLED: <p>Introduction: The appropriate regimen for induction therapy with the intent of conversion therapy for advanced hepatocellular carcinoma (HCC) is unknown. This study aimed to evaluate whether the overall re...
UNLABELLED: <p>Introduction: The appropriate regimen for induction therapy with the intent of conversion therapy for advanced hepatocellular carcinoma (HCC) is unknown. This study aimed to evaluate whether the overall response rate (ORR) of chemotherapy correlates with the conversion rate. METHODS: The studies of phase 2/3 trials of systemic or hepatic artery infusion chemotherapy (HAIC) for patients with advanced HCC were searched. Spearman's correlation coefficient was calculated to measure the strength of the relationship between the conversion rate and the ORR. RESULTS: A total of 42 patient groups from 32 trials were included in the analysis. The ORR and conversion rates in a total of 3,516 patients were 24.7% and 8.3%, respectively. The analysis of only the patient groups treated with 1st-line immune checkpoint inhibitors, tyrosine kinase inhibitors or HAIC revealed a strong correlation between the ORR and the conversion rate (ρ = 0.647, p = 0.0003). In addition, strong correlations between the ORR and median progression-free survival (PFS)/overall survival (OS) were observed (ρ = 0.772, p < 0.0001 and ρ = 0.754, p < 0.0001, respectively). CONCLUSION: Because of the strong correlations of the ORR with the conversion rate and PFS/OS, regimens with high ORRs may be used for patients with advanced HCC who are potential candidates for conversion therapy. </p>.
Methodological Quality of Systematic Reviews on Treatments for Gastric Cancer: A Cross-Sectional Study.
Zhang Y, Wang BH, Cheng BZZ … +3 more , Zhong CCW, Ho F, Chung VCH
Dig Surg · 2026 · PMID 41348663 · Full text
UNLABELLED: <p>Introduction: Systematic reviews (SRs) provide crucial evidence for gastric cancer interventions, but their reliability can be compromised by methodological flaws. We aimed to evaluate the methodological q...
UNLABELLED: <p>Introduction: Systematic reviews (SRs) provide crucial evidence for gastric cancer interventions, but their reliability can be compromised by methodological flaws. We aimed to evaluate the methodological quality of SRs on gastric cancer interventions and identify factors affecting their quality. METHODS: We searched MEDLINE, APA PsycInfo, Embase, and Cochrane Database of SRs for eligible SRs published between January 2014 and October 2023. The methodological quality was assessed using AMSTAR 2. Multivariable regression analyses were conducted to identify factors influencing quality. RESULTS: Among 119 identified SRs (including 1,305 randomized controlled trials with 233,197 participants), only 2.5% were rated as high quality, while 89.1% were critically low quality. Higher journal impact factor was associated with better performance in addressing heterogeneity (adjusted odds ratio [AOR]: 1.37, 95% confidence interval [CI]: 1.02-1.84), investigating publication bias (AOR: 1.41, 95% CI: 1.03-1.94), reporting conflicts of interest (AOR: 2.85, 95% CI: 1.59-5.11), and establishing protocols (AOR: 3.33, 95% CI: 1.89-5.87). More review authors predicted better statistical methods (AOR: 1.20, 95% CI: 1.03-1.40) and protocol establishment (AOR: 1.31, 95% CI: 1.06-1.63). Recent publications showed improved conflict of interest reporting (AOR: 1.54, 95% CI: 1.09-2.10) and risk of bias assessment (AOR: 1.34, 95% CI: 1.03-1.75). Non-pharmacological SRs better discussed heterogeneity compared to pharmacological (AOR: 0.27, 95% CI: 0.09-0.85) or mixed interventions (AOR: 0.12, 95% CI: 0.03-0.53). CONCLUSION: The methodological quality of gastric cancer intervention SRs is unsatisfactory. Future SRs should focus on establishing protocols, explaining study design selection, using comprehensive search strategies, documenting excluded studies with reasons, and describing primary studies in detail. </p>.
Robotically Assisted Gastric Resections Using the hinotori™: A Cadaveric Feasibility Study.
Wandhöfer C, Roviello F, Lozanovski VJ … +4 more , Tagkalos E, Grimminger PP, Lang H, Gisbertz SS
Dig Surg · 2026 · PMID 41313741 · Full text
UNLABELLED: <p>Introduction: In this first preclinical evaluation study of the hinotori™ system in gastric resection procedure, its capabilities to perform distal and total gastrectomy while using human cadaver models we...
UNLABELLED: <p>Introduction: In this first preclinical evaluation study of the hinotori™ system in gastric resection procedure, its capabilities to perform distal and total gastrectomy while using human cadaver models were evaluated. METHODS: Three robotic distal gastrectomies (RADGs) and one total gastrectomy were performed in human cadavers using the same setup. A delta-shaped anastomosis in the RADG procedures were performed with a manual stapler. RESULTS: The mean operative time for three distal gastrectomies was 118 min, while the total gastrectomy procedure focused on the resection only. The dissection could be made up to pulmonary veins, while the entire setup was kept. The procedures were done safely according to the surgical standards with smooth instrument and overall performance without any complications seen. An ergonomic surgeon cockpit and head rest supported the outcome. CONCLUSION: Docking-free design and human arm-like movement with a high degree of operation arm mobility showed a wide range of motion of the wristed robotic instruments. This could be beneficial for multiquadrant procedures resulting in potential shorter procedures times with smother performance, which should be evaluated in further studies. </p>.
Long-Limb Roux-en-Y Reconstruction for Glycemic Control in Patients with Gastric Cancer and Type 2 Diabetes: One-Year Outcomes of Oncometabolic Surgery.
Kwon Y, Kim H, Kim D … +3 more , Lee CM, Kim JH, Park S
Dig Surg · 2026 · PMID 41144608 · Full text
UNLABELLED: <p>Background: Long-limb Roux-en-Y (LLRY) reconstruction has recently been implemented as an oncometabolic surgery to improve glycemic control following surgery for gastric cancer (GC); however, data on its f...
UNLABELLED: <p>Background: Long-limb Roux-en-Y (LLRY) reconstruction has recently been implemented as an oncometabolic surgery to improve glycemic control following surgery for gastric cancer (GC); however, data on its feasibility are insufficient. We investigated the 1-year outcomes of LLRY reconstruction for glycemic control in patients with type 2 diabetes (T2D). METHODS: We reviewed the records of 15 patients with GC and T2D who underwent LLRY reconstruction after gastrectomy, with biliopancreatic and Roux limb lengths of 130-250 cm, to improve postoperative glycemic control. The primary outcome was the T2D remission (glycated hemoglobin <6.5% without antidiabetic medication) rate at 12 months postoperatively. The diabetes prediction (DP) score and Korean nationwide average T2D remission rates following GC surgery were compared. RESULTS: The mean patient age was 66.5 years (standard deviation [SD] 9.6), mean body mass index was 26.4 kg/m2 (SD 4.4), and mean glycated hemoglobin level was 7.7% (SD 1.5). The overall T2D remission rate was 46.7%. The postoperative T2D remission rate was 12.9% higher than the DP score estimate (33.8%) and 25.7% higher than the Korean national average rate (21%) of T2D remission following GC surgery. CONCLUSION: Our results show that LLRY reconstruction after gastrectomy is an effective oncometabolic surgery for treating T2D and GC. </p>.
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