Laparoscopic transabdominal preperitoneal repair (TAPP) is widely used for inguinal hernia repairs. Fibrin glue derived from allogeneic blood has been reported for mesh fixation, but there have been no reports on the use of autologous fibrin glue. Autologous fibrin glue (CryoSeal®) allows for full-surface mesh adhesion. We applied this technique in seven patients. Autologous blood was collected preoperatively and processed to prepare CryoSeal, which was sprayed over the mesh after standard TAPP placement. Three types of mesh were used, and the fixation was satisfactory in all cases. The median autologous blood and CryoSeal volumes were 200 mL and 15 mL, respectively, with median operative and spray times of 107 min and 230 s, respectively. Mesh fixation was achieved across the entire surface using a push test. No recurrence or postoperative complications were observed during the mean follow-up period of 170 days. This technique appears to be safe and clinically applicable for mesh fixation during inguinal hernia repair.

Among several adverse events induced by chemotherapy for patients with far advanced and unresectable cancer, oral mucositis is one that reduces patient quality of life. To evaluate the preventive effects of hangeshashinto on oral mucositis induced by chemotherapy. We performed a comprehensive electronic literature search (PubMed, the Web of Science, and CENTRAL) up to March 2024 to identify studies showing the efficacy of hangeshashinto administration for preventing oral mucositis in patients receiving chemotherapy. To integrate the individual preventive effect of hangeshashinto, a meta-analysis was performed using random-effects models to calculate the risk ratio and 95

BACKGROUND:Robot-assisted surgery (RS) is increasingly used for rectal cancer, but its clinical benefits over laparoscopic surgery (LS) remain uncertain. We compared perioperative and oncological outcomes between RS and LS after propensity score matching (PSM). METHODS:This single-center retrospective study included 553 consecutive patients with clinical Stage I-III rectal adenocarcinoma who underwent RS or LS. PSM was performed using age, sex, body mass index, tumor location, neoadjuvant therapy, clinical T stage, clinical N stage, anastomosis status, and lateral pelvic lymph node dissection as covariates. The primary endpoint was 3-year relapse-free survival (RFS), and perioperative outcomes were secondary endpoints. RESULTS:PSM yielded 214 matched pairs. Operative time was significantly longer in the RS group than in the LS group (254 vs. 231 min; p < 0.001), whereas intraoperative blood loss was significantly lower (10 vs. 20 mL; p < 0.001). Conversion to open surgery was less frequent in the RS group (0.5% vs. 3.7%; p = 0.04). Three-year RFS rates were comparable between the RS and LS groups (82.2% vs. 81.1%; p = 0.68), although the crude overall recurrence proportion was significantly lower in the RS group than in the LS group (15.0% vs. 22.9%; p = 0.048). CONCLUSIONS:RS and LS achieved comparable mid-term oncological outcomes in patients with Stage I-III rectal adenocarcinoma. RS was associated with a lower conversion rate and reduced intraoperative blood loss, suggesting selective perioperative advantages.

Objectives: The purpose of this study was to identify factors associated with conversion to an open procedure during laparoscopic colectomy in patients with body mass index (BMI) 25 kg/m2. The effects of conversion on long-term outcomes were evaluated. Methods: In a multicenter cohort study conducted under the auspices of the Japan Society of Laparoscopic Colorectal Surgery, clinicopathological data were examined for 887 patients with BMI 25 kg/m2 who underwent laparoscopic surgery for colon cancer. Risk factors for conversion to an open procedure were estimated using a logistic model after parameter selection using a least absolute shrinkage and selection operator (lasso) model. Long-term outcomes were compared after inverse probability weighting (IPW) estimation. Results: Among the 887 patients who underwent laparoscopic colectomy, 31 patients (3.5%) required conversion to an open procedure. In multivariate analysis, preoperative BMI 27.5 kg/m2, comorbidity-hypertension, blood loss, and simultaneous resection of adjacent organs were independent factors for conversion. After IPW estimation, there were no significant differences in recurrence-free, cancer-specific and overall survival between the conversion (+) and (-) groups. Conclusions: In obese patients with the factors identified in this study, surgeons should consider the possibility of conversion to open surgery. Long-term outcomes in patients with BMI 25 kg/m2 did not differ between patients who underwent conversion and those who did not. Therefore, conversion to an open procedure was not detrimental in Japanese patients with BMI 25 kg/m2.

Background/objective: Numerous reports suggest that there is no difference in treatment outcomes between obese and non-obese patients undergoing laparoscopic surgery for colorectal cancer. However, contrasting findings also suggest that treatment results may be inferior in obese patients. We aimed to retrospectively analyze outcomes of laparoscopic and open surgeries for right- and left-sided colectomies in 1572 obese patients with colorectal cancer. Methods: Patients were classified by surgical type (laparoscopic vs. open) and colectomy location (right vs. left). We assessed body mass index, tumor diameter, blood loss, operative time, lymph nodes removed, metastases, recurrence rate, and overall survival. Results: No relationship was found between body mass index and the surgical method. Tumor diameter was significantly larger in open surgeries for both sides (p < 0.001). The combined resection rate was also significantly higher in open surgeries (p < 0.001). Laparoscopic surgeries resulted in significantly lower blood loss but significantly longer operative times on both sides (p < 0.001). No difference in operative times was noted between left and right laparoscopic surgeries, whereas left-sided open colectomies took significantly longer (p = 0.9086, p < 0.001). Lymph node-positive metastasis rate, recurrence rate, and overall survival showed no differences. Conclusion: Combined resection (T4b) and tumor size are more critical than body mass index in selecting the surgical approach. Open surgeries had longer operative times for left-sided colectomies, whereas laparoscopic surgeries showed no time difference between sides, suggesting potential advantages for left-sided procedures or greater difficulty with right-sided colectomies. Despite longer operative times, laparoscopic surgery's lower blood loss indicates its oncological safety.

AbstractBackgroundThe impact of obesity on colon cancer remains unclear. Very few studies of colon cancer surgery have analyzed body mass index (BMI) as a continuous variable, with no such reports from Japan. This study examined the association between BMI as a continuous variable and short‐ and long‐term outcomes of laparoscopic surgery for obese colon cancer patients.MethodsObese (BMI ≥25 kg/m2) patients who underwent laparoscopic radical surgery for Stage II/III colon cancer at 46 participating centers from 2009 to 2013 were included. Associations between short‐ and long‐term outcomes and BMI as a continuous variable were analyzed by univariate and multivariate regression models.ResultsAmong patients meeting the study criteria, 1036 were examined. BMI as a continuous variable correlated with log‐transformed operative time (regression coefficient: 0.02, 95% confidence interval [CI]: 0.012–0.028, p < 0.05) and blood loss (odds ratio: 1.089, 95% CI: 1.032–1.149, p < 0.05). There was no association between BMI continuous variables and 3‐year relapse‐free survival (RFS) and overall survival. However, 3‐year RFS was possibly better in patients with BMI ≥28.5 kg/m2 versus those with BMI <28.5 kg/m2 (hazard ratio: 0.682, 95% CI: 0.462–1.008, p = 0.055).ConclusionsThis study showed that BMI as a continuous variable correlated with operative time and blood loss. RFS was possibly better in the severely obese patients (BMI ≥28.5 kg/m2), suggesting that the prognosis for highly obese colon cancer patients appears to follow the obesity paradox.

We aimed to analyze the risk factors for anastomotic leakage (AL) after low anterior resection (LAR) in obese patients (body mass index [BMI] ≥ 25 kg/m2) with rectal cancer. Data were collected from four hundred two obese patients who underwent LAR for rectal cancer in 51 institutions. Forty-six (11.4

Objective: This study evaluated the short-and long-term outcomes of laparoscopic colectomy versus open surgery in obese patients (body mass index >= 25 kg/m2) with locally advanced colon cancer to ascertain the non-inferiority of laparoscopic surgery to open surgery. Methods: In this large cohort study (UMIN-ID: UMIN000033529), we retrospectively reviewed prospectively collected data from consecutive patients who underwent laparoscopic or open surgery for pathological stage II-III colon cancer between 2009 and 2013. A comparative analysis was performed after propensity score matching between the laparoscopic and open surgery groups. The primary endpoint was the 3-year relapse-free survival (RFS). Results: We identified 1575 eligible patients from 46 institutions. Each group comprised 526 propensity score-matched patients. Comparing the laparoscopic versus open surgery group, laparoscopic surgery was significantly associated with increased median operating time (225 vs. 192.5 min; P < .0001) and decreased median estimated blood loss (20 vs. 140 ml; P < .0001). Lymph node retrieval (20 vs. 19; P = 0.4392) and postoperative complications (4.6% vs. 5.7%; P = 0.4851) were similar, postoperative hospital stay was shorter (10 vs. 12 days; P < .0001), and the 3-year RFS rates were similar (82.8 vs. 81.2%). The hazard ratio (HR) for relapse-free survival for laparoscopic versus open surgery was 0.927 (90% confidence interval [CI], 0.747-1.150, one-sided P for non-inferiority = .001), indicating that for obese patients with colon cancer, laparoscopic surgery was non-inferior to open surgery. Conclusion: Laparoscopic surgery in obese patients with colon cancer offers advantages in terms of short-term outcomes and no disadvantages in terms of long-term outcomes.

BACKGROUND:Although several recent meta-analyses have investigated the clinical influence of the addition of lateral lymph node dissection (LLND) on oncologic outcomes in patients with mid-low rectal cancer (RC) undergoing mesorectal excision (ME), most studies included in such meta-analyses were retrospectively designed. Therefore, this study aimed to explore the clinical influence of prophylactic LLND on oncologic outcomes in patients with mid-low RC undergoing ME. METHODS:A comprehensive electronic search of the literature up to July 2022 was performed to identify studies that compared oncologic outcomes between patients with mid-low RC undergoing ME who underwent LLND and patients with mid-low RC undergoing ME who did not undergo LLND. A meta-analysis was performed using fixed-effects models and the generic inverse variance method to calculate hazard ratios (HRs) and 95% CIs, and heterogeneity was analyzed using I2 statistics. RESULTS:A total of 6 studies, consisting of 3 randomized and 3 propensity score matching studies, were included in this meta-analysis. The results of the meta-analysis of 2 randomized studies demonstrated no significant effect of prophylactic LLND on improving oncologic outcomes concerning overall survival (OS) (HR, 1.22; 95% CI, 0.89-1.69; I2 = 0%; P = .22) and relapse-free survival (RFS) (HR, 1.03; 95% CI, 0.81-1.31; I2 = 28%; P = .83). CONCLUSION:The results of this meta-analysis revealed no significant influence of prophylactic LLND on oncologic outcomes-OS and RFS-in patients with mid-low RC who underwent ME.

Objectives: Stoma outlet obstruction (SOO) occurs with an incidence of approximately 40% after proctocolectomy for Ulcerative colitis (UC) with diverting ileostomy. This study aimed to identify the risk factors for SOO after proctocolectomy with diverting ileostomy for patients with UC. Methods: We reviewed the data of 68 patients with UC who underwent proctocolectomy and diverting ileostomy between April 2006 and September 2021. These cases were analyzed on the basis of clinicopathological and anatomical factors. SOO was defined as small bowel obstruction displaying symptoms of intestinal obstruction, such as abdominal distention, abdominal pain, insertion of a tube through the stoma. Results: The study included 38 (56%) men and 30 (44%) women with a median age of 42 years (range, 21-80). SOO categorized as at least Clavien-Dindo grade II occurred in 11 (16%) patients. Six patients required earlier stoma closure than scheduled. Compared with patients without SOO, patients with SOO had a significantly higher total steroid dose from the onset of UC to surgery (p = 0.02), a small amount of intraabdominal fat (p = 0.04), and a higher rate of laparoscopic surgery (p < 0.01). Conclusions: A high preoperative steroid dose, a small amount of intraabdominal fat and laparoscopic surgery were identified as risk factors for SOO. Early detection and treatment for SOO are important for patients at risk.

OBJECTIVE:To investigate whether robotic surgery (RS) decreases the risk of circumferential resection margin (CRM) positivity compared with conventional laparoscopic surgery (LS) in patients with rectal cancer (RC) undergoing mesorectal excision (ME). BACKGROUND:Although it is well known that CRM positivity affects postoperative outcomes in patients with RC undergoing ME, few studies have investigated whether RS is superior to conventional LS for the risk of CRM positivity. METHODS:We performed a comprehensive electronic search of the literature up to December 2022 to identify studies that compared the risk of CRM positivity between patients with RC undergoing robotic and conventional laparoscopic surgery. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) and 95 % confidence intervals (CIs), and heterogeneity was analyzed using I2 statistics. RESULTS:Eighteen studies, consisting of 4 randomized controlled trials (RCTs) and 14 propensity score matching (PSM) studies, involved a total of 9203 patients with RC who underwent ME were included in this meta-analysis. The results demonstrated that RS decreased the overall risk of CRM positivity (RR, 0.82; 95 % CI, 0.73-0.92; P = 0.001; I2 = 0 %) compared with conventional LS. Results of a meta-analysis of the 4 selected RCTs also showed that RS decreased the risk of CRM positivity (RR, 0.62; 95 % CI, 0.43-0.91; P = 0.01; I2 = 0 %) compared with conventional LS. CONCLUSIONS:This meta-analysis revealed that RS is associated with a decreased risk of CRM positivity compared with conventional LS in patients with RC undergoing ME.

Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has not been reported. We encountered two patients with esophageal cancer and previous gastric surgeries who eventually underwent segmental esophagectomy with free-flap jejunal reconstruction. Case one involved a 75-year-old man who underwent abdominal abscess and duodenal ulcer perforation surgeries (abdominal drainage and subsequent gastrojejunal bypass). A type 0–IIa tumor was located posterior to the cervical esophagus’s right wall, 21 cm from the incisor, without lymph node swelling or distant metastasis. The left lobe of the thyroid gland was mobilized to ensure an oral resection margin. Severe abdominal adhesions required careful adhesiolysis to harvest the jejunum (20 cm long) 40 cm from the jejunojejunostomy. An end-to-side and side-to-end esophagojejunostomy were performed for the proximal and distal ends, respectively. Case two involved a 75-year-old male with a history of distal gastrectomy with Billroth I reconstruction for early gastric cancer. A submucosal tumor-like lesion was located on the cervical esophageal wall on the left side, 21 cm from the incisor. The distal esophagus required additional segmental resection because the anal resection line was close to the tumor. Jejunum (10 cm long) 30 cm from Ligament of Treitz was harvested. An end-to-side and end-to-end esophagojejunostomy for the proximal and distal ends, respectively, was performed. This surgery requires a thorough preoperative examination to ensure an adequate surgical margin and a careful free-flap harvest based on post-gastric surgery anatomy.

Laparoscopic Heller myotomy with Dor fundoplication is the standard surgical treatment for esophageal achalasia. However, there are few reports on the use of this method after gastric surgery. We report a case of a 78-year-old man who underwent laparoscopic Heller myotomy with Dor fundoplication for achalasia after distal gastrectomy and Billroth-II reconstruction. After the intraabdominal adhesion was sharply dissected using an ultrasonic coagulation incision device (UCID), Heller myotomy was performed 5 cm above and 2 cm below the esophagogastric junction using the UCID. To prevent postoperative gastroesophageal reflux (GER), Dor fundoplication was performed without cutting the short gastric artery and vein. The postoperative course was uneventful, and the patient is in good health without symptoms of dysphagia or GER. Although per-oral endoscopic myotomy is becoming the mainstay of treatment for achalasia after gastric surgery, laparoscopic Heller myotomy with Dor fundoplication is also an effective strategy.

Objective: To explore the influence of the no-touch isolation technique (NTIT) on oncologic outcomes for patients with colon cancer (CC) undergoing curative surgery. Background: Although several studies have investigated this topic, there have been no meta-analyses exploring the influence of NTIT on oncologic outcomes for these patients. Methods: We performed a comprehensive electronic literature search of studies published prior to March 2022 to identify those that compared oncologic outcomes for patients with CC who did or did not undergo NTIT. We conducted a meta-analysis using a random-effects model to calculate risk ratio (RRs) and 95% confidence in-tervals (CIs), analyzing heterogeneity using I2 statistics. Results: Four studies involving a total of 2885 patients with CC who underwent curative surgery met the inclusion criteria for this meta-analysis. The 5-year overall survival (OS) rate was 76.6% for patients with CC who un-derwent NTIT and 77.2% for those who did not. A meta-analysis of the 3 studies that reported 5-year OS revealed no significant difference between groups (RR, 0.84; 95% CI, 0.62-1.16; P = 0.30; I2 = 70%). In addition, there were no significant differences in 5-year recurrence-free survival (RR, 1.17; 95% CI, 0.93-1.48; P = 0.19; I2 = 45%), and 5-year liver recurrence-free survival (RR, 0.95; 95% CI 0.62, 1.46; P = 0.82; I2 = 65%). Conclusions: The use of NTIT has no significant influence on oncologic outcomes for patients with CC undergoing curative surgery.

Background:Laparoscopic surgery is reported to be useful in obese or elderly patients with colon cancer, who are at increased risk of postoperative complications because of comorbidities and physical decline. However, its usefulness is less clear in patients who are both elderly and obese and may be at high risk of complications. Methods:Data for obese patients (body mass index ≥25) who underwent laparoscopic or open surgery for stage II or III colon cancer between January 2009 and December 2013 were collected by the Japan Society of Laparoscopic Colorectal Surgery. Surgical outcomes, postoperative complications, and relapse-free survival (RFS) were compared between patients who underwent open surgery and those who underwent laparoscopic surgery according to whether they were elderly (≥70 y) or nonelderly (<70 y). Results:Data of 1549 patients (elderly, n = 598; nonelderly, n = 951) satisfied the selection criteria for analysis. Length of stay was shorter and surgical wound infection was less common in elderly obese patients who underwent laparoscopic surgery than in those underwent open surgery. There were no significant between-group differences in overall complications, anastomotic leakage, ileus/small bowel obstruction, or RFS. There were also no significant differences in RFS after laparoscopic surgery according to patient age. Conclusion:Laparoscopic surgery is safe in elderly obese patients with colon cancer and does not worsen their prognosis. There was no significant difference in the effectiveness of laparoscopic surgery between obese patients who were elderly and those who were nonelderly.

OBJECTIVE:Treatment for borderline resectable (cT3br) esophageal squamous cell carcinoma (SCC) is currently undefined. This study aimed to analyze the outcome of treatment strategies including induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) against T3br esophageal SCC.METHODS:A total of 32 patients with cT3br esophageal SCC enrolled in this study were treated with two cycles of DCF induction therapy.RESULTS:The overall response rate to DCF induction therapy was 62.5%, while the disease control rate was 93.8% (complete response (CR), three; partial response (PR), 17; stable disease (SD), 10; progressive disease (PD), 2). After DCF induction chemotherapy, 27 patients underwent conversion surgery (CS) and five patients underwent definitive chemoradiotherapy (CRT). Out of 27 patients who underwent CS, 17 underwent transthoracic esophagectomy and 10 underwent thoracoscopic esophagectomy. Anastomotic leakage occurred in five patients (18.5%) and pneumonia in four (14.8%). Recurrent laryngeal nerve paralysis and arrhythmia were observed in two patients (7.4%). The R0 resection rate was 81.5%. Among the five patients who underwent definitive CRT, only one patient (20.0%) achieved CR. Two patients (40.0%) had PR and two (40.0%) had PD. Salvage esophagectomy was performed in one patient after definitive CRT. The 1-, 3-, and 5-year overall survival rates were 75.0, 50.6, and 46.4%, respectively, whereas the 1-, 3-, and 5-year disease-free survival rates were 54.9, 38.8, and 38.8%, respectively.CONCLUSION:DCF induction therapy and subsequent CS or definitive CRT are promising treatment strategies for cT3br esophageal SCC.

Abstract Background Levodopa–carbidopa intestinal gel (LCIG) treatment is an effective Parkinson’s disease (PD) treatment that requires percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Buried bumper syndrome (BBS) is an uncommon but significant complication of PEG-J for LCIG. Case presentation A 71-year-old man had been undergoing LCIG therapy for PD since a PEG-J was implemented at our department two years previously. He presented with appetite loss. Computed tomography showed that the gastrostomy bumper was buried in the gastric wall. The patient was surgically treated with the simultaneous removal and replacement of PEG-J. Postoperative gastrocutaneous fistula occurred, which was conservatively treated. Conclusions Notably, patients and medical staff should be aware that patients with PD on LCIG treatment have a high risk of BBS in PEG-J and that there might be some patients with latent BBS. When simultaneous removal and replacement surgery is performed, establishing a new route at the stomach and abdominal wall is recommended.

Background/Aim: This study analyzed the outcomes of docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy and DCF plus concurrent radiotherapy (DCF-RT), both followed by conversion surgery, if possible, in patients with cT4b esophageal cancer. Patients and Methods: Forty-six patients with cT4b esophageal cancer, including borderline cT4b lesions, were eligible. Borderline cT4b lesions were treated with induction DCF therapy. For definitive cT4b lesions, definitive DCF-RT was administered. Patients unsuitable for induction DCF therapy or DCF-RT were treated with other therapies. After treatment, conversion surgery (CS) was performed for the residual tumor in resectable cases. Results: Induction DCF therapy was administered to 12 patients (group A), and DCF-RT was provided to 18 patients (group B). Meanwhile, other therapies were provided to 16 patients (group C). The 1-, 3-, and 5-year overall survival (OS) rates were 66.7, 30.0, and 15.0%, respectively, in group A; 66.7, 37.5, and 37.5%, respectively, in group B; and 62.5, 0, and 0%, respectively, in group C. DCF-RT tended to prolong survival, albeit without significance (p=0.1040). The group A + B had significantly better overall survival than group C (p=0.0437). Fourteen patients underwent CS (30.4%), and patients who underwent CS had significantly better overall survival than those who did not undergo surgery (p=0.0291). Conclusion: Induction DCF or DCF-RT is promising for the treatment of cT4b esophageal cancer. Effective CS including combined resection of the invaded organ can contribute to improved therapeutic outcomes.