Background With the widespread availability of whole-slide imaging, many studies have utilized digital images of hematoxylin and eosin (H E)-stained breast cancer tissues and applied convolutional neural networks (CNNs) for pathological diagnosis. However, CNN-based diagnosis is largely a black box and may be limited in quantitative morphological research. In this study, we developed a simple algorithm for morphometric analysis of three nuclear atypia features on H E-stained whole-slide images to predict nuclear grade, hormone receptor status, and Ki-67 levels in breast cancer. Materials and Methods Using 43,183 H E-stained nuclear images larger than 20 µm2 from 131 invasive ductal breast carcinomas, we calculated the following features of nuclear atypia using a computer vision algorithm: anisonucleosis (variation in nuclear size), inhomogeneous chromatin density, and the average size of prominent nucleoli. Anisonucleosis was quantified as the percentage of nuclei larger than 47 μm². Inhomogeneous chromatin was defined as the percentage of blue-saturated structures with 0.92-fold luminance or less than the average nuclear luminance. Prominent nucleoli were identified based on blue-saturated structures with 0.87-fold luminance or less, circularity greater than 0.65, and size greater than 1.15 μm². Using these values of nuclear atypia features, the thresholds that were the most associated with grade and biomarkers were calculated using receiver operating characteristic curves by Youden index. Results The morphometric algorithm using these thresholds predicted nuclear grade (grade 1 and 3), Ki-67 index ≧ 20

Neoadjuvant chemotherapy with 5-FU, cisplatin, and docetaxel (DCF) is standard for resectable esophageal cancer in Japan but is linked to severe adverse events. We report three cases of esophagorespiratory fistulas (ERFs) occurring during DCF therapy. Case 1: A 72-year-old woman (cStage II) developed fever after two DCF cycles. CT and esophagography confirmed an ERF. An esophageal stent was placed, but she later opted for best supportive care. Case 2: A 53-year-old man (cStage IIIB) developed pneumatosis intestinalis and pneumonia nine days into DCF. Imaging confirmed an ERF. He received a stent on day 19 and continued chemotherapy for over a year. Case 3: A 65-year-old man (cStage IIIA) presented with dyspnea eight days after starting DCF. CT revealed pneumothorax and pyothorax. A stent was placed on day 19. His condition initially improved but later declined, leading to best supportive care. DCF therapy may enhance survival but carries significant risk for ERFs. Early recognition of symptoms and rapid intervention are critical to managing complications.

ABSTRACT Background Despite improvements in surgical techniques and perioperative management, the incidence of postoperative surgical site infection after pancreatoduodenectomy remains high. This study aim to assess whether broad‐spectrum antibiotic prophylaxis can reduce complications after pancreatoduodenectomy compared with standard care antibiotics. Methods Data of patients who underwent pancreatoduodenectomy between July 2010 and March 2022 were extracted from a nationwide Japanese inpatient database. First‐ and second‐generation cephalosporins were designated as narrow‐spectrum, and third‐ and fourth‐generation cephalosporins and piperacillin–tazobactam as broad‐spectrum antibiotics. Patients who received either narrow‐ or broad‐spectrum antibiotics on the day of surgery were included in the analysis. Using propensity‐score stabilized inverse probability of treatment weighting, the postoperative complications were compared between patients who received antimicrobial prophylaxis with narrow‐spectrum antibiotics versus broad‐spectrum antibiotics. Results From among 45 099 eligible patients, 36 742 (81.5%) and 8357 (18.5%) patients received narrow‐ and broad‐spectrum antibiotics, respectively. After stabilized inverse probability of treatment weighting, the use of broad‐spectrum antibiotics bore a significant association with the reduction in intra‐abdominal infections [risk difference (RD), −7.4; 95% confidence interval (CI), −8.7 to −6.0], postoperative pancreatic fistula (RD, −3.0; 95% CI, −4.0 to −1.9), post‐pancreatectomy hemorrhage (RD, −1.5; 95% CI, −1.9 to −1.1). The use of broad‐spectrum antibiotics was also associated with a shorter postoperative length of hospital stay and lower total hospitalization costs. The proportion of Clostridioides difficile infection did not differ between the groups. Conclusions The administration of broad‐spectrum antibiotics as antimicrobial prophylaxis was associated with better in‐hospital postoperative outcomes compared with narrow‐spectrum in patients undergoing pancreatoduodenectomy.

Introduction:Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is the standard preoperative chemotherapy for advanced esophageal cancer. Although pegfilgrastim (PEG) is used for prophylaxis, the optimal timing remains unclear. This study aimed to evaluate the safety and efficacy of early PEG administration in DCF therapy. Methods:We retrospectively analyzed 50 chemotherapy cycles in 28 patients who underwent preoperative DCF therapy. The patients were divided into two groups based on the timing of PEG administration: day 3 (Early group) and day 7 (Late group). We compared hematologic and nonhematologic toxicities between the groups. Results:Early PEG administration significantly reduced leukopenia (Early group vs. Late group: 14% vs. 64%) and neutropenia (21% vs. 79%) and was associated with a lower incidence of febrile neutropenia (7% vs. 36%). Early PEG administration also reduced the incidence of grade ≥3 diarrhea and anorexia and improved food oral intake, weight loss, hyponatremia, and anorexia. Conclusions:Early administration of PEG on day 3 during preoperative DCF therapy for esophageal cancer significantly reduced severe neutropenia and was associated with improved treatment tolerability compared to standard day 7 administration. These findings suggest that early PEG administration is a safe and effective strategy to enhance the tolerability of intensive chemotherapy.

BACKGROUND:Myxoid stroma in the tumor stroma has been suggested to play a key role in cancer progression; however, its underlying mechanisms remain unclear. This study aimed to examine the relationship between myxoid stroma, identified in hematoxylin and eosin (HE)-stained tissue, and tumor-infiltrating lymphocytes (TILs), assessed through immunohistochemical staining. Automated image analysis was employed to evaluate these features, and their clinical significance in esophageal squamous cell carcinoma (ESCC) was investigated. METHODS:A total of 139 ESCC patients who underwent esophagectomy were included. From each patient, three serial sections from paraffin blocks were prepared and stained with CD3, HE, and CD8, respectively. An algorithm for identifying myxoid stroma was applied to HE slides, and the resulting data were mapped onto the corresponding CD3 and CD8 slides to analyze the spatial relationship between these pathological findings. RESULTS:The myxoid-high group, comprising 76 cases, had significantly deeper tumor depth compared to the myxoid-low group, which included 63 cases (p < 0.05). CD3+ cell density was significantly lower in the myxoid-high group compared to the myxoid-low group (p < 0.01). Within the myxoid stroma regions, CD3+ cell density was significantly lower than in regions outside the stroma (p < 0.01). The mean distance of all CD3+ cells from the edges of the myxoid stroma was significantly greater than that from the tumor margin (p < 0.01). Similar results were observed for CD8+ cells. CONCLUSIONS:In conclusion, this study demonstrated that myxoid stroma in the invasive front of ESCC is closely associated with the density of CD3+ and CD8+ positive lymphocytes.

This study aimed to determine whether serum squamous cell carcinoma antigen (SCC) value before and after neoadjuvant chemotherapy (NAC) can help to predict pT4 locally advanced esophageal squamous cell cancer (ESCC). The study included 117 ycT3 ESCC patients who received NAC and underwent esophagectomy. The patients were categorized into ycT3r and ycT3br groups according to the 12th edition of the Japanese Classification of Esophageal Cancer. All SCC values before NAC (pre-SCC) and after NAC (post-SCC) as well as the difference between post-SCC and pre-SCC values (ΔSCC) were examined to determine their association with pT4. Pre-SCC levels did not differ significantly across pT stage (P = 0.267), whereas post-SCC levels showed a significant pT stage-dependent variation (P = 0.005). Only pT4 patients exhibited a positive ΔSCC value and showed significant pT-dependent variation (P = 0.002). The highest area under the receiver operating characteristic (ROC) curve for predicting pT4 was achieved by ΔSCC, at 0.779 (P < 0.001), followed by post- and pre-SCC, using the cutoff value of 0.4 determined by the Youden index. Multivariate analysis identified ycT3br (P = 0.004) and ΔSCC ≥0.4 (P = 0.003) as independent predictors for pT4. Among the patients with ycT3r and ΔSCC <0.4, 98.8

Tumor cell nuclear size (NS) indicates malignant potential in breast cancer; however, its clinical significance in esophageal squamous cell carcinoma (ESCC) is unknown. Artificial intelligence (AI) can quantitatively evaluate histopathological findings. The aim was to measure NS in ESCC using AI and elucidate its clinical significance. We investigated the relationship between NS assessed by AI and prognosis in 138 patients with ESCC who underwent curative esophagectomy. Hematoxylin and eosin-stained slides from the deepest tumor sections were digitized. Using HALO-AI DenseNet v2, we created a deep-learning classifier that identified tumor cells with an NS area >20 mm(2). Median NS was 40.14 mm(2), which was used to divide patients into NS-high and NS-low groups (n = 69 per group). Five-year overall survival (OS) and relapse-free survival rates were significantly lower in the NS-high group (43.2% and 39.6%) than in the NS-low group (67.7% and 49.6%). Multivariate analysis showed that greater tumor depth and NS-high status (hazard ratio: 1.79; P = .032) were independent risk factors for OS. In 77 cases with neoadjuvant chemotherapy, increased tumor depth and NS-high status (hazard ratio: 1.99; P =.048) were independent prognostic factors for unfavorable OS. Compared with the NS-low group, the NS-high group had significantly higher anisokaryosis, higher Ki-67 expression as calculated by AI analysis of immunostaining, and higher NS heterogeneity as examined by equidividing the tumors into square tiles. In conclusion, NS assessed by AI is a simple and useful prognostic factor for ESCC. (c) 2024 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

INTRODUCTION:Esophageal squamous cell carcinoma is an aggressive malignancy often diagnosed at an advanced stage. Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have shown promising outcomes for improving survival. Although rare, immune-related adverse events (irAEs) associated with ICI therapy, such as pneumatosis intestinalis (PI) and portal venous gas (PVG), can be fatal. CASE PRESENTATION:A 60-year-old man with unresectable advanced esophageal squamous cell carcinoma received cisplatin, 5-fluorouracil (FP), and pembrolizumab. Three days after treatment initiation, the patient experienced abdominal pain and hypotension. Imaging revealed extensive PI and PVG, with no signs of bowel ischemia. Emergency laparotomy confirmed PI involving the entire length of the small intestine, with no visible perforations. Symptoms resolved with conservative management. After benefits and potential adverse events of the current chemotherapy regimen were explained, the patient chose to continue pembrolizumab-based chemotherapy. In the second and third courses, the doses of cisplatin and 5-FU were reduced to 75% (cisplatin 60 mg/m2, 5-FU 600 mg/m2), while the dose of pembrolizumab was maintained (200 mg). No major adverse events occurred, and follow-up CT scans showed shrinkage of the primary lesion, and PI did not recur during this period. However, 26 days after the 3rd treatment course, the patient developed sudden-onset abdominal pain, shock, more severe PI, and PVG. Despite receiving intensive care, the patient died the following day. Autopsy revealed diffuse intestinal erosion with a CD8-positive lymphocytic infiltration and histologically confirmed pneumatosis intestinalis extensively involving the small intestine and colon. CONCLUSIONS:The patient experienced two episodes of PI and PVG with distinct clinical courses. Although the exact cause of the first episode remains unclear, the fatal recurrence suggests that rechallenging with suspected causative agents carries a significant risk, even after dose reduction. While ICI-based chemotherapy for esophageal cancer was highly effective, this case highlights the importance of continuously reassessing the risk-benefit balance during treatment. Discontinuation of ICIs should be considered when serious irAE are suspected.

Postoperative infectious complications (PICs) are major adverse events following gastrectomy for gastric cancer. The present study investigated whether preoperative programmed cell death 1 (PD-1)+CD4+ lymphocytes reflect immunological and physical frailty and predict PICs. A total of 85 patients who underwent gastrectomy for gastric cancer were retrospectively enrolled. Blood samples were collected preoperatively, and PD-1+CD4+ cells were analyzed using flow cytometry. Patients were divided into PD-1high (N=43) and PD-1low (N=42) groups based on the median value of preoperative PD-1+CD4+/CD4+ cells (cutoff, 22.3%). Preoperative immune-inflammatory markers and nutritional indices included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein-to-albumin ratio (CAR), prognostic nutrition index (PNI) and controlling nutritional status (CONUT) score. Physical vulnerability was assessed using the fall risk assessment score (FRAS) and Charlson comorbidity index (CCI). The PD-1high group was older than the PD-1low group, with no significant differences in sex, comorbidities, or surgical and pathological factors. The PD-1high group had a significantly higher incidence of the PICs (42 vs. 19%; P<0.05). In addition, the PD-1high group exhibited higher C-reactive protein levels, and lower total lymphocyte counts and albumin levels compared with the PD-1low group (P<0.05, respectively). The two groups had significant differences in preoperative NLR, CAR, PNI, CONUT score and FRAS. Notably, there were significant associations between PD-1+CD4+/CD4+ cells and NLR, PLR, CONUT score, PNI, FRAS and CCI (all P<0.05). Preoperative PD-1+CD4+/CD4+ cells were significantly associated with increased PIC risk and markers of immunological and physical frailty. This biomarker may be useful for identifying vulnerable patients requiring tailored perioperative care.

A disintegrin and metalloproteinase 28 (ADAM28), which comprises membrane-anchored form (ADAM28m) and short-secreted form (ADAM28s), is overexpressed by carcinoma cells and involved in cancer cell proliferation and metastasis in several cancers. However, little is known about the implications of ADAM28 in esophageal squamous cell carcinoma (ESCC). In this study, we investigated the expression and clinical implication of ADAM28 in ESCC and examined the molecular mechanism of ADAM28-mediated ESCC cell proliferation. Immunoblotting analysis demonstrated that ADAM28s is overexpressed in active forms of 42 and/or 40 kDa in ESCC tissues compared with nonneoplastic esophageal tissues. Immunohistochemistry and deep learning artificial intelligence showed that ADAM28s is expressed mainly by carcinoma cells in the ESCC tissue, and the 5-year overall survival and disease-specific survival rates in cases with extensive immunostaining are significantly worse than those in low immunostaining cases. Among several factors examined, interleukin 6 (IL-6) enhanced ADAM28s expression in ESCC cell lines (TE-1 and KYSE-140), which exhibited ADAM28 expression but not in a cell line without the expression (TE-8). Proliferation of TE-1 and KYSE-140 cells under IL-6 stimulation was effectively inhibited by treatment with anti-ADAM28 antibody or siRNA-mediated downregulation of ADAM28, whereas no such effect was observed in TE-8 cells. In mouse ESCC cell xenografts, tumor growth of KYSE-140ffLuc-cp156 cells was significantly reduced by treatment with the anti-ADAM28 antibody compared with the control immunoglobulin G-treated group. These results show that ADAM28s is overexpressed as active forms in ESCC cells and suggest that ADAM28s is involved in cell proliferation probably through the IL-6 signaling pathway.

Introduction: A high density of tumor-infiltrating lymphocytes (TILs) has been recognized as an indicator of favorable prognosis of triple-negative breast cancers (TNBCs), and measurement of TILs infiltrating in the stroma of peripheral zone of cancer tissue are considered to be of the optimal clinical significance. However, some studies on other cancer types have indicated that TIL densities in both stromata of peripheral and central zones and in tumor cell nests were associated with prognosis. In this study, we evaluated the density and spatial distribution pattern of TILs manually and with an artificial intelligence (AI) modality and investigated their prognostic implication. Materials and methods: We evaluated 70 surgically resected TNBC specimens from patients who did not receive neoadjuvant chemotherapy. CD3+ TILs and CD8+ TILs were detected by immunohistochemistry. The manual evaluation was performed by counting the total number of CD3+- and CD8+- TILs in peripheral stroma (psTILs), in central stroma (csTILs), and in tumor cell nests (iTILs) in five high-power fields (HPFs) on photomicrographic images. The evaluation with AI was performed by calculating densities of these TILs in 10 tiles (one tile: 500 x 500 μm square) after deep-learning of annotated areas of tumor cell nests, stroma, and other regions on digital slide glasses with HALO AI (Indica Labs, NM, U.S.A.). With AI, the peripheral zone was defined as the region centered on the boundary separating the host tissue from the cancer tissue with a width of 1 mm, and the central zone as the tissue inside the peripheral zone. psTILs, csTILs, and both peripheral and central iTILs (piTILs and ciTILs) were measured. With reference to receiver operating characteristic curves, the optimal cut-off values between high and low TILs were determined to discriminate clinical outcome of the patients. Spatial distribution patterns of TILs were also defined: infiltrated (high psTILs/high csTILs) and non-infiltrated patterns. Recurrence-free survival and overall survival analyses were performed with Cox proportional hazards model analyses. Results: Median follow-up duration was 9.4 years, and 14 patients suffered recurrences and 13 patients died. In manual measurements, cut-off values in totally five HPFs were 1000, 300, 700, 300, 10, and 5 in CD3+ psTILs, CD8+ psTILs, CD3+ csTILs, CD8+ csTILs, CD3+ iTILs, and CD8+ iTILs, respectively. In AI measurements, cut-off values in totally 10 tiles were 1,500, 1,000, 500, 250, 30, and 15 in CD3+ psTILs, CD8+ psTILs, CD3+ csTILs, CD8+ csTILs, CD3+ ciTILs, and CD8+ ciTILs, respectively. By Cox univariate analyses, low CD3+ iTILs and low CD8+ iTILs with AI measurements showed higher risks [recurrence: hazard ratio(HR) 3.11, 95% CI 1.01-9.59, P = 0.047 for CD3+ ciTILs; HR 4.30, 95% CI 1.18-15.7, P = 0.027 for CD8+ ciTILs; HR 5.88, 95% CI 1.30-26.6, P = 0.021 for CD3+ csTILs; death: HR 3.57, 95% CI 1.16-11.0, P = 0.026 for CD3+ ciTILs; HR 4.30, 95% CI 1.18-15.7, P = 0.027; HR 2.23, 95% CI 0.99-10.5, P = 0.052; HR 3.98, 95% CI 1.09-14.5, P = 0.036 for CD3+ csTILs], but other psTILs and csTILs did not show prognostic significance. With regard to spatial distribution of CD3+ TILs, non-infiltrated patterns showed significantly worse prognoses than infiltrated pattern (recurrence: HR 8.52, 95% CI 1.11-65.7, P = 0.039; death: HR 8.98, 95% CI 1.16-69.3, P = 0.035). Similar results were shown by manual evaluations. The CD3+ ciTILs, CD8+ ciTILs, CD3+ csTILs, and spatial distribution pattern with AI measurements were significantly or nearly significant prognostic values independently of patient age, pT, pN, stage, and adjuvant chemotherapy. Conclusions: Evaluation of TILs not only in peripheral stroma but also in central stroma and tumor cell nests appeared important in TNBCs. iTILs and spatial distribution pattern of TILs might be applicable to discern patients who are eligible for dose de-escalation from those who require standard perioperative systemic therapy to TNBC. Citation Format: Makiko Fukumura-Koga, Takanori Watanabe, Keita Kouzu, Kimi Kato, Kosuke Miyai, Tamio Yamasaki, Takahiro Einama, Hideki Ueno, Yoji Kishi, Kimiya Sato, and Hitoshi Tsuda. Intratumor tumor-infiltrating lymphocytes (iTILs) and spatial distribution pattern of stromal TILs (sTILs) evaluated by HALO AI are prognostic indicators of triple-negative breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS1-06.

INTRODUCTION:Immune checkpoint inhibitors (ICIs) have extended survival in various cancers, especially when combined with chemotherapy. This effect is thought to involve tumor-specific antigen release and T cell reactivation. The "abscopal effect," where radiation leads to tumor shrinkage at distant sites, may also be enhanced by ICIs, although this is not fully understood. Photodynamic therapy (PDT), a localized treatment, has shown potential for inducing abscopal effects, but no studies have investigated this in metronomic PDT (mPDT), which uses low fluence rates over extended periods. This study aimed to evaluate if mPDT exerts the abscopal effect and whether the addition of ICIs can enhance this effect. METHODS:Colon-26 tumor-bearing mice were treated with conventional (cPDT) or mPDT, with or without anti-PD-L1 antibodies. Tumor growth in target and nontarget lesions was measured, and immune cell infiltration was analyzed by flow cytometry. RESULTS:When combined with anti-PD-L1, cPDT significantly reduced tumor size in nontarget lesions and increased the infiltration of CD4+, CD8+, and CD3+ cells in these areas. In contrast, mPDT did not elicit a comparable antitumor response or promote CD4+, CD8+, and CD3+ cell infiltration in nontarget lesions. CONCLUSIONS:While cPDT combined with ICIs successfully reduced tumor size in nontarget lesion, mPDT did not, suggesting a limited capacity to induce systemic immune responses. Further research is needed to optimize mPDT for systemic cancer therapy.

Surgical site infections (SSIs) can affect mortality, morbidity, and medical costs. Although it has recently been reported that washing with antiseptic/antibiotic solution can prevent SSI in clean surgery, the clinical impact in gastrointestinal surgery is still uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the efficacy of antiseptic/antibiotic solution during wound irrigation or peritoneal lavage in gastroenterological surgery. The database search used PubMed, MEDLINE, and Cochrane Library. The following inclusion criteria were set for the systematic review. 1) Studies comparing with or without antiseptic/antibiotic irrigation/lavage during gastrointestinal surgery. 2) Studies that described surgical site infections and adverse events. 3) Studies conducted after 2000. A total of 8 randomized controlled studies (RCTs) and 3 observational studies were included in this meta-analysis. Three RCTs of wound irrigation with povidone iodine (PVI) solution revealed no significant difference between the PVI and control groups [RR 1.41, 95

This study aimed to evaluate the impact of drain placement on the incidence of postoperative complications in patients undergoing gastrectomy. The effectiveness of prophylactic abdominal drain placement in gastrectomy remains unclear. Nevertheless, they are still commonly used following gastrectomy. We conducted a retrospective cohort study using a nationwide inpatient database in Japan. Patients who underwent gastrectomy for gastric cancer between January 2014 and March 2022 were included. We applied overlap weighting based on propensity scores to adjust for baseline characteristics. The primary outcome was the incidence of intra-abdominal infections. Secondary outcomes included postoperative percutaneous drainage, in-hospital death, length of hospital stay, and total hospitalization costs. A total of 217,750 patients met the inclusion criteria, and 196,660 (90.3

Prompt diagnosis of strangulated bowel obstruction (SBO) is critical because delayed recognition can lead to life-threatening complications. This study assessed whether the intestinal-to-liver CT attenuation value ratio—a comparison of ischemic bowel-wall enhancement to liver enhancement—can predict the need for intestinal resection in SBO patients. We retrospectively analyzed 52 patients who underwent emergency surgery for suspected SBO from 2014 to 2021. Of these, 35 required intestinal resection due to irreversible ischemia (resection group), while 17 did not (no-resection group). Preoperative clinical and imaging findings were compared between groups. The resection group had a longer time from onset to surgery (p = 0.034) and higher leukocyte counts (p = 0.037). CT values of the poorly enhanced intestinal wall and the intestinal-to-liver attenuation ratio were significantly lower in the resection group (p < 0.0001). Multivariate analysis identified time to surgery (OR 5.08; 95

INTRODUCTION:Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies. MATERIALS AND SURGICAL TECHNIQUE:The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing. CONCLUSION:Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.

Introduction: We investigated the drug resistance status of Pseudomonas aeruginosa (P. aeruginosa) focusing on its isolation sites and types of diseases. Materials and methods : A microbiological laboratory database was searched to identify all clinical cultures positive for P. aeruginosa. Clinicopathologic features and susceptibility of P. aeruginosa to any antibiotics were evaluated in patients admitted to the division of upper (Upper- GI group) or lower gastrointestinal surgery (Lower- GI group). In addition, we investigated the susceptibility of P. aeruginosa to any antibiotics based on the isolation site. Results: P. aeruginosa was frequently detected in the sputum and urine of the Upper- GI and Lower- GI groups, respectively. Among P. aeruginosa isolates from drain discharge, a significantly higher rate of resistance to imipenem, amikacin, and ciprofloxacin was observed; among P. aeruginosa isolates from wounds, a substantially higher proportion had resistance to imipenem and cefozopran in the Upper- GI group. However, there was no difference between the two groups in the drug resistance of P. aeruginosa isolated from urine, sputum, blood, and ascites. P. aeruginosa isolated from sputum showed more resistance to imipenem and ciprofloxacin than those isolated from other sites. Conclusion : There were significant differences in the drug resistance ofP. aeruginosa based on the isolation sites and types of diseases.

AbstractIntroductionThis is a systematic review and meta‐analysis of the efficacy of wound coverage using advanced dressings specifically for the prevention of surgical site infections (SSI) in gastrointestinal surgery, as part of the update of the SSI prevention guidelines of the Japan Society for Surgical Infection (JSSI).MethodsAfter searching CENTRAL, PubMed, and ICHUSHI‐Web in July 2024, we included randomized controlled trials (RCTs) comparing advanced dressings and standard dressings for surgical wounds in gastrointestinal surgery (PROSPERO No. CRD42024569084). Three authors independently screened the RCTs. We assessed the risk of bias and certainty of the body of evidence for the extracted data. The primary outcome was superficial SSI, and the secondary outcomes were length of postoperative hospital stay, costs, and allergy. This study was partially supported by the JSSI.ResultsA total of seven RCTs and 927 patients were included. The use of advanced dressings significantly lowered the risk of SSI compared to that associated with standard dressings (risk ratio: 0.54, 95% confidence intervals: 0.34–0.88). The certainty of the evidence was rated as moderate. According to the subgroup analysis, advanced dressings reduced the risk of SSI in colorectal surgery. Advanced dressings did not reduce the length of postoperative hospital stay or costs compared to that of standard dressings. Allergies were reported in only one patient using silver‐impregnated dressings.ConclusionThe use of advanced dressings for primary wounds in gastrointestinal surgery was associated with a significantly lower risk of SSI than that associated with standard dressings.

Introduction:This study aimed to evaluate the peritoneal computed tomography (CT) attenuation values and investigate their predictive impact for the severity of peritonitis in patients with upper gastrointestinal tract (UGI) perforations. Methods:Overall, 112 consecutive patients with UGI perforations who underwent plain CT were included in this study. Peritoneal CT attenuation values expressed in Hounsfield units (HUs) were measured on a workstation and investigated in relation to laboratory data obtained on admission, severity of illness, and hospital mortality. Results:Peritoneal CT attenuation values were significantly negatively correlated with the Acute Physiology and Chronic Health Evaluation II (p < 0.01, R2 = 0.17) and sequential organ failure assessment (SOFA) (p < 0.01, R2 = 0.30) scores. Peritoneal CT attenuation values of hospital nonsurvivors (n = 7, 12.4 ± 11.0 HU) were significantly lower than those of hospital survivors (n = 105, 34.3 ± 15.8 HU). There was a significant negative correlation between peritoneal CT attenuation values, serum C-reactive protein levels (p < 0.01, R2 = 0.11), and the time after the onset of abdominal pain (p < 0.01, R2 = 0.08). Multivariate analysis revealed that the SOFA score was significantly associated with peritoneal CT attenuation values. Conclusions:Evaluation of peritoneal CT attenuation values in patients with UGI perforation is simple and can be used to objectively assess the severity of peritonitis, which can serve as a reference for treatment strategies.