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Aim The National Clinical Database (NCD) of Japan is a nationwide data entry system for surgery, and it marked its 10th anniversary in 2020. The aim was to present the 2020 annual report of gastroenterological surgery of the NCD. Methods The data of the surgical procedures stipulated by the training curriculum for board‐certified surgeons of the Japanese Society of Gastroenterological Surgery in the NCD from 2011 to 2020 were summarized. Results In total, 5 622 845 cases, including 593 088 cases in 2020, were extracted from the NCD. The total number of gastroenterological surgeries increased gradually in these 10 years, except for the year 2020 due to the COVID‐19 pandemic. The annual number of surgeries of each organ, except the pancreas and liver, decreased by 0.4%–13.1% in 2020 compared to 2019. The surgical patients were consistently aging, with more than 20% of all gastroenterological surgeries in 2020 involving patients aged 80 years or older. The participation of board‐certified surgeons increased for each organ (75.9%–95.7% in 2020). The rates of endoscopic surgery also increased constantly. Although the incidences of postoperative complications of each organ increased by 0.7%–7.9% in these 10 years, postoperative mortality rates decreased by 0.2%–1.5%. Conclusions We present here the short‐term outcomes of each gastroenterological operative procedure in 2020. This review of the 10‐years of NCD data of gastroenterological surgery revealed a consistent increase of the number of surgeries (except for in 2020), especially endoscopic procedures, and aging of the Japanese population. The good safety of Japanese gastroenterological surgeries was also indicated. This study presents the annual report on the National Clinical Database 2020 for gastroenterological surgery in Japan. This manuscript revealed a consistent increase of the number of surgeries, especially with endoscopic surgeries, and aging of the Japanese population. Moreover, it indicated the good safety of Japanese gastroenterological surgeries, most of which have been increasingly carried out by the board‐certified surgeons.

Colorectal cancer (CRC) presents a significant challenge in oldest-old patients (≥85 years), where surgical intervention carries substantial perioperative risks. Nutritional status is a crucial determinant of outcomes, and the Geriatric Nutritional Risk Index (GNRI) has shown promise. This prospective study aimed to validate the GNRI as a key indicator of perioperative outcomes in oldest-old patients undergoing CRC surgery, and to establish its utility in preoperative risk stratification. This prospective study enrolled patients aged ≥85 years undergoing elective surgery for CRC. Preoperative GNRI was calculated using the formula: GNRI=14.89×serum albumin (g/dl)+41.7×[actual body weight/ideal body weight (corresponding to body mass index 22)]. Patients were stratified into two groups: GNRI >98 and GNRI ≤98. Baseline demographics, clinical characteristics, geriatric assessments (including Geriatric-8 and EuroQol 5 dimension), and postoperative complication rates were analyzed. Twenty-four patients (median age 88 years, interquartile range=86-91) were included: 11 in the GNRI >98 group and 13 in the GNRI ≤98 group. The patients with GNRI >98 demonstrated significantly better G8 scores (median 12 11, <0.01) and EQ-5D index values (median 88 75.0, <0.01). The postoperative complication rate was significantly higher in the GNRI ≤98 group ( =0.02). Preoperative GNRI effectively identifies oldest-old patients with CRC at increased risk for postoperative complications. A GNRI ≤98 correlates with poorer nutritional status and impaired geriatric functional parameters. These findings highlight GNRI's utility as a simple, valuable tool for preoperative risk stratification, potentially guiding interventions to optimize outcomes in this vulnerable population.

Aim This study aimed to evaluate the association between surgeons certified via the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES) and surgical outcomes of laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR). Methods Japanese National Clinical Database data on the patients undergoing LDG and LLAR between 2014‐2016 were analyzed retrospectively. The proportion of cases performed by ESSQS‐certified surgeons was calculated for each procedure, and clinicopathological factors with or without participation of ESSQS‐certified surgeons as an operator were assessed. Then, effects of operations performed by ESSQS‐certified surgeons on short‐term patient outcomes were analyzed using generalized estimating equations logistic regression analysis. Results There were 110 610 and 65 717 patients who underwent LDG and LLAR, respectively. The operations performed by ESSQS‐certified surgeons in each procedure totaled 28 467 (35.3%) and 12 866 (31.2%), respectively. A multivariable logistic regression model showed that odds ratios of mortality for LDG and LLAR performed by ESSQS‐certified surgeons were 0.774 (95% CI, 0.566‐1.060, P = 0.108) and 0.977 (0.591‐1.301, P = 0.514), respectively. Odds ratios for secondary endpoints of anastomotic leakage in LDG and LLAR performed by ESSQS‐certified surgeons were 0.835 (95% CI, 0.723‐0.964, P = 0.014) and 0.929 (0.860‐1.003, P = 0.059), respectively, whereas that of ileus/bowel obstruction for LLAR performed by ESSQS‐certified surgeons was 1.265 (1.132‐1.415, P < 0.001). There were no significant associations between the two operations performed by ESSQS‐certified surgeons and other factors such as mortality and overall complications. Conclusions ESSQS certification did not affect postoperative mortality following LDG and LLAR, but annual experience of laparoscopic surgery was associated with it. ESSQS certification may contribute to favorable outcomes regarding anastomotic leakage following LDG and LLAR. This study aimed to evaluate the association between surgeons certified via the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES) and surgical outcomes of laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR). The ESSQS contributes to favorable outcomes regarding anastomotic leakage following LDG and LLAR.

Aim The coronavirus disease 2019 (COVID‐19) pandemic greatly impacted medical resources such as cancer screening, diagnosis, and treatment given to people for various diseases. We surveyed the impacts of the pandemic on the incidence of complications and mortality following pancreaticoduodenectomy for pancreatic cancer in Japan. Methods Data on patients who underwent pancreaticoduodenectomy for pancreatic cancer were extracted from the Japanese National Clinical Database (NCD) between 2018 and 2021. The number of the pancreaticoduodenectomy for pancreatic cancer were obtained and then the morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), which is the ratio of the observed number of incidences to the expected number of incidences calculated by the risk calculator previously developed by the NCD. Results This study included 22 255 cases. The number of pancreaticoduodenectomies exhibited an increasing trend even during the COVID‐19 pandemic. The mean observed incidence rates of Grade C pancreatic fistula and Clavien–Dindo grade ≥4 complications, and the 30‐day mortality and surgical mortality rates were 0.8%, 1.8%, 0.8% and 0.9%, respectively. The standardized morbidity ratios did not increase during the COVID‐19 pandemic. The standardized mortality ratios remained within the range of variations observed before the COVID‐19 pandemic. Conclusion The increasing trend in the number of pancreaticoduodenectomies and favorable short‐term outcomes even in the COVID‐19 pandemic suggest the medical care for pancreatic cancer in Japan functioned well during the pandemic. We surveyed the impacts of the COVID‐19 pandemic on the incidence of complications and mortality following pancreaticoduodenectomy for pancreatic cancer by using the Japanese National Clinical Database. This study revealed the increasing trend in the number of pancreaticoduodenectomies and favorable short‐term outcomes even in the COVID‐19 pandemic and suggests the medical care for pancreatic cancer in Japan functioned well even during the pandemic.

Background To explore whether robotic lobectomy (RL) is superior to video‐assisted lobectomy (VAL) in terms of short‐term outcomes in patients with pulmonary neoplasms. Methods From January 30, 2019 to February 28, 2022, a series of consecutive minimally invasive lobectomies were performed for patients with pulmonary neoplasms. Perioperative outcomes such as operation time, blood loss, dissected lymph nodes (LNs), surgical complications, postoperative pain control, length of postoperative stay in hospital, and total cost of hospitalization were compared. Results A total of 336 cases including 173 RLs and 163 VALs were enrolled. Baseline characteristics were comparable between groups. RLs were associated with shorter operation time (median [interquadrant range, IQR], 107 min [90–130] vs. 120 min [100–149], p < 0.001), less blood loss (median [IQR], 50 mL [30–60] vs. 50 mL [50–80], p = 0.02), and lower blood transfusion rate (3.5% vs. 9.8%, p = 0.02) compared with VALs. More LNs were harvested by the robotic approach (median [IQR], 29 [20–41] vs. 22 [15–45], p = 0.04). The incidences of conversion, major postoperative complications, extra analgesic usage, and postoperative length of stay were all comparable between the RL and VAL groups. As predicted, the total cost of hospitalization was greater in the RL group (median [IQR],$16728.35 [15682.16–17872.15] vs. $ 10713.47 [9662.13–11742.15], p < 0.001). Conclusion RL improved surgical efficacy with shortened operative time, less blood loss, and more thorough LN dissection compared with VAL, compromised by higher cost. Robotic lobectomy improved surgical efficacy with shortened operative time, less blood loss, and more thorough lymph node dissection compared with video‐assisted lobectomy, compromised by higher cost.

Aim Previous studies have shown that the volume and short‐term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short‐term outcomes following advanced hepatectomy in Japan during the postpandemic era. Methods Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien–Dindo grade ≥ III), 30‐day and inhospital mortality rates, and failure‐to‐rescue rates were assessed. The standardized morbidity and mortality ratios—calculated as the observed‐to‐expected incidence rates using an NCD‐established risk model for 30‐day mortality, inhospital mortality, and major complications—were also examined. Results A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID‐19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras. Conclusions Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post‐COVID‐19 era, despite a decreasing procedural volume. This national survey using the National Clinical Database in Japan revealed a persistent decline in the number of advanced hepatectomies, even after the COVID‐19 pandemic. Despite this trend, surgical safety was effectively maintained in the postpandemic period using risk‐adjusted metrics.

Objective: Critical covid-19 patients have complications with acute myocardial injury is still unclear. We observed a series of critically ill patients, paying particular attention to the impact of myocardial injury at admission on short-term outcome. Methods: We prospectively collected and analyzed data from a series of severe covid-19 patients confirmed by real-time RT-PCR. Data were obtained from electronic medical records including clinical charts, nursing records, laboratory findings, and chest x-rays were from Feb 8, 2020, to April 7, 2020. The Acute Physiology and Chronic Health Evaluation (APACHE II) score, CURB-65 Pneumonia Severity Score, Sequential Organ Failure Assessment (SOFA) Score and pneumonia severity index (PSI) score were made within 24 hours of admission. Cardiac injury was diagnosed as hs-cTnI were above > 28 pg/mL. The short-term outcome was defined as mortality in hospital. Results: A total of 100 patients met the diagnostic criteria of severe patients with COVID-19 during 2020.02.08– 2020.04.07. The CURB 65, APACH2, SOFA, and PSI score were significantly higher in Critical group than in Severe group. Univariate regression analysis showed that oxygen flow, PO2/FiO2, SOFA and hs-cTnI were closely related to short-term outcome. The corresponding ROC of hs-cTnI, oxygen flow and SOFA for patient death prediction were 0.949, 0.906 and 0.652. hs-cTnI at 47.8 ng/liter predicted death, sensitivity 92.8%, specificity 92.9%; Oxygen flow at 5.5 liter/minute predicted death sensitivity 100%, specificity 77.9%; SOFA score at 5 predicted death sensitivity 100%, specificity 73.8%. Conclusion: Our cohort study demonstrated that inhaled oxygen flow, SOFA score, and myocardial injury at admission in critically ill COVID-19 patients were important indicators for predicting short-term death of patients, the hs-cTnI can be as a risk stratification, which may provide a simple method for the physicians to identify high-risk patients and give reasonable treatment in time.

Abstract Introduction: This study aimed to evaluate the short- and long-term outcomes of single-incision laparoscopic colectomy (SILC) for right-sided colon cancer (CC) using a craniocaudal approach. Patients and Methods: The data of patients who underwent SILC for right-sided CC at our hospital between January 2013 and December 2022 were retrospectively collected. Surgery was performed using a craniocaudal approach. Short- and long-term operative outcomes were analysed. Results: In total, 269 patients (127 men, 142 women; median age 74 years) underwent SILC for right-sided CC. The cases included ileocaecal resection (n = 138) and right hemicolectomy (n = 131). The median operative time was 154 min, and the median operative blood loss was 0 ml. Twenty-seven cases (10.0%) required an additional laparoscopic trocar, and 9 (3.3%) were converted to open surgery. The Clavien-Dindo classification Grade III post-operative complications were detected in 7 (2.6%) cases. SILC was performed by 25 surgeons, including inexperienced surgeons, with a median age of 34 years. The 5-year cancer-specific survival (CSS) was 96.1% (95% confidence interval [CI] 91.3%-98.2%), and CSS per pathological disease stage was 100% for Stages 0-I and II and 86.2% (95% CI 71.3%-93.7%) for Stage III. The 5-year recurrence-free survival (RFS) was 90.6% (95% CI 85.7%-93.9%), and RFS per pathological disease stage was 100% for Stage 0-I, 91.7% (95% CI 80.5%-96.6%) for Stage II and 76.1% (95% CI 63.0%-85.1%) for Stage III. Conclusions: SILC for right-sided CC can be safely performed with a craniocaudal approach, with reasonable short- and long-term outcomes.

Background and purpose: Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are primary treatments for acute ischemic stroke (AIS), but their efficacy is limited. This study aims to evaluate the short‐term predictive value of the neutrophil‐to‐lymphocyte ratio (NLR) in AIS patients undergoing reperfusion therapies. Method AIS patients who underwent IVT and/or EVT at Chengdu Second People's Hospital were continuously enrolled from January 2020 to September 2024. NLR was calculated from blood samples taken before treatment. Primary outcomes were functional status at discharge (assessed using the modified Rankin Scale [mRS]), while secondary outcomes included in‐hospital mortality and any intracranial hemorrhage (ICH). Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis. Results Among 817 patients, 327 (40.0%) exhibited poor functional outcomes at discharge. NLR positively correlated with the National Institutes of Health Stroke Scale score (ρ = 0.298, p < 0.001). Univariate analysis showed a significant association between NLR and poor functional outcomes at discharge, higher in‐hospital mortality, and increased ICH incidence. After adjusting for confounders, NLR remained an independent predictor of functional outcomes (odds ratio 1.092; 95% confidence interval [CI] 1.006–1.185; p = 0.036). ROC analysis showed that NLR could predict functional outcomes with a cutoff value of 3.66 and an area under the curve of 0.679 (95% CI 0.641–0.717, p < 0.001). Conclusions NLR is an independent predictor of short‐term functional outcomes and complications in AIS patients receiving reperfusion therapies, serving as a valuable tool for early prognosis and clinical decision‐making. Elevated neutrophil‐to‐lymphocyte ratio (NLR) independently predicts unfavorable short‐term functional outcomes in acute ischemic stroke patients receiving reperfusion therapy, highlighting its potential as a simple, accessible biomarker for early risk stratification and prognosis evaluation.

Background High body mass index was considered as a risk factor for minimally invasive surgery. The short‐term outcomes of robot‐assisted pancreaticoduodenectomy (RPD) remain controversial. This study aims to investigate the feasibility and advantage of RPD in patients with high body mass index compared to open pancreaticoduodenectomy (OPD). Methods Clinical data of 304 patients who underwent pancreaticoduodenectomy from January 2016 to December 2019 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine was collected. Patients with BMI >25 kg/m2 were included and divided into RPD and OPD group. After PSM at a 1:1 ratio, 75 patients of OPD and 75 patients of RPD were recorded and analyzed. Results The RPD group showed advantages in the estimated blood loss (EBL) (323.3 mL vs. 480.7 mL, p = 0.010), the postoperative abdominal infection rate (24% vs. 44%, p = 0.010), the incidence of Clavien‐Dindo III‐V complications (14.7% vs. 28.0%, p = 0.042) over OPD group. Conclusion RPD shows advantages in less EBL, lower incidence rate of Clavien‐Dindo III‐V complications over OPD in overweight and obese patients. RPD was confirmed as a safe and feasible surgical approach for overweight or obsess patients.