Annals of Gastroenterological Surgery

The mesopancreas or mesopancreatoduodenum is an important anatomical concept during pancreaticoduodenectomy (PD) in patients with periampullary carcinoma. This study investigated whether the duodenojejunal uncinate process vein (DJUV), which is defined as the vein draining from the upper jejunum to the superior mesenteric vein adjacent to the uncinate process, is a useful anatomical landmark for the caudal border of mesopancreatoduodenum resection during PD.

Masahiko Honjo

Taiji Tohyama

Kohei Ogawa

Kei Tamura

Katsunori Sakamoto

Akihiro Takai

Jota Watanabe

Hiromi Ohtani

Yasutsugu Takada

Anatomical Study of the Duodenojejunal Uncinate Process Vein: A Key Landmark for Mesopancreatoduodenal Resection During Pancreaticoduodenectomy

十二指肠空肠曲钩突静脉的解剖学研究：胰十二指肠切除术中胰十二指肠中段切除的关键标志

Abstract Aim Although rectal neuroendocrine tumors (NETs) are considered to be rare low‐grade malignancies when lymph node metastasis (LNM) is present, their degree of malignancy is comparable to that of colorectal cancer (CRC). However, it remains unclear as to which patients require radical lymph node dissection. The aim of this study was to elucidate the risk factors for LNM and develop a risk‐scoring system for LNM to help determine appropriate therapeutic approaches. Methods In this study, we examined 103 patients with rectal NETs who underwent local resection (n = 55) or radical resection with LN dissection (n = 48). We evaluated each pathological feature, including the depth of submucosal invasion (SM depth) and tumor budding grade. Results According to our univariate analyses and previous reports, the significant five risk factors for LNM were weighted with point values: 2 points for tumor size ≥ 15 mm and muscularis invasion, and 1 point each for SM depth ≥ 2000 µm, positive lymphovascular invasion, budding grade 3, and vertical margin. The area under the receiver operating curve for the scoring system was 0.899 (95% CI: 0.843‐0.955). When a score of 2 was used as the cut‐off value, the sensitivity and specificity for the prediction of LNM were 100% and 72.1%, respectively. Conclusions The risk‐scoring system for LNM of rectal NETs showed high diagnostic performance. Using this risk‐scoring system, it is possible to predict the risk of LNM and thereby potentially avoid unnecessary surgery. Further prospective external validation studies should be performed. The study was registered in the Japanese Clinical Trials Registry as UMIN000036658.

Keigo Chida

Jun Watanabe

Kingo Hirasawa

Yoshiaki Inayama

Toshihiro Misumi

Chikara Kunisaki

Itaru Endo

A novel risk‐scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors

预测直肠神经内分泌肿瘤淋巴结转移的新型风险评分系统

This study has two aims: to evaluate long-term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C-TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases.

Shunsuke Hayakawa

Tetsushi Hayakawa

Kaori Watanabe

Kenta Saito

Hirotaka Miyai

Ryo Ogawa

Minoru Yamamoto

Kenji Kobayashi

Shuji Takiguchi

Moritsugu Tanaka

Evaluation of long‐term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair

单侧与双侧环形切口经腹膜前腹股沟疝修补术的长期慢性疼痛及疗效评估

Biliary tract cancer (BTCs) is a heterogeneous malignancy divided into cholangiocarcinoma, gallbladder cancer, and ampullary cancer. Due to little or no symptoms, most patients with BTCs are diagnosed with unresectable or metastatic disease. Only 20%-30% of all BTCs are suitable for potentially resectable diseases. Although radical resection with a negative surgical margin is the only potentially curative method for BTCs, most patients develop postoperative recurrence, which is associated with poor prognosis. Therefore, perioperative treatment is necessary to improve survival. There are very few randomized phase III clinical trials of perioperative chemotherapy due to the relative rarity of BTCs. Adjuvant chemotherapy with S-1 for patients with resected BTC significantly increased overall survival compared with upfront surgery in a recent ASCOT trial. In East Asia, S-1 is currently considered the standard adjuvant chemotherapy, while capecitabine may still be used in other areas. Since then, our phase III trial (KHBO1401), gemcitabine and cisplatin plus S-1 (GCS) has become the standard chemotherapy for advanced BTCs. GCS not only improved overall survival but demonstrated a high response rate. The efficacy of GCS as a preoperative neoadjuvant chemotherapy for resectable BTCs has been investigated in a randomized phase III trial (JCOG1920) in Japan. In this review, we summarize the current and ongoing clinical trials focusing on adjuvant and neoadjuvant chemotherapy for BTCs.

Tatsuya Ioka

Yoshitaro Shindo

Makoto Ueno

Hiroaki Nagano

Current progress in perioperative chemotherapy for biliary tract cancer

胆道癌围手术期化疗的最新进展

Abstract Aim Previous studies have examined bowel preparation as a measure to reduce surgical site infection (SSI) rates. This retrospective study aimed to identify the risk factors for SSI in right‐sided colon cancer surgery using intracorporeal anastomosis (IA). We focused on perioperative factors, including the bowel preparation method, to clarify the impact of preoperative mechanical bowel preparation (MBP) and oral antibiotics (OA) on SSI incidence. Methods Patients ( n = 150) with right‐sided colon cancer who underwent elective laparoscopic or robot‐assisted colectomy (2019 and 2023) were included. Potential risk factors for SSI were examined using univariate and multivariate analyses. Results The overall incidence of SSI was 11 (7.3%) cases, with eight (5.4%) cases classified as incision site SSI and three (1.9%) as organ/space SSI. Univariate analysis showed that OA ( p &lt; 0.001) and MBP ( p = 0.002) significantly reduced the SSI rate. Multivariate analysis identified OA as an independent risk factor (hazard ratio, 0.142; 95% confidence interval, 0.025–0.827; p = 0.025). Patients with SSI had longer postoperative hospital stays compared to those without SSI (median 9 vs. 8 days, p = 0.012). On postoperative day 1, the group receiving OA had significantly lower white blood cell count (9390 vs. 10 900/μL, p = 0.005) and C‐reactive protein levels (3.81 vs. 7.83 mg/dL, p &lt; 0.001) compared to those in the group not receiving OA. Conclusion Preoperative administration of OA in laparoscopic or robot‐assisted right‐sided colon cancer surgery with IA may help decrease the incidence of SSI.

Naoya Ozawa

Tomohiro Yamaguchi

Takumi Kozu

Tatsuki Noguchi

Takashi Sakamoto

Shimpei Matsui

Toshiki Mukai

Takashi Akiyoshi

Yosuke Fukunaga

Bowel preparation and surgical site infections in laparoscopic and robot‐assisted right‐sided colon cancer surgery with intracorporeal anastomosis: A retrospective study

腹腔镜和机器人辅助右半结肠癌手术中肠道准备与手术部位感染的回顾性研究：体内吻合术的应用

Abstract Pancreatic cancer is among the leading causes of gastrointestinal cancer‐related death, with a dismal prognosis. Over 80% of pancreatic cancer patients present with advanced disease, making curative resection unfeasible. These patients are often presented with malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). In these cases, palliative management is aimed to alleviate symptoms, enhance quality of life, and facilitate subsequent chemotherapy. Currently, neoadjuvant chemotherapy is frequently used in both borderline resectable and resectable pancreatic cancer, necessitating effective biliary and gastrointestinal drainage in a growing number of patients. Traditionally, surgical bypass was the gold standard, performed via either a minimally invasive or open approach. However, notable progress has emerged in developing endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) stenting for MBO and endoscopic enteral stenting for GOO. While these procedures provide rapid symptom relief, they are associated with higher stent dysfunction rates and more frequent re‐intervention needs. When ERCP fails, percutaneous transhepatic biliary drainage is a widely accepted alternative for MBO. Endoscopic ultrasound (EUS)‐guided techniques, including EUS‐guided biliary drainage and EUS‐guided gastroenterostomy, have recently gained prominence. Emerging clinical data suggest that these methods may be superior, potentially becoming the preferred first‐line palliative treatment for unresectable pancreatic cancer. This review will summarize the current evidence on managing MBO and GOO in patients with pancreatic cancer.

Pengfei Wu

Kai Chen

Jin He

Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer

胰腺癌所致恶性胆道梗阻和胃出口梗阻的姑息治疗

Abstract Aim To evaluate the prognostic effect of initiation timing and completion of adjuvant therapy in patients with pancreatic ductal adenocarcinoma. Methods The medical records of patients with pancreatic ductal adenocarcinoma who underwent radical pancreatectomy between 2006 and 2022 at Hiroshima University were retrospectively reviewed. Patient characteristics, perioperative outcomes, clinicopathological factors, and survival rates were analyzed. Adjuvant indications were for all patients who had a good postoperative status as early as possible. Early initiation was defined as adjuvant initiation within 4 weeks after surgery, and completion was defined as a total of 6 months of administration. Results In total, 444 (294, resectable; 150, borderline resectable or locally advanced) patients who received adjuvant therapy were enrolled in this study. The median time to adjuvant therapy initiation was 20 days. In total, 328 patients with early initiation had better overall survival than those with delayed initiation, and 409 patients with adjuvant completion had better survival rates than those with incompletion. Multivariate overall survival analysis demonstrated that early adjuvant therapy initiation and completion were independent prognostic factors for prolonged survival. In total, 310 adjuvant completions with early initiation resulted in a median survival period of 81.8 months. Multivariate analysis identified severe postoperative complication as an independent risk factor preventing adjuvant completion with early initiation. Conclusion Adjuvant completion with early initiation may contribute to the improved survival of patients with pancreatic ductal adenocarcinoma. Preventing severe postoperative complications may facilitate adjuvant completion with early initiation.

Kenjiro Okada

Kenichiro Uemura

Tatsuaki Sumiyoshi

Ryuta Shintakuya

Kenta Baba

Takumi Harada

Yasutaka Ishii

Shiro Oka

Yoshiaki Murakami

Shinya Takahashi

Survival benefit of adjuvant therapy completion with early initiation for patients with pancreatic ductal adenocarcinoma

胰腺导管腺癌患者早期启动并完成辅助治疗的生存获益

Abstract Aim Older adults with cancer are often at increased risk for postoperative complications following major surgeries. This study aimed to evaluate the combined role of frailty and sarcopenia in predicting postoperative complications in older adults with hepatobiliary and pancreatic cancer undergoing surgery. Methods This retrospective study included 107 Japanese patients who underwent comprehensive geriatric assessment (CGA) at the geriatric oncology service before cancer treatment decisions and subsequent curative surgery for hepatobiliary and pancreatic cancer. Frailty status was measured using the validated 10‐item frailty index based on a CGA (FI‐CGA‐10) and categorized as fit, prefrail, or frail. Sarcopenia was assessed using bioelectrical impedance analysis and grip strength. The primary outcome was postoperative complications, defined as Clavien–Dindo grade ≥ III, within 1 month of surgery. Results The median age of the 107 patients was 79 (range, 75–89) years. Patients were categorized as fit ( n = 36, 33.7%), prefrail ( n = 57, 53.2%), or frail ( n = 14, 13.1%). Of these, 21 patients (20%) were diagnosed with sarcopenia; 16 patients (15%) experienced postoperative complications. Patients classified as prefrail or frail had a higher incidence of postoperative complications compared with those classified as fit (19.7% vs. 5.6%, p = 0.08). Patients with both prefrail or frail and sarcopenia had a significantly higher risk of postoperative complications. This association remained significant in the multivariable model (OR 4.74; 95% CI, 1.10–20.29; p = 0.04). Conclusion In this study, patients classified as prefrail/frail and sarcopenic were at significantly higher risk for postoperative complications.

Norifumi Harimoto

Keishi Sugimachi

Tomohiro F. Nishijima

Tomino Takahiro

Tomonari Shimagaki

Yohei Mano

Emi Onishi

Masahiko Sugiyama

Yasue Kimura

Masaru Morita

Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato‐biliary‐pancreatic cancer

衰弱和肌肉减少症对接受肝胆胰癌根治手术的老年患者术后并发症的联合影响

Abstract Aims We previously reported no change in surgical outcomes for laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR) early in the COVID‐19 pandemic (2020), although the number of elective surgeries decreased. In 2021, COVID‐19 spread further, with vaccination and other medical measures based on several medical societies' guidelines being initiated. Using the Japanese National Clinical Database (NCD), we added 2022 data to the 2018–2021 data to analyze the impacts of expansion of the COVID‐19 infection and its spread on laparoscopic surgery (including robot‐assisted surgery). Methods Data on patients who underwent LDG and LLAR for cancer were extracted from the NCD between 2018 and 2022. The numbers of LDG and LLAR were obtained, and morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), i.e. the ratio of the observed number of incidences to expected number of incidences calculated by the risk calculator previously developed by the NCD. Results The numbers of LDG and LLAR cases declined in 2020, the first pandemic year, and continued to decline in 2022 to the same level as 2021, but with no further decline and no recovery trend in the number of cases. Numbers of robot‐assisted LDG and LLAR cases increased but at a rate lower than the prepandemic increase. Mortality and anastomotic leakage, two very important complications assessed in SMR, did not worsen during the pandemic compared to prepandemic levels. Conclusion In Japan, laparoscopic surgery was safe and unaffected by the COVID‐19 pandemic, even in 2022, when the epidemic spread.

Masafumi Inomata

Hideki Endo

Tomonori Akagi

Hidefumi Shiroshita

Shigeki Yamaguchi

Susumu Eguchi

Norihito Wada

Yukinori Kurokawa

Yosuke Seki

Yoshiharu Sakai

Hiroyuki Yamamoto

Yoshihiro Kakeji

Yuko Kitagawa

Akinobu Taketomi

Masaki Mori

Effect on short‐term outcomes of the <scp>COVID</scp>‐19 pandemic following laparoscopic distal gastrectomy and low anterior resection for gastric and rectal cancer: A retrospective study using the Japanese National Clinical Database, 2018–2022

COVID-19大流行对腹腔镜远端胃切除术和低位前切除术治疗胃癌和直肠癌短期结果的影响：基于日本国家临床数据库的回顾性研究（2018-2022）

Abstract Aim To evaluate the impact of the coronavirus disease (COVID‐19) pandemic on short‐term outcomes of low anterior resection (LAR) across hospitals classified by surgical volume. Methods Data of patients who underwent elective LAR for rectal cancer between 2018 and 2022 were obtained from the National Clinical Database of Japan. Hospitals were categorized into high‐, medium‐, and low‐volume groups. Each group was constituted to represent approximately one‐third of all surgeries performed between 2018 and 2019. The standardized morbidity/mortality ratios (SMRs) of Clavien–Dindo grade ≥3 (CD ≥ 3) complications were the primary endpoint. The secondary endpoints included anastomotic leakage, pneumonia, and surgical mortality. Results This study analyzed 91 800 cases of elective LAR, with 10.5% experiencing CD ≥ 3 complications, 8.8% anastomotic leakage, 0.9% pneumonia, and 0.5% surgical mortality. Despite COVID‐19, SMRs of CD ≥ 3 complications decreased from 2018 to 2022 across all groups. However, increases in the rates and SMRs of CD ≥ 3 complications were observed in low‐volume hospitals around mid‐2020, followed by a decline. Anastomotic leakage showed similar trends. The rates and SMRs of pneumonia and surgical mortality remained unchanged. Notably, anastomotic leakage rates were 7.6%, 8.9%, and 10.0% in high‐, medium‐, and low‐volume hospitals, respectively, indicating superior outcomes in high‐volume hospitals. Conclusion Early COVID‐19 waves may have disproportionately affected low‐volume hospitals. However, the decline in SMRs of CD ≥ 3 complications from 2018 to 2022 across all three groups suggests the robustness and resilience of surgical services for rectal cancer in Japan. The potential disparity in short‐term outcomes among hospitals is a new concern.

Hiromichi Maeda

Ryo Seishima

Taizo Hibi

Masashi Takeuchi

Yusuke Takemura

Yasuyuki Seto

Hideki Ueno

Ken Shirabe

Impacts of <scp>COVID</scp>‐19 pandemic on short‐term outcomes of low anterior resection performed in hospitals with different surgical volumes

不同手术量医院中COVID-19大流行对低位前切除短期结果的影响

Abbreviation	Ann. Gastroenterol. Surg.
Journal Impact	2.74
Quartiles(Global)	GASTROENTEROLOGY & HEPATOLOGY(Q2)

ISSN	2475-0328
h-index	32

Publication Information	Publisher: Wiley-Blackwell Publishing Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2017，Proportion of original research papers: 86.96%，Self Citation Rate:10.30%， Gold OA Rate: 71.96%
Journal Fees	$2035Details
Average review cycle	网友分享经验：11 Weeks

Annals of Gastroenterological Surgery

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