Surgery Today

PURPOSE: Prior to publication of the Clavien-Dindo classification in 2004, there were no grading definitions for surgical complications in either clinical practice or surgical trials. This report establishes supplementary criteria for this classification to standardize the evaluation of postoperative complications in clinical trials. METHODS: The Japan Clinical Oncology Group (JCOG) commissioned a committee. Members from nine surgical study groups (gastric, esophageal, colorectal, lung, breast, gynecologic, urologic, bone and soft tissue, and brain) specified postoperative complications experienced commonly in their fields and defined more detailed grading criteria for each complication in accordance with the general grading rules of the Clavien-Dindo classification. RESULTS: We listed 72 surgical complications experienced commonly in surgical trials, focusing on 17 gastroenterologic complications, 13 infectious complications, six thoracic complications, and several other complications. The grading criteria were defined simply and were optimized for surgical complications. CONCLUSIONS: The JCOG postoperative complications criteria (JCOG PC criteria) aim to standardize the terms used to define adverse events (AEs) and provide detailed grading guidelines based on the Clavien-Dindo classification. We believe that the JCOG PC criteria will allow for more precise comparisons of the frequency of postoperative complications among trials across many different surgical fields.

Esophageal cancer is one of the most aggressive gastrointestinal cancers. This review focuses on eight topics within the multidisciplinary approach for esophageal cancer. As esophagectomy is highly invasive and likely to impair quality of life, the development of less invasive strategies is expected. Endoscopic resection (ER) of early esophageal cancer is a less invasive treatment for early esophageal cancer. A recent phase II trial revealed that combined ER and chemoradiotherapy (CRT) is efficacious as an esophagus-preserving treatment for cT1bN0 squamous cell carcinoma (SCC). Esophagectomy and definitive CRT are equally effective for patients with clinical stage I SCC in terms of long-term outcome. For locally advanced resectable cancers, multidisciplinary treatment strategies have been established through several clinical trials of neoadjuvant or perioperative treatment. Minimally invasive esophagectomy may improve the outcomes of patients and CRT is a curative-intent alternative to esophagectomy. CRT with 50.4 Gy radiotherapy combined with salvage surgery is a promising option to preserve the esophagus. Induction chemotherapy followed by esophagectomy may improve the outcomes of patients with locally advanced unresectable tumors. Immune checkpoint inhibitors are effective for esophageal cancer, and their introduction to clinical practice is awaited.

PURPOSE: Lower extremity arterial disease (LEAD) is a risk factor in patients undergoing coronary artery bypass grafting (CABG); however, the impact of chronic limb-threatening ischemia (CLTI), its most advanced stage, remains unclear. We evaluated early and long-term outcomes of CABG in CLTI. METHOD: We retrospectively analyzed 334 consecutive patients who underwent isolated CABG between 2014 and 2024. Patients were stratified into three groups: CLTI (n = 22), non-CLTI LEAD (n = 41), and non-LEAD (n = 271). The primary endpoint was long-term survival; the secondary endpoints were 30-day mortality and major adverse cardiac and cerebrovascular events. RESULTS: The CLTI group had higher rates of diabetes mellitus (90.9%) and hemodialysis (86.4%) (p < 0.01). Thirty-day mortality was similar (9.1%, 2.4%, and 5.5%; p = 0.52), whereas five-year survival was significantly lower in the CLTI group (39.8% vs. 86.2% and 90.8%; p < 0.01). A Cox analysis showed that age, hemodialysis, and acute myocardial infarction were independent predictors of 5-year survival. CONCLUSIONS: CLTI predicts poor long-term survival because of comorbidities. In this high-risk population, individualized strategies balancing the extent of coronary revascularization against operative risk may achieve acceptable early outcomes, although the safety of incomplete/functional revascularization requires confirmation in larger cohorts.

PURPOSE: Persistent descending mesocolon (PDM) is a rare congenital anomaly characterized by a medial shift of the descending colon and vascular variations that can complicate colorectal surgery. This study aimed to clarify the PDM-associated vascular anatomy and describe the short-term outcomes of robot-assisted surgery. METHODS: We retrospectively analyzed 541 patients with primary rectal cancer who underwent robot-assisted surgery (2017-2024) and compared the short-term outcomes between the PDM and non-PDM groups. The vascular anatomy, including inferior mesenteric artery (IMA) branching patterns and marginal artery defects, was assessed in 501 patients using preoperative enhanced computed tomography. RESULTS: PDM was identified in 22 patients (4.1%) in this study. The short-term outcomes were comparable between the groups. The PDM group had a significantly higher prevalence of radial IMA branching patterns and a higher frequency of marginal artery defects than the non-PDM group (9% vs. 2%). CONCLUSION: PDM is associated with a higher prevalence of radial IMA branching patterns. Marginal artery defects were observed more frequently among patients with PDM; however, this finding requires cautious interpretation because of the small number of affected cases and potential verification bias. Appropriate identification and management of vascular variations may contribute to acceptable short-term outcomes of robot-assisted surgery in patients with PDM.