Predictive markers of the response to neoadjuvant chemotherapy (NAC) in pancreatic cancer are limited. We investigated whether the absolute lymphocyte count (ALC), a surrogate marker of host immune competence, could predict the pathological response to NAC. This retrospective single-center study included patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy after NAC (2019 and 2025). The pathological response was classified as good (JPS grade ≥ 2) or poor (grade 1a/1b). Logistic regression was used to identify predictors of a good response. Locoregional recurrence was analyzed using competing risk methods. Among the 110 patients, 20 (18.2

Background/Aim:Total gastrectomy is the cornerstone treatment for gastric cancer, particularly in patients with proximal or large tumors. For early-stage gastric cancer, laparoscopic total gastrectomy (LTG) has demonstrated comparable short- and long-term outcomes to those of open total gastrectomy (OTG), while reports on advanced gastric cancer (AGC) are limited. We aimed to compare the short- and long-term outcomes of patients with AGC who underwent LTG or OTG. Patients and Methods:This study included consecutive patients with AGC who underwent LTG or OTG with lymph node dissection at our institution from January 2002 to June 2024. Propensity score matching was conducted at a 1:1 ratio to reduce bias. Results:A total of 158 patients were enrolled (LTG: 39; OTG: 119). Of these, 64 were paired by propensity score matching. The clinical tumor invasion depth was balanced, but the pathological depth was significantly deeper in the LTG group. The number of patients with lymph node metastasis did not differ. The median operative time was longer for LTG (512.5 min) than for OTG (267 min), whereas LTG resulted in significantly less blood loss (125 g vs. 411 g). Postoperative morbidity (≥Clavien‒Dindo grade 3) was comparable (LTG: 12.5%, OTG: 9.4%). The LTG group had a significantly shorter median hospital stay (11 days vs. 17 days). There were no significant differences in overall or recurrence-free survival between the groups. Conclusion:LTG is a feasible and safe approach for AGC, offering comparable short- and long-term outcomes to OTG.

BACKGROUND/AIM:To clarify postoperative changes in nutritional status and their impact on post-recurrence prognosis after pancrexatoduodenectomy in patients with biliary tract carcinoma based on age and recurrence status. PATIENTS AND METHODS:We compared 91 patients aged ≥70 years and 68 patients aged <70 years and evaluated the relationship between postoperative nutritional indices and prognosis. RESULTS:Although the 5-year recurrence-free survival rates were similar between the two groups (≥70 years, 48.6%; <70 years: 59.3%, p=0.31), the median post-recurrence survival time and the 5-year overall survival rate were significantly worse in older patients (≥70 vs. <70 years: 1.1 vs. 1.7 years, p=0.0024; and 48.8% vs. 69.3%, p=0.0080). In patients with recurrence, many nutritional statuses at recurrence and the rate of treatment after recurrence were significantly poorer in elderly patients; however, no age-related differences in these indices were observed in patients without recurrence. Moreover, among elderly patients, these nutritional parameters were significantly lower in those with recurrence than in those without, whereas they were comparable among younger patients. In the multivariate analyses, no treatment after recurrence was an independent factor for poor post-recurrence survival (hazard ratio=2.1). Furthermore, age ≥70 years at initial surgery and low serum cholinesterase levels at recurrence were risk factors for treatment after recurrence (odds ratios of 0.22 and 0.11). CONCLUSION:Only elderly patients with recurrence had poorer nutritional indices at recurrence, resulting in a lower rate of post-recurrence treatment and shorter post-recurrence survival.

BACKGROUND:Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a major complication after distal pancreatectomy (DP), including minimally invasive distal pancreatectomy (MIDP). Institutions often introduce multiple technical and perioperative refinements over time; however, the cumulative impact of these practice changes on postoperative outcomes has not been fully characterized. This study evaluated whether stepwise institutional refinements in MIDP were associated with improved postoperative outcomes. METHODS:We retrospectively analyzed 124 consecutive patients who underwent MIDP between 2019 and 2025 at a single center. During the study period, several practice changes were implemented, including modification of pancreatic transection strategy using a reinforced stapler platform, transition to robotic assistance, and adoption of continuous negative-pressure drainage. The cohort was divided into an early phase and a late phase reflecting these institutional refinements. The primary outcome was CR-POPF, and secondary outcomes included drain fluid amylase (DFA) levels and postoperative length of stay (LOS). Propensity score matching (PSM) was performed using pancreatic thickness and texture. RESULTS:CR-POPF occurred less frequently in the late phase than in the early phase (5.3% vs. 24.4%, p = 0.012). DFA levels were consistently lower and declined more rapidly in the late phase. LOS was significantly shorter in the late phase (median 8 vs. 11 days, p < 0.001). These findings remained consistent after PSM. CONCLUSION:Stepwise institutional refinements in pancreatic transection technique and perioperative management were associated with improved postoperative outcomes after MIDP. A structured quality-improvement approach focusing on atraumatic transection and rational drain management may contribute to reducing CR-POPF after MIDP.

BACKGROUND/AIM:Although, the number of pancreatoduodenectomy for elderly patients is increasing, the significance of pancreatoduodenectomy for long-term prognosis in elderly patients remains unclear. To clarify the validity of pancreatoduodenectomy in elderly patients with ampullary carcinoma, particularly in terms of nutritional status at recurrence. PATIENTS AND METHODS:We compared 21 patients aged ≥75 years and 40 patients aged <75 years, who underwent pancreatoduodenectomy for ampullary carcinoma and evaluated the relationship among age, nutritional status, and prognosis. RESULTS:The 5-year recurrence-free, disease-specific, and overall survival rates were similar ≥75 years: 42.9, 57.1, and 57.1%, respectively; and <75 years: 44.0, 69.9, and 62.1%; p=0.99, 0.41, and 0.48, respectively. The median time from recurrence to death was significantly shorter in elderly patients than in younger patients (1.3 vs. 1.8 years, p=0.0063). At recurrence, serum albumin levels, prognostic nutritional index, Glasgow prognostic score, controlling nutritional status score, and treatment rate were lower in elderly patients. Moreover, among elderly patients, these four nutritional indices were poorer in recurrent cases than in non-recurrent cases, whereas they were comparable in younger patients. Even in non-recurrent cases, these nutritional indices were similar between elderly and younger patients. In multivariate analysis, age ≥75 years was an independent risk factor for both a short time from recurrence to death and the likelihood of treatment implementation after recurrence (hazard ratio=3.3, odds ratio=0.019). CONCLUSION:In elderly patients, some nutritional status and treatment rates at the time of recurrence were poorer, which resulted in shorter survival times after recurrence. Information on nutritional status changes based on age and recurrence may be important when considering treatment strategies for elderly patients.

BACKGROUND/AIM:Extrapancreatic invasion (EPI) is a well-known adverse prognostic factor in pancreatic cancer; however, whether the absence of EPI defines a distinct clinical entity remains unclear. This study aimed to clarify the clinicopathological features and prognosis of pancreatic ductal adenocarcinoma (PDAC) confined within the pancreas. PATIENTS AND METHODS:A total of 199 patients who underwent curative-intent pancreatectomy for PDAC between 2012 and 2022 were retrospectively analyzed. Patients were classified into EPI-negative (n=19) and EPI-positive (n=180) groups. Clinicopathological characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between the two groups. RESULTS:EPI-positive tumors were significantly associated with higher CA19-9 levels, larger tumor size, lymph node metastasis, and lymphovascular/perineural invasion. None of the EPI-negative patients experienced recurrence within 3 years or disease-specific death within 5 years. Multivariate analysis identified the absence of EPI as an independent favorable prognostic factor for both RFS and OS. CONCLUSION:PDAC confined within the pancreas, without EPI, represents a biologically distinct subset with remarkably favorable outcomes. Assessing EPI status may aid in tailoring perioperative treatment strategies and preventing overtreatment in selected patients.

OBJECTIVE:Esophageal squamous cell carcinoma (ESCC) is characterized by a high incidence of lymph node metastasis, and prophylactic lymphadenectomy plays a critical role in esophagectomy. However, the optimal extent of lymphadenectomy after neoadjuvant chemotherapy (NAC) remains unclear. We aimed to investigate the extent and significance of lymphadenectomy after NAC by comparing its therapeutic impact with that of upfront esophagectomy. METHODS:In total, 200 consecutive patients who underwent McKeown esophagectomy for ESCC between 2009 and 2021 were eligible. We compared the therapeutic value index (TVI) between patients who underwent esophagectomy after NAC and those who underwent upfront esophagectomy. RESULTS:96 (48.0%) patients underwent upfront esophagectomy and 104 (52.0%) patients underwent esophagectomy after NAC. In the upper mediastinum, middle/lower mediastinum, and peri-gastric regions, TVI in the NAC group was greater than that in the upfront group. In contrast, subcarinal lymphadenectomy showed no therapeutic benefit in the NAC group, and supra-pancreatic TVI was lower in the NAC group than in the upfront group (2.4 vs. 7.0). After propensity score matching (PSM), the results were essentially unchanged from those before matching. Subgroup analysis revealed almost no therapeutic benefit in the supra-pancreatic region for upper/middle thoracic tumors or early-stage cancers, whereas a benefit remained for lower thoracic tumors. CONCLUSIONS:Lymphadenectomy in the upper mediastinum, middle/lower mediastinum, and peri-gastric regions remains important after NAC for ESCC. However, the apparent therapeutic value of subcarinal and supra-pancreatic lymphadenectomy was limited after NAC.

Introduction:Intravesical foreign bodies may remain silent until secondary complications occur. Rectovesical fistula caused by an intravesical foreign body is rare. Case Presentation:A 69-year-old man presented with urinary frequency and abdominal distension. Computed tomography revealed a 70.8-mm vesical calculus encasing an approximately 8-cm plastic object, with bilateral hydroureteronephrosis and suspected rectal involvement. Cystoscopic evaluation was limited by the massive calculus. Intravesical indigo carmine appeared from the rectum, and colonoscopy confirmed a foreign body protruding through the anterior rectal wall. Open cystotomy with removal of the foreign body and fragmented adherent stone, suprapubic cystostomy, and diverting transverse colostomy were performed. Delayed laparoscopic fistula closure and subsequent stoma closure were completed. Hydroureteronephrosis and renal function improved, with no recurrence. Conclusion:A long-retained intravesical foreign body can cause rectovesical fistula through stone-mediated fixation. Staged management may be appropriate when inflammation and contamination preclude immediate closure.

Poorly differentiated cancers, including esophageal squamous cell carcinoma (ESCC), exhibit higher malignant potential and worse prognoses than well‑differentiated types. The present study aimed to identify microRNAs (miRNAs or miRs) involved in ESCC progression and their target mRNAs, focusing on tumor differentiation. miRNA candidates were selected using a miRNA array‑based approach and GEO datasets, comparing expression levels between poorly and non‑poorly differentiated ESCC. Clinical samples (n=61) and cell lines were analyzed to determine the significance and function of the selected miRNAs and their target mRNA. miR‑100‑5p and miR‑203a‑3p were significantly downregulated in poorly differentiated ESCC, with lower expression strongly associated with poorer overall survival (OS) (miR‑100‑5p: P=0.02; miR‑203a‑3p: P=0.05) and relapse‑free survival (RFS) (miR‑100‑5p: P=0.04; miR‑203a‑3p: P=0.12). Overexpression of these miRNAs suppressed cell migration and invasion. FKBP5 was identified as a common target, with its expression significantly reduced upon double‑transfection with miR‑100‑5p and miR‑203a‑3p. FKBP5 downregulation reduced tumor aggressiveness in KYSE70 cells, and clinical samples showed significantly worse survival rates in patients with high FKBP5 expression (OS: P=0.02; RFS: P=0.04). These findings suggest that miR‑100‑5p and miR‑203a‑3p act as tumor suppressors by targeting FKBP5, highlighting FKBP5 as a potential therapeutic target in ESCC.

ABSTRACT Aim The prevalence of kyphosis is increasing with increasing life expectancy. One of the most notable gastrointestinal complications is gastroesophageal reflux disease (GERD) in patients with kyphosis. In this study, we investigated the association between kyphosis and the incidence of postoperative GERD in patients who underwent proximal gastrectomy (PG), a procedure with a particularly high risk of GERD. Methods In total, 54 consecutive patients who underwent PG between 2009 and 2023 met the inclusion criteria. The thoracic/lumbar angle ratio (T/L ratio) derived from sagittal computed tomography was performed to preoperatively assess kyphosis, defined as a T/L ratio ≥ 1.25. Results Fifteen patients (27.8%) had kyphosis. Overall, postoperative GERD occurred in seven patients (13.0%). Preoperative albumin levels were significantly lower in the Kyphosis group than in the Normal group ( p = 0.03), whereas other clinical characteristics showed no significant differences between the two groups. The incidence of postoperative GERD was significantly higher in the Kyphosis group than in the Normal group (33.3% vs. 5.1%, p = 0.01). Postoperative reflux symptoms also were more frequently observed in the Kyphosis group than in the Normal group (60.0% vs. 16.0%, p = 0.13). Kyphosis was one of the independent predictive factors for postoperative GERD (Odds ratio, 18.7; 95% confidence interval, 1.46–240; p = 0.02) in the multivariate analysis. Conclusion Kyphosis was significantly associated with the occurrence of postoperative GERD in patients who underwent PG. Alternative preventive measures may be considered when patients with kyphosis undergo PG.

This study aimed to address the article by Yang et al., titled “Primary giant liposarcoma of the gallbladder: A case report and literature review.” The authors reported an extremely rare case of a large atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) arising in the gallbladder, diagnosed through imaging and histopathological findings. However, due to the tumor’s exceptional size, the positional relationship between the gallbladder and the tumor remains unclear. In such cases, it is essential to histologically analyze the interface between the tumor and the gallbladder. Additionally, imaging revealed both fatty and non-fatty components, necessitating consideration of dedifferentiated liposarcoma as a differential diagnosis. In light of these factors, this study discusses the specific information required for further evaluation and accurate diagnosis.

Zolbetuximab, a monoclonal antibody against claudin18.2 (CLDN18.2), shows promise in the treatment of advanced gastric cancer. However, as treatment relies on CLDN18.2 expression in primary tumors, concordance with metastatic lesions remains unclear. We retrospectively analyzed 50 patients with advanced gastric cancer. CLDN18.2 expression was assessed immunohistochemically in paired primary and metastatic lesions, being defined as positive when ≥ 75

OBJECTIVE:To clarify the short- and long-term validity of pancreatoduodenectomy in octogenarian patients with biliary tract carcinoma. METHODS:We compared 23 and 141 patients aged ≥80 and <80 years, who underwent pancreatoduodenectomy for biliary tract carcinoma (distal cholangiocarcinomas and ampullary carcinomas) and evaluated the relationship between age, clinicopathological factors, and surgical and oncological outcomes, especially in terms of recurrence. RESULTS:Median overall survival time of distal cholangiocarcinoma and ampullary carcinoma was 92 and 109 months (p = 0.13). Postoperative complications, mortality, and adjuvant chemotherapy rates did not differ between the groups. Although the 5-year recurrence-free survival rate was similar, the 5-year disease-specific survival and overall survival rate were significantly shorter in octogenarians (≥80 years: 43.5, 47.1, and 35.3%; <80 years: 54.1, 69.2, and 63.0%; p = 0.41, 0.016, and 0.034, respectively). The median time from recurrence to death for octogenarian patients was significantly shorter than that of younger patients (3.3 vs. 16.1 months, p < 0.001). At recurrence, the serum albumin level, prognostic nutritional index, controlling nutritional status score, and treatment rate for recurrence were lower in octogenarians. The multivariate analysis identified age ≥80 years (hazard ratio: 3.8), low prognostic nutritional index (hazard ratio: 2.9), high serum carbohydrate antigen 19-9 (hazard ratio: 2.6), and failure to implement treatment after recurrence (hazard ratio: 3.0) as independent risk factors for a short time from recurrence to death. Furthermore, age ≥80 years (odds ratio 0.09) was an independent risk factor for treatment implementation after recurrence. CONCLUSIONS:Octogenarians had a shorter survival time after recurrence, resulting from low nutritional indices and a reduced rate of treatment implementation at the time of recurrence.

This study investigated the incidence of postoperative complications following pancreatectomy in octogenarians. This study included 291 patients who underwent pancreatic surgery (pancreatoduodenectomy [PD] or distal pancreatectomy [DP]) between 2019 and 2024 in a Japanese University Hospital. Perioperative outcomes were compared between octogenarians and non-octogenarians. The primary outcomes included the risk factors (including age) and incidence rates for postoperative complications. In addition, 1:3 propensity score matching (PSM) was conducted with standardized patient and perioperative factors, and the incidence of postoperative complications was compared. Finally, the clinical characteristics of octogenarians and non-octogenarians in open surgery and minimally invasive pancreatic surgery (MIPS) were compared. The median age was 82.0 and 71.0 years for octogenarians (n = 33) and non-octogenarians (n = 258). We found that a high body mass index (BMI) value, PD, laparotomy, high intraoperative blood loss (IBL) (≥ 320mL), and long operative times were associated with the incidence of postoperative complications in univariate analysis, although patient age (octogenarians) was not significantly correlated. PSM showed that the incidence of postoperative complications was similar between octogenarians and non-octogenarians. MIPS led to similar or lower postoperative complication rates in octogenarians compared with non-octogenarians, and both rates were notably lower than those in laparotomy. Although this study was retrospective, single-center, and with small number of octogenarians, the incidence of postoperative complications after pancreatectomy might not be higher in octogenarians than in non-octogenarians, and it could be reduced with MIPS.

OBJECTIVE:This study aimed to identify and validate miR-7-5p as a non-invasive biomarker for diagnosing and monitoring neuroendocrine tumors (NETs). SUMMARY BACKGROUND DATA:The incidence of NETs has been increasing globally in recent years, yet standardized non-invasive biomarkers for early detection and monitoring of these malignancies are lacking. Although diagnostic imaging is valuable, its resource-intensive nature limits its practicality for routine screening. Thus, reliable, non-invasive biomarkers are urgently needed. METHODS:In the multicenter SKY-NET study, we performed comprehensive genome-wide transcriptome profiling to identify candidate microRNAs (miRNAs) in the tissues of patients with NET. Promising candidates were validated in plasma samples from two independent cohorts using quantitative polymerase chain reaction. RESULTS:We identified miR-7-5p as a diagnostic candidate for NET. In the multicenter SKY-NET study, miR-7-5p exhibited robust diagnostic performance in both tissue and plasma samples, with high sensitivity and specificity. The biomarker differentiated NET tissues from normal tissues, with an area under the receiver operating characteristic curve (AUC) of 0.97 and 0.88 for tissue and plasma samples, respectively. In an independent clinical cohort, plasma miR-7-5p maintained strong diagnostic performance (AUC=0.85). Notably, plasma miR-7-5p levels correlated with tumor dynamics, reflecting treatment response and disease recurrence. CONCLUSION:MiR-7-5p demonstrates substantial potential as a non-invasive biomarker for diagnosing and monitoring NET. Our findings support its potential as a diagnostic tool and for assessing disease progression, offering a new avenue for early detection and treatment evaluation in patients with NET.

Although, recently observation methods has been proposed as one of the treatment options for non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs), determining treatment strategies may be difficult for small and low-malignant NF-PanNENs; thus, clarifying the significance of lymphatic, microvascular, and perineural invasion in these patients is of great clinical importance. This study aimed to assess the incidence and role of lymphatic, microvascular, and perineural invasion in patients with NF-PanNENs based on tumor size and the 2022 World Health Organization classification. From 2000 to 2023, we retrospectively investigated the incidence of lymphatic, microvascular, and perineural invasion and their impact on recurrence in 80 patients who underwent curative resection and were diagnosed with NF-PanNENs. Of the 80 patients, 14 (18

This study aimed to identify and validate miR-7-5p as a non-invasive biomarker for diagnosing and monitoring neuroendocrine tumors (NETs). The incidence of NETs has been increasing globally in recent years, yet standardized non-invasive biomarkers for early detection and monitoring of these malignancies are lacking. Although diagnostic imaging is valuable, its resource-intensive nature limits its practicality for routine screening. Thus, reliable, non-invasive biomarkers are urgently needed. In the multicenter SKY-NET study, we performed comprehensive genome-wide transcriptome profiling to identify candidate microRNAs (miRNAs) in the tissues of patients with NET. Promising candidates were validated in plasma samples from two independent cohorts using quantitative polymerase chain reaction. We identified miR-7-5p as a diagnostic candidate for NET. In the multicenter SKY-NET study, miR-7-5p exhibited robust diagnostic performance in both tissue and plasma samples, with high sensitivity and specificity. The biomarker differentiated NET tissues from normal tissues, with an area under the receiver operating characteristic curve (AUC) of 0.97 and 0.88 for tissue and plasma samples, respectively. In an independent clinical cohort, plasma miR-7-5p maintained strong diagnostic performance (AUC=0.85). Notably, plasma miR-7-5p levels correlated with tumor dynamics, reflecting treatment response and disease recurrence. MiR-7-5p demonstrates substantial potential as a non-invasive biomarker for diagnosing and monitoring NET. Our findings support its potential as a diagnostic tool and for assessing disease progression, offering a new avenue for early detection and treatment evaluation in patients with NET.

Background:The circular stapling technique (CST) is reported to be a simple and time-efficient method; however, it is associated with a high incidence of anastomotic stenosis for McKeown esophagectomy. Meanwhile, the impact of circular stapler size remains controversial. We aimed to investigate the impact of circular stapler size on both short-term outcomes and long-term quality of life (QOL) after McKeown esophagectomy. Methods:In total, 63 consecutive patients who underwent McKeown esophagectomy for esophageal cancer between 2019 and 2022 were eligible. We examined the association between circular stapler size and short-term outcomes and long-term QOL using the PGSAS-37. Results:35 (55.6%) patients underwent anastomosis with a 21 mm stapler, whereas 28 (44.4%) patients used a 23 mm stapler. No significant differences were observed between the groups. The incidence of anastomotic leakage did not differ significantly between the groups (5.7% vs. 7.1%, p = 1.00) Also, the incidence of anastomotic stenosis did not differ between the groups (25.7% vs. 21.4%, p = 0.77). However, in QOL assessment, the meal-related subscale (SS) score in the 21 mm group was significantly worse than in the 23 mm group (p = 0.02). Regarding the details the meal-related SS score, the feeling of dysphagia was significantly worse in the 21 mm group (p < 0.01). Conclusions:Short-term outcomes did not differ between patients who underwent anastomosis with a 21 mm stapler and those with a 23 mm stapler, however QOL, particularly the feeling of dysphagia, was worse in patients who used a 21 mm stapler compared to those who used a 23 mm stapler.