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Background This study aimed to investigate the feasibility and safety of our enhanced recovery after surgery protocol including early oral intake and omitting nasogastric tube (NGT) placement after total gastrectomy. Methods We analyzed 182 consecutive patients who underwent total gastrectomy. The clinical pathway was dramatically changed in 2015 and patients were divided into 2 groups (conventional group and modified group). Postoperative complications, bowel movement, and postoperative hospital stays were compared in two groups in all cases and propensity score matching (PSM). Results Flatus and defecation were significantly earlier in the modified group compared with those in the conventional group (flatus: 2(1-5) days vs 3(2-12) days p=0.03, defecation: 4(1-14) days vs 6(2-12) days p=0.04). The postoperative hospital stay was 18(6-90) days in the conventional group and 14(7-74) days in the modified group (p=0.009). The discharge criteria met day was earlier in the modified group compared with that in the conventional group (10(7-69) days vs 14(6-84) days p=0.01). Overall and severe complications occurred in nine patients (12.6%) and three patients (4.2%) in the conventional group and twelve patients (10.8%) and four patients (3.6%) in the modified group, respectively (p=0.70 and p=0.83) in all cases. In PSM, there is no significant difference between the two groups concerning the postoperative complications (overall complication 6 (12.5%) vs 8 (16.7%) p=0.56, severe complications 1 (2%) vs 2 (4.2%) p=0.83) Conclusions Modified ERAS for total gastrectomy were feasible and safe.

Background: It has been reported that the oral and gut microbiomes are associated with the prognosis in patients who undergo surgery, chemotherapy, and radiation for colorectal cancer. This study is the first to identify a correlation between the number of healthy teeth, which is an oral health indicator, and the efficacy of preoperative chemotherapy for rectal cancer. Methods: This retrospective single-center study included 30 patients who underwent radical surgery after preoperative chemoradiotherapy (CRT) between December 2013 and June 2021. The relationship between number of teeth before CRT and the efficacy of CRT, CRT-related adverse events, postoperative complications, and long-term postoperative outcomes was examined. Results: The number of healthy teeth was significantly greater in patients with downstaging of their disease than in those without downstaging (p=0.027) and in patients with a complete response according to the Response Evaluation Criteria in Solid Tumors than in those who did not have a complete response (p=0.014). Patients were divided into two groups according to whether they had ≥15 teeth or ≤14 teeth. There was no significant between-group difference in CRT-related adverse events. The incidence of all postoperative complications and grade II postoperative complications tended to be higher in patients with ≥15 teeth (p=0.071 and p=0.092, respectively), as did the 5-year overall survival rate (p=0.083) and the 5-year disease-free rate (p=0.007). Conclusions: The number of healthy teeth predicted the response to preoperative CRT, postoperative complications, and the outcome of subsequent surgery in patients with rectal cancer.

Background Robotic surgery (RS) has been rapidly adopted for gastric cancer and adenocarcinoma of the esophagogastric junction (AEG). However, the utility of RS for Siewert type II/III AEG remains unclear. Methods Forty-one patients who underwent either transhiatal RS (n = 15) or laparoscopic surgery (LS) (n = 26) for Siewert type II/III AEG were enrolled in this study. The surgical outcomes of the two groups were compared. Results In the entire cohort, there were no significant intergroup differences in the operative time, blood loss volume, or number of retrieved lymph nodes. The length of the postoperative hospital stay was shorter in the RS group than in the LS group (14.20 ± 7.10 days vs. 18.73 ± 17.82 days, respectively; p = 0.0388). The morbidity rate (Clavien–Dindo grade ≥ 2) was similar between the groups. In the Siewert II cohort, there were no significant intergroup differences in short-term outcomes. In the entire cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (91.67% vs. 91.48%, N.S.) or 3-year disease-free survival rate (91.67% vs. 91.78%, N.S.), respectively. Likewise, in the Siewert type II cohort, there was no significant difference between the RS and LS groups in the 3-year overall survival rate (80.00% vs. 93.33%, N.S.) or 3-year disease-free survival rate (80.00% vs. 94.12%, N.S.), respectively. Conclusions Transhiatal RS for Siewert II/III AEG was safe and contributed to similar short-term and long-term outcomes compared with LS.

Background The aim of this study is to investigate the factors correlated with long-term weight loss and diabetes mellitus (DM) remission after laparoscopic sleeve gastrectomy (LSG). Methods Sixteen obese patients who underwent LSG were enrolled in this study (male/female: 5/11, mean age: 44.0 years, mean body weight: 127.5 kg, mean body mass index: 47.4 kg/m2, DM: n = 11). We investigated the percent excess weight loss (%EWL), %TWL, and DM remission 3 years post-operation and the factors correlated with long-term weight loss and DM remission after LSG. Results The %EWL 3 years post-operation was 49.6%, while the %TWL was 24.0%. Complete remission (CR) of DM was 54.5% and an improvement occurred in 18.2% of cases 3 years post-operation, whereas there was no change in 27.3% of cases. The factor correlated with a %EWL ≥ 50% 3 years post-operation was a better %EWL at 1 year post-operation. Factors correlated with DM remission 3 years post-operation were a low preoperative neutrophil-lymphocyte ratio and DiaRem score and CR or partial remission 1 year post-operation. Conclusion Regarding long-term weight loss after LSG, better weight loss 1 year post-operation was important. In terms of long-term DM remission, a low preoperative neutrophil-lymphocyte ratio and DiaRem score and achieving CR or partial remission 1 year post-operation were key factors.

Metabolic surgery is an effective treatment for patients with type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effect of duodenal-jejunal bypass (DJB) in a rat model of T2DM during the early postoperative period. A rat model of non-obese T2DM was allocated to two groups: a sham group and a DJB group. On postoperative day 1 (1POD), oral glucose tolerance testing (OGTT) was performed and the changes of glucose transporter expressions in the small intestine was evaluated. [18F]-fluorodeoxyglucose ([18]-FDG) uptake was measured in sham- and DJB-operated rats using positron emission tomography-computed tomography (PET-CT). DJB improved the glucose tolerance of the rats on 1POD. The expression of sodium-glucose cotransporter 1 (SGLT1) and glucose transporter 1 (GLUT1) was high, and that of GLUT2 was low in the alimentary limb (AL) of rats in the DJB group. PET-CT showed that [18F]-FDG uptake was high in the proximal jejunum of DJB-operated rats. These results suggest that DJB improve glucose tolerance in very early postoperative period as the result of glucose accumulation in the AL because of changes in glucose transporter expression.

Background: This study aimed to investigate the impacts of calorie restriction and exercise as preoperative interventions in laparoscopic sleeve gastrectomy.Methods: Sixteen patients with obesity who underwent laparoscopic sleeve gastrectomy were enrolled, comprising 4 men and 12 women aged 33–62 years (mean age, 44.8 years). Their mean body weight and body mass index were 124.7 kg and 46.5 kg/m2, respectively. These patients underwent calorie restriction and exercise for a mean duration of 5.9 months before the surgery. The effect of this preoperative intervention on the postoperative outcome was then evaluated.Results: The patients achieved a weight loss of 8.3% (10.8 kg). The visceral fat area significantly decreased by 5.5%, whereas the skeletal muscle mass remained unaffected. Furthermore, the good-responder group (preoperative weight loss > 8%) showed a significantly higher percentage total weight loss (%TWL) at 1 year postoperatively than the poor-responder group (preoperative weight loss < 8%). In the multivariate analysis, preoperative weight loss of >8% revealed the independent factor of correlating 25% ≤ %TWL at 1 year postoperatively.Conclusions: Preoperative intervention with calorie restriction and exercise is effective for postoperative weight loss in laparoscopic sleeve gastrectomy.

Background Frailty plays a crucial role in cancer patients who have received surgery in this recent aging society. We aimed to investigate frailty as a prognostic factor in elderly gastric cancer (GC) patients who underwent curative gastrectomy. Methods In this study, we analyzed 86 elderly (over 75 years old) GC patients who underwent curative gastrectomy. Frailty was defined as clinical frailty scale score of ≥ 4. Patients were assigned to two groups; frailty group (n = 29) and no-frailty group (n = 57). Clinicopathological values, including comorbidity, immune-nutritional score, and long-term outcomes, were compared between the frailty and no-frailty groups.Results The frailty group displayed a positive correlation with a previous history of symptomatic stroke (p < 0.05). Moreover, the overall survival (OS) rate was significantly poorer in the frailty group (5-yr OS; frailty group 52.09% vs. no-frailty group 72.02%, p < 0.05). By contrast, there were no significant differences in both the cancer-specific survival (5-yr CSS; frailty group 82.33% vs. no-frailty group 89.32%, p = 0.14) and the disease-free survival (5-yr DFS; frailty group 74.68% vs. no-frailty group 86.91%, p = 0.33). Finally, frailty, differentiation, surgical procedure and the lymphocyte c-reactive protein ratio were identified among clinicopathological factors as independent prognostic factors for OS in multivariate analysis. Conclusion We identified the clinical impact of frailty as an independent prognostic factor for elderly GC patients who underwent gastrectomy.

Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus (POI (+)) and patients who did not (POI (−)) after ileostomy closure were compared.Results: Fifty-nine patients were evaluated and were divided into two groups: POI (+) (n=9) and POI (−) (n=50), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications after the index surgery was significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications after the index surgery may increase the risk of postoperative ileus after ileostomy closure.

Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus (POI (+)) and patients who did not (POI (−)) after ileostomy closure were compared.Results: Fifty-nine patients were evaluated and were divided into two groups: POI (+) (n=9) and POI (−) (n=50), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications after the index surgery was significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications after the index surgery may increase the risk of postoperative ileus after ileostomy closure.