須田 康一

BACKGROUND: Esophagojejunostomy following minimally invasive total gastrectomy is technically challenging. We developed a novel intracorporeal delta-shaped esophagojejunostomy using linear staplers following robotic total gastrectomy (RTG). The aim of this study was to verify its safety and feasibility, as compared with established techniques. METHODS: Of the 85 consecutive RTG cases performed between February 2021 and March 2025, 74 patients were retrospectively analyzed. The cohort consisted of 24 patients who underwent delta-shaped anastomosis, 29 with functional end-to-end anastomosis (FEEA), and 21 with the overlap method. We compared surgical outcomes, including operative variables, anastomotic leakage, and postoperative complications up to 30 days. RESULTS: No anastomotic leakage occurred in the delta group, whereas one case occurred in the overlap group. The incidence of Clavien-Dindo grade ≥ III complications did not differ significantly among groups. The median anastomotic time with delta-shaped anastomosis was significantly shorter than that with the overlap method (32.0 vs. 45.0 min, p = 0.006) but significantly longer than that with FEEA (23.0 min, p < 0.001). The esophageal resection length was comparable between the delta-shaped anastomosis and FEEA groups; however, the delta-shaped technique required significantly less esophageal mobilization (p < 0.001). No anastomotic strictures were observed within 30 days postoperatively. CONCLUSIONS: Intracorporeal delta-shaped esophagojejunostomy after RTG is a safe and feasible procedure with favorable short-term outcomes. Achieving anastomosis with less esophageal mobilization under equivalent transection conditions may offer a technical advantage. Further large-scale studies with long-term follow-up are warranted.

BackgroundSerum carbohydrate antigen 19-9 (CA19-9) is widely used in the management of pancreatic diseases, but results often vary across immunoassay platforms. This study sought to describe how the values obtained by chemiluminescent immunoassay (CLIA) and electrochemiluminescent immunoassay (ECLIA) differ, to assess whether discrepancies vary across concentration ranges, and to identify clinical factors potentially contributing to this variability.MethodsWe examined 1,760 paired samples measured simultaneously by CLIA (Abbott Alinity i) and ECLIA (Roche Cobas e801) during a transition period. To assess agreement between assays, correlation analysis, Passing-Bablok regression, and Bland-Altman analysis were performed on log10-transformed data.Subgroup comparisons were made by CA19-9 concentration, disease category, and hepatobiliary enzyme status. Multivariable regression was used to explore independent factors associated with the magnitude of inter-assay differences.ResultsCorrelation between CLIA and ECLIA was strong (r = 0.94, ρ = 0.89) although a concentration-dependent bias was observed with CLIA yielding higher values at higher concentrations, whereas ECLIA tended to yield higher values at lower concentrations. Discrepancies were greater in pancreatic cancer samples in those with elevated ALP or γ-GT, and at higher concentrations (CLIA ≥ 1000 U/mL). Older age, female sex, pancreatic cancer, and elevated hepatobiliary enzymes were independently associated with larger assay differences (adjusted R2 = 0.13).ConclusionsDespite good overall agreement, the two methods showed variability that could affect clinical interpretation, especially in low or high concentration ranges. When assay changes are unavoidable, using method-specific reference ranges or confirming results near decision thresholds may help ensure consistent interpretation.

OBJECTIVE: To evaluate contemporary short-term outcomes of robotic gastrectomy (RG) approximately 5 years after its widespread implementation, compared with laparoscopic gastrectomy (LG) using a nationwide Japanese database. BACKGROUND: RG has been introduced to overcome the technical limitations of LG; however, its real-world clinical advantages remain to be fully defined. METHODS: This retrospective study used the Japanese National Clinical Database to identify patients with gastric cancer who underwent minimally invasive distal gastrectomy (DG) or total gastrectomy (TG) between January 2023 and December 2024. Patients were classified as undergoing robotic (RDG or RTG) or laparoscopic (LDG or LTG) procedures. Propensity score matching was performed separately for the DG and TG cohorts to adjust for patient-, tumor-, and hospital-related confounders. The primary outcome was postoperative morbidity within 30 days (Clavien-Dindo grade ≥ IIIa). RESULTS: After propensity score matching, 9743 RDG-LDG pairs and 1617 RTG-LTG pairs were analyzed. RDG was associated with a significantly lower morbidity rate than LDG (4.3 vs. 4.9%, P = 0.049). Despite longer operative time, RDG was associated with lower blood loss, lower conversion rates, fewer intra-abdominal infectious complications, and shorter postoperative hospital stay than LDG. Overall morbidity did not differ significantly between RTG and LTG (8.7 vs. 8.3%, P = 0.66); however, RTG was associated with lower blood loss, lower conversion rates, and shorter hospital stay. CONCLUSIONS: RDG was associated with improvements in multiple short-term outcomes, whereas RTG still did not improve the primary outcome measure.