Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System

[Background]?Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. [Methods]?We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. [Results]?The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P?< 0.001). Postoperative complications were more frequently observed in the early phase (P?= 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. [Conclusion]?Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely

Comparative Study of Complications in CV Catheter Insertion for Pediatric Patients: Real-time Ultrasound-guided Versus Venography-guided Approach

[Background]Tunneled central venous catheters (CVC), called Broviac/Hickman catheter, are widely used in the long-term treatment of pediatric patients. Recently, the percutaneous approach for CVC insertion has become dominant as a less invasive intervention. In this study, we reviewed the mechanical and delayed complications according to different procedures of CVC insertion and assessed the risk factors for complications in CVC insertions for pediatric patients. [Methods]A total of 159 pediatric patients (85 males and 74 females) were included in this study. Primary reasons for indication of CVC settlement were hemato-oncologic disorders (66 cases, 42%), malignant solid tumors (30, 19%) and other benign diseases (63, 40%). CVC insertion was performed with surgical venous cutdown (CD) in 51 patients (32%), with real-time ultrasound-guided puncture (RTUS) in 57 (36%), and venography-guided puncture (VG) in 49 (31%). [Results]CD was dominantly selected and the frequency of venipuncture increased respective to the increased age of patients. RTUS was dominantly selected for one to four year old patients and VG was dominant in 5 to 15 year old patients. Some types of mechanical complication were observed in 4 of 159 (2.5%) and some delayed types were observed in 66 of 159 cases (42%). No mechanical complications occurred in cases with CD and RTUS; on the other hand, 3 (6%) of 49 insertions with VG were observed. However, we could not show any significant risk factors for the mechanical complications. In the meantime, delayed complications and premature removal were significantly observed in patients under 5 years old. [Conclusion]RTUS is superior to our conventional VG considering less frequent mechanical complications. High frequent delayed complication and premature removal should be considered, especially for patients under 5 years old

Therapeutic Value of Lymph Node Dissection Along the Superior Mesenteric Vein and the Posterior Surface of the Pancreatic Head in Gastric Cancer Located in theLower Third of the Stomach

【Background】 Therapeutic value of lymph node dissection along the superior mesenteric vein (14v) and the posterior surface of the pancreatic head (13) remains unclear in gastric cancer patients. 【Methods】 We reviewed 355 patients with advanced gastric cancer in the lower third of the stomach who had undergone gastrectomy at our hospital. 【Results】 The frequency of lymph node (LN) metastasis was 10.2% and 7.4% in stations 13 and 14v, respectively. The frequency of station 13 metastasis was 26.8% for T3/T4 tumors with group 2 LNs metastasis and 1.4% for all other tumors. The frequency of station 14v metastasis was 22.2% for T3/T4 tumors with group 2 LNs metastasis and 1.8% for all other tumors. The therapeutic values for dissecting LN stations 13 and 14v were 1.9 and 0.9, respectively, similar to the therapeutic value for group 2 LN dissection. 【Conclusion】 Because metastasis to stations 13 and 14v occurs frequently in patients with T3/T4 gastric cancer located in the lower third of the stomach who also have metastasis to group 2 LNs, stations 13 and 14v should be dissected in these patients

Prognostic Value of Combined Tumor Marker and Controlling Nutritional Status (CONUT) Score in Colorectal Cancer Patients

[Background] Nutritional status is strongly associated with prognosis in cancer patients. Controlling Nutritional Status (CONUT) score is a nutritional marker based on serum albumin, cholesterol, and total lymphocyte count. We investigated the prognostic significance of a combination of the tumor marker carcinoembryonic antigen (CEA) and CONUT score (T-CONUT) in colorectal cancer (CRC) patients. [Methods] A total of 522 patients who underwent surgery for CRC at our hospital were retrospectively enrolled in this study. [Results] Patients were divided into groups based on the results of receiver operating characteristic (ROC) curve analysis as follows: CONUThigh (CONUT score ? 3) and CONUTlow (CONUT score < 3), and CEAlow (< 5 ng/mL) and CEAhigh (? 5 ng/mL). The 5-year overall survival (OS) rates of patients in the CONUTlow and CONUThigh groups were 76.0% and 53.9%, respectively (P < 0.0001), and in the CEAlow and CEAhigh groups were 80.7% and 47.6%, respectively (P < 0.0001). Regarding T-CONUT, the 5-year OS rates of patients with CEAlow/CONUTlow, CEAlow/CONUThigh, CEAhigh/CONUTlow, and CEAhigh/CONUThigh were 84.7%, 69%, 55.3%, and 36.1%, respectively (P < 0.0001). Multivariate analysis identified T-CONUT score as an independent prognostic indicator in CRC patients. [Conclusion] T-CONUT may be a useful tool for predicting prognosis in CRC patients

Postoperative Serum Albumin is a Potential Prognostic Factor for Older Patients with Gastric Cancer

【Background】 The incidence of gastric cancer (GC) among older adults is increasing. Therefore, determining postoperative age-associated prognostic factors is clinically important. This study retrospectively investigated the prognostic significance of serum albumin level in older GC patients. 【Methods】 We enrolled 135 patients aged ? 75 years, who underwent gastrectomies with histopathological diagnoses of gastric adenocarcinoma. 【Results】 Preoperative albumin (pre-Alb) levels in patients with advanced GC and stage III/IV GC were significantly lower than those in patients with early GC (P = 0.0032) and stage I/II GC (P = 0.006), respectively. Postoperative albumin (post-Alb) levels (measured 1 month after surgery) in male patients and in patients with advanced GC were significantly lower than those in female patients (P = 0.024) and those with early GC (P = 0.044), respectively. Post-Alb levels of patients who died of other diseases were significantly lower than those who were still living (P = 0.0004). Prognosis of patients with high post-Alb levels (? 4g/dL) was significantly better than that of patients with low post-Alb levels (< 4g/dL; P = 0.045); and in multivariate analysis, post-Alb level was an independent prognostic indicator. 【Conclusion】 Post-Alb level is a useful predictive factor for the prognosis of older GC patients. Postoperative nutritional support might help improve the prognosis of older GC patients