Aim:As survival after gastric and esophageal cancer continues to improve, sustained work participation has become an important survivorship outcome. We aimed to evaluate return-to-work (RTW) rates 18 months after curative-intent surgery for gastric and esophageal cancers and to identify clinical and socioeconomic factors associated with delayed or failed RTW. Methods:This multicenter, longitudinal, prospective cohort study evaluated working-age Japanese patients undergoing curative-intent surgery for gastric or esophageal cancer. Working status was assessed preoperatively and at 6, 12, and 18 months postoperatively. The primary outcome was working status at 18 months. Secondary outcomes included time to first RTW, and factors associated with non-working and delayed RTW. Exploratory analyses evaluated 6-month patient-reported outcomes (QLQ-C30) and postoperative weight loss. Results:Among 158 eligible patients, 124 (78.5%) were working at 18 months. Older age (≥ 65 years) and pathological stage≥ III were associated with non-working at 18 months, whereas sedentary work and self-employment were associated with a lower risk of non-working. Postoperative appetite loss, financial difficulties (QLQ-C30), and ≥ 10% body weight loss at 6 months were associated with non-working status. Median time to first RTW was 30 and 70 days for gastric and esophageal cancers, respectively. Esophageal cancer and advanced stage were consistently associated with delayed RTW, with weaker evidence for associations with female sex and preoperative retirement. Conclusions:Approximately 80% of patients were working at 18 months after surgery. Postoperative nutritional impairment and symptom burden were associated with long-term work participation and may help identify patients at risk of not working after surgery.

The hinotori™ Surgical Robot System is an alternative to the da Vinci Surgical System for performing robot-assisted minimally invasive esophagectomy (RAMIE). We introduce our setup and surgical procedure for RAMIE using the hinotori™ Surgical Robot System (H-RAMIE) and present its outcomes and the team’s familiarization with RAMIE using the second robotic system. With the patient in the left semiprone position, the patient cart was rolled in from the right cranial side of the patient. Teaching pivots were optimized for upper mediastinal dissection. An assistant’s sealing device was frequently utilized for middle and lower mediastinal dissections. In addition to the analysis of all the experienced cases, a matched retrospective comparative analysis of short-term outcomes was performed between H-RAMIE and RAMIE using the da Vinci Xi (D-RAMIE). The learning curves of the cockpit time, setting time, and ratio of idle time-to-cockpit time of H-RAMIE were analyzed using the cumulative sum method. H-RAMIE was performed in 45 patients, including 11 salvage esophagectomies. The incidences of postoperative complications of Clavien–Dindo (CD) grades ≥ 2 and ≥ 3a were 55.6 and 20

Boerhaave’s syndrome, a spontaneous transmural rupture of the esophagus, is associated with high mortality and requires left thoracotomy. Minimally invasive surgery (MIS) is an alternative. Although most reports on thoracoscopic repair describe the procedure being performed in the lateral decubitus position, there are few reports of repairs conducted in the prone position. We hereby describe a left-sided thoracoscopic technique for primary esophageal repair, in the prone position. Patients are positioned prone and procedure is conducted under general anesthesia with carbon dioxide pneumothorax, avoiding one-lung ventilation. The esophageal muscular layer is incised for complete visualization of the mucosal defect after exposing the lower esophagus. The rupture is closed with layer-to-layer sutures. The procedure is performed with adequate mediastinal and pleural drainage. The technique was performed on two patients with surgical times of 143 and 208 min, and both patients had uneventful recovery. In the prone position, this procedure offers excellent exposure of the lower mediastinum and might reduce pulmonary burden. This approach appears safe in selected stable patients.

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background We previously evaluated the clinical significance of supraclavicular lymph node dissection (SLND) for lower thoracic esophageal cancer and reported limited benefit. Using the same multicenter cohort, the present study investigated the impact of different abdominal surgical approaches on short-term outcomes. Methods This retrospective multicenter study included patients with lower thoracic esophageal squamous cell carcinoma who underwent esophagectomy between 2013 and 2017 at 18 institutions. Cases reconstructed via routes other than the retrosternal or posterior mediastinal pathway, or using organs other than the gastric conduit, were excluded. Patients were classified according to the abdominal approach: open laparotomy (Open), hand-assisted laparoscopic surgery (HALS), or laparoscopic surgery (Lap). The primary outcomes were postoperative complications, including pneumonia and anastomotic leakage. Comparisons were performed using univariable analysis and inverse probability of treatment weighting (IPTW) based on propensity scores calculated from age, sex, BMI, ASA-PS, pulmonary function, clinical T and N stage, thoracic approach, reconstruction route, preoperative therapy, and supraclavicular lymph node dissection. Logistic regression models were then applied. Results A total of 696 patients were analyzed (Open: 257, HALS: 198, Lap: 241). Patients in the Open group had lower BMI and more advanced clinical stage. Preoperative therapy was administered in approximately 70%. Minimally invasive thoracic approaches were performed in 47.8, 73.2, and 90.5% in the Open, HALS, and Lap groups, respectively. Reconstruction routes differed among groups, with posterior mediastinal reconstruction in 33.9, 54.0, and 27.8%, and retrosternal reconstruction in 53.7, 41.4, and 63.1%; the remaining cases underwent intrathoracic anastomosis. SLND was performed in 47.9, 26.8, and 58.9%. After IPTW adjustment, pneumonia of Clavien–Dindo grade ≥2 did not differ significantly from Open (HALS: OR 0.84, p=0.49; Lap: OR 0.88, p=0.59). Grade ≥3 pneumonia tended to be less frequent in the Lap (OR 0.33, p=0.058), but not in the HALS (OR 0.74, p=0.36). No significant differences were observed in overall complications, anastomotic leakage, or respiratory complications other than pneumonia. Conclusion In esophagectomy for lower thoracic esophageal cancer, laparoscopic abdominal procedures were associated with a trend toward fewer severe pneumonias compared with open surgery, whereas the benefit of HALS was limited. These findings suggest that a fully laparoscopic approach may contribute to reducing severe respiratory complications.

This multicenter cross-sectional analysis examined the prevalence, risk factors, and health-related quality-of-life (HRQoL) correlates of the job resignation occurring between cancer diagnosis and surgery among patients with gastric or esophageal cancer in Japan. A total of 167 employed patients scheduled for curative-intent surgery across nine institutions between September 2022 and March 2024 completed questionnaires assessing employment status, socioeconomic variables, and preoperative HRQoL, including the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-OG25. Among all participants, 4.2

BACKGROUND AND OBJECTIVES:We aimed to examine long-term changes in urinary dysfunction (UD) after rectal cancer surgery, using the three validated assessments: residual urine volume (RUV), International Prostate Symptom Score (IPSS), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). METHODS:This prospective multicenter observational study was conducted in eight hospitals, and a total of 103 patients, who underwent radical resection for rectal cancer, were included. UD was evaluated at baseline and at 6, 12, and 24 months postoperatively. Quality of life (QoL) was assessed using the European Organization for Research and Treatment Cancer (EORTC) quality of life questionnaire-core 30 (QLQ-C30). RESULTS:The proportion of patients with UD based on RUV values decreased from 19.3% at baseline to 7.6% at 24 months (p = 0.022). However, UD, based on IPSS remained relatively constant (33.4% to 29.0%, p = 0.398), whereas UD based on ICIQ-SF score increased significantly from 17.5% to 29.0% (p = 0.019). Patients with UD, based on both IPSS and ICIQ-SF, had lower QoL scores at 24 months (mean differences -10.3; p = 0.028 and -15.4; p = 0.001, respectively), whereas RUV values showed no correlation with QoL scores after surgery. CONCLUSIONS:RUV values gradually improved postoperatively. However, the impact of higher RUV values on long-term QoL was limited. UD, based on both IPSS and ICIQ-SF, persisted after surgery, and negatively affected long-term QoL.

INTRODUCTION:Minimally invasive surgery offers significant advantages, including smaller incisions, reduced postoperative pain, and shorter recovery, especially in surgeries requiring access to multiple abdominal quadrants. However, robot-assisted resection of synchronous colorectal cancer (sCRC) remains technically challenging and unstandardized due to its rarity. Herein, we propose an N-shaped configuration of five-trocar placement for the simultaneous right- and left-sided colectomies with intracorporeal anastomosis. MATERIALS AND SURGICAL TECHNIQUE:An 85-year-old woman with synchronous cecal (T1) and sigmoid colon (T3) cancers underwent simultaneous ileocecal resection and sigmoidectomy. A camera trocar at the umbilical incision and four additional trocars were arranged in an N-shaped configuration. The patient cart was docked from the left caudal side. Right-sided colectomy was performed first with intracorporeal anastomosis using robotic stapling. Following temporary undocking and a 180-degree boom rotation, the robotic sigmoidectomy was completed with a standard double-stapled anastomosis. Total operative time was 311 min with minimal blood loss, and the postoperative course was uneventful. DISCUSSION:This N-shaped port configuration facilitated a seamless transition between right- and left-sided colectomies, maximizing the advantages of robotic surgery. Importantly, all tasks can be completed with this port configuration by a single patient-side surgeon. Although further studies are needed to evaluate the adaptability of this approach to other multiport robotic platforms, our experience suggests this technique is practical and effective for multiport robotic sCRC resections.

OBJECTIVE:To evaluate the efficacy of a simple oral nutritional supplement (ONS) without excess nutrients on body weight loss (BWL) after gastrectomy in patients with gastric cancer. SUMMARY BACKGROUND DATA:BWL is commonly observed in the early few months after gastrectomy for gastric cancer. It is uncertain if a simple ONS with usual diet improve postoperative BWL. METHODS:A multicenter randomized controlled trial was conducted across 19 institutions. Patients undergoing curative gastrectomy for gastric cancer were randomized into the ONS or control group. The ONS group received 400 mL (kcal)/day of ONS mainly containing carbohydrates and proteins for 8 weeks postoperatively. The primary endpoint was the percentage of BWL from baseline to postoperative 8 weeks. Secondary endpoints included handgrip strength, hematological parameters, health-related quality of life, dietary intake, and ONS adherence. RESULTS:The 124 patients were randomized to the ONS group (n=62) or control group (n=62), with 2 in the ONS group lost to follow-up. The ONS group experienced significantly less weight loss at postoperative 8 weeks (-4.8% vs. -6.4%, P=0.039). No significant differences were observed in handgrip strength or hematological parameters. The incidences of adverse events were comparable between the groups (7% vs. 11%, P=0.373), but the ONS group had higher symptom scores for insomnia, appetite loss, and diarrhea during intervention. The mean ONS intake was >75% (308.7 mL±97.0 mL/d). CONCLUSIONS:The simple ONS for 8 weeks after gastrectomy reduced postoperative BWL in patients with gastric cancer.

INTRODUCTION:Immunoglobulin G4-related disease (IgG4-RD) rarely involves the esophagus, typically causing stenosis that presents significant diagnostic and therapeutic challenges. Due to its rarity and its mimicry of other conditions, obtaining a definitive preoperative diagnosis can be difficult. This report details a case of IgG4-RD-induced esophageal stenosis with initial diagnostic ambiguity, which was successfully managed with mediastinoscopy-assisted esophagectomy (MAE), highlighting this minimally invasive approach in a patient with comorbidities. CASE PRESENTATION:A 70-year-old male with comorbidities, including obstructive pulmonary disorder, presented with progressive dysphagia and epigastric discomfort. Endoscopy revealed a persistent mid-esophageal ulcer and a non-passable circumferential stricture; multiple biopsies were nondiagnostic for malignancy or infection. Given the refractory nature of the stenosis, MAE with gastric conduit reconstruction was performed. The postoperative course was uneventful, and the patient achieved symptom resolution without medication. Histopathological examination of the resected esophagus confirmed IgG4-RD, showing obliterative phlebitis and a dense infiltrate of IgG4-positive plasma cells (80/high-power field; IgG4/IgG ratio 80/85). CONCLUSIONS:This case underscores that IgG4-RD should be considered in the differential diagnosis of refractory esophageal stenosis, even with initially inconclusive biopsies. While serum IgG4 measurement has low sensitivity, it is still recommended. For benign esophageal stenosis of unclear etiology, particularly in patients with significant comorbidities, MAE can be a useful and potentially curative surgical option, offering symptom resolution and the possibility of a drug-free outcome.

Although the high accuracy of artificial intelligence (AI) for recognizing surgical anatomy has been reported, its effective usage remains unclear. In this study, we investigated the utility of AI in surgical education for medical students. Fifth-grade medical students were recruited to investigate the educational utility of EUREKA™. After an introductory lecture, they watched a video of distal gastrectomy with or without the suggestion of the connective tissue and the pancreas by EUREKA™ and then drew dissection lines in still images captured from the video. The distance between the lines drawn by students and the optimal dissection line determined by an expert surgeon was integrated to evaluate how well the students appropriately recognized the dissection line. Students filled out questionnaires after the study. A total of 45 operative video frames from radical gastrectomies performed with three different robotic systems were analyzed. The accuracy of the EUREKA™ recognition of the connective tissue and the pancreas was assessed using Dice and Intersection over Union (IoU) as a measurement tool. Twelve students participated in the study, and nine students drew dissection lines. All students completed questionnaires. The students could recognize dissection lines more appropriately with the EUREKA™ suggestion, and the deviations between the dissection lines drawn by the students and the optimal dissection lines were significantly reduced. From the questionnaires completed by the students, eight students agreed with the possibility of AI to facilitate their understanding of the operation, and two students agreed with the potential of AI to increase the number of medical students who choose gastrointestinal surgery as their career. There were no differences in the DICE and IoU scores of the connective tissue and the pancreas between the three robotic systems, suggesting the versatility of the EUREKA™ system. AI may facilitate students’ understanding of surgery.

To evaluate the efficacy of a simple oral nutritional supplement (ONS) without excess nutrients on body weight loss (BWL) after gastrectomy in patients with gastric cancer. BWL is commonly observed in the early few months after gastrectomy for gastric cancer. It is uncertain if a simple ONS with usual diet improve postoperative BWL. A multicenter randomized controlled trial was conducted across 19 institutions. Patients undergoing curative gastrectomy for gastric cancer were randomized into the ONS or control group. The ONS group received 400 mL (kcal)/day of ONS mainly containing carbohydrates and proteins for 8 weeks postoperatively. The primary endpoint was the percentage of BWL from baseline to postoperative 8 weeks. Secondary endpoints included handgrip strength, hematological parameters, health-related quality of life, dietary intake, and ONS adherence. The 124 patients were randomized to the ONS group (n=62) or control group (n=62), with 2 in the ONS group lost to follow-up. The ONS group experienced significantly less weight loss at postoperative 8 weeks (−4.8% vs. −6.4%, P=0.039). No significant differences were observed in handgrip strength or hematological parameters. The incidences of adverse events were comparable between the groups (7% vs. 11%, P=0.373), but the ONS group had higher symptom scores for insomnia, appetite loss, and diarrhea during intervention. The mean ONS intake was >75% (308.7 mL±97.0 mL/d). The simple ONS for 8 weeks after gastrectomy reduced postoperative BWL in patients with gastric cancer.

Introduction: This study aimed to evaluate safety and feasibility of perioperative exercise and nutrition therapy and to explore perioperative changes in skeletal muscle mass (SMM) in patients with esophageal cancer. METHODS:Patients scheduled for curative esophagectomy at two hospitals were enrolled. Exercise and nutrition therapy were performed for 3 weeks preoperatively and 4 weeks postoperatively. Outcomes included SMM, which was the sum of both mid-thigh cross-sectional area on computed tomography and physical function, assessed at T1 (intervention start), T2 (just before surgery), and T3 (1-month postoperatively). The SMM change rate between T1 and T3 was compared with the hypothesized value (-7.5%) from our previous study. RESULTS:Thirty-six patients underwent intervention and esophagectomy (intervention completion rate: 94.4%, no serious adverse events). The SMM increased by 4.9% for T1-T2 (p < 0.001) but decreased by 10.1% for T1-T3 (p < 0.001), suggesting that the primary outcome was not achieved. Physical function results were significantly better at T3 than at T1. Postoperative SMM loss was lower in patients who maintained postoperative caloric intake and physical activity than in those who could not (-8.3% vs. -15.4%, p = 0.011). CONCLUSIONS:Perioperative exercise and nutrition therapy were safe and feasible. An increase in preoperative SMM and postoperative physical function were observed, although SMM decreased after surgery. Further investigation is warranted to evaluate the efficacy of this intervention. .

Body weight loss (BWL) after gastrectomy impact on the short- and long-term outcomes. Oral nutritional supplement (ONS) has potential to prevent BWL in patients after gastrectomy. However, there is no consistent evidence supporting the beneficial effects of ONS on BWL, muscle strength and health-related quality of life (HRQoL). This study aimed to evaluate the effects of ONS formulated primarily with carbohydrate and protein on BWL, muscle strength, and HRQoL. This will be a multicenter, open-label, parallel, randomized controlled trial in patients with gastric cancer who will undergo gastrectomy. A total of 120 patients who will undergo gastrectomy will be randomly assigned to the ONS group or usual care (control) group in a 1:1 ratio. The stratification factors will be the clinical stage (I or ≥ II) and surgical procedures (total gastrectomy or other procedure). In the ONS group, the patients will receive 400 kcal (400 ml)/day of ONS from postoperative day 5 to 7, and the intervention will continue postoperatively for 8 weeks. The control group patients will be given a regular diet. The primary outcome will be the percentage of BWL (

AbstractBackgroundIntensive localized therapy is promising for the treatment of rectal cancer. In Japan, chemoradiotherapy (CRT) and neoadjuvant chemotherapy (NAC) are used as preoperative treatments for this disease. Magnetic resonance imaging (MRI) is used to diagnose lateral pelvic node (LPN) metastases, but the changes in LPN findings on MRI following preoperative treatment are unclear. Furthermore, there may be patients in whom LPN dissection can be omitted after CRT/NAC.MethodsPatients who underwent total mesorectal excision with LPN dissection after CRT/NAC at 13 Japanese Society for Cancer of the Colon and Rectum member institutions between 2017 and 2019 were included. Changes in the short diameter of the LPNs after CRT/NAC and the reduction rate were examined.ResultsA total of 101 LPNs were examined in 28 patients who received CRT and 228 in 47 patients who received NAC. Comparison of LPNs before and after CRT/NAC showed that most LPNs shrank after CRT but that the size reduction was variable after NAC. Although some LPNs with a short diameter of <5 mm showed residual metastasis, no metastases were observed in LPNs that were <5 mm in short diameter before and after CRT/NAC and did not shrink after treatment.ConclusionAlthough the short diameter of LPNs was significantly reduced by both CRT and NAC, even LPNs with a short diameter of <5 mm could have residual metastases. However, dissection may be omitted for LPNs <5 mm in short diameter that do not shrink after preoperative CRT or NAC.

AbstractBackgroundPatients with ulcerative colitis are reported to be at increased risk of colorectal cancer and are also at high risk of postoperative complications. However, the incidence of postoperative complications in these patients and how the type of surgery performed affects prognosis are not well understood.MethodsData collected by the Japanese Society for Cancer of the Colon and Rectum on ulcerative colitis patients with colorectal cancer between January 1983 and December 2020 were analyzed according to whether total colorectal resection was performed with ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), or permanent stoma creation. The incidence of postoperative complications and the prognosis for each surgical technique were investigated.ResultsThe incidence of overall complications was not significantly different among the IAA, IACA, and stoma groups (32.7%, 32.3%, and 37.7%, respectively; p = 0.510). The incidence of infectious complications was significantly higher in the stoma group (21.2%) than in the IAA (12.9%) and IACA (14.6%) groups (p = 0.048); however, the noninfectious complication rate was lower in the stoma group (13.7%) than in the IAA (21.1%) and IACA (16.2%) groups (p = 0.088). Five‐year relapse‐free survival was higher in patients without complications than in those with complications in the IACA group (92.8% vs. 75.2%; p = 0.041) and the stoma group (78.1% vs. 71.2%, p = 0.333) but not in the IAA group (90.3% vs. 90.0%, p = 0.888).ConclusionThe risks of infectious and noninfectious complications differed according to the type of surgical technique used. Postoperative complications worsened prognosis.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of extensive intraoperative peritoneal lavage for resectable advanced gastric cancer.

Abstract We report a new method of esophagogastrostomy after proximal gastrectomy, side overlap with fundoplication by Yamashita (SOFY) in 2017. Recently, even better treatment results can be obtained by modifying the SOFY method. We describe the technical details of the modified SOFY (mSOFY) after laparoscopic proximal gastrectomy. The stomach was dissected in the short axis direction and the esophagus was dissected in the left and right direction. After the proximal gastrectomy, the bilateral diaphragmatic crus were dissected to enhance gastric elevation. After confirming that the esophagus overlapped more than 5 cm at the center of the remnant stomach (we call it SOFY check), the remnant stomach was suture‐fixed to the dissected diaphragmatic crus. The right wall of the esophageal stump and the remnant stomach were anastomosed using the full length of a 45 mm‐linear stapler. The entry hole was closed in a direction that did not widen the anastomotic hole. Both sides of the esophagus, remnant stomach, and diaphragmatic crus were suture‐fixed on the cranial side 1–2 cm away from the anastomosis. Moreover, the left wall and lower end of the esophagus was suture‐fixed to the remnant stomach. The preserved dorsal esophageal wall is pressed and flattened by pressure from the pseudofornix, which is the reflux prevention mechanism. The mSOFY method had favorable treatment outcomes. In conclusion, mSOFY can be one of the safe and feasible reconstruction methods after laparoscopic proximal gastrectomy.