North Medical Center

To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy. This multicenter retrospective study included 327 patients aged ≥ 80 years who underwent curative gastrectomy for gastric cancer. The patients were classified into urban (n = 118) and rural (n = 209) groups. The baseline characteristics, surgical outcomes, and long-term outcomes were compared. Patients in rural areas had poorer performance statuses, more comorbidities, worse nutritional and inflammatory profiles, and longer distances to the hospital. However, no differences were observed between the urban and rural groups in terms of the surgical approach, postoperative complication rates, or the administration of adjuvant chemotherapy. The 5-year overall survival rates in the rural and urban groups were 66.6% and 59.8%, respectively (p = 0.197). A multivariate Cox regression analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio: 2.02), carcinoembryonic antigen ≥ 5 ng/mL (hazard ratio: 1.92), pathological stage III (hazard ratio: 3.72), and Clavien-Dindo grade ≥ III complications (hazard ratio: 2.51) as independent predictors of overall survival. The comparable surgical and long-term survival outcomes between patients treated in rural and urban areas suggest that equitable surgical care may be achievable across different geographic settings.

Abstract Objectives: Robot-assisted radical prostatectomy (RARP) is widely performed as the standard surgical treatment for prostate cancer. However, few studies have comprehensively examined the factors associated with readmission after RARP. This study evaluated postoperative readmissions after RARP at our institution and retrospectively analyzed related clinical factors. Methods: We retrospectively reviewed 932 consecutive patients who underwent RARP for prostate cancer between January 2016 and April 2025 at our institution. Clinical variables such as baseline characteristics, perioperative factors, and pathological findings were examined. We investigated the readmission rate within 30 days after RARP and performed multivariate logistic regression analysis to identify independent predictors of readmission. Results: The 30-day readmission rate was 3.2% (30 of 932 patients). The median interval from discharge to readmission was 7 days, and the median length of stay during readmission was 10 days. The most common causes of readmission were symptomatic lymphoceles (n = 13, 43.3%) and vesicourethral anastomosis leakage (n = 6, 20.0%). Multivariate analysis revealed that the removal of ≥ 8 lymph nodes (OR = 2.14; 95% CI, 1.08–4.59; p = 0.047) and the presence of preoperative pyuria (OR = 4.58; 95% CI, 1.23–17.00; p = 0.049) were significant independent predictors of readmission. Conclusion: The removal of ≥ 8 lymph nodes and the presence of preoperative pyuria were identified as independent risk factors for early readmission after RARP. Incorporating these factors into preoperative risk assessment could contribute to reducing postoperative readmissions.

Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer. A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model. Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function. The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.

BackgroundThe Society for Vascular Surgery (SVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) for blunt traumatic aortic injuries (BTAI) in adults, especially BTAI grades II to IV. TEVAR is increasingly performed for BTAI in children and adolescents; however, reports on treatment strategies are limited. Percutaneous routes for stenting may not be available in children with anatomically small vessel diameters, and the indications for stent grafts are challenging because of the steep aortic angle.Case presentationWe report a case of TEVAR for BTAI performed under laparotomy with n-butyl-2-cyanoacrylate (NBCA) injection in an adolescent patient. The patient was a 13-year-old male who sustained injuries due to a fall and presented with severe hypoxia and shock on admission. Computed tomography (CT) showed a thoracic aortic injury with a pseudoaneurysm (SVS grade III) and bilateral pulmonary contusions. We planned to perform TEVAR after venovenous extracorporeal membrane oxygenation (ECMO); however, because of the small diameters of the bilateral common femoral arteries, we placed a stent graft through the left common iliac artery under laparotomy. In addition, the proximal landing zone of the stent graft to the thoracic pseudoaneurysm was short, and we filled the pseudoaneurysm with NBCA after deploying the stent graft to prevent endoleaks. Subsequent CTs showed no endoleaks, and the patient was discharged on day 110.ConclusionsWe report a case of TEVAR in a 13-year-old boy who underwent laparotomy with NBCA injection into a pseudoaneurysm. This method may be useful as an alternative when percutaneous access is not available, and the proximal landing zone cannot be reached.

Clinical trials rarely focus on elder patients with castration-resistant prostate cancer (CRPC), and data on the outcomes of second-generation androgen receptor signaling inhibitors (ARSIs) remain limited. The ENABLE study for prostate cancer was an investigator-initiated, multicenter, randomized controlled trial conducted in Japan to compare enzalutamide (ENZ) and abiraterone plus prednisolone (ABI). This sub-analysis was performed to evaluate the efficacy and the safety profiles between patients aged ≥ 75 (older) and < 75 years (younger), and then between the ENZ and ABI arms in the older and the younger cohort separately. The ENZ arm included 41 younger and 51 older patients, while the ABI arm included 36 younger and 56 older patients. No significant differences in survival endpoints were observed between younger and older patients. Median time to prostate-specific antigen (PSA) progression (TTPP) was 15.2 months for younger and 21.2 months for older patients (HR 0.84, 95% CI 0.53-1.33, p = 0.4647). Median overall survival (OS) was 33.7 months for younger and 37.8 months for older patients (HR 0.80, 95% CI 0.50-1.29, p = 0.3651). Among older patients (n = 107), the ENZ arm had a TTPP of 21.2 months compared to 10.1 months for the ABI arm and an OS of 37.8 months compared to 44.7 months for the ABI arm (p = 0.1506 and p = 0.9321, respectively). Any grade and grade ≥ 3 adverse events were observed in 47 (61%) and 11 (14%) younger patients and 73 (68%) and 18 (17%) older patients, respectively. No significant differences were found in any grade or grade ≥ 3 adverse events between younger and older patients (p = 0.3487 and p = 0.6885, respectively). ARSIs demonstrated similar efficacy and safety in both younger and older patients. ENZ may be a more suitable option for older patients due to its higher PSA response rate. This trial was registered with the University Hospital Medical Information Network (UMIN) Center under identifier UMIN000015529.

116 Background: Fluoropyrimidine agents are the key component of adjuvant chemotherapy for pathological stage III colorectal cancer (CRC). Western studies have shown that female sex is associated with favorable survival outcomes after surgery, yet a risk factor for fluoropyrimidine-related adverse events (AEs) during adjuvant chemotherapy. However, it remains unclear whether there are sex differences in the treatment outcomes in this setting among the Japanese population. Methods: Patients enrolled in four randomized controlled trials (JCOG0205, JCOG0404, JCOG0910, and JCOG1006) who received adjuvant fluoropyrimidine monotherapy for pathological stage III CRC were analyzed. Incidences of AEs and survival outcomes (relapse-free survival [RFS], and overall survival [OS]) were compared between males and females. Multivariable logistic regression analyses were performed to evaluate associations between sex and the development of AEs. Multivariable Cox regression analyses were performed using Cox proportional hazard models to evaluate associations between sex and survival outcomes. Results: A total of 3170 patients (male, n = 1654; female, n = 1516) were included in the analysis. Compared with male patients, female patients were more likely to require dose reduction (male, 20.4%; female: 28.8%, p &lt; 0.0001) and had low completion proportions of adjuvant chemotherapy (male, 81.7%; female, 77.0%, p = 0.0011). Female patients experienced higher incidences of any-grade hematological and non-hematological AEs (Table). Female sex was associated with higher incidences of grade 3/4 hematological AEs (odds ratio [OR]: 1.702 [95% CI 1.272–2.278], p = 0.0003) and non-hematological AEs (OR: 1.666 [95% CI 1.373–2.020], p &lt; 0.0001). Female sex was identified as a favorable prognostic factor for RFS (hazard ratio [HR]: 0.729 [0.627–0.848], p &lt; 0.0001) and OS (HR: 0.796 [0.653–0.970], p = 0.0238). Conclusions: Sex differences had implications for the development of AEs and survival outcomes of Japanese patients with pathological stage III CRC who received adjuvant fluoropyrimidine monotherapy. Incidences of adverse events. Adverse event Any grade Grade 3/4 Male% (95% CI) Female% (95% CI) p-value Male% (95% CI) Female% (95% CI) p-value Any hematological toxicity 63.7 (61.3–66.0) 83.9 (82.0–85.8) &lt;0.0001 5.0 (4.0–6.1) 8.9 (7.5–10.4) &lt;0.0001 Any non-hematological toxicity 93.3 (92.0–94.5) 96.1 (95.0–97.0) 0.0006 13.3 (11.7–15.1) 20.8 (18.8–22.9) &lt;0.0001

Werner syndrome (WS) is an autosomal recessive, adult-onset, progeroid syndrome caused by WRN mutations. As refractory skin ulcers significantly affect the quality of life of patients with WS, this study identified ulcer risk factors and assessed prevention methods. We analyzed the data of 51 patients with WS enrolled in the Japanese Werner Syndrome Registry between 2016 and 2022. A cross-sectional analysis was performed to determine the association with skin ulcers at baseline. Statistical analyses were conducted, including Welch's and Pearson's chi-square tests. Age was adjusted using a logistic regression model. The mean patient age was 48.8±7.6 years, and 66.7% of patients presented with skin ulcers. Univariate analysis showed that patients with skin ulcers were older than those without ulcers. Systolic blood pressure (SBP) was higher in patients with skin ulcers. Patients without skin ulcers received metformin and pioglitazone treatment significantly more often than those with ulcers. Logistic regression analysis adjusted for age showed that higher SBP remained a significant risk factor for skin ulcers. Patients administered pioglitazone had lower ulcer morbidity. Age and SBP are risk factors for skin ulcers in patients with WS. Moreover, pioglitazone treatment may prevent skin ulcers.

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

We previously reported that abdominal aortic calcification is associated with poor overall and recurrence-free survival after hepatectomy for hepatocellular carcinoma (HCC). However, the effect of abdominal aortic calcification on cancer-specific prognosis in very old patients with several comorbidities remains unknown. This multicenter study aimed to evaluate the impact of abdominal aortic calcification on the cumulative recurrence rate and recurrence-free survival in patients with HCC aged >80 years. We retrospectively analyzed the data of 128 patients (aged ≥80 years) who underwent liver resection for hepatocellular carcinoma at seven hospitals belonging to Hiroshima Surgical Study Group of Clinical Oncology between January 2014 and December 2018. Patients were divided into two groups: high and low abdominal aortic calcification groups. The primary endpoints were cumulative recurrence rate and recurrence-free survival. Kaplan-Meier survival curve analysis demonstrated that the cumulative recurrence rate in the high abdominal aortic calcification group was significantly higher than that in the low abdominal aortic calcification group, and the high abdominal aortic calcification group had a significantly lower recurrence-free survival rate. In the multivariate analysis, high abdominal aortic calcification (p = 0.03), high des-gamma-carboxyprothrombin score (p = 0.04), and multiple tumors (p < 0.01) were independent predictive factors for recurrent HCC, and high abdominal aortic calcification (p = 0.01) and high des-gamma-carboxyprothrombin (p = 0.01) were independent predictive factors for poor cancer-specific survival. Our results indicate that the abdominal aortic calcification score is associated with cumulative recurrence rate and recurrence-free survival in very old patients with HCC.