ABSTRACT Objective To evaluate the diagnostic performance of integrating the Asia‐Pacific Colorectal Screening (APCS) score with dual biomarker testing comprising the fecal immunochemical test (FIT) and blood‐based methylated Septin9 (mSEPT9) for risk stratification and detection of advanced colorectal neoplasia (ACN) in a high‐risk population, using colonoscopy with pathological examination as the reference standard. Methods A retrospective analysis included 115 patients who underwent FIT, plasma mSEPT9 testing, and colonoscopy between January 2024 and December 2025. FIT was analyzed quantitatively for ROC analysis, while the 20 μg/g threshold was used for binary operating characteristics. Logistic models included ordinal APCS tier, ln(FIT + 1), and mSEPT9 status. The triple‐model threshold was selected by the Youden index, and 1000 bootstrap resamples were used for internal validation. Results Among 115 participants, 45 had ACN, including 20 CRCs and 25 advanced adenomas. Quantitative FIT yielded an AUC of 0.836 (95% CI, 0.762–0.910). Apparent AUCs were 0.873 for APCS + FIT and 0.912 for APCS + FIT + mSEPT9 (ΔAUC = 0.039; p = 0.047). At a cutoff of 0.318, the triple model showed 91.1% sensitivity, 68.6% specificity, 65.1% PPV, and 92.3% NPV. The optimism‐corrected AUC was 0.886 for the triple model and 0.852 for APCS + FIT; corrected ΔAUC was 0.034 (95% CI, −0.007 to 0.078). Conclusion The integrated model showed high apparent discrimination and sensitivity for ACN, but the incremental benefit over APCS + FIT was uncertain after internal validation. Prospective external validation is required before clinical implementation.
Background This study aimed to examine whether preoperative serum total iron-binding capacity (TIBC), which is directly proportional to transferrin level, correlates with long-term outcomes after pancreatectomy. Methods Preoperative TIBC levels, calculated by summing serum iron and unsaturated iron binding capacity, were evaluated in 158 patients who underwent pancreatectomy for pancreatic cancer. We defined TIBC < 258 mu g/dL calculated by receiver-operating characteristic (ROC) analysis as low TIBC. We evaluated the relationship between preoperative TIBC levels and long-term outcomes after pancreatectomy. Results Low preoperative TIBC levels were correlated with lower body mass index, higher rate of preoperative chemotherapy, lower albumin, and higher amount of intraoperative blood loss compared to those in high TIBC levels (p = 0.041, 0.046, 0.0002, 0.0032, respectively). Patients with low preoperative TIBC levels had significantly poorer overall survival (OS) and recurrence-free survival (RFS) compared to that in high TIBC level in Kaplan-Meier analysis (p < 0.0001, p = 0.0031). Furthermore, these patients were significantly correlated with worse OS and RFS in univariate and multivariate analyses (OS; hazard ratio [HR] 6.22, 95% confidence interval [CI] 1.770-21.838, p = 0.0044/RFS; HR 3.24, 95% CI 1.012-13.206, p = 0.048). Conclusion Preoperative low serum TIBC levels may be a potential surrogate marker of long-term survival after pancreatectomy for pancreatic cancer.
ABSTRACT Groin hernia is a common surgical condition. The Japanese Hernia Society (JHS) Guidelines for Groin Hernia Management 2024 were developed to reflect both international evidence and the realities of clinical practice in Japan. This article is an authorized English translation of a summary of the adult section of the JHS Guidelines for Groin Hernia Management 2024, presenting key clinical questions, recommendations, and concise explanations for an international readership. It covers diagnosis, classification, surgical indications, operative approaches, mesh and fixation, anesthesia, chronic postoperative inguinal pain, recurrent and emergency hernia, training, cost‐effectiveness, and registry‐based outcome assessment; relevant differences from the international HerniaSurge guidelines are discussed. Laparoscopic repair is favored in selected patients when performed by experienced surgeons, particularly for pain reduction and early recovery, whereas open anterior mesh repair remains appropriate when general anesthesia or laparoscopy is unsuitable. For femoral hernia, chronic pain management, recurrent hernia, and incarcerated or strangulated hernia, evidence remains limited, leading to cautious or conditional recommendations.
ABSTRACT Aim Transanal total mesorectal excision (TaTME) combined with intersphincteric resection (ISR) has emerged as a sphincter‐preserving surgical option for very low rectal cancer. However, multicenter data evaluating oncological outcomes and risk factors for local recurrence (LR) following TaTME with ISR remain limited. This study aimed to evaluate oncological outcomes and identify risk factors for LR in patients undergoing TaTME with ISR. Methods This multicenter retrospective cohort study included patients who underwent TaTME with ISR for lower rectal cancer at 26 institutions participating in the Japan Society for Laparoscopic Colorectal Surgery. Oncological outcomes and clinicopathological factors associated with LR were analyzed. Multivariable analysis was performed to identify independent risk factors for LR. Results A total of 224 patients were included. The 3‐year LR, recurrence‐free survival (RFS), and overall survival (OS) rates were 7.3%, 79.5%, and 98.1%, respectively. Multivariable analysis identified circumferential resection margin (CRM)/radial margin (RM) positivity as the key independent risk factor for LR. In contrast, pathological features, including histopathological classification, lymphatic invasion, vascular invasion, perineural invasion, and tumor budding, reflected tumor biological aggressiveness rather than surgical performance. A biological aggressiveness score demonstrated a stepwise increase in LR risk according to the number of adverse pathological factors. Conclusion TaTME combined with ISR is a feasible sphincter‐preserving option for lower rectal cancer, with acceptable oncological outcomes in a nationwide multicenter cohort. Both surgical factors, particularly margin status, and tumor biological characteristics may contribute to LR risk. Careful margin assessment and close postoperative surveillance are essential for optimizing oncological outcomes.
ABSTRACT Aim This study investigated nationwide temporal trends, age‐specific changes, and seasonal variations in appendectomies in Japan using the national database of health insurance claims and specific health checkups (NDB). Methods Data on appendectomies (open [OA] and laparoscopic [LA]) were extracted from the 2018–2023 NDB Open Data. Crude and age‐adjusted appendectomy rates per 100,000 person‐years were calculated. Temporal trends were assessed using Poisson regression, and age‐specific annual relative risks were estimated. Seasonality (April 2019 to March 2024) was evaluated, and correlations with meteorological variables were assessed using Pearson correlation coefficients. Time‐series Poisson regression was used to evaluate the association between monthly appendectomy volume and ambient temperature. Results During the study period, 323,980 appendectomies were performed. The age‐adjusted appendectomy rate declined slightly overall (relative risk [RR] = 0.991, p < 0.0001), with a significant decrease in men (RR = 0.982, p < 0.0001), whereas no significant change was observed in women (RR = 1.003, p = 0.0676). Age‐specific analyses demonstrated declining appendectomy rates among younger populations, whereas the overall rates increased after approximately 40 years of age, with larger increases observed among women than men. OA use decreased (RR = 0.793, p < 0.0001), whereas LA use increased (RR = 1.022, p < 0.0001). The monthly appendectomy volume exhibited significant seasonality and was positively correlated with ambient temperature using meteorological data from five cities. Conclusion Appendectomy rates decreased in younger populations but increased among older adults, particularly women. A shift toward laparoscopic surgery and temperature‐associated seasonality was also observed.
