Masatsune Shibutani

Background/Aims: Ulcerative colitis (UC)-associated colorectal neoplasia (UCAN) in patients with UC and primary sclerosing cholangitis (PSC) has not been studied well in Japan. This retrospective study examined the clinicopathological features and prognosis of UCAN in patients with PSC-UC. Methods: A total of 808 patients with UCAN were enrolled from 1983 to 2020 and categorized into PSC (PSC-UCAN, n = 26) and no PSC (UCAN-alone, n = 782) groups. Clinicopathological features were compared between the 2 groups, and the 10-year overall survival (OS) and cancer-specific survival (CSS) were analyzed. Results: The PSC-UCAN group had a shorter UC duration before UCAN diagnosis (12.8 years vs. 16.9 years, P= 0.044), were younger at UCAN diagnosis (47.8 years vs. 53.3 years, P= 0.046), and developed UCAN more frequently in the right-sided colon (34.6% vs. 15.9%, P= 0.028) than the UCAN-alone group. The PSC-UCAN group showed a trend toward a lower proportion of high-grade dysplasia (19.2% vs. 30.7%) and a higher proportion of early-stage cancers (53.9% vs. 31.2%). The 10-year OS (64.6% vs. 79.3%, P=0.080) and CSS (80.8% vs. 83.9%, P=0.60) were comparable. Conclusions: Patients with PSC-UCAN showed earlier and younger development of UCAN than patients with only UCAN, with a high prevalence in the right-sided colon. Early-stage cancer was more frequently observed in the PSC-UCAN group, despite the shorter duration of UC. Patients with PSC-UC probably benefit from early initiation of surveillance colonoscopy.

Background Port-site hernia (PSH) at 8-mm robotic trocar sites is considered uncommon, and routine fascial closure is generally not recommended. However, clinically significant PSH continues to occur, and its underlying mechanisms remain incompletely understood. This study aimed to evaluate the incidence and risk factors of 8-mm PSH after robotic-assisted surgery and to explore practical preventive strategies. Methods We retrospectively analyzed 816 patients who underwent robotic-assisted surgery across the gastrointestinal, hepatobiliary-pancreatic, urological, and gynecological specialties between January 2020 and December 2024. A total of 2337 8-mm ports were included, all of which were left without fascial closure. Patient characteristics, port locations, drain placement and size, operative times, and perioperative factors were evaluated in patients who developed PSH. Results The median BMI of the overall cohort was 22.9 kg/m² (range 11.0–48.9 kg/m²). The incidence of 8-mm PSH was 0.49% per patient (4/816) and 0.17% per port (4/2337). All PSH cases occurred at lateral abdominal wall port sites in non-obese patients (body mass index 2). Three of the four cases (75%) developed at drain insertion sites, and symptoms appeared shortly after drain removal. The median total operative time was 323.5 min in the PSH group versus 317 min in the non-PSH group. All hernias were Richter-type hernias. Clinical findings suggested a multifactorial mechanism involving mechanical enlargement of the fascial defect by robotic torque, impaired muscular shutter mechanisms at lateral abdominal sites, and drain-related factors that prevented spontaneous fascial closure. Conclusions Eight-millimeter PSH is a rare but potentially preventable complication of robotic-assisted surgery. The risk appears to be concentrated in non-obese patients with lateral abdominal wall ports, particularly when these sites are used for drain placement. Intraoperative digital assessment of the fascial defect using the “pinky test” may facilitate selective fascial closure of high-risk port sites and help reduce the occurrence of this complication.

Background: Japan’s rapidly aging population has led to an increase in elderly patients undergoing gastrectomy for gastric cancer. However, the impact of postoperative complications on survival in patients aged ≥80 years remains unclear. This study aimed to evaluate the association between postoperative complications and survival outcomes in patients aged ≥80 years with gastric cancer. Materials and methods: We retrospectively analyzed 61 patients aged ≥80 years who underwent gastrectomy with D2 lymph node dissection between 1999 and 2020. Postoperative complications were classified according to the Clavien-Dindo (CD) classification into a “no or minor complication group” (CD Grade ≤ II, including no postoperative complications) and a “major complication group” (CD Grade ≥ III), and the impact of postoperative complications on survival outcomes were assessed. A subgroup analysis excluding macroscopic type 4 was also performed. Results: Postoperative complications occurred in 24 patients (39.3%), of which 8 (13.1%) experienced major complications. Patients in the major complication group had a significantly longer postoperative hospital stay, while other baseline characteristics were similar between groups. Kaplan–Meier analysis showed a trend toward poorer OS in the major complication group (P = 0.063), and recurrence-free survival (RFS) was significantly worse in this group (P = 0.004). Multivariate analysis showed that postoperative complications of CD grade ≥ III were independently associated with poorer OS (HR 2.51; 95% CI 1.01–6.24; P = 0.049). Subgroup analysis in patients without type 4 also showed significantly worse OS in the major complication group (P = 0.036). Conclusion: This study showed that postoperative complications were associated with poorer OS and RFS even in patients aged ≥80 years with gastric cancer. Future large-scale studies are needed to further clarify this association and optimize treatment strategies for this population.

Background: Trifluridine/tipiracil (FTD/TPI) combined with bevacizumab (Bev) is an established later-line therapy for metastatic colorectal cancer (mCRC). However, the clinical impact of insufficient Bev dose intensity, often caused by cumulative renal toxicity, on treatment efficacy remains unclear. Methods: This retrospective cohort study evaluated 101 patients with mCRC receiving FTD/TPI + Bev to determine the clinical impact of Bev relative dose intensity (RDI). Based on a receiver-operating-characteristic analysis, a Bev RDI cutoff of 70% was established, categorizing patients into high-RDI (≥70%, n = 75) and low-RDI (n = 26) groups. Results: The high-RDI group demonstrated significantly longer progression-free survival (131 vs. 82 days, p = 0.003) compared to the low-RDI group. For overall survival, although statistical significance was not reached, a favorable trend was observed in the high-RDI group (343 vs. 215 days, p = 0.093). The disease control rate was also significantly higher in the high-RDI group (46.7% vs. 23.1%, p = 0.040). Treatment interruption due to proteinuria was the primary cause of reduced RDI. Furthermore, a history of severe proteinuria during prior anti-VEGF therapy strongly predicted its recurrence during the current regimen. Conclusions: Maintaining the dose intensity of Bev is crucial for maximizing the efficacy of FTD/TPI + Bev, highlighting the necessity of long-term proteinuria management across treatment lines.

Familial adenomatous polyposis (FAP) is a genetic disease caused by APC mutation. It develops into multiple adenomatous polyps when patients are in their early 20s and eventually transforms into colorectal cancer at 100% penetrance unless treated. Therefore, prophylactic surgery is the only effective treatment option. However, individual approaches such as total colectomy with ileorectal anastomosis, proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA), proctocolectomy with mucosectomy, hand-sewn IPAA, and total proctocolectomy with end ileostomy are required based on the balance between the risk of metachronous rectal cancer, postoperative complications, and decreased anal function. Herein, we summarize the current evidence regarding the surgical treatment and postoperative surveillance for FAP.

Febrile neutropenia (FN) remains a major complication of neoadjuvant chemotherapy (NAC) and is a frequent cause of treatment disruption. However, FN is a h

Purpose: The 21-gene Oncotype DX Recurrence Score (RS) is widely used to guide adjuvant chemotherapy decisions in hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer. However, the clinical interpretation of RS remains challenging in premenopausal women with node-positive disease, where discordance between genomic and clinicopathological risk is frequently encountered. This study aimed to elucidate the determinants of clinical–genomic risk discordance and to clarify its impact on real-world treatment selection, with a specific focus on premenopausal node-positive patients. Methods: We retrospectively analyzed 290 patients with HR+/HER2- breast cancer who underwent curative surgery and Oncotype DX testing between September 2023 and November 2025. Clinical risk was defined according to the St. Gallen criteria, and concordance or discordance was determined based on agreement or disagreement between clinical risk and RS. Logistic regression analyses were performed to identify predictors of discordance in the overall cohort and in node-positive patients. Treatment allocation was further examined in a predefined subgroup of 28 premenopausal patients with node-positive disease. Treatment strategies were categorized as chemotherapy plus endocrine therapy, endocrine therapy combined with systemic intensification (abemaciclib or S-1), or endocrine therapy alone. Results: Clinical–genomic risk discordance was observed in 123 patients (42.4%). In multivariable analysis of the overall cohort, larger tumor size (OR 8.33) and nodal positivity (OR 6.43) were independently associated with discordance, indicating a strong association with tumor burden. In contrast, among node-positive patients, premenopausal status (OR 0.18, p = 0.045) and high proliferative activity (Ki-67 > 20%; OR 4.81, p = 0.048) were independently associated with discordance, indicating a distinct biological pattern associated with proliferative activity in premenopausal disease. In the premenopausal node-positive subgroup, all concordant cases received intravenous chemotherapy, whereas discordant cases showed marked heterogeneity in treatment selection: chemotherapy in 2 patients (8.0%), endocrine therapy combined with targeted or fluoropyrimidine-based intensification strategies (including abemaciclib or S-1) in 11 patients (44.0%), and endocrine therapy alone in 12 patients ( p < 0.001). Conclusions: Clinical–genomic risk discordance is frequent in premenopausal women with node-positive hormone receptor-positive, HER2-negative breast cancer and is associated with distinct biological characteristics, including high proliferative activity. In real-world clinical practice, discordance was linked to substantial variation in adjuvant treatment selection, with many patients managed using endocrine-based strategies. These findings highlight the clinical relevance of integrating genomic and clinicopathological information in treatment decision-making and support the role of genomic assays as complementary tools for individualized therapy in this challenging population.

Background/Aim: A smooth transition to subsequent treatments is crucial for improving the prognosis of patients with metastatic colorectal cancer who receive chemotherapy. This study aimed to examine how patient factors at the initiation of treatment influence the feasibility of transitioning to subsequent treatments in patients who received trifluridine-tipiracil plus bevacizumab (FTD/TPI + Bev) therapy. Patients and Methods: This retrospective study included 80 patients treated with FTD/TPI + Bev therapy for metastatic colorectal cancer at Osaka City University Hospital between January 2016 and December 2023. Results: Patients who were able to transition to subsequent treatments showed a significantly longer overall survival after the discontinuation of FTD/TPI + Bev therapy than those who were not. Immunonutritional indicators, such as the serum albumin concentration and Geriatric Nutritional Risk Index (GNRI), were significantly elevated in patients who were able to proceed to subsequent treatments in comparison to those who were not able to do so. Conclusion: A poor immunonutritional status at the initiation of FTD/TPI + Bev therapy may lead to a lower rate of transitioning to subsequent treatments, thus resulting in a worse prognosis.