Traumatic pancreatic injuries are uncommon but challenging to manage. This study aimed to clarify the clinical characteristics of traumatic pancreatic injury and explore the role of early endoscopic retrograde pancreatography (ERP) as a diagnostic and therapeutic approach. We reviewed 14 patients with traumatic pancreatic injuries treated between 2007 and 2025. Injuries were classified according to the Japanese Association for the Surgery of the Trauma System. Clinical outcomes were analyzed according to early ERP use (≤ 24 h after injury). Three patients had a type I injury, one had a type II injury, five had a type IIIa injury, and five had a type IIIb injury. Patients with a type IIIa/b injury had higher serum amylase levels at 24 and 48 h, as well as higher secondary intervention rates and longer hospital stays. Among five patients who underwent early ERP, the main pancreatic duct injury was successfully bridged in one patient with a type IIIb injury, enabling non-operative management. There were no significant differences in clinical outcomes between the early ERP and delayed/no ERP groups. Appropriate management of traumatic pancreatic injuries resulted in favorable outcomes. Further studies are required to clarify the clinical importance of early ERP.
This prospective single-arm multicenter phase 2 trial investigated the efficacy and safety of chemoradiotherapy with gemcitabine (GEM) + S-1 (GSRT) in patients with locally advanced pancreatic ductal adenocarcinoma (PDAC) (BR + UR-LA). Forty patients with locally advanced PDAC based on imaging findings were enrolled at three high-volume centers in Japan (April 2013–December 2018). The patient received full-dose GSRT concurrent with 50.4 Gy of radiation therapy. After chemoradiotherapy completion, the patients were reevaluated for surgical eligibility, and resection was performed if the tumors were considered resectable. In patients with unresectable tumors, chemotherapy was continued for over 6 months, and resection was performed if the tumors were considered resectable during the treatment course. The primary endpoint was the 1-year survival rate. Thirty-nine patients received GSRT, and their 1-year survival rate, median overall survival time, and median progression-free survival time were 64.1
Resternotomy during total arch replacement surgery is associated with adverse outcomes. We aimed to determine the accuracy of this statement. From January 2008 to February 2021, 384 consecutive total arch replacement surgeries were performed at our institution. Resternotomy was performed in 53 (14
This study aimed to evaluate the effect of small intestine arrangement on the bowel function after laparoscopic colectomy. A total of 160 patients were randomly divided into two groups. The control group received conventional treatment, while the experimental group underwent small intestine arrangement. The primary outcome was the time to initial postoperative gas discharge. The experimental group showed a significant difference in the time of initial postoperative gas discharge compared to the control group (45.2 ± 19.7 vs. 54.9 ± 21.8 h, P = 0.004). Additionally, the experimental group had a significantly shorter time to first tolerability of liquid food (64.4(43.0,68.3) vs. 67.5(60.5,86.8) hours, P = 0.005). One case involved the identification of a Meckel’s diverticulum and a small intestinal stromal tumor through intervention. Arranging the small intestine may promote the postoperative intestinal function and improve the detection of complications, thereby avoiding the potential risk of reoperation. NCT05485857.
Tolvaptan sodium phosphate (TSP) is an intravenous aquaretic agent that is rapidly converted to tolvaptan after administration. This study aimed to evaluate the safety and efficacy of TSP in open-heart surgery cases. This study included 103 patients (31 women; mean age, 70.5 ± 10.8 years) who received intravenous TSP following open-heart surgery. The urine output was measured hourly from 1 h before to 6 h after administration, and time-dependent changes were assessed. The magnitude of the response was defined as ΔU1–6 = (U1+U2+U3+U4+U5+U6) – U-1. Patients were ranked according to ΔU1–6, and the top 25 (marked responders) and bottom 25 (poor responders) were compared. The urine output was significantly increased within 1–3 h after TSP administration, peaked at 2–3 h, and remained above the baseline through 6 h (all p < 0.05). In a multivariable linear regression analysis, the serum sodium level at the time of TSP administration was independently associated with ΔU1–6 (p=0.018). The serum sodium levels at TSP administration were lower in marked responders (p=0.033). No TSP-related adverse events were observed in any of the cases. Intravenous TSP can induce a rapid and sustained diuretic response following open-heart surgery, and the serum sodium levels determine the magnitude of the aquaretic response to intravenous TSP.
Anatomical lung resection using the da Vinci SP system was recently introduced in Japan. We retrospectively evaluated our initial experience and analyzed the learning curve for the first 53 consecutive cases. Fifty-three patients with primary lung cancer underwent anatomical resection, including lobectomy and segmentectomy, using the da Vinci SP system. We reviewed the perioperative outcomes, including the operative time, console time, conversion rates, and complications. The learning curves for operative and console times were assessed using a cumulative summation analysis. The mean patient age was 71.5 years. Thirty-five and 18 patients underwent lobectomy and segmentectomy, respectively. The mean operative and console times were 207.1 min and 147.5 min, respectively. Two patients (4
This study retrospectively investigated the risk factors for postoperative pain after thoracoscopic surgery, with a particular focus on chest wall anatomical characteristics. We reviewed patients who underwent thoracoscopic surgery between August 2021 and June 2025 at our institution. At routine outpatient visits 2–3 weeks after discharge, postoperative pain was assessed using the Numerical Rating Scale. Patients were categorized into a pain group (score ≥ 3) and a low-pain group (score ≤ 2). Clinical variables, perioperative factors, and preoperative chest wall anatomy were compared using an imaging analysis workstation. Among the 149 patients, 62 (41.6
Distal pancreatectomy with celiac axis resection (DP-CAR) is performed for locally advanced pancreatic body cancers involving the common hepatic artery (CHA) and/or celiac axis (CA). This procedure becomes especially intractable in cases of portal vein (PV) invasion due to poor mobility around both the CA and PV. However, no previous reports have described the surgical strategies for such difficult situations. To overcome the difficulty of CA and PV invasion, we devised a novel procedure called "pre-resection portal vein reconstruction." In this procedure, PV reconstruction using an inferior mesenteric vein patch graft is implemented after division of the CHA and pancreatic neck. The greatest advantage of this procedure is improved mobility around the pancreatic body after PV reconstruction, thereby enabling a subsequent sequential approach around the superior mesenteric artery, abdominal aorta, and CA root. "Pre-resection portal vein reconstruction" is an option for locally advanced pancreatic body cancers with both CA and PV invasion.
The importance of preoperative lymph-node enlargement as a prognostic factor for patients with colorectal cancer remains unclear because of inconsistent staging and size criteria. We conducted this study to evaluate its clinical impact, using a standardized definition for pathological stage II colorectal cancer. The subjects of this retrospective study were patients with pathological stage II colorectal adenocarcinoma, who underwent curative resection between January 2009 and December 2020. Patients were categorized based on preoperative lymph-node enlargement, defined as a short-axis diameter ≥5 mm on imaging. Independent risk factors for 5-year overall survival (OS) and relapse-free survival (RFS) were investigated. A total of 562 patients were included (185 without and 377 with enlarged lymph nodes), and the median follow-up period was 61.8 months. Multivariate analysis identified that preoperative hemoglobin level < 12 g/dL (hazard ratios (HRs) = 1.937, 95
The precise identification of intersegmental planes is critical in lung segmentectomy. Indocyanine green (ICG) is commonly used, but it requires specialized equipment and it also has a short fluorescence duration. This study explored the use of intravenous vitamin B2 (riboflavin) with a blacklight (ultraviolet A, UV-A) as a simpler, cost-effective alternative. In a porcine model (n = 4), both ICG and vitamin B2 accurately delineated the same intersegmental plane. However, vitamin B2 fluorescence lasted over 30 min —significantly longer than ICG’s 7.3 min —and it was visible to the naked eye without specialized imaging systems. The method was safe and practical, utilizing readily available UV light. This approach may be particularly useful for visualizing lung segments during surgery without the need for expensive fluorescence cameras. Although the results in healthy animals are promising, further validation in humans is required. Overall, vitamin B2 with blacklight shows potential as a reliable, long-lasting, and accessible tool for pulmonary segment identification during anatomical resections.
Percutaneous transhepatic gallbladder drainage (PTGBD) is often performed for acute cholecystitis in medically fragile patients, but the factors associated with discharge to the pre-admission residence remain unclear. Thus, we examined the determinants of discharge to the pre-admission residence after PTGBD. The subjects of this retrospective study were 73 patients who underwent PTGBD for acute cholecystitis between March 2018 and March 2025. The primary outcome was final discharge to the pre-admission residence, defined as discharge without escalation of residential care needs. Multivariable logistic regression included age, sex, pre-admission Barthel Index (BI), serum albumin (ALB), Tokyo Guidelines 2018 severity, and interval cholecystectomy. The median age was 79 years (interquartile range, 68–85 years), and 55 patients (75.3
Cholecystectomy (CCY) may influence the colorectal cancer (CRC) outcomes in a location-specific manner. We investigated the association between CCY history and RAS mutations in CRC, focusing on tumor location. We retrospectively analyzed 1,340 patients with CRC diagnosed between 2012 and 2024, with an available RAS mutation status. Patients were classified into proximal and distal groups for analysis. The survival outcomes were compared using multivariate Cox proportional hazard regression models. CCY was associated with a higher RAS mutation prevalence in proximal CRC (58
This study aimed to evaluate the sex- and age-specific survival impacts of body composition (BC) parameters in patients with surgically treated gastroesophageal cancer. A total of 1382 patients were retrospectively analyzed. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and visceral/subcutaneous adipose tissue index (VATI/SATI) were determined. The survival impacts of the BC parameters were investigated according to age (≥ 75 or < 75 years) and sex. Multivariate Cox hazard models were used to identify independent predictors of a poor overall survival (OS) and cancer-specific survival (CSS). The median age was 67 years, and 1028 (74.4
The IAP resectability classification defines biologically borderline resectable pancreatic cancer using elevated CA19-9 (≥ 500 U/mL) and PET-suspected lymph node (LN) metastasis; however, these criteria have limited clinical applicability. This study aimed to refine the biological dimension of resectability by reassessing the CA19-9 cut-off and developing a preoperative LN metastasis prediction model. We retrospectively analyzed 399 patients with anatomically resectable or borderline resectable pancreatic cancer who underwent surgery at a single institution. The optimal CA19-9 cutoff for disease-specific survival was determined using maximally selected rank statistics. A logistic regression model incorporating pretreatment CA19-9 levels and tumor size was developed to predict LN metastasis. Survival was evaluated using Kaplan–Meier survival analysis. The maxstat-derived CA19-9 cutoff (133 U/mL) showed superior prognostic discrimination compared to the IAP threshold. Patients with CA19-9 ≥ 133 U/mL had survival rates comparable to those with anatomically borderline resectable disease. Pathological LN metastasis was strongly prognostic, even in anatomically resectable diseases. The LN prediction model demonstrated good discrimination (AUC 0.739), and the highest-risk group showed outcomes equivalent to those of patients with anatomically borderline resectable disease. A data-driven CA19-9 cutoff and preoperative LN prediction model accurately identified biologically high-risk pancreatic cancer, potentially improving risk stratification for neoadjuvant therapy.
Transcatheter aortic valve–in–surgical aortic valve (TAV-in-SAV) is central to lifetime aortic stenosis management, making the initial surgery in small annuli increasingly important. In bioprosthetic surgical aortic valve replacement (AVR), surgeons must balance minimally invasive access, avoid prosthesis–patient mismatch, and prepare for future transcatheter reinterventions. We describe a sternum-sparing, minimally invasive AVR program using the Stonehenge technique with a TAV-in-SAV–oriented strategy for annular and root enlargement. Although Y-incision enlargement allows for valve upsizing, the geometry may remain unfavorable without adequate sinotubular junction (STJ) expansion, increasing the risk of sinus sequestration and coronary obstruction despite acceptable virtual valve-to-coronary (VTC) distances. We added STJ enlargement using the roof technique to achieve an en bloc expansion of the annulus, sinuses, STJ, and proximal ascending aorta. CT analyses and simulations showed that prosthesis tilt can shorten the VTC, especially in the right coronary artery (RCA), recreating a high-risk anatomy. STJ enlargement with tilt minimization may improve future TAV-in-SAV feasibility while preserving the surgical AVR benefits.
Robotic pancreaticoduodenectomy has been increasingly adopted; however, its economic feasibility under the Japanese national health insurance system remains unclear. This study aimed to evaluate the clinical and economic outcomes of robotic pancreaticoduodenectomy (RPD) compared with open pancreaticoduodenectomy (OPD). Patients who underwent pancreaticoduodenectomy between January 2020 and December 2024 at The University of Tokyo were identified from an institutional database. Patients with pancreatic ductal adenocarcinoma were excluded because portal vein resection and reconstruction performed on a robotic platform were not covered by the Japanese National Health Insurance System during the study period. The clinical outcomes and economic indicators, including hospital revenue, costs, and profit, were assessed under the Japanese lump-sum payment system. Eighty-three patients were included in the study (41 in the robotic group and 42 in the open group). The rate of clinically relevant pancreatic fistula was significantly lower (2.4
This study assessed whether institutional case volume influences the short- and long-term outcomes following laparoscopic surgery for LARC in a nationwide Japanese cohort. Patients who underwent laparoscopic surgery for clinical stage II/III rectal cancer between 2010 and 2011 at 55 centers were analyzed. Hospitals were categorized as higher-volume (HVHs) or lower-volume (LVHs). Mixed-effects models adjusted for 13 clinical and demographic variables estimated the adjusted odds ratios (aORs) for postoperative complications and adjusted hazard ratios (aHRs) for the 5-year relapse-free survival (RFS) and overall survival (OS). Among the 571 patients, 271 underwent surgery at nine HVHs and 300 at 46 LVHs. HVHs had significantly fewer postoperative complications (23.6
Oral frailty may increase surgical risk; however, its association with postoperative infections in patients with colorectal cancer remains unclear. We evaluated whether preoperative oral frailty, assessed using the Oral Frailty Index-8 (OFI-8), could predict 30-day postoperative infectious complications. We retrospectively reviewed patients who underwent colorectal cancer surgery between April 2022 and December 2024 at our institution. Before surgery, patients completed the OFI-8 and Mini Nutritional Assessment Short-Form, which were verified by the nursing staff. A high oral frailty risk was defined as an OFI-8 score ≥ 4. Clinicopathological variables and infectious complications were compared between the groups. Logistic regression was used to identify the factors associated with complications. Among the 140 patients, those with OFI-8 ≥ 4 were older and had more polypharmacy, larger tumors, and a poorer renal function. Eighteen patients developed infectious complications. Age ≥ 75 years, rectal cancer, OFI-8 ≥ 4, and pathological T4 stage were identified as predictors of infectious complications. Multivariate analyses confirmed that OFI-8 ≥ 4 and rectal cancer were independent risk factors. Infectious complications were associated with prolonged hospitalization. OFI-8 is a simple outpatient screening tool for identifying patients at high risk of infectious complications following colorectal cancer surgery. Targeted OFI-8-guided perioperative risk interventions may improve the outcomes and reduce the healthcare burden.
We evaluated the clinical significance of plasma autoantibodies against cancer stem cell-associated antigens in breast cancer, with diagnostic performance as the primary endpoint and clinicopathological and prognostic relevance as secondary endpoints. In this single-center observational study, autoantibodies against SOX2, survivin, and DNAJB8 were measured using ELISA. The diagnostic performance of anti-DNAJB8 autoantibodies was evaluated in 292 patients with breast cancer and 24 benign controls. Clinicopathological and postoperative analyses were exploratory in a preoperative cohort (175 patients). Only DNAJB8 showed a distinct high-titer subset in the breast cancer group. The primary endpoint was not met, as plasma anti-DNAJB8 autoantibodies showed a non-significant diagnostic performance (AUC, 0.602; 95
