清島 亮

Tumor spread through air spaces (STAS) is a histological feature associated with poor prognosis in primary lung cancer, but its relevance in colorectal cancer (CRC) pulmonary metastases remains unclear. This study evaluated the prognostic impact of STAS in CRC pulmonary metastases and its association with histologic features of the primary tumor. A total of 124 patients who underwent pulmonary resection for CRC metastases were retrospectively analyzed. Quantitative STAS parameters, including density and maximum spread distance, were assessed histologically. Survival outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models, and logistic regression identified predictors of STAS. STAS was present in 33.1% of patients and was associated with significantly shorter 5-year recurrence-free survival (18.7% vs. 53.0%, p = 0.002) and overall survival (p = 0.001). Quantitative STAS metrics correlated with intrathoracic recurrence. Patients with high tumor budding grade had a significantly higher STAS-positive rate than those with none or low grade (60% vs. 31.2%, p = 0.036). Tumor budding independently predicted STAS (odds ratio: 3.19, 95% confidence interval: 1.05-9.69, p = 0.040). STAS independently predicted poor prognosis, particularly intrathoracic recurrence. Quantitative STAS assessment enhanced prognostic precision, and tumor budding grade may serve as a preoperative marker for predicting STAS.

BACKGROUND: This study aims to elucidate the effects of renin-angiotensin system inhibitors (RASIs) on renal function throughout the stoma period in patients undergoing ileostomy formation and subsequent stoma closure following rectal cancer surgery. METHODS: In this single-center retrospective study, patients who underwent rectal resection with temporary ileostomy between January 2010 and December 2020 were divided into two groups based on RASI use. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at pre-surgery (T0), a month post-surgery (T1), and pre-stoma closure (T2). The eGFR, its change at each point, and the chronic kidney disease (CKD) classification were used to assess early and subsequent changes in renal function. RESULTS: Nineteen of 101 patients were using RASI. The RASI and control groups both exhibited eGFR decline at T1, with the former group showing a significantly lower median eGFR (56.2 mL/min/1.73m2 vs. 68.7; p = 0.007). Although a slight improvement in eGFR was observed, neither group returned to baseline levels by T2. The RASI group showed lower eGFR values at both time points. Multivariate analyses indicated that RASI use was a significant risk factor for renal function impairment in terms of a worse CKD classification at T1 (OR: 9.099; 95% CI: 3.015-27.460; p < 0.001). CONCLUSION: Our findings suggest that the use of RASIs is associated with early perioperative renal function impairment in patients undergoing ileostomy and stoma closure, with relatively slow recovery. These results indicate the impact of RASIs on eGFR and the importance of careful renal function management.

AIM: Previous studies have shown that the volume and short-term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short-term outcomes following advanced hepatectomy in Japan during the postpandemic era. METHODS: Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien-Dindo grade ≥ III), 30-day and inhospital mortality rates, and failure-to-rescue rates were assessed. The standardized morbidity and mortality ratios-calculated as the observed-to-expected incidence rates using an NCD-established risk model for 30-day mortality, inhospital mortality, and major complications-were also examined. RESULTS: A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID-19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras. CONCLUSIONS: Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post-COVID-19 era, despite a decreasing procedural volume.