Yoshihiro Hiramatsu

Ayamitsu Maeda, Masashi Takao, Shunji Takashima, Makoto Hasui, Yoshifumi Morita, Yoshihiro Hiramatsu, Katsuya Yamauchi. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.26-136

We evaluated how perioperative changes in the prognostic nutritional index (PNI) influence recurrence and survival after hepatectomy for colorectal cancer liver metastases (CRLM). We conducted a retrospective analysis of 108 patients who underwent hepatectomy for CRLM. Preoperative and postoperative PNI levels were compared, and patients were categorized into high (postoperative PNI equal to or higher than preoperative PNI) and low (postoperative PNI lower than preoperative PNI) groups. Statistical analyses included the Kaplan–Meier analysis, log-rank tests, Cox proportional hazards regression models, and Akaike information criterion. The median observation period was 3.3 years. The Kaplan–Meier analysis showed worse overall survival and recurrence-free survival in the low group. Subgroup analysis demonstrated reproducibility regardless of patient background, era of surgery, surgical outcomes, neoadjuvant or adjuvant chemotherapy, and liver metastasis status. Multivariate analysis identified low group assignment and synchronous liver metastasis as independent predictors of recurrence (hazard ratio [HR], 3.788; 95% confidence interval [CI], 2.030–7.621; HR, 3.338; 95% CI, 1.715–6.964, respectively) and survival (HR, 4.484; 95% CI, 1.945–10.334; HR, 2.529; 95% CI, 1.183–5.407, respectively). The Akaike information criterion analysis showed that perioperative shifts in PNI were superior to preoperative or postoperative PNI alone in predicting outcomes. Perioperative shifts in PNI predicted recurrence and prognosis post-hepatectomy for CRLM more accurately compared to using preoperative or postoperative PNI alone.

Background/Objectives: Thoracoscopic esophagectomy is an accepted minimally invasive approach for resectable esophageal and esophagogastric junction cancer in Japan. Whether robot-assisted minimally invasive esophagectomy (RAMIE) improves short- and long-term outcomes compared with video-assisted thoracoscopic esophagectomy (VATS) remains clinically relevant. Methods: We retrospectively reviewed patients who underwent VATS or RAMIE between January 2017 and April 2026. Patients who underwent open esophagectomy, non-gastric conduit reconstruction, or staged operation were excluded. Propensity score matching (PSM) was performed using age, sex, body mass index, histology, tumor location, clinical stage, preoperative therapy, extent of lymph node dissection, abdominal approach, and reconstruction route. Long-term outcomes were explored in a PSM cohort limited to patients treated between January 2017 and December 2023. Results: The main cohort included 369 patients (VATS, n = 186; RAMIE, n = 183). Overall complications of Clavien–Dindo (CD) grade ≥ II were comparable between VATS and RAMIE (32.8% vs. 32.8%, p = 0.999), whereas RLNP CD ≥ I (9.7% vs. 3.8%, p = 0.025) and RLNP CD ≥ II (3.8% vs. 0.5%, p = 0.034) were less frequent after RAMIE. PSM yielded 128 matched pairs; RLNP remained less frequent after RAMIE (CD ≥ I, 10.9% vs. 3.1%, p = 0.015; CD ≥ II, 4.7% vs. 0%, p = 0.013), while other short-term outcomes were comparable. In the survival PSM cohort (79 pairs), 3-year overall survival (66.0% vs. 73.4%, p = 0.203) and recurrence-free survival (62.3% vs. 59.3%, p = 0.651) did not differ significantly between VATS and RAMIE. Conclusions: RAMIE showed comparable short-term safety to VATS and was associated with lower RLNP after adjustment for clinicopathological, treatment-related, and surgical factors. Exploratory long-term analysis was limited by cohort size and follow-up duration but suggested that RAMIE did not compromise oncologic outcomes.

Background: Surgical site infection (SSI) is one of the postoperative complications. Risk factors for SSI primarily pertain to laparotomy, particularly within the field of gastroenterological surgery. It has been reported that laparoscopic surgery is associated with a lower incidence of SSI compared to open surgery; however, minimally invasive surgery (MIS) has become increasingly widespread in recent years. Therefore, the aim of this study was to examine the risk factors for SSI specifically in patients undergoing MIS. Methods: This study is a secondary analysis of 529 patients selected from a previously reported clinical trial that focused on gastroenterological surgery and included 697 participants. The patient undergoing elective MIS were divided into two groups based on the occurrence of SSI, and the risk factors associated with SSI in MIS were examined. Results: SSI within 30 days after surgery was observed in 62 patients (11.7%). In the univariate analysis, male sex, alcohol consumption, bleeding, and operation time were significantly more frequent in the SSI group ( p < 0.05). Multivariate analysis was performed including these variables as well as current smoking, immunosuppressive drugs, diabetes, and serum albumin. Only alcohol consumption showed a statistically significant association with SSI (odds ratio: 2.818, 95% confidence interval: 1.510–5.260, p = 0.001). Conclusion: The findings of this study revealed that alcohol consumption is significantly associated with SSI occurrence in patients undergoing MIS for gastroenterological indications. Whether preoperative abstinence from alcohol prevents the occurrence of SSI warrants further investigation.

Esophagectomy confers high postoperative morbidity and mortality. To improve postoperative outcomes, this study investigated the effectiveness of a 2-week

Background/Objective: Postoperative dysphagia is a common cause of postoperative pulmonary complications (PPCs) following esophagectomy for esophageal cancer. Although the reclining posture is effective for general dysphagia, its effectiveness after esophagectomy remains unclear. Therefore, we aimed to explore effective approaches in the management of dysphagia after esophagectomy. Methods: This study included patients who underwent esophagectomy at the Department of Surgery, Hamamatsu University School of Medicine Hospital between January 2018 and March 2021. For the postoperative swallowing evaluation, the patients underwent a videofluoroscopic swallowing study by drinking 30 mL of liquid in two postures, a 45-degree reclining position (45°R) and a 90-degree upright position (90°U), and assessments were performed using the Penetration–Aspiration Scale. Results: Eighty-seven patients participated in the study. Laryngeal penetration and aspiration were, respectively, observed in 19 (21.8%) and 21 patients (24.1%) at 90°U, and in 14 (16.1%) and five patients (5.7%) at 45°R (p < 0.05). PPCs occurred in 10 patients (11.5%), and vocal cord paralysis occurred in 22 patients (25.3%). However, after adjusting the feeding conditions based on the results of the swallowing assessment, PPCs after meal initiation occurred in only five of these 10 patients (5.7%). Conclusions: Although dysphagia after esophagectomy is observed in approximately half of the patients, including those with minor dysphagia, the risk of aspiration can be reduced by changing the patient’s posture during food consumption. Thus, postural changes may be a useful approach for reducing the risk of PPCs.

Goals: To clarify the characteristics of desmoid tumors in Japanese patients with familial adenomatous polyposis after colectomy. Background: Few comprehensive reports have been published on desmoid tumors in Asian patients with familial adenomatous polyposis. Study: This retrospective study included the data of 81 patients with familial adenomatous polyposis who underwent surgery between 1978 and 2021. The adenomatous polyposis coli gene mutation sites, risk factors, and long-term outcomes associated with desmoid tumors in Japanese patients with familial adenomatous polyposis after colectomy were analyzed. Results: No association was observed between the gene mutation sites and desmoid tumor development in 40 patients who underwent genetic analyses. The rate of desmoid tumor development was 30.3% in 66 patients. Multivariate analysis revealed that age below 32 years at colectomy (hazard ratio = 5.491, 95% confidence interval 1.820-16.50, P < 0.001) and familial adenomatous polyposis-related malignancies other than colorectal cancer (hazard ratio = 5.574, 95% confidence interval 2.075-14.98, P < 0.001) were independent risk factors for desmoid tumor development following colectomy. The 10-year disease-specific survival and overall survival rates for desmoid tumors were 92.9% and 76.9%, respectively. The median surveillance duration was 90 months. Conclusions: Adenomatous polyposis coli gene mutation sites alone were not considered a factor for delaying or avoiding colectomy to prevent desmoid tumors in Japanese patients with familial adenomatous polyposis. The timing of colectomy and careful surveillance should be considered for managing patients at a high risk of developing desmoid tumors. Desmoid tumors in patients with familial adenomatous polyposis did not significantly impact prognosis, and pharmacological treatments are important for disease control.