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Yamamoto K, Inoue H, Tanaka I, Miyake R, Saino M, Ushikubo K, Iwasaki M, Nishikawa Y, Abiko S, Gantuya B, Onimaru M, Tanabe M. A pilot study on anti-reflux mucoplasty with valve as novel endoscopic therapy for gastroesophageal reflux disease. DEN OPEN 2026; 6:e70131. [PMID: 40330866 PMCID: PMC12050175 DOI: 10.1002/deo2.70131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 04/06/2025] [Accepted: 04/20/2025] [Indexed: 05/08/2025]
Abstract
Background and aims Endoscopic anti-reflux therapies like anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation have shown efficacy for gastroesophageal reflux disease (GERD) in systematic reviews and meta-analyses. Anti-reflux mucoplasty (ARM-P), a refinement of ARMS, incorporates immediate closure of the resection site to reduce complications. Recently, anti-reflux mucosal valvuloplasty (ARMV), which employs endoscopic submucosal dissection to create a mucosal valve, was introduced but retains ARMS's limitations, requiring extensive incisions (three-quarters to four-fifths circumference). To address these challenges, we developed anti-reflux mucoplasty with valve (ARM-P/V), integrating ARMV's valvuloplasty with ARM-P's closure technique to improve safety and reduce complications. This pilot study evaluates the safety, feasibility, and efficacy of ARM-P/V. Methods This retrospective study reviewed data from patients undergoing ARM-P/V for proton pump inhibitor (PPI)-refractory or PPI-dependent GERD at Showa University Koto Toyosu Hospital, Tokyo, from April to August 2024. Symptom severity and quality of life were assessed using validated questionnaires (GERD-Health Related Quality of Life Questionnaire [GERD-HRQL], GERD Questionnaire [GerdQ], and Frequency Scale for the Symptoms of GERD [FSSG]), comparing pre- and post-treatment scores. PPI discontinuation rates were also analyzed. Results Eighteen patients (mean age 55.4 years) underwent ARM-P/V. Within 3 months, 72.2% (13/18) reduced or discontinued PPI use. GERD-HRQL scores improved from 20.3 to 10.9 (p = 0.004), GerdQ from 10.4 to 6.9 (p < 0.001), and FSSG from 24.0 to 13.2 (p < 0.001). No severe complications (Clavien-Dindo Grade ≥3), delayed bleeding or dysphagia requiring balloon dilation were reported. Conclusions ARM-P/V demonstrates safety, technical feasibility, and short-term efficacy in GERD treatment. As a refinement of ARMV, it offers a promising alternative to current techniques.
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Affiliation(s)
- Kazuki Yamamoto
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Haruhiro Inoue
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Ippei Tanaka
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Rei Miyake
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Masachika Saino
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Kei Ushikubo
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Miyuki Iwasaki
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Yohei Nishikawa
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Satoshi Abiko
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Boldbaatar Gantuya
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
- Department of GastroenterologyMongolian National University of Medical SciencesUlaanbaatarMongolia
- Endoscopy UnitMongolia Japan HospitalUlaanbaatarMongolia
| | - Manabu Onimaru
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
| | - Mayo Tanabe
- Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan
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Alder S, Papaikonomou K, Tebani L, Rooda I, Dhejne C, Damdimopoulou P, Gidlöf S. Surgical outcomes after gender-affirming hysterectomies: a consecutive case series of 72 patients. J OBSTET GYNAECOL 2025; 45:2463419. [PMID: 39951000 DOI: 10.1080/01443615.2025.2463419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 01/31/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Hysterectomy is a significant component of gender-affirming treatment for transgender individuals. The choice of surgical technique and associated complications have been studied, but very few studies have used a standardised classification system to grade surgical complications. This study aimed to describe our hospital's experience on gender-affirming hysterectomies with regards to patient demographics, surgical techniques, and postoperative complications using a validated classification system. METHODS The study is a prospective follow-up case-series study of 72 consecutive patients undergoing gender-affirming hysterectomy at Karolinska University Hospital between 2016 and 2023. Patient demographics (age and mean body mass index), tobacco and alcohol habits, medical history and comorbidities, route of hysterectomy, complications and 30-days postoperative outcomes were reported. Surgical complications were graded according to the Clavien-Dindo classification system. RESULTS The study population, with an average age of 27.6 years, presented diverse medical conditions, with psychiatric diagnoses being the most prevalent. The most common procedure was total laparoscopic hysterectomy, with low intraoperative blood loss. Surgical complications were rare, and primarily required minimal interventions. The 30-day Clavien-Dindo postoperative complication rate of grade II or higher was 19%, although only 4% experienced complications necessitating re-surgery (grade III or higher). Postoperative follow-up emerged as a critical aspect, with 22% of patients seeking non-elective medical attention within the first month, often due to vaginal bleeding or abdominal pain. CONCLUSIONS Our findings support the safety and feasibility of gender-affirming hysterectomies, particularly when performed laparoscopically, with very few severe complications observed using a validated scoring system. Extensive follow-up care, as well as addressing common postoperative concerns, is essential. Despite a relatively small sample size and lack of a control group, this study provides valuable insights into transgender healthcare from a previously unstudied region. Future research should preferably include larger cohorts, multicentre and registry-based studies.
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Affiliation(s)
- Susanna Alder
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kiriaki Papaikonomou
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Leonora Tebani
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Unit for Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ilmatar Rooda
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Unit for Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- ANOVA: Andrology - Sexual Medicine - Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Pauliina Damdimopoulou
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Unit for Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Gidlöf
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Unit for Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Jia K, Huang S, Wang Z, Lin Y, Bai Y, Shen C, Zhang Z, Wu Z, Qie Y, Hu H. Utilizing vaginal natural orifice to facilitate bowel manipulation during totally intracorporeal ileal conduit construction: a retrospective cohort study. Ann Med 2025; 57:2453827. [PMID: 39826911 PMCID: PMC11748861 DOI: 10.1080/07853890.2025.2453827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 10/08/2024] [Accepted: 01/07/2025] [Indexed: 01/22/2025] Open
Abstract
OBJECTIVE To explore the feasibility and efficacy of the modified technique of totally intracorporeal ileal conduit (IC) construction via vaginal approach following robot-assisted radical cystectomy (RARC) in females. METHODS By comparing the perioperative outcomes of the modified technique with extracorporeal urinary diversion (ECUD), 31 females treated for bladder cancer with RARC and IC from May 2020 to December 2023 were retrospectively analyzed and divided into two groups: the ECUD group (10 patients) and the modified intracorporeal urinary diversion (MICUD group) (21 patients). The modified technique involved performing transvaginal natural orifice specimen extraction surgery (TV-NOSES) after RARC; followed by the transvaginal placement of an Endo-GIA stapler to manipulate the bowel for intracorporeal IC construction. RESULTS Both groups' surgeries were successfully completed by the same surgeon and team. Patients in the MICUD group had shorter total operative time, lower postoperative pain scores, quicker recovery, and shorter hospital stays. The learning curve of the MICUD showed two phases: a learning phase (cases 1-7) and a proficiency phase (cases 8-21). The incidence of postoperative complications between the two groups was similar. The mean follow-up times were 29.3 months (ECUD group) and 22.6 months (MICUD group). In the MICUD group, there was one case of local tumor recurrence, two cases of distant metastasis, including one death from progression; in the ECUD group, one patient had distant metastasis and died from progression. CONCLUSION RARC with MICUD represents a safe, feasible and easy-to-learn minimally invasive surgical approach. Patients experience less trauma and faster recoveries.
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Affiliation(s)
- Kaipeng Jia
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shiwang Huang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhun Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuda Lin
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yiduo Bai
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chong Shen
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhouliang Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yunkai Qie
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Hsieh CL, Lan CC, Liu KH, Hsu JT, Tsai CY, Yeh TS, Hung YS, Chou WC. Comparative value of frailty versus ECOG performance in preoperative risk assessment for elderly patients with gastric cancer. Am J Surg 2025; 246:116396. [PMID: 40367598 DOI: 10.1016/j.amjsurg.2025.116396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/19/2025] [Accepted: 05/06/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Radical gastrectomy with D2 lymphadenectomy reduces the postoperative recurrence in gastric cancer, but increases risk of complications, especially among elderly patients. This study aimed to assess the predictive value of frailty in determining postoperative complication risks in patients aged ≥80 years undergoing D2 gastrectomy. METHODS This prospective observational study enrolled 78 patients aged ≥80 years who underwent gastrectomy with D2 lymphadenectomy for gastric cancer between January 2020 and December 2021 at a medical center in Taiwan. Frailty was evaluated using the Comprehensive Geriatric Assessment (CGA) within one week before surgery. OUTCOMES Length of hospital stay (LOS), intensive care unit (ICU) stays, postoperative complications, and survival were analyzed and compared with the Eastern Cooperative Oncology Group (ECOG) performance status. RESULTS Among the 78 patients, ECOG performance scores were 0, 1, 2, and 3 in 47 %, 40 %, 12 %, and 1 % of patients, respectively; 19 patients (24 %) were classified as fit and 59 (76 %) as frail based on CGA. Frail patients had a significantly longer median LOS (20 days vs. 12 days, p = 0.001), a higher ICU admission rate (46 % vs. 16 %, p = 0.027), a higher incidence of any surgical complication (85 % vs. 47 %, p = 0.001), and an increased rate of major surgical complications (Accordion grade 2 or higher) (24 % vs. 0 %, p = 0.012) compared to fit patients. Although ECOG performance was associated with major complication rates, it did not significantly predict LOS, ICU admissions, or overall complication rates. Survival did not differ significantly between the frail and ECOG performance groups. CONCLUSIONS This study demonstrates that frailty is commonly observed in Taiwanese octogenarian patients and is a valuable predictor of postgastrectomy outcomes.
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Affiliation(s)
- Chi-Lin Hsieh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chen Lan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Geriatric Medical Center, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Geriatric Medical Center, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Taqi K, Icchhpuniani S, Stockley C, Assadzadeh GE, Dixon E, Mack L, Bouchard-Fortier A. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) and Liver-Directed Therapy for Synchronous Peritoneal and Liver Metastatic Colorectal Cancer: A Systematic Review with Meta-analysis. Ann Surg Oncol 2025; 32:5063-5082. [PMID: 40372590 DOI: 10.1245/s10434-025-17321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 03/30/2025] [Indexed: 05/16/2025]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can improve survival in colorectal cancer (CRC) patients with peritoneal carcinomatosis (PC). The presence of synchronous liver metastases (LMs) often precludes patients from CRS/HIPEC; however, multiple studies suggest that CRS/HIPEC with liver-directed treatments may be beneficial. This systematic review examines outcomes and selection factors in CRC patients with PC and LM treated with CRS/HIPEC and liver-directed therapy. METHODS A systematic review and meta-analysis was performed using the PubMed, EMBASE, and Web of Science databases from 2009 to 2024. The outcomes included patient selection factors, overall survival (OS) and disease-free survival (DFS). RESULTS A total of 482 articles were retrieved, of which 17 retrospective studies met the inclusion criteria, comprising a total of 988 patients. Liver-directed therapy with CRS/HIPEC for PC and LM was associated with 3- and 5-year OS rates of 47% and 37%, respectively, with a median survival range of 15.3-47.6 months. The adjusted 1- and 3-year DFS rates were 34% and 23%, respectively, with a median DFS range of 6.2-29.4 months. Patients with PC and LM were more likely to have received preoperative systemic therapy (86%), undergone minor liver resection (90%), had a limited burden of LM (mean of three lesions, median size of 1.4-3 cm), and limited PC (mean peritoneal cancer index of 13). CONCLUSION This study indicates that CRS/HIPEC with liver-directed therapy can yield favorable survival outcomes for well-selected CRC patients with limited PC and LM. Further trials are needed to confirm its efficacy and refine optimal patient selection.
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Affiliation(s)
- Kadhim Taqi
- Division of Surgical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Surgery, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
| | - Simarpreet Icchhpuniani
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cecily Stockley
- Division of Surgical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Golpira Elmi Assadzadeh
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elijah Dixon
- Division of Hepatobilliary and Pancreatic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lloyd Mack
- Division of Surgical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Antoine Bouchard-Fortier
- Division of Surgical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Mizusawa H, Higashimoto Y, Shiraishi O, Shiraishi M, Sugiya R, Noguchi M, Kanki K, Kimura T, Ishikawa A, Yasuda T. Preoperative inspiratory muscle training preserved diaphragmatic excursion after esophagectomy: a randomized-controlled trial. Esophagus 2025; 22:331-339. [PMID: 40178716 PMCID: PMC12167333 DOI: 10.1007/s10388-025-01123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 03/22/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Preoperative inspiratory muscle training (IMT) enhances diaphragmatic excursion (DE) in patients with esophageal cancer; however, the postoperative effects of IMT on DE have not yet been evaluated. This study aimed to investigate the effect of preoperative IMT on perioperative diaphragmatic function as measured by DE, inspiratory muscle strength, lung function, and exercise tolerance. METHODS This was a parallel, randomized-controlled trial. Patients with thoracic or abdominal esophageal cancer scheduled for esophagectomy were randomized into either the incentive spirometry (IS) or IMT group. Each intervention was performed during preoperative neoadjuvant chemotherapy (NAC). The primary outcome was the DE, and the secondary outcomes were maximal inspiratory pressure (MIP), lung function, and exercise tolerance, which were measured before and 1-3 months after esophagectomy. RESULTS Thirty-two patients were included in the analysis. The DE in the IMT group (n = 15) increased from baseline to pre-operation, and the rate of change was significantly greater than that in the IS group (n = 17). Although the DE and MIP decreased in both groups after esophagectomy, the decline in the DE after esophagectomy was significantly lower in the IMT group than that in the IS group (p < 0.05). Furthermore, significant differences in DE persisted at least until 3 months post-esophagectomy, whereas MIP did not differ significantly at any time point. Pulmonary function and exercise tolerance were not significantly different between the two groups. CONCLUSIONS The IMT before esophagectomy enhanced diaphragmatic function, which was preserved for more than 3 months after esophagectomy.
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Affiliation(s)
- Hiroki Mizusawa
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan.
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
| | - Yuji Higashimoto
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
- Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka, Japan
| | - Osamu Shiraishi
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
| | - Masashi Shiraishi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Ryuji Sugiya
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Masaya Noguchi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Kengo Kanki
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Tamotsu Kimura
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Akira Ishikawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Takushi Yasuda
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
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Liu W, Tao H, Zeng X, Huang C, Yang J, Fang C. Synchronous portal vein embolization of terminal branches with transcatheter arterial chemoembolization before planned major hepatectomy for hepatitis B virus-related hepatocellular carcinoma: a single-center retrospective cohort study. J Gastrointest Surg 2025; 29:102036. [PMID: 40222551 DOI: 10.1016/j.gassur.2025.102036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/10/2025] [Accepted: 03/22/2025] [Indexed: 04/15/2025]
Abstract
BACKGROUND Terminal branches portal vein embolization (TBPVE) is a novel technical modification. The clinical effect of synchronous TBPVE with transcatheter arterial chemoembolization (TACE) before planned major hepatectomy in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unknown. METHODS From November 2016 to December 2021, the study enrolled 115 patients with HBV-related HCC who were scheduled for major hepatectomy but had insufficient future liver remnant (FLR). Patients were grouped according to whether they received TBPVE combined with TACE (the TBPVE group [n = 62]) or PVE combined with TACE (the PVE group [n = 53]). This study compared the outcomes of the procedures and the perioperative and long-term outcomes of patients who subsequently underwent major hepatectomy between the 2 groups. RESULTS FLR volume increment and degree of hypertrophy were significantly higher in the TBPVE group than in the PVE group (P ≤.003). FLR proliferation was pronounced remarkably within the first 2 weeks after TBPVE synchronous with TACE, and the kinetic growth rates were 17.4 mL/d (IQR, 12.7-21.9) in the first week and 6.9 mL/d (IQR, 4.1-11.1) in the second week. Of note, 54 patients in the TBPVE group and 41 patients in the PVE group finally underwent major hepatectomies. The Pringle maneuver time, intraoperative blood loss, transfusion, and postoperative hospital stays were lower in the TBPVE group than in the PVE group (P <.05). Disease-free survival (DFS) rates were better in the TBPVE group than in the PVE group (P =.042). CONCLUSION TBPVE synchronous with TACE induced safe and rapid FLR hypertrophy with satisfactory efficacy in patients with initially unresectable HBV-related HCC, improved the planned major hepatectomy resectability rate, and had better DFS.
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Affiliation(s)
- Wenying Liu
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Hepatobiliary Surgery, Yuebei People's Hospital, Shantou University Medical College, Shaoguang, China
| | - Haisu Tao
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China; National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments - South China Institute, Guangzhou, China; Digital Intelligent Minimally Invasive Surgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojun Zeng
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China; National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments - South China Institute, Guangzhou, China; Digital Intelligent Minimally Invasive Surgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Congyun Huang
- Department of Hepatobiliary Surgery, Yuebei People's Hospital, Shantou University Medical College, Shaoguang, China
| | - Jian Yang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China; National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments - South China Institute, Guangzhou, China; Digital Intelligent Minimally Invasive Surgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China; National Engineering Research Center of Innovation and Application of Minimally Invasive Instruments - South China Institute, Guangzhou, China; Digital Intelligent Minimally Invasive Surgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Kawashima J, Akabane M, Khalil M, Woldesenbet S, Endo Y, Sahara K, Ruzzenente A, Ratti F, Marques HP, Oliveira S, Balaia J, Cauchy F, Lam V, Poultsides GA, Kitago M, Popescu I, Martel G, Gleisner A, Hugh T, Weiss M, Aucejo F, Aldrighetti L, Endo I, Pawlik TM. Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden (MELD-AFP-TBS) score to stratify prognosis after liver resection for hepatocellular carcinoma. Surgery 2025; 183:109388. [PMID: 40311416 DOI: 10.1016/j.surg.2025.109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/06/2025] [Accepted: 03/31/2025] [Indexed: 05/03/2025]
Abstract
INTRODUCTION Morphologic criteria, such as the Barcelona Clinic Liver Cancer staging system often fail to accurately predict long-term survival among patients undergoing liver resection for hepatocellular carcinoma. We sought to develop a continuous risk score that incorporates established markers of tumor biology and liver function to improve the prediction of overall survival. METHODS Data from a multi-institutional database were used to identify patients who underwent curative-intent hepatectomy for hepatocellular carcinoma. A predictive score for overall survival was developed using weighted beta-coefficients from a multivariable Cox regression model. RESULTS Among 850 patients, 595 (70.0%) were assigned to the training cohort, and 255 (30.0%) to the test cohort. In the training cohort, multivariable analysis identified the Model of End-Stage Liver Disease (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07), log-transformed alpha-fetoprotein (hazard ratio, 1.07; 95% confidence interval, 1.02-1.13), and tumor burden score (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11) as independent predictors of worse overall survival. The Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden score, based on the Cox model, stratified patients into low-risk (n = 466, 78.3%) with a 5-year OS of 70.5% and high-risk (n = 129, 21.7%) with a 5-year OS of 47.0% (P < .001). In the test cohort, the Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden score demonstrated superior discriminative accuracy (C-index: 0.72, time-dependent area under the curve 1-year: 0.80, 3-year 0.76, 5-year 0.70) compared with the Barcelona Clinic Liver Cancer staging system (C-index: 0.53, time-dependent area under the curve 1-year: 0.61, 3-year 0.55, 5-year 0.56). An online tool was made accessible at https://jk-osu.shinyapps.io/MELD_AFP_TBS/. CONCLUSION The Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden score provides a novel, accurate tool for prognostic stratification of patients with hepatocellular carcinoma, identifying high-risk patients who may benefit from alternative treatments to improve outcomes.
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Affiliation(s)
- Jun Kawashima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Miho Akabane
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Yutaka Endo
- Department of Transplant Surgery, University of Rochester Medical Center, Rochester, NY
| | - Kota Sahara
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Sara Oliveira
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Jorge Balaia
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Ana Gleisner
- Department of Surgery, University of Colorado Denver, Denver, CO
| | - Tom Hugh
- Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Weiss
- Department of Surgery, Cancer Institute, Northwell Health, New Hyde Park, NY
| | - Federico Aucejo
- Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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9
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Mateos JJ, De la Fuente E, Valero P, Martínez D, De la Gala F, Bellón JM, Duque P, Piñeiro P, Calvo A, Reyes A, Simón C, Hortal FJ, Garutti I. Utility of High-Sensitivity Cardiac Troponin Monitoring in Thoracic Surgery for Predicting Severe Postoperative Complications. J Cardiothorac Vasc Anesth 2025; 39:1763-1773. [PMID: 40189451 DOI: 10.1053/j.jvca.2025.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 03/07/2025] [Accepted: 03/13/2025] [Indexed: 06/16/2025]
Abstract
OBJECTIVES To evaluate the utility of high-sensitivity cardiac troponin (hs-cTn) monitoring in thoracic surgery to predict severe postoperative complications (sPOCs) according to the Clavien-Dindo classification. DESIGN Retrospective, observational cohort study. SETTING Tertiary-level hospital involving multiple departments. PARTICIPANTS A total of 220 patients who underwent lung resection surgery between November 2018 and October 2021, with preoperative and postoperative troponin measurements. INTERVENTIONS hs-cTnI levels (Abbott Alinity) were measured before surgery and within the first 24 hours postoperatively. Myocardial injury (MI) was defined as hs-cTnI greater than 26.2 ng/L postoperatively. In addition, the impact of a postoperative cTnI elevation greater than 20% or a preoperative value below 1.6 ng/L on the occurrence of sPOCs is analyzed. Postoperative complications were recorded for the first 30 days and classified using the Clavien-Dindo classification. MAIN MEASUREMENTS AND RESULTS Patients with sPOCs had higher pre- and postoperative hs-cTnI levels compared to those without complications. Patients with MI had a higher incidence of POCs than those without MI. Additionally, undetectable preoperative hs-cTnI levels were associated with better survival. CONCLUSIONS Perioperative troponin elevation is associated with worse short-term postoperative outcomes, including a higher incidence of sPOCs and prolonged hospital stays. Preoperative hs-cTnI levels correlate with preoperative morbidity (frailty) in patients.
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Affiliation(s)
- Javier J Mateos
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain.
| | - Elena De la Fuente
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Pablo Valero
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - David Martínez
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Francisco De la Gala
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jose M Bellón
- Department Biostatistical, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Patricia Duque
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Alberto Calvo
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Almudena Reyes
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Carlos Simón
- Department of Thoracic Surgery, Gregorio Marañón General University Hospital, Madrid, Spain; Surgery Department, School of Medicine, Complutense University of Madrid, Spain
| | - Francisco J Hortal
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain; Pharmacology Department, School of Medicine, Complutense University of Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Reanimation, Gregorio Marañón General University Hospital, Madrid, Spain; Pharmacology Department, School of Medicine, Complutense University of Madrid, Spain
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10
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Koga N, Morita M, Nagai T, Iwanaga A, Kasagi Y, Sugiyama M, Kimura Y, Sugimachi K, Toh Y. Multimodal therapy for oligometastases after curative esophagectomy for esophageal cancer. Esophagus 2025; 22:418-426. [PMID: 40192995 DOI: 10.1007/s10388-025-01125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 03/25/2025] [Indexed: 06/16/2025]
Abstract
BACKGROUND Oligometastases, defined as a limited metastatic disease, have been considered potential therapeutic targets of cancers. This study aimed to clarify the characteristics of oligometastatic recurrence and therapeutic strategy after curative esophagectomy for esophageal cancer. METHODS Clinical details, such as recurrence site, timing and contents of therapies for recurrence, and prognosis, were examined in 138 patients who experienced recurrence among 366 who underwent curative esophagectomy for esophageal cancer. Oligometastases were defined as three or fewer metastatic recurrence lesions within a single organ or lymph node (LN) station. RESULTS Oligometastases were identified in 36 patients (26%). The most common oligometastatic recurrence site was the LN (21 patients), followed by the lung (14 patients). In addition, the oligometastases group had a significantly better prognosis than the multiple metastasis group (P < 0.0001). Analysis for prognostic factors revealed that surgical resection for oligometastases had a significant prognostic impact on long-term survival after treatment for initial recurrence of esophageal cancer (P = 0.012). CONCLUSION Oligometastases serve as a prognostic factor for recurrent esophageal cancer after curative esophagectomy. The surgical resection of isolated oligometastatic recurrences, particularly pulmonary and cervical node metastases, combined with chemotherapy or radiotherapy, represents a promising treatment strategy with a survival benefit in recurrent esophageal cancer.
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Affiliation(s)
- Naomichi Koga
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan.
| | - Taichiro Nagai
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Ayako Iwanaga
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Yuta Kasagi
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Yasue Kimura
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-Pancreatic Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811- 1395, Japan
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11
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Xie YS, Lei SH, Wen SK, Wang JQ, Zhang Y, Liu JM, Luo WC, Li ZL, Peng HC, Liu KX, Zhao BC, PREVENGE-CB Collaborators. Predictive Value of a Novel Frailty Index for Cardiovascular Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study. Anesthesiology 2025; 143:51-61. [PMID: 39998236 DOI: 10.1097/aln.0000000000005426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
BACKGROUND Older patients undergoing noncardiac surgery are at risk of postoperative cardiovascular events. Accurate cardiovascular risk assessment is important for informed decision-making. METHODS This prospective cohort study enrolled older patients undergoing elective major noncardiac surgery. A frailty index based on preoperative geriatric assessment (FI-PGA) was constructed using 32 health-related parameters. The primary outcome was the occurrence of any cardiovascular events within 30 days after surgery. The associations between the FI-PGA and outcomes were assessed using logistic regression models. The added predictive value was evaluated by comparing nested models using improvement in model fit, fraction of new predictive information, net reclassification improvement, and decision curve analysis. The predictive performance of the Clinical Frailty Scale was also evaluated. RESULTS A total of 1,808 patients were included, with 316 (17.5%) patients experiencing the primary outcome. The FI-PGA was associated with increased odds of the primary outcome after adjustment for clinical predictors (odds ratio, 1.56; 95% CI, 1.33 to 1.82 per 0.1-point increment), and clinical predictors plus preoperative N-terminal pro-B-type natriuretic peptide (odds ratio, 1.37; 95% CI, 1.16 to 1.61 per 0.1-point increment). Integration of the FI-PGA in prediction models significantly improved model fit and provided new predictive information. Net reclassification improvement analysis showed that adding the FI-PGA to risk models improved risk estimation for patients who did not develop postoperative cardiovascular events, but did not improve risk estimation for those who experienced events. Decision curves showed the models containing the FI-PGA achieved higher net benefit. Improved model performance was also observed when the Clinical Frailty Scale was used for frailty assessment, although the added predictive values appeared lower. CONCLUSIONS A frailty index derived from preoperative multidimensional geriatric assessment can improve cardiovascular risk prediction before noncardiac surgery, primarily by improving risk estimation for patients who will not develop postoperative cardiovascular events.
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Affiliation(s)
- Yi-Shan Xie
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Shao-Hui Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Shi-Kun Wen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Jia-Qi Wang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Ya Zhang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Jia-Ming Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Wen-Chi Luo
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Zhen-Lue Li
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China
| | - Huan-Chuan Peng
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China; Outcomes Research Consortium, Houston, Texas
| | - Bing-Cheng Zhao
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Precision Anesthesia and Perioperative Organ Protection of Guangdong Province, Guangzhou, China; Department of Anesthesiology, Nanfang Hospital Ganzhou Hospital, Ganzhou, China; Outcomes Research Consortium, Houston, Texas
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Collaborators
Ming-Hua Cheng, Xin Kuang, Yi-Min Wang, Hui Zhang, Rui-Peng Zhong, Zhi-Hao Li, Chen Mao,
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12
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Kishimoto Y, Otsuka K, Yamashita T, Saito A, Kohmoto M, Motegi K, Ariyoshi T, Goto S, Murakami M, Aoki T. The correlation between intrathoracic herniation of the gastric tube and postoperative complications and the efficacy of laparoscopic retrosternal route creation. Esophagus 2025; 22:382-389. [PMID: 40108066 PMCID: PMC12167243 DOI: 10.1007/s10388-025-01119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 03/10/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND Gastric tube prolapse into the thoracic cavity in retrosternal route reconstruction during esophagectomy is known as intrathoracic herniation of the gastric tube (IHGT). However, few reports have determined whether a correlation exists between IHGT and postoperative complications. Moreover, the optimal procedure for avoiding IHGT remains unclear. METHODS This retrospective study included 200 patients who had undergone subtotal esophagectomy and retrosternal gastric tube reconstruction at a single institution. The diagnosis of IHGT was defined as a gastric tube herniation length of ≥ 5 cm on plain chest radiography. The frequency of postoperative complications in patients with IHGT was measured to determine any correlation. The incidence of IHGT in a laparoscopic retrosternal route creation group was also measured and the efficacy of this procedure was investigated. RESULTS The overall incidence of IHGT was 7.5%. The incidence of grade II or higher anastomotic leakage and atelectasis was significantly higher in the IHGT( +) (anastomotic leakage, 26.7% vs. 4.3%, P = 0.007; atelectasis, 40.0% vs. 13.5%, P = 0.016). In univariate analysis, IHGT( +) showed a significantly higher incidence of anastomotic leakage (OR 7.88, P = 0.007). In multivariate analysis, IHGT was an independent risk factor for atelectasis (OR 5.03, P = 0.005). Furthermore, the incidence of IHGT was significantly lower in the laparoscopic group (2.0% vs. 13.0%, P = 0.005). CONCLUSION Our findings show that IHGT may be correlated with grade II or higher anastomotic leakage and atelectasis. Laparoscopic retrosternal route creation may be effective in avoiding IHGT and contributes to a reduction in postoperative complications.
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Affiliation(s)
- Yutaka Kishimoto
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Koji Otsuka
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan.
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan.
| | - Takeshi Yamashita
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Akira Saito
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Masahiro Kohmoto
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Kentaro Motegi
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Tomotake Ariyoshi
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Satoru Goto
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Masahiko Murakami
- Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - Takeshi Aoki
- Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan
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13
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Kawata S, Booka E, Honke J, Haneda R, Soneda W, Murakami T, Matsumoto T, Morita Y, Kikuchi H, Hiramatsu Y, Takeuchi H. Relationship of phase angle with postoperative pneumonia and survival prognosis in patients with esophageal cancer: A retrospective cohort study. Nutrition 2025; 135:112743. [PMID: 40203785 DOI: 10.1016/j.nut.2025.112743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 02/17/2025] [Accepted: 03/05/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVES Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is an indicator of cell membrane health. Low PhA values reflect poor cellular function and low muscle mass. However, consensus regarding the appropriate cutoff value of PhA remains insufficient, and its impact on outcomes after esophagectomy in patients with esophageal malignancies is not well studied. We aimed to investigate whether preoperative PhA is associated with postoperative complication risk and survival prognosis and whether PhA decrease during the surgical preparation period is a prognostic factor in patients with esophageal cancer. METHODS This retrospective cohort study analyzed data from 194 patients who had undergone esophagectomy for esophageal malignancies. A PhA measured several days before surgery, with cutoff values of 5.0° for men and 4.2° for women, was used. The relationship between postoperative pneumonia and clinicopathological factors and between low PhA and postoperative outcomes and survival prognosis was investigated. The preoperative PhA decline and survival prognosis were analyzed in 134 patients whose PhA was measured twice before surgery. RESULTS Overall, 93 and 101 patients were classified into the low and high PhA groups, respectively. A multivariate analysis showed that a serum albumin level lower than 3.5 g/dL and low PhA were independent risk factors for pneumonia (odds ratio [OR] = 3.40, P = 0.03; OR = 3.42, P = 0.03, respectively). The low PhA group exhibited significantly higher intraoperative fluid balance (6.7 versus 6.0 mL/kg/h, P = 0.01) and a higher proportion of patients who failed to achieve early mobilization on the first postoperative day (46 versus 32%, P = 0.04) than did the high PhA group. Multivariate analysis using a Cox proportional hazards model revealed that low PhA was a poor survival prognostic factor, independent of the clinical stage of esophageal cancer (hazard ratio = 2.61, P < 0.01). In patients whose PhA was measured twice preoperatively, a decrease in PhA during the preoperative period was a significant indicator of poor survival (hazard ratio = 2.59, P < 0.01). The group with a decrease in PhA during the preoperative period had significantly fewer steps than the group with an increase in PhA (6220 ± 2880 versus 8200 ± 2850, P < 0.01). CONCLUSIONS Low PhA was a risk factor for postoperative pneumonia in patients who had undergone esophagectomy and was associated with poor survival prognosis. A decrease in PhA during the preoperative period was a significant poor prognostic factor. Increasing physical activity before surgery may lead to an increase in PhA. Thus, it is important to measure and evaluate PhA changes sequentially in patients with esophageal cancer.
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Affiliation(s)
- Sanshiro Kawata
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Junko Honke
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryoma Haneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Wataru Soneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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14
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Chen X, Yang Z, Huang H, Xu C, Li G, Hu Y, Lin T, Yu J. Joint Nasogastric Tube Versus Traditional Decompression Nasogastric Tube to Guided OGT-Overlap Esophagojejunostomy in Laparoscopic Total Gastrectomy: A Randomized Controlled Trial. Ann Surg Oncol 2025; 32:5173-5182. [PMID: 40301205 DOI: 10.1245/s10434-025-17302-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 03/24/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy. OBJECTIVE We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy. METHODS From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53). RESULTS The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups. CONCLUSIONS The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.
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Affiliation(s)
- Xinhua Chen
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Zhijing Yang
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Huilin Huang
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Chuanjin Xu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
- Southern Medical University Nanfang Hospital, Guangzhou, China.
| | - Tian Lin
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
- Southern Medical University Nanfang Hospital, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
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15
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Lendoire M, Maki H, Haddad A, Jain AJ, Tran Cao HS, Chun YS, Tzeng CWD, Vauthey JN, Newhook TE. Parenchymal-sparing hepatectomy vs single-stage major hepatectomy for bilateral colorectal liver metastases: a higher rate of microscopically positive margins is not associated with increased local recurrence after parenchymal-sparing hepatectomy. J Gastrointest Surg 2025; 29:102070. [PMID: 40280465 DOI: 10.1016/j.gassur.2025.102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/04/2025] [Accepted: 04/20/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Surgeons may consider parenchymal-sparing hepatectomy (PSH) or major hepatectomy (MH) for patients with bilateral colorectal liver metastases (CLMs). This study aimed to evaluate the outcomes between PSH and MH for patients with extensive, bilateral CLMs. METHODS A prospective database was queried for patients with ≥5 bilateral CLMs who underwent R0-intent initial single-stage hepatectomy (1998-2022). The outcomes were compared between patients who underwent PSH and those who underwent MH (≥3 Couinaud segments). The median follow-up was 49 months. RESULTS Among 206 patients, 90 (44%) underwent PSH, and 116 (56%) underwent MH. Although the PSH cohort had smaller tumors than the MH cohort (median: 2.0 vs 3.5 cm, respectively; P =.001), there were no differences in the treatment approach or mutational status. Patients who underwent PSH had lower rates of posthepatectomy liver insufficiency than those who underwent MH (1% vs 13%, respectively; P =.030). PSH increased significantly during the study period, and more patients who underwent PSH had margin-positive resections (47% in the PSH group vs 30% in the MH group; P =.02). Across the study period, 173 patients (84%) had recurrence. Local recurrence rates (35% in the PSH group vs 28% in the MH group), median recurrence-free survival (RFS: 7 months in the PSH group vs 9 months in the MH group), and hepatic-specific disease-free survival (DFS: 8 months in the PSH group vs 14 months in the MH group) were similar, regardless of approach (all P >.3). When stratified by tumor number (5-7, 8-10, or ≥11), the rates of PSH, margin-positive resection, and local recurrence were comparable. Overall survival was similar between the PSH and MH groups (median: 59 vs 47 months, respectively; P =.072). CONCLUSION PSH was associated with increased rates of positive margins for patients with high-volume bilateral CLMs who underwent R0-intent hepatectomy. However, hepatic-specific DFS and RFS were comparable with patients with similar disease who underwent MH.
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Affiliation(s)
- Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Sędłak K, Bobrzyński Ł, Mlak R, Kołodziejczyk P, Pelc Z, Kobiałka S, Pawlik TM, Szczepanik A, Richter P, Sierżęga M, Polkowski WP, Rawicz-Pruszyński K. Proximal gastrectomy as an alternative to total gastrectomy in patients with advanced proximal gastric cancer: propensity score matching analysis of the 2-center study in European population. J Gastrointest Surg 2025; 29:102091. [PMID: 40381832 DOI: 10.1016/j.gassur.2025.102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 04/15/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Proximal gastric cancer (PGC) is more common in the West than in the East. Improvements related to the minimally invasive approach in GC surgery and benefits to quality of life may be reasons for adopting proximal gastrectomy (PG). This study aimed to compare short- and long-term oncologic and surgical outcomes among patients with PGC with advanced PGC undergoing total gastrectomy (TG) vs PG in 2 expert centers in a European population. METHODS Patients with locally advanced PGC treated between 2010 and 2020 were included in the study. Patients who had not undergone gastrectomy, had early or metastatic GC, underwent palliative care, or had incomplete clinical or pathologic information were excluded. Propensity score matching (PSM) analysis was used to balance known covariates. RESULTS After PSM, patients who underwent TG had a higher incidence of positive margins (19.1% vs 8.6%; P =.0064), a higher median number of harvested lymph nodes (LNs) (26 vs 18 LNs; P <.0001), and a higher incidence of serious postoperative complications (35.2% vs 20.4%; P =.0030) than individuals who underwent PG. Older age (≥65 years) was related to a higher risk of serious postoperative complications (odds ratio [OR], 1.91). The use of neoadjuvant chemotherapy was related to a lower risk of serious postoperative complications (OR, 0.36). TG was independently associated with a higher risk of serious postoperative complications (OR, 2.02). Median overall survival for PG and TG groups was 44 and 23 months, respectively (hazard ratio, 1.22; 95% CI, 0.94-1.60; P =.1340). CONCLUSION PG may be considered as an alternative approach to TG in well-selected patients with locally advanced PGC. This surgical approach was associated with fewer serious postoperative complications.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
| | - Łukasz Bobrzyński
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Piotr Kołodziejczyk
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Sebastian Kobiałka
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH, United States
| | - Antoni Szczepanik
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Richter
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Sierżęga
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Cai Y, Li H, Nan H, Xu P, Li J, Pan H, Wang H, Ge M, Guan J, Jiang Z, Wang G. Randomized Trial on Electroacupuncture for Recovery of Postoperative Gastrointestinal Function Based on Long-Term Monitoring Device. Ann Surg Oncol 2025; 32:5165-5172. [PMID: 40183888 PMCID: PMC12129847 DOI: 10.1245/s10434-025-17239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 03/09/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND This research aimed to explore the efficacy and safety of electroacupuncture in promoting the recovery of postoperative gastrointestinal function and to discuss the potential mechanism on the basis of heart rate variability (HRV). PATIENTS AND METHODS This was a randomized controlled study. Postoperative patients with gastric cancer received either electroacupuncture (EA) or sham electroacupuncture (SEA) 2 h after surgery and on the morning of the first 2 days after surgery, with each session lasting 30 min. The acupoints, treatment timepoints, and treatment durations in the SEA group were kept consistent with those in the EA group, but the intervention was SEA. Both groups were equipped with artificial intelligence HRV monitoring devices to monitor perioperative HRV and continuous bowel sound auscultation recorders to monitor perioperative bowel sound recovery in real time. Gastrointestinal function recovery indicators, HRV indicators, inflammatory markers, the incidence of postoperative complications, and adverse events were analyzed. RESULTS There was no statistically significant difference (P > 0.05) in baseline. First flatus time, first oral feeding time, intestinal function recovery time, and length of postoperative hospitalization of EA group were better than those of the SEA group, (P < 0.05). On day 3 after surgery, in EA group, C-reactive protein, interleukin-1 beta (IL-1β) were lower than those in SEA group (P < 0.05). HRV indicators such as standard deviation of the average NN intervals, percentage of successive RR intervals that differ by more than 50 ms (PNN50), and high frequency were higher in EA group than those in SEA group (P < 0.05). CONCLUSIONS EA can safely and effectively promote gastrointestinal function rehabilitation in postoperative patients with gastric cancer, whose mechanism may be associated with higher tension in the vagus nerve, affected by EA.
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Affiliation(s)
- Yuling Cai
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haoyang Li
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haiou Nan
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Pengyan Xu
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jiayu Li
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huafeng Pan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haifeng Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Miaomiao Ge
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Junjie Guan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhiwei Jiang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gang Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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Chen QX, Zhang YB, Zeng WM, Cai YC, Lv CB, Lian MQ, Huang RJ, Lian MJ, Lian WL, Xu QH, Sun YQ, Cai LS. Efficacy and safety of sintilimab combined with nab-paclitaxel plus S-1 for neoadjuvant treatment of locally advanced gastric cancer. World J Gastrointest Surg 2025; 17:106361. [DOI: 10.4240/wjgs.v17.i6.106361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/28/2025] [Accepted: 05/13/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Gastric cancer is a leading global cause of cancer mortality, with poor survival in locally advanced stages. While immune checkpoint inhibitors (ICIs) like sintilimab have improved outcomes in advanced disease, their role as neoadjuvant therapy remains understudied. This study investigates sintilimab combined with nab-paclitaxel/S-1 as preoperative treatment for locally advanced gastric cancer (LAGC), addressing an unmet need for effective neoadjuvant strategies.
AIM To explore the efficacy and safety of combination treatment with sintilimab and nab-paclitaxel plus S-1 as neoadjuvant therapy for LAGC.
METHODS Clinical data from 82 patients diagnosed with LAGC, who underwent preoperative treatment and surgery between April 2020 and December 2022, were included. Patients were divided into 2 groups according to treatment regimen: ICI (sintilimab + nab-paclitaxel + S-1; and non-ICI (nab-paclitaxel + S-1). Imaging and pathological efficacy, intra- and postoperative conditions, molecular subtypes, short-term survival outcomes, and safety were compared between the 2 groups.
RESULTS Imaging evaluation of therapeutic efficacy revealed that the inclusion of ICI yielded a significantly higher complete response rate (13.2% vs 0.0%; P = 0.048), and objective response rate (69.8% vs 31.0%, P = 0.001) compared with non-ICI treatment. Pathological evaluation revealed that the ICI group exhibited a significantly higher pathological complete response rate (13.2% vs 0.0%; P = 0.048) and major pathological response rate (35.8% vs 13.8%; P = 0.041) than those in the non-ICI group. The two-year disease-free survival rate in the ICI group was greater than that in the non-ICI group (83.0% vs 55.2%; P = 0.043). The use of ICI did not increase the incidence of adverse reactions (47.2% vs 41.4%; P = 0.614) or perioperative adverse events (18.9% vs 13.8%; P = 0.761).
CONCLUSION The combination of sintilimab with nab-paclitaxel + S-1 for neoadjuvant treatment of LAGC improved efficacy in patients without increasing adverse drug reactions and perioperative adverse events, suggesting that this treatment regimen is safe and feasible.
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Affiliation(s)
- Qiu-Xian Chen
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Yong-Bin Zhang
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Wei-Ming Zeng
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Yi-Chen Cai
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing 211816, Jiangsu Province, China
| | - Chen-Bin Lv
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Ming-Qiao Lian
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Rong-Jie Huang
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Ming-Jie Lian
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Wei-Long Lian
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Qian-Hui Xu
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Yu-Qin Sun
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Li-Sheng Cai
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
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Tulahong A, Zhu DL, Liu C, Jiang TM, Zhang RQ, Tuergan T, Aji T, Shao YM. Simultaneous combined surgery for hepatic-renal double organ alveolar or cystic echinococcosis: A retrospective study. World J Gastrointest Surg 2025; 17:105007. [DOI: 10.4240/wjgs.v17.i6.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/19/2025] [Accepted: 03/20/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections, leading to alveolar echinococcosis (AE) or cystic echinococcosis (CE), respectively. No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.
AIM To investigate the feasibility and efficacy of simultaneous combined surgery (SCS) as a comprehensive treatment approach for patients with hepatorenal echinococcosis.
METHODS Clinical datasets of hepatorenal AE (n = 10) and CE (n = 11) patients were retrospectively collected and systematically analyzed. The SCS approach was introduced, and surgical outcomes, complications, and prognoses were documented in detail.
RESULTS The SCS approach incorporated hybridized techniques, including partial hepatectomy, partial or total nephrectomy, ex vivo liver resection and autotransplantation, and total or subtotal cystectomy with endocystectomy. Radical SCS was achieved in 100% of AE patients and 63.6% of CE patients. All surgeries were completed without intraoperative complications. The short-term complication rate was 28.6% (Clavien-Dindo classification: AE-1 IIIb, 3 IIIa; CE-2 II), while the long-term complication rate was 4.8% (Clavien-Dindo classification: AE-1 IIIb). Patients were followed up for a median of 37 months (AE: 6-81 months; CE: 34-123 months), with no reported deaths or disease relapses.
CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE. It fulfills the management criteria for advanced AE or CE cases, aiming to maximize patient benefits.
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Affiliation(s)
- Alimu Tulahong
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Da-Long Zhu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Chang Liu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tie-Min Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Ying-Mei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Farina Junior MA, Utz-Melere M, da Silva CS, Nader LS, Trein CS, Lucchese AM, Machry M, Mariano R, Ferreira CT, Kalil AN, Feier FH. Ten years of a pediatric living donor liver transplantation program in Brazil. World J Transplant 2025; 15:98616. [DOI: 10.5500/wjt.v15.i2.98616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 11/15/2024] [Accepted: 12/11/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease. Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.
AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.
METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023. Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.
RESULTS A total of 25 and 48 patients underwent transplantation in the first (2013-2017) and second period (2018-2023), respectively. Portal vein and hepatic artery thrombosis occurred in 11 (15.1%) and seven (9.6%) patients, respectively. Biliary complications were observed in 39 of 73 patients (53.4%). A lower warm ischemia time was observed in the second period compared to the first (32.6 ± 8.6 minutes vs 38.4 ± 9.8 minutes, P = 0.018, respectively). Patient survival rates at 1 and 5 years were 84% in the first period and 91.7% in the second period, with no significant difference (P = 0.32).
CONCLUSION The reported indications and outcomes align with the current literature. Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.
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Affiliation(s)
- Marco Aurélio Farina Junior
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Melina Utz-Melere
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Carolina Soares da Silva
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Luiza Salgado Nader
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Cristine Suzana Trein
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Angelica Maria Lucchese
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Mayara Machry
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Rodrigo Mariano
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Cristina Targa Ferreira
- Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Antônio Nocchi Kalil
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Department of Surgical Oncology, Santa Rita Hospital/Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Flávia Heinz Feier
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
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21
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Hiramitsu T, Himeno T, Shimamoto Y, Hasegawa Y, Futamura K, Okada M, Ichimori T, Watarai Y, Narumi S. Perioperative Severe Complications Can Cause Pancreatic Graft Failure and Mortality in Pancreas Transplantation. Transplant Proc 2025:S0041-1345(25)00278-7. [PMID: 40517104 DOI: 10.1016/j.transproceed.2025.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 02/14/2025] [Accepted: 05/25/2025] [Indexed: 06/16/2025]
Abstract
BACKGROUND Pancreas transplantation (PTx) is a radical treatment for type 1 diabetes, frequently associated with complications. Herein, we examined the impact of severe perioperative complications on pancreatic graft and recipient survival. METHODS Between January 2010 and December 2024, 40 patients with type 1 diabetes underwent PTx: 35 underwent simultaneous PTx and kidney transplantation, and 5 underwent PTx after kidney transplantation. Pancreatic graft and recipient survival rates were compared between recipients with and without severe perioperative complications defined by grades more severe than grade Ⅱ in the Clavien-Dindo classification, using the Kaplan-Meier survival curve and log-rank tests. RESULTS Although severe perioperative complications were identified in 12 recipients (30.0%), no perioperative mortality was observed. Pancreatic graft failure and mortality occurred in 4 (33.3%) and 3 (25.0%) recipients, respectively, along with severe perioperative complications. In contrast, in recipients without severe perioperative complications, pancreatic graft failure and mortality occurred in 3 (10.7%) and 1 (3.6%) recipients, respectively. Pancreatic graft failure and recipient mortality were significantly higher in recipients with severe perioperative complications than in those without severe perioperative complications (P = .024 and P = .017, respectively). CONCLUSION Severe perioperative complications can result in pancreatic graft failure and mortality. Appropriate surgical interventions are required to prevent severe perioperative complications.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
| | - Tomoki Himeno
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yuki Shimamoto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yuki Hasegawa
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
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Su S, Lin Z, Cai Z, Huang L, Xiao Y, Yang F, Huang X, Chen Y, Zheng Z, Li X, Huang R. Preoperative CT-derived sarcopenia as a predictor of postoperative complications in patients undergoing laparoscopic radical resection for non-metastatic colorectal cancer: a retrospective study. Int J Colorectal Dis 2025; 40:140. [PMID: 40517183 PMCID: PMC12167240 DOI: 10.1007/s00384-025-04932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2025] [Indexed: 06/16/2025]
Abstract
PURPOSE Sarcopenia is increasingly recognized as a risk factor for postoperative complications in gastrointestinal cancer surgery. This study aimed to assess the association between sarcopenia and postoperative complications following laparoscopic radical resection of non-metastatic colorectal cancer (CRC). METHODS In this retrospective study, 387 non-metastatic CRC patients undergoing laparoscopic radical resection were categorized into a sarcopenic group and a non-sarcopenic group based on preoperative skeletal muscle index (SMI, cm2/m2). Logistic regression analysis was performed to identify independent predictors for postoperative complications. RESULTS Sarcopenia was present in 156 (40.31%) patients. The incidence of postoperative complications was 32.3%, with a serious complication (Clavien-Dindo III-V) rate of 12.1%. Compared with non-sarcopenic patients, sarcopenic patients had significantly higher incidences of total complications (P < 0.001) and severe complications (P = 0.026). Multivariable analysis identified sarcopenia as an independent risk factor for total postoperative complications (OR = 3.42, 95%CI 1.85-6.31). Further analysis of specific types of postoperative complications revealed that anastomotic leakage (P = 0.001), surgical site infection (P = 0.002), and surgical site adverse events (P = 0.001) rates were higher in sarcopenic patients. In multivariable analysis, sarcopenia was independently associated with anastomotic leakage (OR = 3.36, 95%CI = 1.12-10.12) and surgical site adverse events (OR = 3.02, 95%CI = 1.55-5.90). CONCLUSIONS Preoperative CT-derived sarcopenia can predict postoperative complications in patients with non-metastatic CRC undergoing laparoscopic radical resection, particularly anastomotic leakage and surgical site adverse events.
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Affiliation(s)
- Shuyan Su
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zejia Lin
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zelong Cai
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Lipeng Huang
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yubin Xiao
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Fangjie Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xiujie Huang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Yikai Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhuoqun Zheng
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xinxin Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Ruibin Huang
- Department of Radiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China.
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23
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Alfarawan F, Qaneer BAFA, Vincke A, Bockhorn M, El-Sourani N. Short-term outcomes of robotic eTEP versus TAPP for ventral hernia repair: insights from a propensity-matched cohort. J Robot Surg 2025; 19:292. [PMID: 40517208 PMCID: PMC12167236 DOI: 10.1007/s11701-025-02439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Accepted: 05/28/2025] [Indexed: 06/16/2025]
Abstract
Robotic ventral hernia repair (rVHR) is an advanced form of minimally invasive surgery that offers enhanced precision, reduced complications, and faster recovery time. However, direct comparisons between enhanced-view totally extraperitoneal (eTEP) and transabdominal preperitoneal (TAPP) approaches remain limited. This study aimed to compare the safety and clinical outcomes of eTEP and TAPP in rVHR. In this retrospective cohort study, 117 patients underwent rVHR (82 eTEP, 35 TAPP) between 2023 and 2024. Propensity score matching (PSM) (1:1) balanced baseline characteristics, resulting in 33 patients per group. Patient demographics, operative data, and postoperative outcomes were collected from electronic medical records. Statistical analyses were conducted using SPSS, with statistical significance defined as p < 0.05. Following matching, eTEP demonstrated significantly longer operative times (median 115 vs. 83 min, p = 0.004) and larger mesh sizes (420 cm2 vs. 195 cm2, p = 0.001). Surgical drains were more frequently used in eTEP (48.4% vs. 3%, p = 0.001). Postoperative outcomes, length of hospital stay, and pain scores did not differ significantly between the groups. Surgical site occurrences (SSOs) showed no significant difference between groups (18.1% eTEP vs. 9% TAPP, p = 0.475). Both eTEP and TAPP are safe and effective robotic approaches for ventral hernia repair with comparable clinical outcomes. The longer operative time and larger mesh size in eTEP suggests its preferential use in more complex hernia cases requiring detailed anatomical reconstruction.
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Affiliation(s)
- Fadl Alfarawan
- Universitätsklinik für Allgemein - und Viszeralchirurgie, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Rahel-Strauss-Str. 10, 26133, Oldenburg, Germany
| | - Baha Aldeen Faraj Ali Qaneer
- Carl von Ossietzky Universität Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Anna Vincke
- Universitätsklinik für Allgemein - und Viszeralchirurgie, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Rahel-Strauss-Str. 10, 26133, Oldenburg, Germany
| | - Maximilian Bockhorn
- Universitätsklinik für Allgemein - und Viszeralchirurgie, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Rahel-Strauss-Str. 10, 26133, Oldenburg, Germany
- Carl von Ossietzky Universität Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Nader El-Sourani
- Universitätsklinik für Allgemein - und Viszeralchirurgie, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Rahel-Strauss-Str. 10, 26133, Oldenburg, Germany.
- Klinik für Allgemein-, Viszeral - und Transplantationschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Munster, Germany.
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24
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Gallo E, Zarfati A, Hameury F, Rossignol G, Gelas T, Dubois R, Tulelli B. Laparoscopic "TOUSSEN" fundoplication for pediatric gastroesophageal reflux disease: a new modified technique gentle as Toupet and solid as Nissen? Pediatr Surg Int 2025; 41:162. [PMID: 40493216 DOI: 10.1007/s00383-025-06057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2025] [Indexed: 06/12/2025]
Abstract
AIMS Existing fundoplication techniques, although effective, may present drawbacks as dysphagia and recurrence. This study presents a new modified Laparoscopic Toussen (TOUpet-niSSEN) Fundoplication (LTF) developed to reduce the risk of dysphagia and recurrence. We aim to report its safety, feasibility and efficacy in the treatment of pediatric Gastroesophageal Reflux Disease (GERD). METHODS A retrospective study was performed on the clinical data, surgical procedures, and follow-up of a cohort of consecutive patients who received LTF at our tertiary center from 2010 to 2023. The LTF combines a 270° Toupet valve at the upper section and a 360° Nissen valve at the lower section. The exclusion criteria encompassed age over 18 years and patients referred for a redo fundoplication. The diagnosis was based on symptoms and radiological/additional exams, corroborated by a multidisciplinary meeting. RESULTS Over a span of 13 years, we treated 219 patients (average of 16 LTF each year), including 49 (22%) with neurological impairment and 13 (6%) with esophageal atresia. The median age at surgery was 5.5 years (range: 1.1-17.5 years), and the median weight 18.2 kg (range: 5.5-80 kg). Gastrostomy was performed in 33 instances (15%). The median duration was 70 min (range: 44 to 177 min). No patient required conversion to laparotomy. Intraoperative problems were observed in 0.4% of patients. During the first postoperative month, 13 early complications occurred (6%): 8 dysphagia, 1 bronchopneumonia, 1 removal of the gastrostomy button, 1 bleeding from trocar orifice, 1 umbilical incisional hernia, and 1 self-limiting neurological symptom. The median duration of hospitalization was 2 days (range: 1-45 days). Overall, we monitored 190 patients for at least 6 months, with a median follow-up of 4.5 years (range: 0.6-11 years). Four patients (2%) required additional surgical intervention: two laparoscopic partial valve releases, one redo fundoplication, and one incisional hernia repair. CONCLUSIONS In this first analysis of the short- and medium-term outcomes, LTF seemed safe and efficacious for the treatment of pediatric GERD. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Emanuela Gallo
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
- University of Genoa, DINOGMI, Genoa, Italy
| | - Angelo Zarfati
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
- University of Tor Vergata, Rome, Italy.
| | - Frederic Hameury
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Guillaume Rossignol
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Thomas Gelas
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Remi Dubois
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Berenice Tulelli
- Department of Pediatric Surgery and Transplantation, Hospital Femme Mere Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
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25
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Hanaki T, Goto K, Tokuyasu N, Endo Y, Sunada H, Noma H, Kishino M, Yagyu T, Uchinaka E, Murakami Y, Miyatani K, Kihara K, Matsunaga T, Yamamoto M, Sakamoto T, Hasegawa T, Fujiwara Y. Systemic indocyanine green administration to detect bile leakage after liver surgery: a prospective clinical trial, using historical controls. BMJ Open 2025; 15:e097205. [PMID: 40499957 PMCID: PMC12161367 DOI: 10.1136/bmjopen-2024-097205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 05/20/2025] [Indexed: 06/18/2025] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of intraoperative indocyanine green (ICG) assessment and subsequent interventions on the total bilirubin concentration in postoperative drainage fluid after hepatectomy. Specifically, this study was conducted to determine whether systemic ICG administration and near-infrared (NIR) imaging to detect and address bile leakage (BL) during liver surgery could improve postoperative outcomes in an intervention group compared with a historical control group. DESIGN This was a prospective clinical trial with historical controls that involved inverse probability of treatment weighting (IPTW) analysis to adjust for potential confounding biases resulting from nonrandomised treatment assignments. SETTING Tottori University Hospital, Japan. PARTICIPANTS This study included 84 participants who were undergoing hepatectomy. Among these participants, 40 were prospectively enrolled in the intervention group. The remaining 44 participants underwent hepatectomy without ICG-based assessment or interventions and served as historical controls. INTERVENTION In the intervention group, 10 mg of ICG was intravenously administered before liver parenchymal dissection. After hepatic dissection, the resection plane was evaluated and treated as necessary via NIR imaging to detect and address BL. PRIMARY OUTCOME MEASURE The primary outcome measure was the total bilirubin concentration in the drainage fluid on postoperative day 3 (POD 3). RESULTS According to the IPTW analysis, the total bilirubin concentration in the drainage fluid on POD 3 was significantly lower in the intervention group than in the historical control group. The adjusted mean difference was -1.11 mg/dL (95% CI: -1.49 to -0.72; p<0.001). No adverse events or side effects related to ICG administration were reported in the intervention group, indicating both the efficacy and safety of this approach in reducing postoperative bilirubin levels. CONCLUSIONS Intraoperative ICG administration and assessment effectively lower bilirubin levels in drainage fluid during hepatectomy, potentially reducing the incidence of BL. TRIAL REGISTRATION NUMBER jRCTs061210043.
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Affiliation(s)
- Takehiko Hanaki
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
- Department of Medical Education, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Keisuke Goto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Naruo Tokuyasu
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Yusuke Endo
- Department of Advanced Medicine, Innovation, and Clinical Research Centre, Tottori University Hospital, Yonago, Tottori, Japan
| | - Hiroshi Sunada
- Department of Advanced Medicine, Innovation, and Clinical Research Centre, Tottori University Hospital, Yonago, Tottori, Japan
| | - Hisashi Noma
- Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Mikiya Kishino
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Takuki Yagyu
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Ei Uchinaka
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Yuki Murakami
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kozo Miyatani
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kyoichi Kihara
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Tomoyuki Matsunaga
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Manabu Yamamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Teruhisa Sakamoto
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Toshimichi Hasegawa
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Department of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
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26
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Kahn AE, Geldmaker LE, Qosja N, Haehn DA, Fuqua TF, Tiwari V, Hochwald A, Thomas CS, Thiel DD. Assessing Renal Function Recovery Following Treatment for Post-Robot-Assisted Partial Nephrectomy Renal Artery Pseudoaneurysm. J Endourol 2025. [PMID: 40491414 DOI: 10.1089/end.2025.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2025] Open
Abstract
Introduction: To evaluate the impact of the treatment for renal artery pseudoaneurysm (RAP) on long-term renal function after robot-assisted partial nephrectomy (RAPN). Materials: We retrospectively reviewed 581 consecutive RAPNs performed by a single surgeon from February 2008 to February 2022. We evaluated patient variables, postoperative complications, and renal function at postoperative day one, 1 month, and 6 months after RAPN. Renal function was defined as estimated glomerular filtration rate (eGFR) based on the chronic kidney disease epidemiology collaboration Cr 2009 equation. We utilized the Fisher's exact test and Kruskal-Wallis rank sum test to analyze our data through categorical and continuous variables. Results: Twenty-one patients (3.61%) developed a symptomatic RAP after RAPN that was treated with Interventional Radiology embolization. Patients with a RAP had a median age of 61.8 years (IQR: 53.5-69.7), median preoperative eGFR of 83.9 (IQR: 69.5-85.2), median BMI of 29.4 (IQR: 25.4-33.1), and median mass size of 3 cm (IQR: 2.5-4.2). There was no statistical difference in baseline characteristics between patients with RAP and patients without RAP. Patients with RAP had a longer length of stay (LOS) (3.0 IQR: 2.0-4.0 vs 2.0 IQR: 2.0-3.0). Patients with a RAP had a larger change in absolute eGFR value based on the difference from baseline to 1 month and 6 months (1 month: 20.5 vs 11.2, p < 0.001; 6 months: 18.1 vs 10.4, p = 0.001). RAP patients were also less likely to be within 10% of pre-RAPN levels (1 month: 24% vs 49%, p = 0.021; 6 months: 18% vs 47%, p = 0.016). Conclusions: Patients treated for RAP post-RAPN had a decrease in renal function recovery at 1 month and 6-month intervals compared to patients not requiring post-RAPN RAP treatment.
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Affiliation(s)
- Amanda E Kahn
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Laura E Geldmaker
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Neda Qosja
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Daniela A Haehn
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Taylor F Fuqua
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Vartika Tiwari
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Alex Hochwald
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Colleen S Thomas
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA
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27
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Monti S, Brandao F, Drudi D, Ifteme CV, Van Goethem B, Sommaruga P, Massari F. Near-infrared fluorescence-guided minimally invasive surgery for iliosacral lymph node removal in 18 dogs (2023-2025). Vet Surg 2025. [PMID: 40492451 DOI: 10.1111/vsu.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 05/15/2025] [Accepted: 05/20/2025] [Indexed: 06/12/2025]
Abstract
OBJECTIVE To describe laparoscopic extirpation of iliosacral lymph nodes (ISLNs) in tumor-bearing dogs using near-infrared fluorescence (NIRF) guidance with indocyanine green (ICG), detailing the surgical technique and complications. STUDY DESIGN Retrospective case series. ANIMAL POPULATION A total of 18 client-owned dogs. METHODS Medical records of dogs that underwent laparoscopic ISLN excision with NIRF-ICG guidance between July 2023 and January 2025 were reviewed. Collected data included tumor location and histotype, sentinel lymph node (SLN) identified on preoperative computed tomography (CT) lymphangiography, and number, size, and metastatic status of the excised ISLNs. Complications were classified as intra- or postoperative and graded using a modified Clavien-Dindo system. RESULTS A total of 25 ISLNs were laparoscopically excised: 18 medial iliac, three internal iliac, and four sacral. All patients were positioned in lateral recumbency, and resected ISLNs were ipsilateral to the primary tumor and laparoscopic ports. Median laparoscopic dissection time was 12 min. Histopathology confirmed metastasis in 12/25 ISLN. Median size of the excised ISLN was 5 × 6 mm. Two dogs (11.1%) required conversion to open surgery: one due to LN capsular disruption and dye spread, and one due to a lack of ICG uptake. No postoperative complications were documented. CONCLUSION Laparoscopic ISLN removal under NIRF-ICG using a standardized lateral recumbency approach is feasible and enables access to unilateral ISLN. Intraoperative fluorescence facilitates precise localization of target nodes, especially those of normal size or mildly enlarged, minimizing dissection-related damage. CLINICAL RELEVANCE This technique supports accurate staging of various neoplasms in dogs. Further studies are warranted to refine indications and patient selection.
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Affiliation(s)
| | - Fausto Brandao
- AniCura Atlântico - Hospital Veterinario, Mafra, Portugal
| | - Dario Drudi
- "DocVet" Clinica Veterinaria Nervianese, Milan, Italy
| | - Constantin V Ifteme
- Centru de Endoscopie si Chirurgie Minim Invaziva Veterinara, Bucharest, Romania
| | - Bart Van Goethem
- Small Animal Teaching Hospital, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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28
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Achour Y, Sekkat H, Moufid A, El Hamzaoui J, El Fakir S, Bakali Y, Alaoui MM, Raiss M, Sabbah F, Hrora A. Retrospective analysis of curative rectal cancer surgery outcomes in elderly patients. Sci Rep 2025; 15:19917. [PMID: 40481132 PMCID: PMC12144196 DOI: 10.1038/s41598-025-91088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 02/18/2025] [Indexed: 06/11/2025] Open
Abstract
Colorectal cancer is the third most common cancer worldwide. Elderly patients, typically defined as those over 70 years, face a heightened risk of developing colorectal cancer as they age, and the proportion of elderly individuals affected by cancer will continue to increase. However, the current guidelines lack optimal treatment recommendations for the elderly and there is a scarcity of clinical trial evidence of clinical trial evidence addressing rectal cancer in this group. Retrospective data was extracted from patients aged 18 and who underwent curative surgery for rectal cancer. A total of 71 patients were included and divided into two groups: an elderly group (EG), comprising patients aged over 70, and a younger group (YG). Age, sex, ASA score, comorbidities, surgical treatments and post-operative morbidity and mortality were extracted from patients 'files. The study population included 55 patients (77.46%) in the YG, and 16 patients (22.54%) in the EG. The cohort consisted of 30 men (42.3%) and 41 women (57.7%), with an average age of 57.1 ± 14.6. Comorbidities were present in 37 patients (52.1%), and 53 patients (74.6%) presented advanced-stage rectal cancer. Of the total cohort, 9 patients underwent primary surgery, while 62patients (87.3%) received neoadjuvant therapy. Laparoscopic surgery was employed in 63 patients (86.6%), with 8 cases (12.69%) of conversion to open surgery. Thirty-seven patients (52.1%) required stomas, of which 11 (16.7%) were definitive. Postoperative morbidity was higher in the EG (50%) compared to the YG (21.81%) with severe complication rate at 12.5% and 7.27%, respectively. Anastomotic leakage rate was similar in both groups (EG = 12.5% vs YG = 3.6.). However, the post-operative mortality rate was significantly higher in the EG (2.81% vs 0%). Within 90 days postoperatively, 6 readmissions were recorded, with a severe morbidity rate (Clavien-Dindo > 2) of 12.3% and a 90-day mortality of 4.2%. Curative surgery for rectal cancer in elderly patients appears to present more difficulties to manage preoperatively, and presents more postoperative mortality, requiring a tailored approach that considers the specific clinical features and functional status of this population.
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Affiliation(s)
- Youssef Achour
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
| | - Hamza Sekkat
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdellah Moufid
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Jihane El Hamzaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Samira El Fakir
- Statistics Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Younes Bakali
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mouna Mhamdi Alaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Farid Sabbah
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
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29
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Zhan F, Jiang C, Yang L, Zhang Y, Zhang M, Zhang K, Shen Z, Shen Z, Chen X, Zhang Y. Primary closure with self-disengaging biliary stent following laparoscopic CBD exploration in normal-diameter ducts: a propensity score matching study. Sci Rep 2025; 15:19959. [PMID: 40481100 PMCID: PMC12144154 DOI: 10.1038/s41598-025-04949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 05/29/2025] [Indexed: 06/11/2025] Open
Abstract
Laparoscopic Common Bile Duct Exploration (LCBDE) is highly effective for treating common bile duct stones (CBDS). This study aims to evaluate the safety and feasibility of primary closure with a self-disengaging biliary stent during LCBDE in patients with normal-diameter CBDs (≤ 8 mm) and to compare perioperative outcomes and complications with those in dilated CBDs (> 8 mm). From May 2022 to May 2024, patients with CBDSs who underwent LCBDE with primary closure and a self-disengaging biliary stent were retrospectively analyzed. Patients were stratified into two subgroups based on CBD diameter (normal: ≤8 mm vs. dilated: >8 mm). Propensity score matching (PSM) was adjusted for baseline differences between normal and dilated CBD groups, and perioperative indicators and postoperative complications were compared. Multivariate analysis identified risk factors for postoperative bile leakage. Of 491 patients, 343 underwent primary closure with a self-disengaging biliary stent during LCBDE. The mean operation time was 85 (IQR 70-110) min, with blood loss of 20 (IQR 15-20) ml. The postoperative hospital stay was 8 (IQR 8-10) days, and the hospitalization cost was CNY 28,143 (IQR 25,522-32,809). The overall complication rate was 32 (9.3%), with 25 (7.3%) experiencing bile leakage. The Charlson Comorbidity Index (CCI) score was an independent risk factor for bile leakage (OR 2.587; 95% CI 1.729-3.873, P < 0.001). PSM of dilated (> 8 mm, n = 225) and normal (≤ 8 mm, n = 118) CBD groups resulted in 114 matched pairs. No significant differences were observed in operative time, blood loss, hospital stay, costs, or complications between the groups. Primary closure with a self-disengaging biliary stent following LCBDE is equally safe and effective in patients with normal-diameter CBDs as in those with dilated ducts. CBD diameter should not be a contraindication for this technique. The CCI score is a critical predictor of bile leakage and should be considered in perioperative risk assessment.
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Affiliation(s)
- Feng Zhan
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Chao Jiang
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Lixia Yang
- Department of Gynaecology and Obstetrics, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Yu Zhang
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Miao Zhang
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Kai Zhang
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Zhenghai Shen
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Zhenwei Shen
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China
| | - Xiang Chen
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China.
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China.
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China.
| | - Yun Zhang
- Department of general Surgery, Yixing People's Hospital, Yixing, 214200, Jiangsu, China.
- Yixing Hospital Affiliated to Jiangsu University, Wuxi, 214200, Jiangsu, China.
- Yixing Branch of Wuxi Medical Center of Nanjing Medical University, Wuxi, 214200, Jiangsu, China.
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Yu Y, Liang R, Xue Y, Li D, Li S, Xia S, Sun J, Luo J, Chen H, Qin J, Li Y, Wang Z. Mechanical bowel preparation versus no bowel preparation for oesophageal cancer surgery: a multicentre, randomized, parallel, open-labelled trial. Eur J Cardiothorac Surg 2025; 67:ezaf182. [PMID: 40471745 DOI: 10.1093/ejcts/ezaf182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 04/29/2025] [Accepted: 06/04/2025] [Indexed: 06/18/2025] Open
Abstract
OBJECTIVES To compare post-operation influence between mechanical bowel preparation (MBP) and no MBP (NBP) before surgery for patients with oesophageal cancer. METHODS In this multicentre, parallel, open-labelled trial, eligible patients who were prepared to undergo oesophagectomy in 3 hospitals in China were randomly assigned (1:1) to an MBP or NBP group. Patients allocated to the MBP group prepared their bowel by drinking 3-4 l of polyethylene glycol dissolved in water the day before surgery. Patients in the NBP group did not receive MBP. The primary outcome was the incidence of major complications during or within 30 days after surgery. RESULTS Between 20 September 2022 and 30 April 2023, 652 patients were recruited (326 patients were randomized to MBP and 326 patients were randomized to NBP), with 612 patients included in the final analyses (311 patients for MBP and 301 patients for NBP). Risk difference (RD) was -2.6% between the 2 groups (29.9% in NBP vs 32.5% in MBP), and the relative risk (RR) was 0.92 [97.5% confidence interval (CI) 0.727-1.165]. The upper limit of the 1-sided 97.5% CI for RD was 4.73%, and the upper limit for RR was 1.165, both lower than the predefined non-inferiority margins (Δ = 10% for RD; threshold = 1.308 for RR). No significant differences of CCI were observed; CCI was similar between the 2 groups (15.6 in MBP vs 15.1 in NBP). Ten items in EORTC QLQ-C30 were better in the MBP group than in the NBP group in the 7 days after the operation (P < 0.05). No statistical differences were found in the EORTC OES-18 results between the 2 groups. CONCLUSIONS This study confirms that in preoperative preparation for oesophageal cancer surgery, the non-inferiority of NBP is established both by the RD and the RR. These results collectively support the safety of omitting MBP and provide robust evidence for simplifying preoperative protocols.
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Affiliation(s)
- Yuan Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Liang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yibo Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfang Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuxin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siqiu Xia
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji Luo
- Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Hongna Chen
- Department of Thoracic Surgery, the First Hospital of Handan, Handan, China
| | - Jianjun Qin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Can U, Dinçer E, Coşkun A, Mert MS, Çanakçı C, Göktaş C. A Pragmatic Randomized Trial Comparing Suturing Techniques for Vesicourethral Anastomosis: One-Year Voiding Function Outcomes After Radical Prostatectomy. J Clin Med 2025; 14:3934. [PMID: 40507695 PMCID: PMC12156946 DOI: 10.3390/jcm14113934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2025] [Revised: 05/11/2025] [Accepted: 05/31/2025] [Indexed: 06/16/2025] Open
Abstract
Background: Vesicourethral anastomosis (VUA) is a critical step in radical prostatectomy (RP), with interrupted suture (IS) and running suture (RS) as common techniques. However, there is no conclusive evidence suggesting the superiority of one technique over the other regarding voiding function. This study compares their effects on voiding function and continence recovery after retropubic RP. Methods: A two-group, parallel-design study included 70 patients with localized prostate cancer (pT1-pT2) undergoing retropubic RP by a single surgical team. Patients were randomized to VUA with IS (n = 35) or RS (n = 35). The primary outcomes included uroflowmetry parameters-maximum flow rate (MFR), voiding volume (VV)-post-void residual volume (PVR), urinary function assessed by the International Prostate Symptom Score (IPSS), and continence recovery. These outcomes were measured preoperatively and at 1, 3, 6, and 12 months post-surgery. Secondary outcomes included surgical parameters, perioperative complications and one-year oncological outcomes. Results: Suturing time was shorter for RS than IS (21 vs. 33 min, p = 0.001). Minimal anastomotic leakage occurred more frequently in the IS group (23% vs. 9%), while long-term anastomotic stenosis rates were comparable between RS and IS groups (12% vs. 9%). IS demonstrated significantly higher MFR at 1-month post-surgery (23.3 vs. 17.2 mL/s, p = 0.003). In subsequent follow-ups (3, 6, and 12 months), the mean MFR remained higher in the IS group, though without statistical significance. Logistic regression favored IS for early MFR outcomes (OR 4.16; 95% CI, 1.22-14.18; p = 0.023). Continence recovery and IPSS scores were similar between groups. Conclusions: Both techniques are effective and safe. RS reduces suturing time and leakage risk, while IS improves early postoperative MFR.
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Affiliation(s)
- Utku Can
- Department of Urology, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, 34865 Istanbul, Türkiye; (E.D.); (A.C.); (M.S.M.); (C.Ç.)
| | - Erdinç Dinçer
- Department of Urology, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, 34865 Istanbul, Türkiye; (E.D.); (A.C.); (M.S.M.); (C.Ç.)
| | - Alper Coşkun
- Department of Urology, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, 34865 Istanbul, Türkiye; (E.D.); (A.C.); (M.S.M.); (C.Ç.)
| | - Mahmut Selman Mert
- Department of Urology, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, 34865 Istanbul, Türkiye; (E.D.); (A.C.); (M.S.M.); (C.Ç.)
| | - Cengiz Çanakçı
- Department of Urology, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, 34865 Istanbul, Türkiye; (E.D.); (A.C.); (M.S.M.); (C.Ç.)
| | - Cemal Göktaş
- Department of Urology, Avicenna Ataşehir Hospital, 34750 Istanbul, Türkiye;
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Assaf W, Kazlow E, Rowe M, Gawi R, Abu Shtaya A, Barsha H, Segev Y, Haddad R, Mahamid A. Blood Type as a Potential Predictor of Hemorrhagic Risk in Patients Undergoing Partial Hepatectomy for Colorectal Liver Metastasis. J Clin Med 2025; 14:3905. [PMID: 40507666 PMCID: PMC12155596 DOI: 10.3390/jcm14113905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2025] [Revised: 05/26/2025] [Accepted: 05/28/2025] [Indexed: 06/16/2025] Open
Abstract
Background: Hepatic resection is performed for liver lesions and requires careful preoperative planning to minimize bleeding. Blood type O, associated with lower von Willebrand factor (vWF) levels, may increase bleeding risk. This study investigates the relationship between the ABO blood type and perioperative bleeding in partial hepatectomy for colorectal liver metastases (CRLMs). Methods: Out of 563 patients who underwent hepatectomy, 135 cases were analyzed for CRLM at Carmel Medical Center (2013-2023). Patients were categorized into blood type O (61 patients) and non-O (74 patients) groups. Data on perioperative hemoglobin levels, blood loss, coagulation parameters, transfusion needs, and complications were assessed using χ2, t-tests, and ANOVA (p < 0.05). Results: No significant differences were observed for estimated blood loss (474.3 ± 696 mL for O vs. 527.8 ± 599 mL for non-O; p = 0.29), intraoperative hemoglobin drop (p = 0.613), or transfusion rates (24.59% for O vs. 28.37% for non-O; p = 0.698). Although non-O patients had a higher postoperative INR (p = 0.035), this did not correlate with increased bleeding or transfusion needs. Conclusions: Blood type O does not significantly affect perioperative bleeding or transfusion requirements in partial hepatectomy for CRLM. Further research is needed to better understand the significance of the ABO blood type.
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Affiliation(s)
- Wisam Assaf
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (H.B.); (Y.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
| | - Esther Kazlow
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Surgery, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Max Rowe
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Surgery, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Reem Gawi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Surgery, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Aasem Abu Shtaya
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Gastroenterology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Hanin Barsha
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (H.B.); (Y.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
| | - Yakir Segev
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; (H.B.); (Y.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
| | - Riad Haddad
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Surgery, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
| | - Ahmad Mahamid
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel; (E.K.); (R.G.); (R.H.); (A.M.)
- Department of Surgery, Lady Davis Carmel Medical Center, Haifa 3436212, Israel
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Yang Z, Zhang Y, Zheng J, Tao L, Song C, Gong L, Jin R, Liang X. Minimally invasive versus open liver resection for hepatocellular carcinoma with microvascular invasion: a propensity score-matching study. Surg Endosc 2025; 39:3492-3503. [PMID: 40251314 DOI: 10.1007/s00464-025-11717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 04/06/2025] [Indexed: 04/20/2025]
Abstract
BACKGROUND Microvascular invasion (MVI) is one of the major risk factors for postoperative recurrence of HCC. For HCC patients with MVI, few studies have examined the differences in prognosis between minimally invasive and open liver resection. MATERIALS AND METHODS A total of 171 HCC patients with MVI who underwent curative-intent hepatectomy from September 2017 to October 2022 at Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, were enrolled in this study. Patients were categorized into minimally invasive liver resection (MILR) group (Robotic or laparoscopic) and open liver resection (OLR) group. In order to balance the baseline characteristics between the two groups, 1:4 propensity score matching (PSM) was performed on the two groups. The survival parameters and perioperative parameters were compared between the two groups before and after PSM, respectively. RESULTS There was no significant difference in Recurrence Free Survival (RFS) and Overall Survival (OS) between the two groups before and after PSM. Subgroup analysis showed that there were no significant differences in OS and RFS between the two groups regarding anatomical resection, IWATE difficulty score, surgical margins, and postoperative adjuvant therapy. Perioperative parameters and the rate of major postoperative complications were comparable between the two groups. CONCLUSION Minimally invasive approach can provide a comparable long-term survival result compared with conventional open approach for patients with HCC associated with MVI.
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Affiliation(s)
- Zaibo Yang
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Department of Radiology, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Yewei Zhang
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
- School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China
| | - Junhao Zheng
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Liye Tao
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Chao Song
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Linghan Gong
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China
- Zhejiang University Cancer Center, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Renan Jin
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China.
- Zhejiang University Cancer Center, Hangzhou, 310058, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China.
| | - Xiao Liang
- Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
- Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China.
- Zhejiang University Cancer Center, Hangzhou, 310058, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China.
- School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China.
- School of Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China.
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Sorour AA, Sharew B, Kuka C, Dong S, Fulton E, Reinert NJ, Khalifeh A, Quatromoni JG, Rowse JW, Kirksey L, Lyden SP, Caputo FJ. No difference in midterm outcomes and complication rate between retroperitoneal and transperitoneal open aortic aneurysm repair in females. Vascular 2025; 33:511-519. [PMID: 38861481 DOI: 10.1177/17085381241257742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ObjectivesAbdominal Aortic Aneurysms (AAA) in females are less prevalent, have higher expansion rates and experience rupture at smaller diameters than in males. Studies have compared outcomes of the retroperitoneal (RP) and transperitoneal (TP) approach in open aortic aneurysm repair (OAR) with conflicting results. No study to date has compared the two approaches solely in females. In this study we compare midterm outcomes of the RP and TP approach in females undergoing OAR.MethodsSingle-center, retrospective review of all females undergoing OAR from 2010 to 2021. Patients undergoing elective, symptomatic and ruptured OAR were included. The cohort was stratified by surgical approach RP versus TP and midterm outcomes were compared amongst the groups. Outcomes included mortality, graft related, and non-graft related complications.ResultsA total of 244 patients (RP n = 133; TP n = 111) were identified. Follow-up period was 28 ± 30.7 months. Baseline perioperative characteristics were similar except that more people in the RP group had ejection fraction ((EF) > 50% (82% vs 68%), p = .037). Patients who underwent RP repair had longer visceral/renal ischemia time (p = .01), larger graft diameter (18 vs 16 mm; p = <0.001), were more likely to have a suprarenal clamp placed(70.5 vs 48.2; p < .001), and had decreased autotransfusion volume (611 vs 861 mL; p < .01) compared to those who underwent TP repair. Number of deaths was higher in the TP group during study follow-up period (36.4 vs 23.8; p = .035), but the difference of the time to event analysis was not significant. There was no difference in all-cause survival at 36 months between RP and TP (77.8 vs 76.8; p = .045). Overall midterm complications were 9.5% in both groups. Any graft related complication was 1.8% in TP versus 3% RP (p = .69). In a multivariable model, after adjusting for age, urgency, smoking, prior aneurysm repair, and ASA level, the hazard ratio decreases with the RP approach, however this did not reach significance (p = .052).ConclusionIn a 12-year period of OAR in females, TP and RP results were comparable at midterm analysis. The RP approach appeared to be used more often for OAR requiring suprarenal clamping. Although the TP group had increased mortality, the difference of the time to event analysis was not significant. Midterm postoperative complications in both groups were low. This suggests that both approaches are safe in the female population and decision should be driven by anatomy and surgeon's preference.
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Affiliation(s)
- Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betemariam Sharew
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Casey Kuka
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Siwei Dong
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emma Fulton
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nathan J Reinert
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Khalifeh
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jon G Quatromoni
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jarrad W Rowse
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francis J Caputo
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Singh A, Xie Y, Mazzola E, Wang S, McAllister M, Pezeshkian F, Cooper L, Frain LN, Wilder FG, Steimer D, Jaklitsch MT, DuMontier C. Gait Speed as a Measure of Frailty and Outcomes After Lung Resection. Ann Surg Oncol 2025; 32:4181-4188. [PMID: 40016615 DOI: 10.1245/s10434-025-17066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/09/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND As a powerful, objective marker of frailty, 4-m gait speed (4MGS) can predict morbidity and mortality in various populations including cardiac surgery and oncology patients. Its role in thoracic surgery is understudied. This study aimed to evaluate associations between preoperative 4MGS and outcomes after pulmonary resection. METHODS A cohort study analyzed patients undergoing pulmonary resections at a high-volume surgical center from January 2021 to October 2023. Preoperative 4MGS was prospectively collected by medical assistants as part of routine vital sign assessments in clinic. Uni- and multivariable analyses were performed to evaluate the associations of preoperative 4MGS with postoperative length of stay, adverse events, and discharge disposition, controlling for lung function (FEV1), extent of resection, comorbidity, and other covariates. RESULTS Overall, 401 patients were included (median age, 69 years; interquartile range, 61-75 years): 123 (31%) lobectomy and 278 (69%) sublobar resection patients. After controlling for covariates, each decrease of 0.1 m/s in 4MGS was associated with average longer length of stay (beta, 0.12; 95% confidence interval [CI], 0.01-0.23) and increased odds of adverse events (odds ratio [OR], 1.10; 95% CI 1.00-1.25). These associations were largely maintained when analyses were repeated within the lobar and sublobar cohorts. Among the sublobar resections, decreases in 0.1 m/s of 4MGS was associated with increased odds of discharge to home requiring home services or to a rehabilitation facility (OR, 1.10; 95% CI 1.00-1.22). CONCLUSIONS Preoperative 4MGS is independently associated with important surgical outcomes after lung resection. The 4MGS marker can complement other preoperative measures used to risk-stratify patients undergoing lung resection.
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Affiliation(s)
- Anupama Singh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yue Xie
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sue Wang
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Miles McAllister
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Lisa Cooper
- Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Laura N Frain
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Fatima G Wilder
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Desiree Steimer
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
- New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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Charters E, Boehm J, D'Silva AM, Wu R, Mueller SA, Low T(H, Clark JR, Wykes J. A Pilot Trial of Tongue Reconstruction Using the Chimeric Innervated Vastus Lateralis Muscle and Antero-Lateral Thigh Free Flap. Head Neck 2025; 47:1758-1768. [PMID: 39876833 PMCID: PMC12068542 DOI: 10.1002/hed.28087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 11/13/2024] [Accepted: 01/14/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Subtotal and total glossectomies for advanced tongue cancer result in significant speech- and swallow-related morbidity, impairing quality of life. This prospective pilot study compares the safety and functional outcomes associated with using a chimeric innervated muscle and fasciocutaneous flap for soft tissue reconstruction. MATERIALS AND METHODS A prospective, non-randomized controlled pilot study evaluated a standardized technique for tongue reconstruction using a chimeric innervated vastus lateralis muscle and anterolateral thigh fasciocutaneous flap. Inclusion criteria were ≥ 50% resection of the oral tongue. Participants were followed longitudinally, with measures recorded at baseline, 6-8 weeks, 6 months, and 12 months after surgery. The primary endpoints were post-operative complications, time to radiotherapy, operative time, and locoregional failure, videofluoroscopy swallow studies (dynamic imaging grade of swallowing toxicity (DIGEST), penetration and aspiration score, performance status scale for head and neck). Secondary endpoints were patient-rated outcomes. RESULTS Eighteen participants were recruited (10 intervention: 8 controls). Fourteen (78%) experienced complications, only one of which was related to the innervated flap. DIGEST scores deteriorated post-operatively across all participants but did not differ significantly between the intervention and control groups (p = 0.4) at any point post-surgery, despite more extensive resections in the intervention group. Those in the intervention group had better patient-rated intelligibility (p = 0.04). Multimodality treatment was associated with worse speech (p = 0.03) and normalcy of diet (p = 0.02). Less extensive resections were associated with better scores in eating in public (p = 0.005), tongue range of movement (p = 0.0008), intelligibility (p = 0.006), and diet (p = 0.001). CONCLUSIONS The innervated vastus lateralis and antero-lateral thigh free-flap technique is safe and improves speech intelligibility for patients with subtotal and total glossectomy defects. However, the technique requires refinement to optimize functional and quality-of-life outcomes.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck SurgeryChris O'Brien LifehouseSydneyAustralia
- School of Health Sciences, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Jessica Boehm
- Speech PathologyWollongong HospitalWollongongAustralia
| | | | - Raymond Wu
- Department of Radiation OncologyChris O'Brien LifehouseSydneyAustralia
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyAustralia
| | - Simon A. Mueller
- Department of Head and Neck SurgeryChris O'Brien LifehouseSydneyAustralia
- Department of Oto‐Rhino‐Laryngology, Head and Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
| | - Tsu‐Hui (Hubert) Low
- Department of Head and Neck SurgeryChris O'Brien LifehouseSydneyAustralia
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyAustralia
- Department of Otolaryngology‐Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNSWAustralia
| | - Jonathan R. Clark
- Department of Head and Neck SurgeryChris O'Brien LifehouseSydneyAustralia
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyAustralia
- Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictSydneyAustralia
| | - James Wykes
- Department of Head and Neck SurgeryChris O'Brien LifehouseSydneyAustralia
- Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictSydneyAustralia
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Putila E, Helminen O, Helmiö M, Huhta H, Jalkanen A, Junttila A, Kallio R, Koivukangas V, Kokkola A, Lietzen E, Louhimo J, Meriläinen S, Pohjanen VM, Rantanen T, Ristimäki A, Räsänen JV, Sihvo E, Toikkanen V, Tyrväinen T, Valtola A, Kauppila JH, FINEGO group. Preoperative predictors of postoperative complications after gastrectomy for gastric cancer, a population-based study in Finland. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109682. [PMID: 40009919 DOI: 10.1016/j.ejso.2025.109682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 01/24/2025] [Accepted: 02/08/2025] [Indexed: 02/28/2025]
Abstract
INTRODUCTION International studies on preoperative risk factors of postoperative complications after gastrectomy for gastric cancer are few, and studies done in a population-based setting or using standardized definitions are lacking. Gastrectomy for gastric cancer is characterized by high complication rates and mortality, and identifying the risk factors for postoperative complications and mortality enables to improve the postoperative outcomes. MATERIALS AND METHODS This nationwide population-based cohort study is based on the Finnish National Esophago-Gastric Cancer Cohort, and it included all patients undergoing gastric cancer surgery in Finland during 2005-2016 aged 18 years or older. The Esophagectomy Complications Consensus Group's (ECCG) standardized list of complications was used for describing different types of postoperative outcomes. RESULTS This study analyzed a total of 1993 patients. The results suggested that of potential risk factors, higher ASA-class, and advanced tumor stage increased the risk of major postoperative complications after gastrectomy for gastric cancer, whereas age ≥70 years and distal tumor location may be protective factors. The results suggested that older age, higher ASA-class, comorbidity, and advanced tumor stage were risk factors for 90-day mortality. Older age seemed to be a risk factor for 90-day mortality, whereas it seemed to protect from major postoperative complications and 90-day reoperations. CONCLUSIONS Higher ASA-class, and advanced tumor stage were risk factors for major complications after gastrectomy for gastric cancer, while older age and distal tumor location seemed to be protective factors.
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Affiliation(s)
- Emilia Putila
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland.
| | - Olli Helminen
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland
| | - Mika Helmiö
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Heikki Huhta
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland
| | - Aapo Jalkanen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Junttila
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Raija Kallio
- Department of Oncology and Haematology, Oulu University Hospital, Oulu, Finland
| | - Vesa Koivukangas
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland
| | - Arto Kokkola
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Lietzen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Johanna Louhimo
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Meriläinen
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomo Rantanen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Vesa Toikkanen
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti Valtola
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Joonas H Kauppila
- Surgery Research Unit, Medical Research Center Oulu, Oulu. University Hospital and University of Oulu, Oulu, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Stockholm, Sweden
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Bianchi F, Vestri E, Patanè S, Zampieri N, Camoglio FS. Laparoscopic and open approach for inguinal hernia in pediatric age: report of 8 years. Minerva Pediatr (Torino) 2025; 77:197-204. [PMID: 34859646 DOI: 10.23736/s2724-5276.21.06316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ongoing innovation in laparoscopy lead pediatric surgeons to consider a mini-invasive approach for inguinal hernia correction. We review cases and evolution of surgical technique in a pediatric center. METHODS A retrospective study included patients that underwent inguinal hernia repair between 01/01/2011 and 30/06/2019. Surgical techniques are compared. Outcomes considered: surgery duration, intraoperative and postoperative complications. RESULTS Six Hundred sixty-four patients were included; 187 patients underwent laparoscopy(group A), 477 underwent open surgery(group B). Throughout time from 2011 to 2019, there has been an increase in laparoscopy, accounting in 2019 for more than 60% of overall surgeries. In 151 patients of group A initial diagnosis was of monolateral hernia; in 25.8% contralateral side was corrected at the same time because of intraoperative finding of open internal inguinal ring. Surgery duration in group B is shorter than group A; difference loses significance in bilateral corrections. Complications: 2.9% short term: prematurity related as well as to duration in group B. 1.7% relapses, regardless of technique. 5.2% metachronous hernias, related with age and open surgery. 0.6% secondary cryptorchidism, unrelated to technique. CONCLUSIONS There is not an evident superiority of laparoscopy over open repair. Laparoscopy should be preferred in case of doubt about bilaterality and in case of emergency surgery.
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Affiliation(s)
- Federica Bianchi
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy -
| | - Elettra Vestri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Simone Patanè
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Nicola Zampieri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Francesco S Camoglio
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Abbasi Dezfouli S, Dooghaie Moghadam A, Sabetkish N, Khajeh E, Ramouz A, Majlesara A, Mieth M, Chang DH, Golriz M, Mehrabi A. Outcomes and Cost of Major Liver Resection Using Combined LigaSure and Stapler: A Propensity Score Matching Study. J Clin Med 2025; 14:3892. [PMID: 40507653 PMCID: PMC12156395 DOI: 10.3390/jcm14113892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2025] [Revised: 05/24/2025] [Accepted: 05/30/2025] [Indexed: 06/16/2025] Open
Abstract
Background: Bile leakage remains a significant challenge following major liver resection, with potential for improvement depending on the transection technique used. In this study, we aimed to evaluate the effectiveness of our hybrid resection technique-utilizing both LigaSure and stapler devices-in reducing bile leakage after major liver resection compared to our conventional stapler-only technique. As a secondary aim, we compared overall morbidity, costs, and reimbursements. Method: Patients who underwent major hepatectomy without biliary reconstruction using either the hybrid or stapler technique between August 2014 and December 2021 were included in the study. Propensity score matching was performed using a one-to-two algorithm. Perioperative data, bile leakage rates, and cost and reimbursement information based on the diagnosis-related group (DRG) system were analyzed. Results: In total, data from 492 patients were evaluated (hybrid = 152; stapler = 340). After one-to-two propensity score matching, the operation time was significantly longer in the hybrid group (p = 0.005). A cost analysis showed no significant difference in total operative costs between the two techniques (p = 0.092). However, the hybrid group had a significantly lower rate of bile leakage (p = 0.002), as well as shorter intensive care unit (ICU) and overall hospital stays (p = 0.034 and p = 0.007, respectively). Consequently, ICU and ward costs were significantly lower in the hybrid group (p = 0.024 and p = 0.014, respectively) compared to the stapler group. The financial difference calculated as DRG reimbursement minus costs was two-fold higher in the hybrid group (p = 0.02). Conclusions: Although the hybrid technique resulted in a longer operating time, it proved superior to the stapler technique in reducing postoperative bile leakage and shortening ICU and hospital stays. Furthermore, the use of the hybrid technique was more cost efficient and resulted in a greater positive financial margin.
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Affiliation(s)
- Sepehr Abbasi Dezfouli
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
| | - Nastaran Sabetkish
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - De Hua Chang
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (S.A.D.); (A.D.M.); (N.S.); (E.K.); (A.R.); (A.M.); (M.M.); (M.G.)
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120 Heidelberg, Germany
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Hu B, Yin Y, Liu C, He C, Zou H, Liu Z, Lv F, Wen Y, Liu W. Optimizing pancreatic enucleation for benign tumors: the role of pre-placed pancreatic duct stents-a retrospective cohort study. Surg Endosc 2025; 39:3775-3785. [PMID: 40325247 DOI: 10.1007/s00464-025-11748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Accepted: 04/16/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE To investigate the effectiveness of pre-placed pancreatic duct stents on improving outcomes of pancreatic enucleation for benign tumors, a procedure often discouraged by postoperative complications, such as pancreatic fistulae. METHODS This single-center retrospective cohort study analyzed 148 patients with benign tumors located in the head, neck, and body of the pancreas between February 2021 and February 2024. Thirty-four patients received stent placement by endoscopic retrograde cholangiopancreatography 1-2 days before surgery, while 114 did not. Propensity score matching resulted in two groups: stent (n = 30) and non-stent (n = 60). Outcomes compared included enucleation success rate, incidence of pancreatic fistulae, hospital stay, procedural costs, pancreatic function deficiency, and quality of life. RESULTS Pre-placement of stents significantly increased enucleation success rate (86.7% vs. 28.3%, p = 1.763 × 10-7), facilitated more laparoscopic surgeries (86.7% vs. 41.7%, p = 4.9 × 10-5), and shortened hospital stays (median 7.5 days vs. 11 days, p = 0.001). The stent group also showed a lower incidence of pancreatic exocrine dysfunction (10.3% vs. 35.7%, p = 0.016) and higher quality of life scores (91.2 ± 5.8 vs. 85.5 ± 13.6, p = 0.019). No significant differences were observed in postoperative complications or overall costs. Additionally, the distance between tumor and main pancreatic duct was shorter in the stent group (4.2 ± 2.2 mm vs. 6.2 ± 2.5 mm, p = 0.008). CONCLUSION Pre-placement of pancreatic duct stents significantly enhances enucleation success rate, reduces hospital stays, preserves pancreatic function, and improves quality of life. These findings advocate the use of pre-placed stents in enucleation procedures. Further prospective studies are warranted to validate these outcomes.
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Affiliation(s)
- Baoyang Hu
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Yiming Yin
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Chun Liu
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Chao He
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Heng Zou
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Zhongtao Liu
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Fang Lv
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Yu Wen
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Wei Liu
- Department of Biliary and Pancreatic Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People's Republic of China.
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Rajan S, Dhamija E, Malhotra N, Kaur P, Yadav RK, Meena J, Kumari R, Singh A, Singh A, Khurana S, Deb KS, Upadhyay AD, Singhal S. Nutritional assessment in gynecological cancers: Experience from an Indian tertiary care center. Eur J Obstet Gynecol Reprod Biol 2025; 310:113964. [PMID: 40215809 DOI: 10.1016/j.ejogrb.2025.113964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 04/03/2025] [Accepted: 04/04/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND Malnutrition is highly prevalent among cancer patients and significantly impacts treatment outcomes. In India, the cancer-specific mechanisms of malnutrition are further exacerbated by the already high prevalence of malnutrition in the general population. Despite its clinical significance, nutritional screening remains underutilized in women with gynecological cancers. This study aims to assess malnutrition in Indian women with gynecological cancers using the standard Patient-Generated Subjective Global Assessment (PG-SGA) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria screening tools. METHODS A prospective observational study was conducted at a tertiary center in India, involving 130 women with newly diagnosed gynecological cancers. Nutritional status was assessed using anthropometric measures (BMI, mid-arm circumference, calf circumference), inflammatory markers (serum albumin, C-reactive protein, neutrophil-to-lymphocyte ratio), and the PG-SGA and GLIM criteria. Perioperative outcomes, including blood loss, hospital stay, and complications, were evaluated. RESULTS Malnutrition was identified in 56.1 % of patients, using both PG-SGA and GLIN criteria, with the highest prevalence observed in ovarian cancer (68.1 %). Calf circumference < 33 cm and hypoalbuminemia (<3.5 g/dL) exhibited the best diagnostic accuracy to detect malnutrition (AUC: 0.70-0.71). Weighted kappa statistic showed moderate agreement between the PG-SGA and GLIM classifications, but PG-SGA defined malnutrition significantly predicted postoperative complications (p = 0.029), whereas the GLIM criteria did not show a significant correlation. CONCLUSION Both PG-SGA and GLIM are effective in detecting malnutrition, though PG-SGA is a stronger predictor of postoperative outcomes. While anthropometric and biochemical markers aid in diagnosis, they cannot replace comprehensive nutritional screening. Standardized nutritional screening and multimodal prehabilitation strategies, should be integrated into gynecological cancer management to improve patient care and surgical outcomes.
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Affiliation(s)
- Saroj Rajan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, All India Institute of Medical Sciences, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India
| | - Parmeet Kaur
- Cheif Dietician, All India Institute of Medical Sciences, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India
| | - Anju Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India
| | - Archana Singh
- Department of Biochemistry, All India Institute of Medical Sciences, India
| | - Sachin Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, India
| | - Koushik Singh Deb
- Department of Psychology, All India Institute of Medical Sciences, India
| | | | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, India.
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Yanagisawa T, Tatematsu N, Asano S, Horiuchi M, Migitaka S, Yasuda S, Itatsu K, Kubota T, Sugiura H. Perioperative decline in isometric knee extension force is a predictor of unplanned readmission within 1 year in patients with colorectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109673. [PMID: 40009920 DOI: 10.1016/j.ejso.2025.109673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 01/07/2025] [Accepted: 02/01/2025] [Indexed: 02/28/2025]
Abstract
INTRODUCTION Exploring the relationship between perioperative physical function and unplanned readmission (UR) in patients with colorectal cancer (CRC) can aid in rehabilitation interventions. In this study, we aimed to determine whether perioperative physical function is associated with UR within 1 year in patients with CRC. MATERIALS AND METHODS This retrospective cohort study included 155 consecutive patients with CRC who underwent surgery. The outcome was UR within 1 year. Physical function was evaluated through isometric knee extension force (IKEF) and 6-min walk distance. Additionally, the decline ratio of physical function was calculated using the following formula: the decline ratio (%) = ([before discharge - before surgery]/before surgery) × 100. The propensity score-matching strategy was used to adjust for confounders in the relationship between perioperative physical function and UR. Subsequently, the association between perioperative physical function and UR was assessed using the log-lank test and Cox proportional hazards model analysis. RESULTS Of 155 patients, 120 were included in the analysis. A significant difference in the decline ratio of IKEF was observed between patients with and without UR (p = 0.007). After propensity score-matching, 52 patients were matched. In matched patients, the decline in IKEF (decline ratio of IKEF ≤ -18.8 %) was significantly correlated with UR in the log-rank test (p = 0.003) and Cox proportional hazards model analysis (hazard ratio, 9.26; 95 % confidence interval, 1.15, 74.12; p = 0.035). CONCLUSION A decline in IKEF was associated with UR within 1 year in patients with CRC.
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Affiliation(s)
- Takuya Yanagisawa
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan; Faculty of Rehabilitation and Care, Seijoh University, 2-172 Fukinodai, Tokai, Aichi, 476-8588, Japan.
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
| | - Shiho Asano
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan; Department of Rehabilitation, Toyohashi Municipal Hospital, 50 Hachikennishi Aotake-cho, Toyohashi, Aichi, 441-8570, Japan.
| | - Mioko Horiuchi
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Saki Migitaka
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Shotaro Yasuda
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Keita Itatsu
- Department of Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Tomoyuki Kubota
- Department of Breast Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
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Venkatramani V, Reis IM, Gonzalgo ML, Swain S, Svatek RS, Parekh DJ. Comparison of Complication and Readmission Rates Between Robot-Assisted and Open Radical Cystectomy: Results From the Randomized RAZOR Clinical Trial. J Urol 2025; 213:684-692. [PMID: 40080805 PMCID: PMC12064358 DOI: 10.1097/ju.0000000000004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 02/20/2025] [Indexed: 03/15/2025]
Abstract
PURPOSE We assessed differences in complications and readmissions between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). MATERIALS AND METHODS This study uses data from the per-protocol population of the Randomized Robotic-Assisted vs Open Radical Cystectomy (RAZOR) study, a multicenter, open-label, phase 3, noninferiority clinical trial. RAZOR enrolled across 15 academic medical centers in the United States between 2011 and 2014. The median follow-up was 2 years. Complications up to 90 days using the Clavien-Dindo classification, and readmissions at 90 days and 1 year postoperatively were compared. Multivariable logistic regression analyses were performed to determine any predictors of major complications and of postsurgery readmission. RESULTS Baseline characteristics were similar, and there was no significant difference in overall and major complication rates between RARC (n = 150) and ORC (n = 152) arms. Simplified frailty index ≥ 3 (HR, 4.22, 95% CI, 2.67-6.66, P < .0001) was a significant predictor of major complications within 90 days. Readmission rates at 90 days were 24.1% for RARC and 23.1% for ORC, and readmission rates at 1 year were 29.5% for RARC and 28.5% for ORC (P = .80). Simplified frailty index ≥ 3 was a significant predictor of readmission at both time points (subdistribution HR 4.43, 95% CI, 1.75-11.2, P = .002 at 90 days and subdistribution HR, 5.28, 95% CI, 2.22-12.6, P < .001, at 1 year). CONCLUSIONS No significant differences in major complications and readmission rates between ORC and RARC were noted. Patient frailty was an important predictor of these outcomes, and special attention needs to be taken in ensuring appropriate patient selection and preoperative preparation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01157676.
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Affiliation(s)
- Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Isildinha M Reis
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sanjaya Swain
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Robert S Svatek
- Department of Urology, Division of Urologic Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Milana F, Procopio F, Calafiore E, Famularo S, Costa G, Galvanin J, Branciforte B, Torzilli G. Long-Term Outcomes According to Surgical Margin in Mass-Forming Cholangiocarcinoma: The Role of R1vasc. Ann Surg Oncol 2025; 32:4363-4373. [PMID: 40019600 DOI: 10.1245/s10434-025-17038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/04/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND R0 resection is the standard for mass-forming cholangiocarcinoma (MFCCC). R1vasc resection (tumor-vessel detachment) yielded results comparable to R0 and superior to parenchymal-tumor exposure (R1par) for hepatocellular carcinoma and colorectal liver metastases. This study aims to clarify R1vasc outcomes for MFCCC. PATIENTS AND METHODS Margin status of patients with MFCCC undergoing resection between 2008 and 2022 was assessed to determine the oncological efficacy of R1vasc regarding survival and hepatic recurrence. RESULTS The study analyzed 125 patients: 68 (54.4%) R0, 18 (14.4%) R1vasc, 24 (19.2%) R1par, and 15 (12.0%) R1vasc + par. Tumor size was similar between R0 (4.4 cm, range 1.5-19.0) and R1vasc (4.3 cm, range 2.3-14.5, p = 0.754) but larger for R1par (8.2 cm, range 2.5-15.0, p = 0.005) and R1vasc + par (9.0 cm, range 5.0-17.0, p < 0.001). The median overall survival (OS) was comparable for R0 [64.8 months; 95% confidence interval (CI): 50.0-79.6], R1vasc (54.4 months; 95% CI 19.6-89.2; p = 0.932), and R1vasc + par (62.0 months; 95% CI 35.6-88.5; p = 0.989). R1par showed lower OS (26.8 months; 95% CI 16.1-37.6; p = 0.134). Local recurrence was higher for R1par (45.8%, p < 0.0001) compared with R0 (10.3%) and similar for R1vasc (16.6%) and R1vasc + par (20.0%). Survival after hepatic recurrence was higher for R1vasc compared with R1par (p = 0.041). CONCLUSIONS R1vasc is a valid option for increasing resectability in patients with MFCCC, with OS being comparable to R0. R1vasc + par may be necessary for larger tumors.
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Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Procopio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Eleonora Calafiore
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jacopo Galvanin
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Bruno Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.
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Watanabe H, Matsushita Y, Tamura K, Motoyama D, Otsuka A, Miyake H. Robot-Assisted Radical Cystectomy With Intracorporeal Ileal Conduit Using the Hinotori Surgical Robot System: A Single Surgeon's Initial Experience of 20 Cases. Int J Med Robot 2025; 21:e70074. [PMID: 40376798 DOI: 10.1002/rcs.70074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 04/14/2025] [Accepted: 05/05/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND The objective of this study was to assess the perioperative outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (ICIC) using the hinotori surgical robot system. METHODS This retrospective study included 20 consecutive patients with bladder cancer who underwent RARC with ICIC using hinotori from October 2023 to July 2024. Major perioperative outcomes were comprehensively analysed. RESULTS The median operative time, time using the robotic system, bowel reconstruction and urinary diversion time, and estimated blood loss were 435.0, 330.0, 122.5 min, and 175.0 mL, respectively. No marked intraoperative complications were observed. Perioperative, 30-day, and 90-day complications occurred at rates of 25%, 10%, and 0%, respectively. The learning curve tended to decrease in a case volume-dependent manner. CONCLUSIONS RARC using hinotori was successfully completed, and favourable perioperative outcomes were achieved without severe complications. This suggests that RARC using hinotori provides a potentially comparable alternative to conventional surgical systems.
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Affiliation(s)
- Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Peng Y, Liu F, Li B, Wei Y, Tan HL, Syn NL, Fuks D, Soubrane O, Dokmak S, Gruttadauria S, Zimmitti G, Jaber B, Cipriani F, Kato Y, Scatton O, Herman P, Aghayan DL, Marino MV, Croner RS, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Prieto M, Vivarelli M, Giuliante F, Ruzzenente A, Yong CC, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Dalla Valle R, Boggi U, Geller D, Belli A, Memeo R, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Hasegawa K, Wang X, Sutcliffe RP, Pratschke J, Lai ECH, Chong CCN, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Liu R, Ferrero A, Ettorre GM, Cherqui D, Liang X, Mishima K, Wakabayashi G, Troisi RI, Cheung TT, Sugimoto M, Sugioka A, Han HS, Duy Long TC, Abu Hilal M, Zhang W, Chen KH, Aldrighetti L, Edwin B, Goh BKP, International robotic and laparoscopic liver resection study group investigators. Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109597. [PMID: 40088501 DOI: 10.1016/j.ejso.2025.109597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 01/02/2025] [Accepted: 01/10/2025] [Indexed: 03/17/2025]
Abstract
INTRODUCTION The Iwate difficulty scoring system (DSS) is one of the most widely validated DSS for laparoscopic liver resection (LLR). However, these studies only validated the 4 difficulty levels and did not validate the 12-point difficulty index of the system. To address current limitations in the studies validating the Iwate difficulty scoring system (DSS), we performed an international multicenter study to validate the Iwate DSS across both its four difficulty levels and 12-point difficulty index. METHODS A retrospective cohort study of 22,252 patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the four difficulty levels and 12-point difficulty index of the Iwate DSS. RESULTS A total of 14,759 patients met the inclusion criteria. The main indications for LLR were hepatocellular carcinoma/intrahepatic cholangiocarcinoma (52.8 %), and metastatic tumors liver (26.5 %). In terms of underlying liver pathology, 5127 patients (34.8 %) had liver cirrhosis, and 1214 patients (8.3 %) had portal hypertension. Intraoperative outcomes (operation time, blood loss, blood transfusion, use of Pringles maneuver and open conversion) and postoperative outcomes (length of stay, morbidity, major complications, and 90-day mortality) significantly increased with stepwise increases across the four difficulty levels (P < 0.001) and 12-point difficulty index (P < 0.001). These trends remained significant following adjustment for baseline characteristics (P < 0.001). CONCLUSION The Iwate DSS 12-point difficulty index and four difficulty levels correlated well with LLR difficulty as determined by key surrogate perioperative measures.
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Affiliation(s)
- Yufu Peng
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Liu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Li
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Wei
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Hwee-Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center Italy, Palermo, Italy; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
| | | | - Bashar Jaber
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitte-Salpetriere, Sorbonne Universite, Paris, France
| | - Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Davit L Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Marco Vivarelli
- HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Ruzzenente
- General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy
| | - Chee-Chien Yong
- Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mengqiu Yin
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Zenichi Morise
- Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Brustia
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France
| | - Raffaele Dalla Valle
- Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - David Geller
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center - IRCCS-G. Pascale, Naples, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alejandro Mejia
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - James O Park
- Department of Surgery, University of Washington Medical Center. Seattle, USA
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric C H Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, China
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Santiago Lopez-Ben
- Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Alessandro Ferrero
- Department of General and Oncological Surgery. Mauriziano Hospital, Turin, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Xiao Liang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kohei Mishima
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China
| | - Motokazu Sugimoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Hospital East, Chiba, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, South Korea
| | - Tran Cong Duy Long
- Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Mohammad Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy; Department of Surgery, University Hospital Southampton, United Kingdom
| | - Wanguang Zhang
- Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Kuo-Hsin Chen
- Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Bjorn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke National University of Singapore Medical School, Singapore.
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Collaborators
Francesca Ratti, Mikel Gastaca, Juul Meurs, Celine De Meyere, Kit-Fai Lee, Kelvin K Ng, Diana Salimgereeva, Ruslan Alikhanov, Nita Thiruchelvam, Jae Young Jang, Masayuki Kojima, Jaime Arthur Pirola Kruger, Fabricio Ferreira Coelho, Victor Lopez-Lopez, Margarida Casellas I Robert, Roberto Montalti, Mariano Giglio, Boram Lee, Mizelle D'Silva, Hao-Ping Wang, Mansour Saleh, Franco Pascual, Zewei Chen, Shian Yu, Simone Vani, Francesco Ardito, Ugo Giustizieri, Davide Citterio, Federico Mocchegiani, Marco Colasanti, Giammauro Berardi, Yoelimar Guzmán, Kevin P Labadie, Maria Conticchio, Epameinondas Dogeas, Emanuele F Kauffmann, Mario Giuffrida, Daniele Sommacale, Alexis Laurent, Paolo Magistri, Francois Cauchy, Chung-Ngai Tang, Marco Barbara, Duilio Pagano, Qu Liu, Tiing-Foong Siow, Chetana Lim, Phan Phuoc Nghia, Bernardo Dalla Valle, Yoshikuni Kawaguchi, Prashant Kadam, Felix Krenzien, Moritz Schmelzle, Junhao Zheng, Mirhasan Rahimli, Asmund Avdem Fretland, Jacob Ghotbi,
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47
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Palen A, Ratone JP, Garnier J, Caillol F, Poizat F, Ewald J, Turrini O, Giovannini M. R1 Endoscopic papillectomy for adenocarcinoma: is complementary pancreatoduodenectomy unavoidable? Surg Endosc 2025; 39:3671-3680. [PMID: 40301156 DOI: 10.1007/s00464-025-11747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Accepted: 04/16/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Research on the oncological outcomes of complementary pancreatoduodenectomy (PD) following incomplete (R1) endoscopic papillectomy (EP) for early-stage ampullary adenocarcinoma (AA) is limited, despite the increasing use of endoscopic approaches and the risks associated with PD. This study aimed to assess short- and long-term outcomes in patients undergoing complementary PD after EP R1 for AA. METHODS Between January 2010 and December 2022, four patient groups were compared: patients with complete endoscopic resection (EP R0), those with R1 margins after EP closely followed up without complementary surgery (EP R1), those who underwent complementary PD after R1 EP (EP + PD), and those who underwent upfront PD (uPD). The primary endpoint was the difference in survival rates (overall [OS] and disease-free [DFS]) between the EP R1 and EP + PD groups and morbidity and mortality rate comparison between the EP + PD and uPD groups. RESULTS In the EP cohort (n = 56), the major complication was intraluminal hemorrhage (29%), and the median duration of hospitalization was 4 days (range 2-17 days). The presence of biliary obstruction, manifested as jaundice (p < 0.01), abnormal liver biology test results (p = 0.022), or biliary duct dilatation during endoscopic ultrasound (p < 0.001), was significantly higher in the EP R1 group (n = 20) than in the EP R0 (n = 16) group. After PD (n = 92), Clavien-Dindo ≥ 3 complications occurred in 28 patients (31%), and the 90-day mortality rate was 5.5%. Postoperative outcomes were similar between the EP + PD (n = 20) and uPD (n = 72) groups. Regarding endoscopic and surgical resection for early stage (T1-T2) adenocarcinoma, there was no significant difference in OS (p = 0.074) and DFS (p = 0.16) between groups. The median survival was not reached. CONCLUSIONS EP before complementary PD did not increase the incidence of postoperative complications or mortality rate. However, complementary PD after R1 EP did not improve long-term outcomes.
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Affiliation(s)
- Anais Palen
- Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France.
| | | | - Jonathan Garnier
- Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Flora Poizat
- Department of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - Jacques Ewald
- Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France
| | - Olivier Turrini
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
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Tsujimura K, Nakauchi M, Hiro J, Ito A, Chikaishi Y, Kobayashi Y, Kamishima M, Inaguma G, Omura Y, Cheong Y, Kumamoto T, Masumori K, Hanai T, Uyama I, Suda K, Otsuka K. Comparison of short-term outcomes for robotic rectal surgery between the hinotori™ surgical robot system and da Vinci surgical system: a single-center retrospective study using propensity score matching analysis. Surg Endosc 2025; 39:3993-4005. [PMID: 40316750 DOI: 10.1007/s00464-025-11766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Accepted: 04/21/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Robotic surgery for rectal cancer has grown popular in recent years and has primarily used the da Vinci Surgical System (Intuitive Surgical, CA, USA; da Vinci). In 2020, Japan introduced the hinotori™ Surgical Robot System (Medicaroid, Kobe, Japan; hinotori). We report our initial surgical experiences with robotic surgery using hinotori for rectal cancer and its feasibility and safety comparing with da Vinci. METHODS A single-institution retrospective study was conducted. Between November 2022 and November 2023, 38 and 96 patients with rectal cancer underwent robotic surgery using hinotori and da Vinci, respectively. The primary endpoint was the incidence of postoperative complications of the Clavien-Dindo classification (CD) grade ≥ II within postoperative 30 days. Secondary endpoints included surgical and console time, blood loss, conversion to other approaches, number of dissected lymph nodes, and postoperative hospital stay. A propensity score matching (PSM) analysis was used to adjust for imbalance in baseline characteristics. RESULTS After PSM, a total of 76 patients (hinotori: 38, da Vinci: 38) were included. Compared to the da Vinci group, the hinotori group showed a similar postoperative complication rate of CD ≥ II (15.8% vs. 18.4%), comparable operative time (280.5 vs. 258 min), comparable console time (166 vs. 156 min), and less blood loss (9 vs. 17.5 mL, p = 0.025). There was no conversion in either group. The number of dissected nodes and postoperative stay were similar between the two groups. CONCLUSION Our findings support that robotic surgery for rectal cancer using hinotori is as safe as surgery performed using the da Vinci system.
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Affiliation(s)
| | - Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Junichiro Hiro
- Department of Surgery, Fujita Health University, Toyoake, Japan.
| | - Ayaka Ito
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | | | - Gaku Inaguma
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yusuke Omura
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | | | - Koji Masumori
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan
| | - Koki Otsuka
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Tidadini F, Fawaz J, Quesada JL, Abba J, Malgras B, Trilling B, Sage PY, Fischer J, Pocard M, Arvieux C, Ezanno AC. Risk factors for postoperative evisceration after cytoreductive surgery and HIPEC. A comparative study of open and closed abdominal techniques. Surg Oncol 2025; 60:102229. [PMID: 40373642 DOI: 10.1016/j.suronc.2025.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 04/14/2025] [Accepted: 05/08/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Standard treatment for resectable peritoneal metastasis (PM) includes the combination of cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Postoperative evisceration is a rare but major complication after CRS and HIPEC. This study aimed to identify the risk factors associated with evisceration after HIPEC, comparing outcomes between open and closed abdominal HIPEC. METHODS We conducted a retrospective multi-center study analyzing data of 233 patients with PM who underwent CRS/HIPEC between 2014 and 2023. Patients were categorized based on the HIPEC technique: Open (OPEN_HIPEC), n = 110; Closed abdominal technique (CLOSED_HIPEC), n = 123). We aimed to identify patient factors associated with evisceration within 30 days of CRS/HIPEC, using multivariate analysis. RESULTS Among 233 patients included, 129 (55.4 %) were women. The median age was 60 [51; 67] years. The OPEN_HIPEC group was significantly younger than the CLOSED_HIPEC group (median 57 [47; 62] vs 63 [54; 70] years; p ≤ 0.001) with a higher PCI score (median 9.5 [5; 17] vs 6 [2; 11]; p ≤ 0.001). Severe complications were similar between OPEN and CLOSED_HIPEC: 17 (15.5 %) vs 15 (12.2 %); p = 0.471 with no mortality. Eight (3.4 %) patients had postoperative evisceration with significantly more occurrences in the OPEN_HIPEC than in the CLOSED_HIPEC group (7/110 (6.4 %) vs 1/123 (0.8 %); p = 0.028). Univariate analysis identified chronic obstructive pulmonary disease (COPD)/respiratory pathology (HR = 7.02 [1.76-28.1]) and PCI score category of 11-15 (HR = 5.09 [1.03-25.2] as risk factors. Multivariate analysis identified a history of COPD/respiratory pathology (HR = 7.39 [1.85-29.6], p = 0.005) and OPEN_HIPEC (HR = 8.37 [1.03-68.1], p = 0.047) as risk factors of postoperative evisceration. Although suture material was not identified as a significant factor by the analysis, all eviscerations in the OPEN_HIPEC group were observed following musculoaponeurotic closures using Vicryl 1 sutures. CONCLUSIONS Following CRS/HIPEC treatment, 3.4 % patients had evisceration by day 30. A history of COPD/respiratory pathology and OPEN_HIPEC technique were identified as independent risk factors associated with evisceration, necessitating reintervention. It should also be noted that in the OPEN_HIPEC group there were no eviscerations after the change to PDS sutures.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
| | - Jade Fawaz
- Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Paris, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France; French Military Health Service Academy, Ecole Du Val de Grace, Paris, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre-Yves Sage
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Juliette Fischer
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Marc Pocard
- Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Paris, France; INSERM, U965 CART Unit, Paris, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Anne-Cécile Ezanno
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France; INSERM, Univ Rennes, OSS (Oncogenesis, Stress, Signaling) Laboratory, UMR_S 1242, Rennes, France.
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Falagario UG, Pellegrino F, Fanelli A, Guzzi F, Bartoletti R, Cash H, Pavlovich C, Emberton M, Carrieri G, Giannarini G. Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies. Prostate Cancer Prostatic Dis 2025; 28:270-279. [PMID: 38580833 PMCID: PMC12106061 DOI: 10.1038/s41391-024-00827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Three primary strategies for MRI-targeted biopsies (TB) are available: Cognitive TB (COG-TB), MRI-US Fusion TB (FUS-TB), and In Bore TB (IB-TB). Despite nearly a decade of practice, a consensus on the preferred approach is lacking, with previous studies showing comparable PCa detection rates among the three methods. METHODS We conducted a search of PubMed, EMBASE, PubMed, Web of Science, and Scopus databases from 2014 to 2023, to identify studies comparing at least two of the three methods and reporting clinically significant PCa (csPCa) detection rates. The primary and secondary outcomes were to compare the csPCa and insignificant prostate cancer (iPCa, ISUP GG 1) detection rates between TB techniques. The tertiary outcome was to compare the complication rate between TB techniques. Detection rates were pooled using random-effect models. Planned sensitivity analyses included subgroup analysis according to the definition of csPCa and positive MRI, previous biopsy status, biopsy route, prostate volume, and lesion characteristics. RESULTS A total of twenty studies, involving 4928 patients, were included in the quantitative synthesis. The meta-analysis unveiled comparable csPCa detection rates among COG-TB (0.37), FUS-TB (0.39), and IB-TB (0.47). iPCa detection rate was also similar between TB techniques (COG-TB: 0.12, FUS-TB: 0.17, IB-TB: 0.18). All preplanned sensitivity analyses were conducted and did not show any statistically significant difference in the detection of csPCa between TB methods. Complication rates, however, were infrequently reported, and when available, no statistically significant differences were observed among the techniques. CONCLUSIONS This unique study, exclusively focusing on comparative research, indicates no significant differences in csPCa and iPCa detection rates between COG-TB, FUS-TB, and IB-TB. Decisions between these techniques may extend beyond diagnostic accuracy, considering factors such as resource availability and operator preferences. Well-designed prospective studies are warranted to refine our understanding of the optimal approach for TB in diverse clinical scenarios.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, (Solna), Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy.
| | - Francesco Pellegrino
- Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Fanelli
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Francesco Guzzi
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- PROURO, Berlin, Germany
| | - Christian Pavlovich
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Giuseppe Carrieri
- Department of Urology and kidney transplantation, University of Foggia, Foggia, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria Della Misericordia University Hospital, Udine, Italy
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