ABSTRACT Aim A novel systemic inflammatory response marker, the neutrophil × monocyte value (NM value), has been identified as a negative predictive factor for responses to chemoradiotherapy in rectal cancer. However, the clinical implications of the NM value remain unknown. Methods This study reviewed 352 patients with rectal cancer who received preoperative chemoradiotherapy between 2003 and 2023. The cut‐off value for the pre‐treatment NM value was established at the median. A pre‐treatment size of lateral lymph node (LLN) ≥ 8 mm was defined as clinical LLN metastasis. The prognostic significance of the NM value was evaluated. Results The cut‐off NM value was 1 100 000; 179 patients had an NM value ≥ 1 100 000. Ninety‐nine patients had LLN ≥ 8 mm. Disease‐free survival (DFS) was significantly shorter in patients with an NM value ≥ 1 100 000 than in those with an NM value < 1 100 000. DFS and overall survival (OS) were shorter in patients with LLN ≥ 8 mm than in those with LLN < 8 mm. The LLN size and NM value were identified as independent prognostic factors for DFS (LLN size—hazard ratio (HR): 1.51, p = 0.04, NM value—HR: 1.53, p = 0.04). Patients with LLN ≥ 8 mm and an NM value ≥ 1 100 000 had the poorest prognosis among the populations compared by the combination of LLN size and NM value. Conclusions The pre‐treatment NM value is an independent prognostic factor associated with DFS. In patients with LLN ≥ 8 mm, a high NM value may be a significant indicator of a poor prognosis.

ABSTRACT Aim Emergency cholecystectomy for acute cholecystitis remains controversial in patients classified as high risk by the Tokyo Guidelines 2018 (TG18), although surgery is often unavoidable in real‐world emergency settings. The perioperative risk profile of this TG18 non‐recommended population remains insufficiently defined. The objective of this study was to examine perioperative outcomes in patients undergoing emergency cholecystectomy against TG18 recommendations, while also exploring clinical factors associated with actual operative risk. Methods This retrospective cohort study included 252 consecutive patients who underwent emergency cholecystectomy for acute cholecystitis between 2018 and 2025. Patients were stratified into TG18 emergency‐surgery‐recommended and non‐recommended groups. Perioperative outcomes were compared, and independent risk factors of major postoperative complications, defined as Clavien‐Dindo grade≥III events, were evaluated. Results Major postoperative complications occurred in 11.9% of patients and were significantly more frequent in the TG18 non‐recommended group than in the recommended group (18.0% vs. 2.9%, p < 0.001). In multivariable analysis, American Society of Anesthesiologists physical status classification ≥ 3 and preoperative shock status were independent predictors of major postoperative complications, whereas age and Charlson Comorbidity Index were not. Exploratory stratification of the non‐recommended cohort demonstrated substantial heterogeneity in risk, with comparatively low complication rates observed in patients without physiological instability. Conclusion Emergency cholecystectomy may be feasible in carefully selected TG18 non‐recommended patients. Perioperative risk appears to be driven by physiological instability rather than chronological age or comorbidity burden, supporting a more individualized approach to surgical decision‐making.

ABSTRACT Aim Clinical benefits of robot‐assisted colectomy over laparoscopic colectomy for colon cancer remain uncertain, and real‐world data are limited. We evaluated the short‐term outcomes of robot‐assisted colectomy versus laparoscopic colectomy in patients with colon cancer. Methods This single‐center, retrospective cohort study evaluated patients who underwent minimally invasive colectomies for colon cancer at Osaka General Medical Center from January 2014 to November 2024. Short‐term outcomes were compared after 1:1 propensity score matching to minimize confounding by indication. Results In total, 480 patients underwent laparoscopic colectomies and 282 underwent robot‐assisted colectomies, with 218 matched pairs. Baseline characteristics were well‐balanced. Surgical procedure distribution was similar between the groups ( P = 0.897). Mean operative times were significantly longer (212 vs. 200 min, P = 0.040), mean intraoperative blood loss was significantly lower (22.8 vs. 37.5 mL, P < 0.001), rates of conversion to open surgery were significantly lower (0.0% vs. 2.3%, P = 0.026), and mean hospital stays were significantly shorter (7.0 vs. 11.3 d, P < 0.001) in the robot‐assisted colectomy group. The number of lymph node dissections ( P = 0.27) and local R0 resection rates ( P = 0.34) were comparable. Overall complication rates were significantly lower in the robot‐assisted colectomies (11.0% vs. 17.9%, P = 0.007), whereas clinically meaningful complication rates (Clavien–Dindo grades ≥ II) were comparable ( P = 0.150). Conclusions These findings provide real‐world data supporting the feasibility of robot‐assisted colectomy for colon cancer treatment. Further research should evaluate the long‐term oncologic outcomes and cost‐effectiveness.

ABSTRACT Background Retroperitoneal tumors (RPTs) are rare and anatomically complex neoplasms, for which surgery remains the mainstay of treatment. However, real‐world data on their surgical management in Japan have been limited. Objective To describe the clinical characteristics and short‐term outcomes of patients undergoing resection for RPTs in Japan, based on data from gastroenterological surgical practice. Methods This study analyzed data from the Japanese National Clinical Database (NCD) for gastroenterological surgery. A total of 4948 patients with RPT who underwent surgery between 2019 and 2021 were included. Results There were 2360 men (47.7%) and 2588 women (52.3%), with a median age of 66 years. RPTs were histologically classified as malignant in 75.3% and benign in 24.7% of cases. The median operative time was 205 min, and the median blood loss was 150 mL. Postoperative complications occurred in 23.9% of patients, with 7.5% experiencing severe complications (Clavien–Dindo grade III or higher). The 30 day postoperative mortality rate was 0.5%, and the perioperative mortality rate was 1.0%. Conclusion This analysis demonstrates that a substantial number (approximately 1650 per year) of RPTs surgeries are performed annually by gastrointestinal surgeons in Japan, and that the short‐term surgical outcomes are acceptable. These data provide an important reference to exhibit the current surgical practice in Japan and to develop future strategies for RPTs.

ABSTRACT Background Gemcitabine plus cisplatin (GC) has been the global standard for advanced biliary tract cancer (BTC). The triplet regimen gemcitabine–cisplatin–S‐1 (GCS) demonstrated superiority in the MITSUBA trial, but its real‐world effectiveness remains unclear. We compared survival outcomes of GCS versus GC, focusing on conversion surgery (CS). Methods We retrospectively analyzed 542 patients with unresectable BTC treated between 2017 and 2024 at 19 Japanese institutions. Patients received GC ( n = 310) or GCS ( n = 232). Survival was evaluated using multivariable Cox regression, 90‐day landmark analysis, and propensity score matching (PSM) to adjust for baseline imbalances. Results Patients treated with GCS achieved greater tumor shrinkage (median −23.0% vs. –10.0%, p = 0.014) and a higher CS rate (16.4% vs. 4.5%, p < 0.001) than GC. Median progression‐free survival was 8.6 versus 5.4 months ( p = 0.002), and median overall survival (OS) was 17.2 versus 11.6 months ( p = 0.006). In multivariable analysis, GCS was associated with a lower risk of death (HR 0.80, 95% CI 0.65–0.98, p = 0.035), with consistent results after PSM. Fifty‐two patients underwent CS, with comparable perioperative safety and R0 resection rates between regimens. Patients who underwent CS achieved markedly longer OS; in the overall cohort, median OS was 31.0 months in the GCS with CS group and not reached in the GC with CS group ( p = 0.131). Conclusions Treatment with GCS was associated with longer survival compared with GC in unresectable BTC, alongside a higher rate of conversion surgery, which was associated with favorable long‐term outcomes.

ABSTRACT Background Determining whether to resect disappearing liver metastases (DLMs) after chemotherapy for colorectal liver metastases (CRLMs) remains challenging. Methods Patients who underwent hepatectomy after systemic chemotherapy for initially unresectable CRLMs were reviewed. True complete response (CR) was defined as either resected DLMs with pathological CR or unresected DLMs without local recurrence. Long‐term outcomes were compared between patients with and without resection of all DLMs. Results Among 58 patients, 26 (44.8%) had DLMs, totaling 106 lesions. True CR was achieved in 70.8% of DLM lesions. Long‐term outcomes did not differ between patients with and without resection of all DLMs (median recurrence‐free survival, 11.1 vs. 7.6 months, p = 0.594; median surgical failure‐free survival, 11.1 vs. 17.2 months, p = 0.758; median overall survival, 43.6 vs. 53.6 months, p = 0.819). DLM lesions with true CR had smaller initial diameters than those without true CR (5 vs. 9 mm, p = 0.013). Conclusion Regardless of whether all DLMs were resected, patients had acceptable long‐term outcomes. DLM lesions with a larger initial diameter before chemotherapy may warrant proactive intraoperative exploration for residual disease using contrast‐enhanced ultrasonography.

ABSTRACT Aim Post‐liver transplant (LT) alcohol relapse complicates long‐term outcomes and organ allocation. The traditional “six‐month abstinence rule” remains widely used, but relapse risk is also shaped by psychosocial, socioeconomic, and psychiatric factors. We examined the impact of pre‐LT abstinence duration on post‐LT alcohol relapse and developed a multivariable risk model integrating abstinence, psychosocial assessment, and socioeconomic status. Methods In this single‐center retrospective study, 383 adults undergoing LT for alcohol‐related liver disease were included. Results Any post‐LT alcohol relapse occurred in 20.9% ( n = 80). Relapse phenotypes were non‐mutually exclusive: sustained alcohol use (77.5%), harmful drinking (68.8%), and recurrent ALD (46.3%). On multivariable analysis, shorter pre‐LT abstinence, higher Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores, and higher educational attainment were independently associated with relapse. Each additional month of abstinence reduced relapse odds by 4%, whereas each one‐point increase in SIPAT increased relapse odds by 3%. Cumulative risk curves demonstrated a non‐linear relationship between abstinence duration and relapse, with risk peaking around 9 months and declining thereafter across all relapse phenotypes. A prediction model combining abstinence duration, SIPAT score, and education achieved an area under the receiver operating characteristic curve (AUC) of 0.70, with consistent performance on fivefold cross‐validation. Conclusion These findings support a multifactorial approach to relapse risk stratification that goes beyond a fixed 6‐month abstinence rule. Incorporating abstinence duration together with structured psychosocial assessment and education level may better inform both transplant listing decisions and the intensity of post‐LT addiction care for patients.

ABSTRACT Esophageal cancer surgery is evolving from technical standardization to a paradigm of personalized, strategy‐oriented care. Robotic‐assisted techniques and enhanced perioperative protocols have improved safety, but the field is increasingly shaped by three forces: integration of immune checkpoint inhibitors (ICIs), population aging, and the rise of intelligent technologies such as artificial intelligence (AI) and extended reality. Adjuvant nivolumab after neoadjuvant chemoradiotherapy (nCRT) remains the standard for residual disease, while other regimens such as durvalumab or dual checkpoint blockade have not demonstrated consistent survival benefit. Neoadjuvant ICI strategies, particularly camrelizumab plus chemotherapy in esophageal squamous cell cancer (ESCC), achieve high pathological response rates without increasing surgical morbidity, and pooled analyses confirm their feasibility. Immune‐related adverse events (irAEs) occur in approximately 20%–35% of patients but are usually manageable. Perioperative outcomes remain comparable to conventional regimens. Elderly and frail patients require individualized optimization. The integration of minimally invasive techniques, assessment of sarcopenia and nutritional risk, and adjustment of chemotherapy intensity have contributed to improved outcomes. Moreover, salvage surgery—once prohibitive—now offers meaningful long‐term survival when performed in high‐volume centers with specialized expertise. AI and machine learning are transforming risk stratification, intraoperative guidance, and surgical training. AI‐assisted video analytics and VR/AR simulators enhance skill acquisition, credentialing, and standardization. Future progress will depend on multicenter validation, prospective registries, and integration of oncologic, physiologic, and technological variables. Ultimately, the future of esophageal cancer surgery will be defined not only by technical precision but also by the surgeon's ability to leverage data‐driven innovation for personalized care.