柴崎 晋

PURPOSE: To develop an educational program that enables young surgeons to safely perform laparoscopic transabdominal preperitoneal repair (TAPP). METHODS: This retrospective study comprised 365 patients who underwent elective TAPP performed by surgical residents (SRs; n = 145 patients) and board-certified surgeons (BCSs; n = 220 patients) from January 2018 to December 2023. An educational program for SRs has been underway since April 2021 to facilitate efficient learning and ensure the safe performance of TAPP. This program comprises four steps and highlights the two points mentioned, including understanding technical principles and acquiring fundamental skills. The surgical outcomes of laparoscopic TAPP performed by SRs and BCSs were compared retrospectively. RESULTS: A total of 43 operators (16 SRs and 27 BCSs) performed the laparoscopic TAPP. The SRs demonstrated longer operative times (median 126 vs. 98 min; p < 0.01). No significant differences in the rates of seroma (7.6% vs. 5.5%), grade IIIa or higher Clavien-Dindo complications (early: 0.7 vs. 0.9%; late: 0.7% vs. 0%), and recurrence at 1 year after surgery (1.4% vs. 0.5%) were observed between the SR and BCSs groups. Following the implementation of the educational program in April 2021, laparoscopic TAPP procedures performed by SRs were associated with significantly shorter operation times compared to those conducted before the program was introduced. CONCLUSIONS: SRs who received presurgical education improved the operative time in laparoscopic TAPP, although with intraoperative guidance from Endoscopic Surgical Skill Qualification System-qualified surgeons.

INTRODUCTION: Gastrectomy considerably affects the gut microbiome; however, the association between dysbiosis and post-gastrectomy syndrome remains to be explored. This study prospectively explored fecal gut microbiota alterations before and 3 months after gastrectomy, investigating their potential association with weight loss. METHODS: The gut microbiome of 21 patients with gastric cancer scheduled for gastrectomy in April-October 2022 was analyzed using 16S rRNA gene Next-Generation Sequencing. Their microbiome profiles were compared to those of healthy controls. Bacterial taxa demonstrating significant changes were determined using the Linear Discriminant Analysis Effect Size algorithm and further analyzed for their relationship with weight loss in the gastrectomy cohort. RESULTS: Postoperative complications (≥grade 2) were observed in 14.3% of patients. Postoperative weight loss was －10.9%, with the following breakdown: distal (－7.0%), total (－13.5%), and proximal (－14.0%) gastrectomy (P = 0.003). Microbiota analysis demonstrated a significant incline in the abundance of the Streptococcus salivarius group and a decline in Bacteroides uniformis in patients with gastric cancer compared to healthy controls. The S. salivarius group exhibited a further increase, while B. uniformis showed signs of recovery after gastrectomy. Additionally, 5α-reductase gene levels, reported to decrease as several cancers progress, were found to elevate post-surgery. Furthermore, patients experiencing greater weight loss showed a significant reduction in Faecalibacterium prausnitzii levels, while lower serum prealbumin and zinc levels were associated with the abundance of Escherichia coli. CONCLUSION: Gastrectomy significantly alters the gut microbiome. Supporting microbiome health with prebiotics may help alleviate postoperative issues and improve patients' quality of life.

PURPOSE: Reduced-port surgery has been utilized in gastric cancer surgery but is not predominantly used due to its high technical difficulty. A new single-port surgical robot named da Vinci™ SP System (DVSP) was launched and eventually approved for clinical use in Japan in November 2022. We initiated robotic gastrectomy for gastric cancer using DVSP in March 2023. Here, we report our initial experiences and assessments of the feasibility and safety of robotic gastrectomy for gastric cancer using DVSP. METHODS: This single-center retrospective study included 20 patients with gastric cancer who underwent robotic gastrectomy with DVSP from March 2023 to April 2024. The primary endpoint was the postoperative complication rate within 30 days postoperatively. Secondary endpoints were surgical outcomes, including intraoperative adverse events, operative time, blood loss, and the number of dissected nodes. RESULTS: Of the 20 patients, 6 (30.0%) were male. The median age was 74 years. Tumors in the middle to lower stomach were observed in 20 patients (100.0%), including 18 (90.0%) and 2 (10.0%) with clinical stages I and II diseases, respectively. All patients underwent distal gastrectomy. The postoperative complications of Clavien-Dindo grade ≥ II occurred in 3 (15%) patients. Intraoperative adverse events, including conversion to other approaches, were not observed. All patients underwent R0 resection. The median operative and console times were 289 and 240 min, respectively. The median blood loss was 11 mL with 50 dissected nodes. CONCLUSION: This study revealed the safe performance of robotic distal gastrectomy with standard lymphadenectomy for clinical stage I/II gastric cancer using DVSP.

ABSTRACT Background This study aimed to explore the commonalities and differences in systematic lymph node dissection between lung and esophageal cancer surgeries. Methods A survey comprising 11 questions related to systematic lymph node dissection techniques for both lung and esophageal cancer was conducted across 265 facilities specializing in thoracic and esophageal surgeries. Additionally, a comprehensive search was performed using the MEDLINE database. Results Responses were received from 63 facilities specializing in thoracic surgery and 79 facilities specializing in esophageal surgery. Many facilities chose minimally invasive surgery for lung and esophageal cancer. Most thoracic and esophageal surgeons paid attention to the concepts of visceral and vascular sheaths. The results of the survey and literature review revealed the key anatomical structures that define the area of mediastinal lymph node dissection. Conclusion This survey and the literature review have clarified the current consensus among thoracic and esophageal surgeons regarding systematic mediastinal lymph node dissection.