...the surgical oncologist needs to possess advanced techniques and the ability to select the optimal surgical approach based on the preoperative assessment of local and systemic changes in the ...patient's condition. In recent years, there have been cases where surgery has been transformed by clinical oncology translational research and by organ regeneration research applying regenerative medicine technology. For this reason, it is crucial for academic surgeons to master the skills needed to properly design randomized controlled studies and soundly carry them out, including with respect to ethical obligations. ...big data-driven research, which has become increasingly important in recent years, depends on the analytical skills needed to efficiently find answers in the real-world clinic to the clinical questions raised.
As the Director General of Keio University Hospital, I hereby document the recent outbreak of health care-associated novel coronavirus (SARS-CoV-2) COVID-19 infections at our hospital in the spring ...of 2020.
Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest sarcoma in the gastrointestinal tract. Molecularly targeted therapy, such as imatinib therapy, has ...revolutionized the treatment of advanced GIST and facilitates scientific research on GIST. Nevertheless, surgery remains a mainstay of treatment to obtain a permanent cure for GIST even in the era of targeted therapy. Many GIST guidelines have been published to guide the diagnosis and treatment of the disease. We review current versions of GIST guidelines published by the National Comprehensive Cancer Network, by the European Society for Medical Oncology, and in Japan. All clinical practice guidelines for GIST include recommendations based on evidence as well as on expert consensus. Most of the content is very similar, as represented by the following examples: GIST is a heterogeneous disease that may have mutations in
KIT
,
PDGFRA
,
HRAS
,
NRAS
,
BRAF
,
NF1
, or the succinate dehydrogenase complex, and these subsets of tumors have several distinctive features. Although there are some minor differences among the guidelines—for example, in the dose of imatinib recommended for exon 9-mutated GIST or the efficacy of antigen retrieval via immunohistochemistry—their common objectives regarding diagnosis and treatment are not only to improve the diagnosis of GIST and the prognosis of patients but also to control medical costs. This review describes the current standard diagnosis, treatment, and follow-up of GISTs based on the recommendations of several guidelines and expert consensus.
Immune cells constitute an important element of tumor tissue. Accumulating evidence indicates their clinicopathological significance in predicting prognosis and therapeutic efficacy. Nonetheless, the ...combinations of immune cells forming the immune microenvironment and their association with histological findings remain largely unknown. Moreover, it is unclear which immune cells or immune microenvironments are the most prognostically significant. Here, we comprehensively analyzed the immune microenvironment and its intratumor heterogeneity in 919 regions of 158 hepatocellular carcinomas (HCCs), and the results were compared with the corresponding histological and prognostic data. Consequently, we classified the immune microenvironment of HCC into three distinct immunosubtypes: Immune‐high, Immune‐mid, and Immune‐low. The Immune‐high subtype was characterized by increased B‐/plasma‐cell and T cell infiltration, and the Immune‐high subtype and B‐cell infiltration were identified as independent positive prognostic factors. Varying degrees of intratumor heterogeneity of the immune microenvironment were observed, some of which reflected the multistep nature of HCC carcinogenesis. However, the predominant pattern of immunosubtype and immune cell infiltration of each tumor was prognostically important. Of note, the Immune‐high subtype was associated with poorly differentiated HCC, cytokeratin 19 (CK19)+, and/or Sal‐like protein 4 (SALL4)+ high‐grade HCC, and Hoshida's S1/Boyault's G2 subclasses. Furthermore, patients with high‐grade HCC of the predominant Immune‐high subtype had significantly better prognosis. These results provide a rationale for evaluating the immune microenvironment in addition to the usual histological/molecular classification of HCC. Conclusion: The immune microenvironment of HCC can be classified into three immunosubtypes (Immune‐high, Immune‐mid, and Immune‐low) with additional prognostic impact on histological and molecular classification of HCC. (Hepatology 2018)
AGSurg emerged from the belief that our society’s publication of an internationally respected official English-language journal would enhance our society’s standing in the global medical community ...and provide a much larger audience for the scientific insights that we desire to share, while also inspiring younger generations of gastroenterological surgeons to engage in scientific pursuits with greater confidence, pride, and sense of purpose. ...we will focus all our energy on the orthodox approach: publishing high-caliber original research grounded in solid evidence. ...we have increased the frequency of general meetings of the editorial staff, started holding sectional meetings led by the Chief of Associate Editors, strengthened the rigor of our peer review process, strived to enhance the currency of information provided in review articles, and expanded our networking with scientists both inside and outside Japan. ...AGSurg has taken a purposely limited approach to achieve growth over a short span, calling for manuscripts from Japan’s top institutions and actively soliciting submissions from institutions connected with JSGS members.
Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well ...understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.
Purpose
This study aimed to compare short-term outcomes of minimally invasive esophagectomy (MIE) with those of open esophagectomy (OE) for thoracic esophageal cancer using a nationwide Japanese ...database.
Methods
Overall, 9584 patients with thoracic esophageal cancer who underwent esophagectomy at 864 hospitals in 2011–2012 were evaluated. We performed one-to-one matching between the MIE and OE groups on the basis of estimated propensity scores for each patient.
Results
After propensity score matching, operative time was significantly longer in the MIE group (
n
= 3515) than in the OE group (
n
= 3515) 526 ± 149 vs. 461 ± 156 min,
p
< 0.001, whereas blood loss was markedly less in the MIE group than in the OE group (442 ± 612l vs. 608 ± 591 ml,
p
< 0.001). The populations of patients who required more than 48 h of postoperative respiratory ventilation was significantly less in the MIE group than in the OE group (8.9 vs. 10.9%,
p
= 0.006); however, reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0 vs. 5.3%,
p
= 0.004). There were no significant differences between the MIE and OE groups in 30-day mortality rates (0.9 vs. 1.1%) and operative mortality rates (2.5 vs. 2.8%, respectively).
Conclusions
MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.
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