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 Metastasis has traditionally been investigated and treated as a single manifestation of gastric cancer progression. Although this approach has generated important biological insights and effective systemic therapies, it may obscure route‐dependent vulnerabilities. Lymphatic, peritoneal, and hematogenous metastases require cancer cells to traverse different anatomical routes, overcome distinct barriers, and adapt to different microenvironments. This review therefore distinguishes broadly metastasis‐associated mechanisms from pattern‐associated candidates and reserves pattern‐specific designation for evidence based on direct route comparison, pattern prediction, or route‐selective functional experiments. We examine representative molecular determinants and link their identification in surgical specimens to functional validation, biomarker development, and drug discovery. Evidence is most mature for peritoneal dissemination, whereas lymph‐node‐specific determinants remain less developed. The SYT13/ASO‐4733 program is presented as an illustrative translational case: Intraperitoneal ASO‐4733 has entered first‐in‐human Phase I evaluation, but clinical efficacy has not been established. For any candidate, clinical utility requires independent validation, incremental value beyond established clinicopathological factors, and a defined effect on decision‐making. Rigorously collected, rapidly processed, and clinically annotated surgical biospecimens remain indispensable. Reframing gastric cancer metastasis by route may expand opportunities for precise risk prediction, rational delivery, and biologically coherent early‐phase trials.
ABSTRACT Background Management of super‐elderly patients (aged ≥ 80 years) with gastric cancer (GC) has become an increasingly important clinical issue. We aimed to evaluate the prognostic significance of preoperative “hemoglobin, albumin, lymphocyte, and platelet” (HALP) scores, which may reflect both tumor‐ and host‐related conditions, in super‐elderly patients with GC. Methods This study included 507 super‐elderly patients who underwent curative gastrectomy for GC at 10 hospitals. HALP scores were calculated as follows: hemoglobin × albumin × lymphocytes/platelets. We evaluated the prognostic significance and clinical robustness of the HALP score. Results Preoperative HALP scores ranged from 1.628 to 289.201 (median, 50.795), and the optimal cutoff value for predicting overall survival (OS) was 42.382, based on receiver operating characteristic curve analysis. Multivariate analysis identified that male sex, high preoperative carcinoembryonic antigen levels, poor performance status, pT3/4, pN(+), and low HALP scores (hazard ratio [HR], 2.23; 95% confidence interval, 1.63–3.04; p < 0.001) were independent risk factors for poor OS. We demonstrated the robustness of the prognostic significance of the HALP score using quartile, continuous variable, leave‐one‐center‐out, and subgroup analyses. In addition, a low HALP score was independently associated with worse cancer‐specific survival (HR, 2.08) and other‐cause mortality (HR, 2.39), suggesting that the HALP score may reflect both tumor‐ and host‐related conditions in super‐elderly patients with GC. Conclusion The HALP score appears to be a clinically useful and robust prognostic biomarker that may contribute to prognostic stratification and clinical decision‐making in super‐elderly patients with GC undergoing curative gastrectomy.
ABSTRACT Aim Although randomized trials have discouraged routine prophylactic abdominal drainage after uncomplicated hepatectomy, these drains are still widely used in clinical practice. This study evaluated the association between prophylactic abdominal drain placement and short‐term outcomes after hepatic resection using a nationwide inpatient database. Methods We identified patients who underwent initial hepatic resection for liver tumors from the Japanese Diagnosis Procedure Combination database. Patients were classified into drain and no‐drain groups according to whether a prophylactic abdominal drain was placed intraoperatively. In‐hospital outcomes were compared using propensity score overlap weighting. Subgroup analyses were performed for intra‐abdominal infection and in‐hospital mortality. Results Among 73 613 eligible patients, 62 934 (85.5%) received prophylactic abdominal drains. After overlap weighting, the incidence of intra‐abdominal infection did not differ significantly between the drain and no‐drain groups (5.1% vs. 5.5%; risk difference, −0.3%; 95% confidence interval [CI], −0.8 to 0.1). Bile leakage, postoperative transfusion, postoperative drainage, and hospitalization costs were also comparable between groups. In contrast, prophylactic drain placement was associated with lower in‐hospital mortality (0.5% vs. 1.0%; risk difference, −0.6%; 95% CI, −0.8 to −0.4). Subgroup analyses showed that this association was more evident in patients with low body mass index and those treated at low‐ or middle‐volume hospitals. Conclusion Prophylactic abdominal drain placement after hepatic resection was not associated with a lower incidence of intra‐abdominal infection.
ABSTRACT Background Pancreaticoduodenectomy (PD) carries a high risk of postoperative complications. Although steroids are widely prescribed for various chronic diseases, the specific impact after PD remains unclear. This study evaluated the association between preoperative chronic steroid use and short‐term outcomes following PD. Methods This retrospective cohort study used Japanese National Clinical Database data from 2019 to 2022. Patients undergoing PD were categorized by preoperative chronic steroid use. To account for varying background factors, three multivariable regression models with different adjustment levels (Models 1–3) were constructed. Results Of 40 878 patients, 521 (1.3%) had chronic steroid use prior to PD. The steroid group had higher crude rates of adverse outcomes, including postoperative pancreatic fistula (POPF; 30.7% vs. 22.1%) and severe complications (7.7% vs. 4.4%). In the most extensively adjusted multivariable model (Model 3), preoperative steroid use remained a significant factor associated with POPF (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.47–2.20) and severe complications (OR 1.71, 95% CI: 1.22–2.40). The adverse impacts on infectious complications and surgery‐related mortality were also consistently significant across all models, whereas preoperative steroid use was not significantly associated with re‐operation in any of the models. Conclusions Preoperative chronic steroid use is significantly associated with poor short‐term outcomes after PD, including POPF, severe complications, infectious complications, and mortality. These risks remained consistent regardless of adjustment level, highlighting the need for intensive perioperative management.
