廣 純一郎

BACKGROUND AND OBJECTIVES: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS: This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I-III disease after R0 resection who underwent surgery within September 2012-2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS). RESULTS: Among 109 patients (median age: 78 [interquartile range, 76-82]; 65.1% male), the CFS 5-7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1-4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien-Dindo grade ≥ II. CFS 5-7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. CONCLUSIONS: CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.

BACKGROUND: Total mesorectal excision (TME) with bilateral lateral lymph node dissection (BLLND) is a standard surgical approach for low advanced rectal cancer (LARC) in Eastern countries. Although robotic surgery has been increasingly adopted for rectal cancer, its impact on lateral lymph node recurrence (LLNR) after BLLND remains unclear. METHODS: We retrospectively reviewed 180 patients with pathological stage II/III LARC who underwent TME with BLLND between 2009 and 2019. Of these, 149 patients underwent open surgery and 31 underwent robotic surgery. Perioperative outcomes, long-term oncological outcomes, and patterns of LLNR were compared between the two groups. RESULTS: Robotic surgery was associated with a significantly longer operative time but resulted in markedly reduced blood loss, lower rates of wound infection and anastomotic leakage, and a shorter postoperative hospital stay compared with open surgery (p < 0.0001, p < 0.0001, p < 0.0001, p = 0.02, and p = 0.003, respectively). There were no significant differences between the two groups in 5-year overall survival or disease-free survival (p = 0.25 and p = 0.11, respectively). Notably, LLNR was observed exclusively in the open surgery group (16 patients), whereas no cases of LLNR occurred in the robotic surgery group. Recurrence sites in the open group were predominantly located in the distal internal iliac region (263D), followed by the proximal internal iliac (263P) and obturator (283) regions. CONCLUSION: Robotic TME with BLLND demonstrated favorable short-term outcomes and technical feasibility; however, definitive oncological superiority could not be established.

OBJECTIVE: The risk factors for residual liver recurrence after resection of colorectal cancer liver metastases were analyzed separately for synchronous and metachronous metastases. METHODS: This retrospective study included 236 patients (139 with synchronous and 97 with metachronous lesions) who underwent initial surgery for colorectal cancer liver metastases from April 2010 to December 2021 at the Fujita Health University Hospital. We performed univariate and multivariate analyses of risk factors for recurrence based on clinical background. RESULTS: Univariate analysis of synchronous liver metastases identified three risk factors: positive lymph nodes (p = 0.018, HR = 2.067), ≥3 liver metastases (p < 0.001, HR = 2.382), and use of adjuvant chemotherapy (p = 0.013, HR = 0.560). Multivariate analysis identified the same three factors. For metachronous liver metastases, univariate and multivariate analysis identified ≥3 liver metastases as a risk factor (p = 0.002, HR = 2.988); however, use of adjuvant chemotherapy after hepatic resection was not associated with a lower risk of recurrence for metachronous lesions. Inverse probability of treatment weighting analysis of patients with these lesions with or without adjuvant chemotherapy after primary resection showed that patients with metachronous liver metastases who did not receive this treatment had fewer recurrences when adjuvant therapy was administered after subsequent liver resection, although the difference was not significant. Patients who received adjuvant chemotherapy after hepatic resection had less recurrence but less benefit from this treatment. CONCLUSION: Risk factors for liver recurrence after resection of synchronous liver metastases were positive lymph nodes, ≥3 liver metastases, and no postoperative adjuvant chemotherapy. Adjuvant chemotherapy is recommended after hepatic resection of synchronous liver metastases.