The Japanese Society of Gastroenterological Surgery

This scoping review mapped the existing literature on the application of asenapine for delirium management in patients with cancer, including prevention and treatment, while summarizing current research trends. The review followed the methodological framework proposed by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. PubMed and Ichushi-Web were searched on June 30, 2025, using the keywords "asenapine," "delirium," and "cancer." Eligible studies included reports on asenapine management for delirium in patients with cancer. Two reviewers independently screened records and extracted data. Among the six records identified, three studies met the inclusion criteria and were included in this review. Two of these were retrospective observational studies, and one was a case report. One retrospective study described six terminally ill patients treated with sublingual asenapine, showing marked improvement in agitation, as measured using the Richmond Agitation-Sedation Scale. The other study analyzed 20 patients with advanced cancer and reported reductions in the Agitation Distress Scale scores, particularly among those with poor performance status. Moreover, this case report highlighted the successful use of sublingual asenapine in a patient with aphagia unresponsive to other antipsychotic agents. Across the studies, asenapine was generally well-tolerated, with one suspected dysarthria and no serious adverse events. The current evidence is limited in quantity and quality, and no preventive studies were identified. While preliminary findings suggest that sublingual asenapine may be useful and well-tolerated for treating delirium in patients with cancer, further high-quality studies are warranted.

Artificial intelligence (AI) is reshaping radiology by improving image reconstruction, workflow efficiency, and decision support.Yet, technological excellence alone does not guarantee clinical adoption.The equation often cited by healthcare economists-value = outcome/cost-captures the essence of why reimbursement matters: innovations must demonstrate measurable improvements in safety, quality, or timeliness of care while remaining economically feasible [1].In Japan, the relationship between regulatory approval and reimbursement is distinctive.Both processes fall under the Ministry of Health, Labor and Welfare (MHLW), with technical evaluation by the Pharmaceuticals and Medical Devices Agency (PMDA).This unified system allows rapid alignment between approval and reimbursement but limits flexibility for post-market evidence evaluation or price revision.

To evaluate the impact of the coronavirus disease (COVID-19) pandemic on short-term outcomes of low anterior resection (LAR) across hospitals classified by surgical volume. Data of patients who underwent elective LAR for rectal cancer between 2018 and 2022 were obtained from the National Clinical Database of Japan. Hospitals were categorized into high-, medium-, and low-volume groups. Each group was constituted to represent approximately one-third of all surgeries performed between 2018 and 2019. The standardized morbidity/mortality ratios (SMRs) of Clavien-Dindo grade ≥3 (CD ≥ 3) complications were the primary endpoint. The secondary endpoints included anastomotic leakage, pneumonia, and surgical mortality. This study analyzed 91 800 cases of elective LAR, with 10.5% experiencing CD ≥ 3 complications, 8.8% anastomotic leakage, 0.9% pneumonia, and 0.5% surgical mortality. Despite COVID-19, SMRs of CD ≥ 3 complications decreased from 2018 to 2022 across all groups. However, increases in the rates and SMRs of CD ≥ 3 complications were observed in low-volume hospitals around mid-2020, followed by a decline. Anastomotic leakage showed similar trends. The rates and SMRs of pneumonia and surgical mortality remained unchanged. Notably, anastomotic leakage rates were 7.6%, 8.9%, and 10.0% in high-, medium-, and low-volume hospitals, respectively, indicating superior outcomes in high-volume hospitals. Early COVID-19 waves may have disproportionately affected low-volume hospitals. However, the decline in SMRs of CD ≥ 3 complications from 2018 to 2022 across all three groups suggests the robustness and resilience of surgical services for rectal cancer in Japan. The potential disparity in short-term outcomes among hospitals is a new concern.

3609 Background: The role of biomarker-guided therapy for resectable colorectal cancer (CRC) remains unestablished. Circulating tumor DNA (ctDNA) has emerged as a minimally invasive biomarker for detecting molecular residual disease (MRD) and predicting recurrence. Tumor-informed ctDNA testing offers the advantage of tumor sequencing and MRD detection in a single workflow, suggesting its potential for facilitating integration of biomarker-guided therapy into perioperative treatment. Methods: GALAXY, a large-scale prospective observational study, monitored post-surgical ctDNA MRD status in patients with clinical stage II to IV or relapsed CRC (UMIN000039205). Tumor tissue and matched normal DNA were processed for whole-exome sequencing (WES) to identify and track patient-specific somatic single nucleotide variants (SNVs), for ctDNA detection in the associated patients’ plasma samples. Actionable biomarkers having OncoKB therapeutic levels 1-3 were explored and identified separately from the Signatera test (through WES data). Results: Of the 4,590 patients enrolled between May 2020, and October 2022, 2,695 who were not enrolled in randomized trials and had available WES data were included in this analysis. Identified actionable biomarkers included RAS/ BRAF wild-type in 1,369 (50.8%) patients, tumor mutational burden (TMB) high in 256 (10.3%), MSI high in 236 (9.5%), BRAF V600E in 176 (6.5%), KRAS G12C in 61 (2.3%), ERBB2 amplification in 47 (1.7%), TP53 Y220C in 33 (1.2%), NTRK1/ 2/ 3 fusion in 1 (0.04%), and RET fusion in 1 (0.04%). ctDNA positivity during the MRD window (2 to 10 weeks post-surgery) varied from 5.1% in those with TMB high and MSI high to 29.8% in those with ERBB2 amplification. ERBB2 amplification was the only actionable biomarker significantly associated with ctDNA positivity during the MRD window (odds ratio 2.20). Positive ctDNA MRD status correlated with significantly worse DFS across all actionable biomarkers, with hazard ratios ranging from 8.46 for TP53 Y220C to 5.53e+8 for BRAF V600E. In MSI high disease, recurrence was observed in only 3 of 225 (1.3%) patients with negative ctDNA compared to 5 of 12 (41.7%) with positive ctDNA during the MRD window. Adjustment by the propensity score revealed that adjuvant chemotherapy provided survival benefits in ctDNA-positive patients with pathological stage II and III disease across various biomarkers. In patients with one or more actionable mutations selected among the16-plex of the ctDNA MRD assay, those variants were detected at time of disease recurrence. Conclusions: Our study highlights the importance of ctDNA-based MRD as both a prognostic and predictive tool for CRC across different actionable biomarkers. These findings suggest the potential of MRD-driven targeted therapeutic strategies for CRC with specific actionable biomarkers. Clinical trial information: UMIN000039205.

Due to the coronavirus disease 2019 (COVID-19) pandemic, cancer screening, diagnosis, and treatment have changed. This study aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prior to gastroenterological cancer surgeries on postoperative complications using data from a nationwide database in Japan. Data on patients who underwent surgery for cancer including esophageal, gastric, colon, rectal, liver, and pancreatic cancer between July 1, 2019, and September 300, 2022, from real-world sources in Japan were analyzed. The association between preoperative SARS-CoV-2 infection and short-term postoperative outcomes was evaluated. A similar analysis stratified according to the interval from SARS-CoV-2 infection to surgery (<4 vs. >4 weeks) was conducted. In total, 60 604 patients were analyzed, and 227 (0.4%) patients were diagnosed with SARS-CoV-2 infection preoperatively. The median interval from SARS-CoV-2 infection to surgery was 25 days. Patients diagnosed with SARS-CoV-2 infection preoperatively had a significantly higher incidence of pneumonia (odds ratio: 2.05; 95% confidence interval: 1.05-3.74; p = 0.036) than those not diagnosed with SARS-CoV-2 infection based on the exact logistic regression analysis adjusted for the characteristics of the patients. A similar finding was observed in patients who had SARS-CoV-2 infection <4 weeks before surgery. Patients with a history of SARS-CoV-2 infection had a significantly higher incidence of pneumonia. This finding can be particularly valuable for countries that have implemented strict regulations in response to the COVID-19 pandemic and have lower SARS-CoV-2 infection-related mortality rates.