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

We conducted a multicenter study on classical laparoscopic and endoscopic cooperative surgery (LECS) and LECS-related procedures to retrospectively clarify the safety, problems, and mid-term outcomes of these methods after their coverage by the national health insurance.

Yoshikazu Hashimoto

Nobutsugu Abe

Souya Nunobe

Hirofumi Kawakubo

Tetsuya Sumiyoshi

Naohiro Yoshida

Yoshinori Morita

Masanori Terashima

Zenichiro Saze

Manabu Onimaru

Eigo Otsuji

Shu Hoteya

Haruhiro Yamashita

Takashi Fujimura

Tsuneo Oyama

Ken Ohata

Satoki Shichijo

Kazuaki Tanabe

Kiyohiko Shuto

Takashi Ikeya

Hisashi Shinohara

Satoshi Tanabe

Naoki Hiki

Outcomes of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors: A retrospective multicenter study at 21 Japanese institutions

日本21家机构胃黏膜下肿瘤腹腔镜与内镜合作手术结果的回顾性多中心研究

Abstract Aims The incidence of postoperative chronic liver failure (PCLF) after major hepatectomy for perihilar cholangiocarcinoma is relatively low, but it warrants careful attention. This study aimed to analyze the risk factors for PCLF, with a specific focus on the correlation with postoperative changes in liver and spleen volumes. Methods A total of 172 patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2006 and 2021 were included in the study. PCLF is defined as the presence of liver failure, such as ascites, esophageal varices, encephalopathy, and jaundice at 3 mo postoperatively. Risk factors, including chronological changes in liver volume, spleen volume, and hepatospleno volume ratio for PCLF, were evaluated by univariate and multivariate analyses. Results PCLF occurred in 8 of the 172 patients. On univariate analysis, multiple factors including preoperative prealbumin levels, indocyanine green retention test, and future remnant liver volume were identified as risk factors for PCLF. On multivariate analysis, the hepatospleno volume ratio ( p = 0.033) and prealbumin level ( p = 0.015) 3 mo after surgery were significantly associated with PCLF. The cutoff value for the hepatospleno volume ratio was 3.0 (area under the curve [AUC]: 0.881, sensitivity: 91.7%, specificity: 66.7%) and that for prealbumin level was 10 mg/dL (AUC: 0.894, sensitivity: 83.3%, specificity: 88.9%). Conclusion Hepatospleno volume ratio &lt;3.0 and prealbumin level &lt;10 mg/dL 3 mo after surgery were identified as risk factors for PCLF, implying the importance of postoperative nutritional guidance to preserve the remnant liver function for patients with these risk factors.

Atsushi Takahashi

Yoshihiro Ono

Kosuke Kobayashi

Atsushi Oba

Takafumi Sato

Hiromichi Ito

Yosuke Inoue

Akio Saiura

Yu Takahashi

Impact of hepatospleno volume ratio on postoperative chronic liver failure after major hepatectomy for perihilar cholangiocarcinoma

肝脾体积比对肝门部胆管癌大手术后慢性肝衰竭的影响

Abstract Background Despite the prevalence of laparoscopic techniques in abdominal surgeries today, bowel obstruction remains a potentially serious complication. Small bowel strangulation (SBS), in particular, is a critical condition that can lead to patient mortality. However, the prognosis for SBS is favorable if surgery is performed before the onset of necrosis. Non‐necrotic SBS is a reversible condition in which blood flow can be restored by relieving the strangulation. The purpose of this study was to identify sensitive and specific contrast‐enhanced computed tomography (CT) findings that are useful for diagnosis of both non‐necrotic and necrotic SBS. Methods We included patients diagnosed with SBS and simple bowel obstruction (SBO) who underwent contrast‐enhanced CT followed by surgery from 2006 to 2023. Two gastrointestinal surgeons independently assessed the images retrospectively. Results Eighty SBO and 141 SBS patients were included. Eighty‐seven had non‐necrotic SBS and 54 had necrotic SBS. Mesenteric edema was most frequently observed in both necrotic and non‐necrotic SBS cases followed by abnormal bowel wall thickening. These two findings were observed significantly less frequently in SBO. Bowel hypo‐enhancement is identified in only about half of the non‐necrotic SBS cases, and it was detected at significantly higher rates in necrotic SBS compared to non‐necrotic. Conclusion Mesenteric edema and abnormal bowel wall thickening are sensitive and specific signs of both non‐necrotic and necrotic SBS. These two findings indicate mesenteric and bowel congestion. Detecting intestinal congestion can lead to an accurate diagnosis of SBS, particularly in case of non‐necrotic SBS, where bowel hypo‐enhancement may sometimes be absent.

Takeshi Yamada

Yuto Aoki

Akihisa Matsuda

Yasuyuki Yokoyama

Goro Takahashi

Takuma Iwai

Seiichi Shinji

Hiromichi Sonoda

Kay Uehara

Hiroshi Yoshida

Diagnosis of necrotic and non‐necrotic small bowel strangulation: The importance of intestinal congestion

坏死性和非坏死性小肠绞窄的诊断：肠淤血的重要性

Abstract Aim Minimally invasive surgery for colorectal cancer is increasing globally. However, the safety in older patients have not been thoroughly examined. Methods Patients with colorectal cancer who underwent laparoscopic or robot‐assisted surgery at Kyoto University Hospital and 18 affiliated institutions in Japan that participated in the Kyoto Colorectal Surgery Group between 2018 and 2023 were enrolled. Focusing on patients ≥80 y, we investigated the risk factors for postoperative complications. Results In total, 7303 patients were enrolled in this study. The mean age was 71 ± 11 y, with 1665 patients (22.8%) ≥80 y old. Older patients (≥80 y) had significantly higher ASA and ECOG‐PS scores and more comorbidities including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, heart disease, and cerebrovascular disease than patients ≤79 y old (all p &lt; 0.05). In the older group, postoperative complications (Clavien–Dindo grade ≥II) occurred in 210 patients (12.6%). After adjusting for covariates using the multivariable logistic regression model, rectal cancer (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.30–2.60, p = 0.001), operation time ≥300 min (OR: 1.52, 95% CI: 1.07–2.16, p = 0.020), and blood loss ≥100 mL (OR: 2.19, 95% CI: 1.80–3.24, p &lt; 0.001) were associated with the occurrence of complications, whereas their comorbidities showed no association. Conclusion In minimally invasive colorectal cancer surgery for older patients (≥80 y old), prioritizing shorter operation time and blood loss control is crucial, especially for patients with rectal cancer because of their high risk of complications.

Takehito Yamamoto

Koya Hida

Kentaro Goto

Meiki Fukuda

Susumu Inamoto

Hiroki Hashida

Ryo Matsusue

Ryo Takahashi

Rei Mizuno

Hiroaki Terajima

Kazutaka Obama

Risk factors for postoperative complications in laparoscopic and robot‐assisted surgery for octogenarians with colorectal cancer: A multicenter retrospective study

腹腔镜和机器人辅助手术治疗80岁以上结直肠癌患者术后并发症的风险因素：一项多中心回顾性研究

Abstract Aim During the COVID‐19 pandemic, there were delays in transport of emergency cases to hospital by ambulance due to increased difficulties in obtaining hospital acceptance. The aim of this study was to examine if this had a negative effect on postoperative short‐term outcomes in patients with colorectal perforation. Methods The National Clinical Database (NCD) includes &gt;95% of surgical cases in Japan. Postoperative 30‐day mortality, surgical mortality, and postoperative complications (Clavien–Dindo grade ≥3) were examined in 17 770 cases of colorectal perforation registered from 2019 to 2022 in the NCD. These outcomes were compared for cases with new COVID‐19 infection and emergency cases with difficulties in transport to hospital. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) did not contain 1. Results Postoperative 30‐day mortality occurred in 1826 cases (10.3%), surgical mortality in 2382 cases (13.4%), and postoperative complications in 5276 cases (29.7%). Significantly higher SMRs were found for 30‐day mortality in November 2020 (1.44 [95% CI: 1.07–1.89]) and February 2021 (1.54 [95% CI: 1.14–2.03]), and for postoperative complications in June 2020 (1.27 [95% CI: 1.07–1.50]). In 2022, there were marked increases in new COVID‐19 cases and in emergency cases with difficulties in transport to hospital, but no month had a significantly high SMR. Conclusions Emergency cases with difficulties in transport markedly increased during the COVID‐19 pandemic but had little effect on short‐term outcomes of colorectal perforation.

Shimpei Ogawa

Hideki Endo

Masahiro Yoshida

Tomomitsu Tsuru

Michio Itabashi

Hiroyuki Yamamoto

Yoshihiro Kakeji

Hideki Ueno

Ken Shirabe

Taizo Hibi

Akinobu Taketomi

Norihiko Ikeda

Masaki Mori

Effects of an increase in emergency cases with difficulties in transport to hospital during the <scp>COVID</scp>‐19 pandemic on postoperative short‐term outcomes of colorectal perforation: A study based on the National Clinical Database

COVID-19疫情期间急诊病例增加对结直肠穿孔术后短期转归的影响：基于国家临床数据库的研究

Abstract Aim The study aimed to clarify how nutrition was managed in patients based on surgical site during the first 7 d after gastroenterological cancer surgery. Methods A Japanese medical claims database was used to identify patients who had gastroenterological cancer surgery from 2011 to 2022. Patients were divided into groups based on the surgical sites, and postoperative feeding routes and timing of initiation of oral intake for groups were assessed. For the subset of patients fasting postoperatively for ≥7 d, the proportion of patients prescribed target doses of energy (20 kcal/kg) and amino acids (0.8 g/kg) on postoperative d 7 were assessed. Results Surgical sites of 360 296 study patients were: esophagus, 14 784; stomach, 103 339; colon/rectum, 194 049; liver, 19 277; gallbladder/bile duct, 8279; pancreas, 20 568. The median postoperative day of oral intake initiation was: esophagus, seven; stomach and pancreas, four; colon/rectum and gallbladder/bile duct, three; liver, two. The proportions of fasting patients prescribed target doses of energy and amino acids on postoperative d 7 were: esophagus, 42.6% and 34.4%; stomach, 21.8% and 28.0%; colon/rectum, 20.9% and 29.1%; liver, 21.2% and 22.5%; gallbladder/bile duct, 31.0% and 33.4%; pancreas, 28.2% and 37.8%, respectively. Conclusion Oral intake after gastroenterological cancer surgery was started earliest in patients undergoing liver surgery and latest in patients undergoing esophageal surgery. Target parenteral energy and amino acid doses were prescribed to less than half of fasting patients. Education is needed to promote early initiation of oral intake and the use of guidelines‐based parenteral nutrition dosing in patients after gastroenterological cancer surgery.

Yoshikuni Kawaguchi

Kenta Murotani

Nahoki Hayashi

Satoru Kamoshita

Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

全国性医疗数据库研究：消化道癌症手术后患者的营养管理

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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