Surgery Today

Maze, Yasumi; Tokui, Toshiya; Inoue, Ryotaro; Sekoguchi, Tomotake; Narukawa, Takahiro; Murakami, Masahiko; Inoue, Ryosai; Hirano, Koji; Chino, Shuji; Nakajima, Ken; Kato, Noriyuki; Ito, Hisato

2024 Surgery Today

doi: 10.1007/s00595-024-02934-7pmid: 39227396

PurposeJapan has adopted its own reimbursement system, which differs from other countries in terms of its diagnostic procedure combination (DPC) methods. However, there are few reports on the cost analysis of open repair and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms in Japan. We aimed to evaluate the long-term outcomes and cost-effectiveness of these two procedures.MethodsThis study included patients who underwent open repair (n = 224) and EVAR (n = 87) between January 2012 and December 2022. After propensity score matching, we compared the two groups.ResultsThe drug and blood products, procedures, and DPC costs were significantly higher in the open repair group (p < 0.001) than in the EVAR group. The surgical equipment and total costs were significantly higher in the EVAR group than in the open repair group (p < 0.001). There was no significant difference in the 5-year survival rate (88.5% in the open repair group vs. 72.0% in the EVAR group; p = 0.33) and freedom from re-intervention rate at 5 years (93.1% in the open repair group vs. 89.9% in the EVAR group; p = 0.15) between the two groups.ConclusionsOpen repair is more cost-effective than EVAR. The cost-effectiveness of EVAR may therefore depend on the cost of the endograft.

Watanabe, Isamu; Hattori, Aritoshi; Fukui, Mariko; Matsunaga, Takeshi; Takamochi, Kazuya; Suzuki, Kenji

2024 Surgery Today

doi: 10.1007/s00595-024-02933-8pmid: 39245749

PurposeWe assessed the safety of general thoracic surgery in patients with prior coronary stents undergoing lung resection, based on differences in perioperative antiplatelet therapy management.MethodsWe retrospectively examined 150 patients with coronary artery stents who underwent pulmonary resection between July 2009 and July 2018. The impact of the antiplatelet agent on thoracic surgery safety was assessed by comparing perioperative outcomes, including major adverse cardiac and cerebrovascular events, among the discontinued antiplatelet therapy (group D), heparin bridging (group H), and continuous antiplatelet therapy (group C) groups.ResultsGroups D, H, and C included twenty-four, eighty-four, and forty-two patients, respectively. Second-generation drug-eluting stents were used in > 50% of the patients. No significant differences were found in the estimated blood loss, transfusion rate, or operative duration. Major adverse cardiac and cerebrovascular events occurred in four (2.7%) patients, which was comparable among the groups. In group H, postoperative heart failure and transient ischemic attack with stroke occurred in one patient each. Major bleeding occurred in two (4.7%) patients in group C.ConclusionsPulmonary resection surgical outcomes in patients with coronary artery stents were feasible regardless of antiplatelet therapy continuation. However, discontinuing dual-antiplatelet or single-antiplatelet therapy in such patients may be reasonable because this generation of drug-eluting stents has a higher safety profile than bare-metal and first-generation drug-eluting stents.

Nobori, Chihoko; Matsumoto, Ippei; Nakano, Masaya; Ami, Katsuya; Yoshida, Yuta; Lee, Dongha; Murase, Takaaki; Kamei, Keiko; Takebe, Atsushi; Nakai, Takuya; Takeyama, Yoshifumi

2024 Surgery Today

doi: 10.1007/s00595-024-02935-6pmid: 39222257

PurposeTo clarify the prevalence, risk factors, and clinical implications associated with zinc deficiency in patients undergoing pancreatic surgery.MethodsThe serum zinc levels were measured in 329 patients post-pancreatic surgery between January and April 2021. The postoperative serum zinc levels and clinicopathological variables were retrospectively analyzed.ResultsThe median serum zinc level was 73 µg/dL (33–218). Zinc deficiency (zinc level < 60 µg/dL) was observed in 52 patients (16%). A total of 329 patients were classified into zinc-deficient (n = 52) and non-deficient (zinc ≥ 60 µg/dL, n = 277) groups. A univariate analysis revealed significant differences in sex, postoperative body mass index, serum albumin, total cholesterol, creatinine, aspartate aminotransferase (AST), HbA1c levels, diabetes, surgical procedures, and operative blood loss. According to a multivariate analysis, male sex [odds ratio (OR) 3.70; 95% confidence interval (CI) 1.67–8.20; p = 0.001], postoperative serum albumin levels < 3.9 g/dL (OR 6.39; 95% CI 3.30–12.37; p < 0.001), postoperative serum AST ≥ 51 U/L (OR, 4.6; 95% CI 0.07–0.29; p < 0.001), and total pancreatectomy (OR 3.68; 95% CI 1.37–9.85; p = 0.009) were found to be independent predictors of zinc deficiency after pancreatic surgery.ConclusionsZinc deficiency frequently occurs in patients undergoing pancreatic surgery. Lower postoperative zinc levels could be linked to sex, the serum albumin and AST levels, and surgery type.

Iwata, Yoshinori; Tanaka, Chihiro; Ohno, Shinya; Suetsugu, Tomonari; Tanaka, Hideharu; Watanabe, Taku; Komori, Shuji; Nagao, Narutoshi; Katayama, Masaki; Kawai, Masahiko

2024 Surgery Today

doi: 10.1007/s00595-024-02932-9pmid: 39249113

PurposeIn Japan, immunohistochemistry for mismatch repair (MMR) proteins targeted at stage II and III colorectal cancers (CRCs) has been covered by national insurance since October, 2022. This study aimed to clarify the long-term outcomes of patients with stage II and III CRCs receiving postoperative adjuvant chemotherapy based on their MMR status.MethodsThe outcomes of 640 patients who underwent radical surgery for stage II and III CRCs were analyzed retrospectively.ResultsDeficient MMR (dMMR) was diagnosed in 41 (13.3%) patients with stage II and 28 (9.1%) patients with stage III CRC. The overall survival and recurrence rates were not significantly different between the patients with stage II and those with stage III CRC. The risk factors for recurrence among those with stage II CRC were tumors on the left side, T4 disease, and the presence of BRAF wild type. The recurrence rates were lower in the stage II CRC patients with sporadic dMMR than in those with suspected Lynch syndrome (LS). The first site of recurrence was more frequently the peritoneum or distant lymph node in patients with dMMR.ConclusionsStage II CRC patients with sporadic dMMR were found to have a very good prognosis. On the other hand, peritoneal dissemination or distant lymph node metastasis tended to develop in patients with dMMR.