清島 亮

Objective: To validate the utility of recurrence prediction value (RPV) in identifying patients with UICC stage II colon cancer who would benefit from adjuvant chemotherapy (AC). Summary Background Data: The benefits of AC in Stage II colon cancer remain insufficient. Methods: We performed a multi-institutional international retrospective analysis of patients with Stage II colon cancer who had undergone surgery. RPV was developed based on the weighting of each high-risk factor. Data from multi-institutional databases in Japan, the United States, and Jordan were used (cohort 1). In addition, nationwide data were obtained from Denmark (Cohort 2). The primary endpoint was recurrence-free survival (RFS). Results: According to the RPV, a low score was found in 750 (70.2%) patients and high scores in 318 (29.8%) patients in cohort 1. The corresponding numbers were 1031 (70.4%) and 433 (29.6%) patients in cohort 2, respectively. The five-year RFS rates were significantly higher in the group of patients who received AC than in the group who did not in the RPV high sub-group of cohort1 (76.2% vs. 55.6%, P <0.001) and in cohort2 (65.6% vs. 49.8%, P=0.001). Multivariate analyses revealed that AC was an independent prognostic factor for RFS only in the RPV high sub-group of both cohort 1 (hazard ratio (HR) 0.48; 95% confidence interval (CI) 0.29-0.81; P=0.005) and cohort2 (HR 0.69; 95% CI 0.48-0.99; P=0.043). Conclusions: This global study validates a readily available clinical data-based algorithm for predicting recurrence in Stage II colon cancer, identifying patients across diverse populations who benefit significantly from AC.

Background: Liver resection for colorectal liver metastases (CRLM) with concurrent extrahepatic disease (EHD) has demonstrated potential benefits for long-term prognosis; however, its effectiveness remains controversial. Additionally, the prognostic impact of different EHD sites is not well elucidated. This study aimed to assess the significance of liver resection in patients with CRLM with concurrent EHD and evaluate how different EHD sites influence prognosis. Methods: A nationwide multicenter database was used for a retrospective analysis of patients diagnosed during two periods: 2005–2007 and 2013–2015. EHD was classified into the following five subgroups: lung, peritoneum, lymph nodes, local, and others. The inverse probability of treatment weighting (IPTW) method was applied to minimize selection bias. Kaplan–Meier survival curves and Cox proportional hazards models were used to compare the overall survival (OS) between the different treatment groups and EHD subgroups. Results: Among 3,787 patients, 874 (23.1%) underwent liver resection. Following IPTW adjustment, the hepatectomy (HT) group demonstrated significantly better OS than the non-hepatectomy (non-HT) group (5-year hazard ratio, 0.322; 95% confidence interval, 0.273–0.379; p < 0.001). Analysis by the EHD site subgroup demonstrated that liver resection was associated with a better prognosis across all sites. However, the prognostic impact differed by EHD site, with peritoneal metastasis associated with poorer outcomes in both the HT (5-year OS rates, 30.1% vs. 45.0%) and non-HT (5-year OS rates, 4.4% vs. 8.6%) groups. Conclusions: Regardless of the EHD site, liver resection was associated with a significantly better OS in patients with CRLM with concurrent EHD. The prognostic impact varies across EHD sites, underscoring the significance of considering differential prognostic risks when selecting treatment strategies.

ABSTRACT Aim This study evaluated the short‐term outcomes of low anterior resection for rectal cancer in Japan before and after the COVID‐19 pandemic, with a particular focus on the timing of its reclassification within Japan in May 2023. Methods Using data from the Japanese National Clinical Database, we analyzed 109 754 low anterior resection cases between January 2018 and December 2023, categorized into pre‐pandemic (February 2020 and earlier), pandemic (March 2020–April 2023), and post‐pandemic (May 2023 onward) periods. Trends in the number of low anterior resection cases, postoperative intensive care unit utilization, and complications, including anastomotic leakage and pneumonia, were examined. Standardized morbidity ratios were used to adjust for risk and assess trends over time. Results The number of low anterior resection cases declined during the pandemic but returned to pre‐pandemic levels thereafter. The postoperative intensive care unit admission rates remained stable, with a slight increase post‐pandemic. The incidence of major complications gradually declined from pre‐pandemic to post‐pandemic, with anastomotic leakage rates decreasing from 9.8% to 7.1% and the standardized morbidity ratio for anastomotic leakage decreasing from 1.0 to 0.8, reflecting improved outcomes. The number of robot‐assisted surgeries significantly increased from 246 cases in March 2020 to 535 in May 2023, and their proportion among total surgeries also rose from 16.8% to 41.2%. Conclusion Despite initial challenges, the healthcare system of Japan effectively managed rectal cancer surgeries during and after the pandemic. Robotic surgery became more widely adopted, and complication rates improved, demonstrating resilience and adaptability in surgical care.

BACKGROUND: Extended colectomy is considered standard treatment for neoplasia associated with ulcerative colitis, but there is limited supporting evidence, particularly from large-scale studies. OBJECTIVE: This study aimed to assess the prognostic benefits of extended colectomy in patients with neoplasia associated with ulcerative colitis using a nationwide database. DESIGN: Multicenter retrospective study. SETTINGS: Forty-three institutions in Japan participated in this study. PATIENTS: Patients with ulcerative colitis diagnosed with intestinal neoplasia between 1983 and 2020 at 43 institutions were analyzed. MAIN OUTCOME MEASURES: Five-year overall survival and disease-free survival were assessed based on different surgical procedures, with a subgroup analysis comparing neoplasia associated with ulcerative colitis to sporadic cancer. RESULTS: Among 879 patients, 801 were diagnosed with neoplasia associated with ulcerative colitis and 78 with sporadic cancer. The 5-year disease-free survival for total proctocolectomy and subtotal colectomy were similar (87.8% and 83.9%), both superior to segmental colectomy (72.0%). When comparing neoplasia associated with ulcerative colitis to sporadic cancer, extended colectomy (total proctocolectomy and subtotal colectomy) showed significantly better outcomes for neoplasia associated with ulcerative colitis, while no significant difference was observed for sporadic cancer. Multivariable analysis revealed a significantly better prognosis for extended colectomy compared to segmental colectomy in neoplasia associated with ulcerative colitis patients, both in overall survival and disease-free survival (P < 0.001). LIMITATION: Nonrandomized retrospective study design. CONCLUSION: This nationwide cohort study supports extended colectomy as the gold standard for neoplasia associated with ulcerative colitis management and underscores the importance of accurate diagnosis to distinguish between neoplasia associated with ulcerative colitis and sporadic cancer for optimal treatment decisions. See Video Abstract.