須田 康一

ABSTRACT Aim The adoption of robot‐assisted surgery (RAS) in Japan has progressed significantly since its initial approval in 2009. RAS gradually expanded into various surgical fields with 35 procedures now covered under Japan's national health insurance. This study provides an inaugural assessment of RAS outcomes for seven digestive procedures introduced in 2018. Methods The Japanese Society for Endoscopic Surgery working group established an RAS registry integrating data from the National Clinical Database and additional RAS‐specific records. The analysis focused on three major gastrointestinal fields: the esophagus, stomach, and rectum. Results In 2019, 530 esophagectomies, 2295 gastrectomies, and 3269 proctectomies were performed. RAS for these procedures was characterized by relatively long operative times, low intraoperative blood loss, and very low conversion rates to open surgery (< 1%). Postoperative morbidity rates Grade IIIa or higher were 23.2% for esophagectomy, 4.9% for gastrectomy, and 9.4% for proctectomy. Length of postoperative hospital stay correlated with morbidity, though readmission (1.3%–3.1%) and postoperative mortality rates (0.3%–0.6%) remained low. The early nationwide implementation of RAS in Japan was marked by a high surgeon qualification rate (98.9%) and meticulous case selection; the DVSS Xi model accounted for 66.3% of robotic platforms used. Conclusion These findings underscore the need for ongoing surveillance and data‐driven evaluation to ensure safe and effective implementation of RAS. Future longitudinal analyses will refine surgical quality, optimize resource allocation, and advance minimally invasive techniques. This study highlights the transformative potential of RAS in Japanese surgical practice and its alignment with global trends.

BACKGROUND: The incidence of chemotherapy-induced nausea and vomiting (CINV) when using an oxaliplatin-based regimen may vary according to the cancer type. This study compared the occurrence of CINV in patients with gastric or colorectal cancers. METHODS: This retrospective study included patients who received oxaliplatin-containing regimens for gastric or colorectal cancer. The incidence of CINV during the first treatment course was evaluated. Propensity score matching (PSM) was performed between gastric cancer (GC) and colorectal cancer (CRC) groups to compare the complete response (CR) and total control (TC) rates as indicators of antiemetic efficacy. The impact of primary tumor resection history, surgical procedure, and antiemetic agents was analyzed in the group with a higher incidence of CINV. RESULTS: The GC group included 99 patients and the CRC group included 180 patients, with 60 patients per group, after PSM. The CR rate was significantly lower in the GC group (75.0%) than in the CRC group (95.0%) (P < 0.01). Before PSM, the TC rate varied significantly by resection type in patients with GC (P = 0.012), indicating that tumor resection influenced the TC rate (P = 0.015). In patients with GC who underwent tumor resection, neither dopamine 2 receptor antagonists (P = 0.090) nor neurokinin 1 receptor antagonist (P = 0.66) use was associated with a significant difference in the CR rate. CONCLUSION: Patients with GC have a higher incidence of CINV than those with CRC. In patients with GC, tumor resection significantly influenced the total control rate of CINV.

BACKGROUND: Late biliary complications, consisting of anastomotic stricture and cholangitis, are known to impair long-term quality of life and significantly impact patient outcomes following robot-assisted pancreaticoduodenectomy (RPD). The role of stent placement in HJ remains debatable. This study aimed to investigate the incidence of late biliary complications and the impact of stent placement on long-term outcomes after RPD. METHODS: This retrospective observational study included patients who underwent RPD from November 2009 to April 2024 at two institutions. Patients were categorized into no-stent, internal stent, and external stent groups. The incidence of late biliary complications was analyzed with Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: The analysis included 157 patients. Late biliary stricture occurred in 20 (13%) cases, with 17 (11%) cases being nontumor-related. No cases of late biliary stricture were observed in patients with a preoperative bile duct diameter of ≥ 15 mm. Internal stent placement was determined as an independent protective factor against late biliary stricture compared to no-stent placement among patients with a bile duct diameter of < 15 mm (hazard ratio: 0.310, 95% confidence interval: 0.096-0.999, p = 0.050). Spontaneous dislocation of internal stents occurred in 71% of cases at 6 months postoperatively. The incidence of postoperative late cholangitis in the internal stent group was 17% (15/89), which was not significantly different compared with the no-stent group (30%, 12/40; p = 0.237). External stent placement prolonged hospitalization and was not superior in biliary complication prevention. CONCLUSIONS: Internal stent placement may decrease the incidence of late biliary stricture after RPD and should be considered a preferred strategy for biliary reconstruction, except in cases with significant bile duct dilatation.

BACKGROUND: Trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) is a standard third-line therapy for unresectable advanced or recurrent colorectal cancer. The standard dosing schedule (5 days of administration followed by 2 days off) is associated with a high incidence of severe neutropenia. Conversely, a biweekly dosing schedule (5 days of administration followed by 9 days off) reportedly reduces this incidence. However, no direct comparison of these regimens has been made. In this study, we retrospectively compared the efficacy and safety of these two dosing schedules. METHODS: We analyzed data from patients who received FTD/TPI + BEV treatment between June 2016 and January 2024 at three hospitals affiliated with Fujita Health University. The effects of the dosing schedules on hematological toxicity, overall survival (OS), and time to treatment failure (TTF) were assessed. RESULTS: Among the 125 patients, 26 and 99 were classified into the standard and biweekly groups, respectively. Grade ≥ 3 neutropenia occurred in 50.0% of patients in the standard group and 29.3% of those in the biweekly group (P = .062), with multivariable analysis confirming the dosing schedule impact (P = .048). Median TTF was 5.4 and 7.0 months, while median OS was 16.4 and 14.5 months (P = .908, 0.947) in the standard and biweekly groups, respectively. CONCLUSION: The biweekly regimen of FTD/TPI + BEV resulted in a lower tendency for severe neutropenia than that in the standard regimen, while maintaining comparable OS and TTF in patients with unresectable advanced or recurrent colorectal cancer.