Open Resection Research Articles

Effect of Laminectomy Methods on the Surgical Safety of Automatic Laminectomy Robot.

The efficacy of laminectomy procedures is contingent on the method of resection. The objective of this study was to investigate the impact of different methods of resection on the surgical safety of automated laminectomy robots, an area that remains uncharted. Lamina resection surgeries using both drilling and layer-by-layer methods, are performed on ovine spinal samples. An analysis of the force and lateral deviation at the end of the robotic arm is conducted. For the drilling and layer-by-layer lamina resection methods, the average peak force for the drilling method is 1.21N, and deviations are within 1mm. For the layer-by-layer resection method, the peak force reaches 2.39N, and deviations are within 1.6mm. During the drilling resection, the ultrasonic osteotome experiences less force and minimal lateral deviation. This method demonstrates higher precision and safety in laminar resection surgeries. The drilling method should be the primary choice for robot manufacturers.

Long-term follow-up of the randomized trial on open versus laparoscopic surgery for primary tumor resection in patients with non-curable stage IV colon cancer (JCOG1107).

55 Background: The Japan Clinical Oncology Group (JCOG) 1107 (UMIN-CTR: UMIN000009715) was a non-inferiority phase III trial to compare laparoscopic surgery (LAP) with open surgery (OP) for symptomatic, non-curable stage IV colon cancer, using progression-free survival (PFS) as the primary endpoint based on the intention-to-treat principle. The planned primary analysis confirmed the non-inferiority of the LAP over the OP. Additionally, the present study aimed to compare the LAP and OP using long-term 3-year follow-up data from the JCOG1107. Methods: Eligibility criteria included pathologically proven adenocarcinoma or adenosquamous carcinoma; primary tumor located at the cecum, ascending, transverse, descending, sigmoid, and rectosigmoid colon; primary tumor with bowel stenosis and/or bleeding; and having at least one to three non-curable factors. The sample size was 194 with a power of 70%, one-sided alpha of 5%, and non-inferiority margin of the hazard ratio (HR) of 1.38. Results: In total, 195 patients were randomized (OP 95, LAP 100) between January 2013 and January 2021. OP was performed in 92 and LAP in 98 patients. Postoperative chemotherapy was administered in 82 OP and 86 LAP patients. As the data cut-off date of Feb 2024, 93 (98%) and 100 (100%) PFS event occurred in OP and LAP. The 3-year PFS were 5.3% (95% CI, 2.0-11.0) and 3.0% (0.8-7.8) for OP and LAP arms, respectively (HR: 1.028, 95% confidence interval [CI]: 0.772–1.370; P for non-inferiority = 0.0222). Regarding OS, 87 (92%) and 90 (90%) death occurred in OP and LAP. The 3-year OS were 31.5% (22.5-41.0) and 28.5% (20.0-37.6) for OP and LAP arms, respectively (HR: 1.048; 95% CI: 0.780–1.410). Conclusions: Long-term follow-up data supported the non-inferiority of LAP over OP for primary tumor resection in patients with non-curable stage IV colon cancer. Our study findings indicate that LAP is acceptable as a standard treatment for symptomatic, non-curable stage IV colon cancer. Clinical trial information: UMIN000009715 .

Chitosan-based thermosensitive injectable hydrogel with hemostatic and antibacterial activity for preventing breast cancer postoperative recurrence and metastasis via chemo-photothermal therapy.

Primary resection surgery is a conventional approach in breast cancer treatment, which plays a pivotal role in the prevention of recurrence and metastasis. In this study, an injectable hydrogel comprising chitosan (CS), β-glycerophosphate (β-GP), and dopamine (DA) with near-infrared (NIR) photothermal attributes was developed. The composite hydrogels integrate doxorubicin (DOX), termed DCGD, and can be used for chemotherapy, synergistic photothermal therapy, anti-bacterial and hemostasis. Local administration of injectable DCGD hydrogels into breast cancer resection cavities could prevent the postoperative breast cancer recurrence and metastasis via chemo-photothermal therapy. Additionally, the remarkable hemostatic and anti-bacterial properties of DCGD facilitated postoperative wound healing. Notably, the DCGD hydrogel had a dual pH- and photothermal-responsive DOX release profile, ensuring sustained drug release to residual tumor tissues triggered by NIR laser irradiation and the acidic tumor microenvironment. Histological analyses including H&E, TUNEL, and Ki67 immunohistochemistry confirmed the potent anti-recurrent and anti-metastatic efficacy of DCGD hydrogels. Therefore, the DCDG hydrogels developed in our study had the favorable hemostatic, anti-bacterial, photothermal and drug-loading effects, which provided a new strategy for postoperative breast cancer recurrence and metastasis treatment.

Surgical treatment results for oligo-recurrence of gastric cancer.

462 Background: Despite advancements in diverse treatments, approximately 40-50% of advance gastric cancer patients experience recurrence even after curative resection surgery. The condition where there is a limited recurrence after the control of the primary tumor site is referred to as oligo-recurrence. However, there is scarce reporting on oligo-recurrence after gastric cancer surgery. This study compiled cases of patients who underwent surgery for recurrent gastric cancer after R0 surgery. Since there are no specific treatment guidelines for recurrence after gastric cancer surgery, this research could be beneficial in providing insights and assistance. Methods: This retrospective study includes data from 25 patients who underwent surgery for suspected oligo-recurrence of gastric cancer among those who had undergone surgery from June 2008 to May 2018. If a solitary mass suspected of recurrence is identified during surveillance, a PET-CT is performed. Patients with suspicion of peritoneal dissemination, carefully excluded through a multidisciplinary approach, are selectively omitted. All patients undergo excision surgery for both treatment and tissue examination purposes. Results: Out of 25 cases, there were 6 cases of paraaortic lymph node enlargement, 9 cases liver nodules, 8 case lung nodules, and 1 case tumor bed mass. In the postoperative tissue analysis, 4 cases of paraaortic lymph node enlargement, 5 cases of the liver nodules, and 1case tumor bed mass were confirmed to be recurrences of gastric cancer. All of lung nodule were diagnosed with lung cancer. All 10 cases underwent chemotherapy after metastatectomy. Among them, 3 cases experienced recurrence and died an average of 12.3 months after surgery. Seven cases did not experience recurrence and have survived with an average survival time of 102 months to date. Conclusions: The metastatectomy is safe and effective for patients with oligo-recurrence from GC and can improve their prognosis. For an accurate diagnosis, oligometastectomy is essential. However, our results need to be confirmed by more randomized controlled clinical studies. Treatment result after metastatectomy. Case Diagnosis Chemotherapy aftermetastatectomy Recurence after metastatectomy DFS after metastatectomy OS after metastatectomy OS after gastrectomy Status 1 LN metastasis 1/1 15cycles FOLFOX 147 147 156.4 ALIVE 2 LN metastasis 1/1 37cycles TAS-118 liver metastasis 22 40.6 74.9 DEATH 3 LN metastasis 1/3 12cycles FOLFOX 98.1 98.1 125.5 ALIVE 4 LN metastasis 1/1 35cycles FOLFOX 50.9 50.9 71.3 ALIVE 5 Liver metastasis ONO tiral Liver, bone mets. 3.73 27.9 64.6 DEATH 6 Liver metastasis 12cycles FOLFOX 68.3 68.3 122.2 ALIVE 7 Liver metastasis 12cycles FOLFOX 96 96 105.8 ALIVE 8 Liver metastasis 82cycles FOLFOX 55 55 77.4 ALIVE 9 Liver metastasis 12cycles FOLFOX 94.4 94.4 103.9 ALIVE 10 Tumor bed 12cycles FOLFOX 9 25.5 24.4 DEATH

The effect of the type of anaesthesia on long-term outcomes after cancer resection surgery: a narrative review.

The peri-operative period may create a biological environment conducive to cancer cell survival and dissemination. Microscopic residual tumours (micrometastases) can be dislodged even with excellent surgical technique. At the same time, the stress response from surgery can temporarily impair immune function and activate inflammatory processes, increasing the risk of tumour proliferation. This narrative review investigates how peri-operative anaesthetic and analgesic interventions may influence cancer recurrence and metastasis by exploring evidence from both experimental and clinical studies. A comprehensive review of the literature was conducted to identify relevant preclinical and clinical studies published. While surgery remains the best curative option for many cancers, metastasis remains the leading cause of death. Numerous studies have suggested that different anaesthetic drugs and techniques could impact cancer outcomes including volatile anaesthetic agents; total intravenous anaesthesia with propofol; local anaesthetics; regional anaesthesia; and opioids. This review focuses on these five commonly used anaesthetic approaches and evaluates their potential impact on cancer progression. There is a complex interplay between anaesthetic and analgesic techniques and cancer outcomes. Despite promising data from laboratory experimental models, the balance of available clinical trials indicates an equivalent influence of all evaluated anaesthetic techniques on long-term oncologic outcomes, except, possibly, for peritumoral or intraperitoneal local anaesthetic infiltration.

Comparison of textbook outcomes between laparoscopic and open liver resection for patients with hepatocellular carcinoma: a multicenter study.

We aimed to clarify whether laparoscopic liver resection (LLR) is better than open liver resection (OLR) concerning textbook outcome (TO) achievement for patients with hepatocellular carcinoma (HCC). Data from HCC patients who underwent liver resection from a multicenter database were retrospectively reviewed (n = 2617). Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. Logistic regression analysis was performed to identify the risk factors that are independently associated with TO. Before PSM, more aggressive biological characteristics were observed in patients who underwent OLR. After PSM, 771 patients in each group were matched. The overall rate of TO achievement in patients with LLR (78.2%) was higher than that in patients with OLR (71.7%; P < 0.001) after PSM. Subgroup analysis further revealed that LLR was associated with a greater incidence of TO achievement than OLR was in patients who underwent minor liver resection (after PSM; LLR: 83.8% vs. OLR: 73.0%, respectively; P < 0.001) but was similar in those who underwent major liver resection (after PSM; LLR: 68.8% vs. OLR: 65.7%; P = 0.468). Multivariate logistic regression analysis suggested that the LLR (OR = 0.471, 95% CI 95% CI = 0.361-0.614, P < 0.001) was an independent protective factor against non-TO in patients who underwent minor liver resection but not in those who underwent major liver resection. After PSM, the 5-year overall survival (OS) rates of patients who underwent OLR (74.6%) and LLR (73.9%) were similar (P = 0.485). Patients with TO had significantly better OS than those without TO, regardless of whether they underwent LLR (TO: 76.5% vs. non-TO: 65.7%, P = 0.005) or OLR (TO: 76.8% vs. non-TO: 69.1%, P = 0.042). LLR favored TO achievement in HCC patients who received minor liver resection but not in those who underwent major liver resection. Patients who achieved TO had better OS regardless of LLR or OLR.

Giant hemorrhagic omental cyst mimicking ascites in an 8-month-old infant: a case report

Introduction: Omental cysts are rare congenital lymphatic lesions in children, presenting as a palpable mass, abdominal distension, or acute abdomen. Complications include hemorrhage, rupture, and torsion. Diagnosis is challenging due to nonspecific symptoms, often requiring imaging. Surgical excision is the definitive treatment. This case highlights a unique presentation of a large hemorrhagic cyst, initially misdiagnosed as ascites. Case presentation: An 8-month-old male presented with irritability for 1 week, abdominal distension, poor feeding, and no stools for 3 days. Examination revealed fever, tachycardia, pale appearance, and distended abdomen with shifting dullness. Investigations showed severe anemia, leukocytosis, and complex ascites on imaging. Surgical exploration identified a 25 × 15 cm hemorrhagic omental cyst, resected alongside herniotomy for a left inguinal hernia. Histopathology confirmed cystic lymphangioma. Recovery was uneventful, with normal follow-up ultrasound at 6 months. Discussion: Omental cysts, rare in children, arise from ectopic lymphatic tissue and present variably as abdominal distension, pain, or intestinal obstruction. Misdiagnosed as ascites in this case, imaging often identifies cystic masses, though definitive diagnosis can be challenging. This infant’s severe anemia was unusual, requiring pre- and postoperative transfusions. Treatment typically involves complete excision; here, open resection was chosen due to the cyst’s size and hemorrhagic nature. This case underscores diagnostic challenges and emphasizes tailored management for rare abdominal cysts in children. Conclusion: This case highlights the diagnostic challenges of omental cysts in pediatric patients with atypical presentations. It underscores the importance of considering rare entities like omental cysts in acute abdomen cases and utilizing comprehensive diagnostic and surgical approaches.

Roles of anoikis in hepatocellular carcinoma: mechanisms and therapeutic potential.

Hepatocellular carcinoma (HCC), the most common primary liver cancer, is a highly aggressive malignancy with limited viable therapeutic options. For early HCC, resection surgery is currently the most effective treatment. However, in advanced stages, resection alone does not sufficiently address the disease, so finding a method with a better prognosis is necessary.Anoikis, known as matrix detachment-induced apoptosis or detachment-induced cell death, is crucial for tissue development and homeostasis. Cancer cells develop means to evade anoikis, e.g. anoikis resistance, thereby allowing for cells to survive under anchorage-independent conditions. HCC cells often acquire resistance to anoikis, allowing them to survive after detaching from the extracellular matrix and contributing to tumor spread. This review discusses the mechanisms of anoikis in HCC, exploring the potential of drug-induced anoikis and targeting anoikis resistance as promising therapeutic strategies for treating HCC, analyzing the value of anoikis in the immune of HCC, and propose potential pathways in oncotherapy, which can provide background knowledge for subsequent related research.

Immediate postoperative cardiac tamponade following robotic lung resection surgery: a case report

Immediate postoperative cardiac tamponade following robotic lung resection surgery: a case report

Association between surgery and increased survival in primary central nervous system lymphoma: a retrospective cohort study

This study investigated the effect of surgery on the prognosis of patients with primary central nervous system lymphoma (PCNSL) using data from the surveillance, epidemiology, and end results (SEER) database. A cohort of 5932 patients was analyzed, with 1466 undergoing surgical intervention (780 subtotal resection (STR), 686 gross total resection (GTR)) and 4466 receiving no surgery or biopsy only. The median age of the study population was 61.5 years. The median survival was 24.0 months for STR, 30.0 months for GTR, and 18.0 months for non-surgical patients (P < 0.001). Multivariate Cox regression analyses showed that the adjusted hazard ratio (HR) for STR was 0.77 (95% CI 0.70–0.85, P < 0.001) for overall survival (OS) and 0.74 (95% CI 0.66–0.83, P < 0.001) for cancer-specific survival (CSS). For GTR, the adjusted HR was 0.73 (95% CI 0.65–0.80, P < 0.001) for OS and 0.73 (95% CI 0.65–0.82, P < 0.001) for CSS. These results remained robust even after subgroup analyses, sensitivity analyses and propensity score matching (PSM). No significant interactions were observed in any subgroup. These findings indicate that surgery may improve the survival of patients with PCNSL, though further research is needed to confirm these findings. A key limitation is the inability to stratify patients by performance status and lesion number, critical for assessing resective surgery suitability.

Comparing Operative Outcomes and Resection Quality in Robotic vs Open Pancreaticoduodenectomy: A Meta-analysis of 54,000 Patients.

High morbidity and mortality make pancreaticoduodenectomy (PD) one of the most complicated surgical procedures. This meta-analysis aimed to compare the outcomes of robotic pancreaticoduodenectomy (RPD) versus open pancreaticoduodenectomy (OPD). A comprehensive literature search of PubMed, Cochrane Central, and Google Scholar was conducted from inception to November 2024. Studies comparing RPD and OPD in adults aged ≥ 18years were included. Data for the outcomes of interest were extracted. Forty-one studies with a total of 54,287 patients were pooled. RPD is significantly superior to OPD in terms of overall postoperative complications (RR = 0.91, 95% CI: [0.86-0.97]; p = 0.001), wound infections (RR = 0.63, 95% CI: [0.49-0.81], p = 0.0004), estimated blood loss (WMD = -171.99ml, 95% CI: [ -217.76 to -126.22], p < 0.01) and hospitalization duration (WMD = -1.33days, 95% CI: [ -1.84 to -0.82], p < 0.01) with a longer operating time (WMD = 73.22min, 95% CI: [56.20 to 90.23], p < 0.01). In conclusion, RPD shows a lower risk of wound infections and overall postoperative morbidity compared to OPD. It has lower estimated blood loss, shorter hospitalization duration, and a longer operating time. The two approaches were comparable in terms of resection quality. More high-quality RCTs are required to draw definite conclusions.

Meckel's Diverticulum-Induced Intussusception Coinciding with Diabetes Mellitus in a Young Adult Male

Introduction: Intussusception in adults, especially when caused by Meckel's Diverticulum, is a rare occurrence, often presenting with nonspecific symptoms such as abdominal pain and nausea, making it challenging to diagnose. When concurrent with conditions like diabetes mellitus, the situation need particular care. Case Illustration: A 27-year-old male with a medical history of diabetes presented with severe right abdominal pain, nausea, and a reduced appetite. Initial symptomatic treatment did not alleviate the condition. Subsequent CT scans revealed an ileo-ileal intussusception triggered by Meckel's Diverticulum and partial high obstruction ileus, leading to surgical intervention. Discussion: Ileo-ileal resection (end to end anastomosis) and adhesiolysis surgery were successfully performed, followed by vigilant postoperative monitoring for complications, effective pain management, maintenance of drain patency, and careful glucose level monitoring. The patient's significant postoperative improvement underscores the importance of early diagnosis and timely surgical intervention in managing Meckel's Diverticulum-induced intussusception in adults. Conclusion: The clinical course also highlighted the importance of tailoring postoperative care considering the patient's comorbidities, in this case, diabetes mellitus. This case served as a reminder for clinicians to consider Meckel's Diverticulum as a potential cause of intussusception in adults presenting with abdominal pain.

The impact of resective epilepsy surgery on the brain network: evidence from post-surgical imaging.

Resective epilepsy surgery can be an effective treatment for patients with medication-resistant focal epilepsy. Epilepsy resection consists of the surgical removal of an epileptic focus to stop seizure generation and disrupt the epileptic network. However, even focal surgical resections for epilepsy lead to widespread brain network changes. Understanding the impact of epilepsy surgery on the brain is crucial to improve surgical outcomes for patients. Here we provide a summary of studies imaging the postsurgical effects of epilepsy resection on the brain. We focus on MRI and PET studies of temporal lobe and pediatric epilepsy, reflecting the current literature. We discuss three potential mechanisms for surgery-induced brain changes: damage and degeneration, recovery, and reorganization. We additionally review the postsurgical brain correlates of surgical outcomes as well as the potential to predict the impact of surgery on an individual patient's brain. A comprehensive characterization of the impact of surgery on the brain and precise methods to predict these brain network changes could lead to more personalized surgeries that improve seizure outcomes and reduce neuropsychological deficits after surgery.

Clinical Characteristics and Influencing Factors of Feeding Intolerance After Surgery for Neonatal Necrotizing Enterocolitis

Background: Feeding intolerance (FI) following surgery for neonatal necrotizing enterocolitis (NEC) can impact recovery and prognosis, making the early identification of FI risk essential for optimizing management and improving outcomes. Methods: We retrospectively collected data from patients who underwent surgery for NEC between January 2013 and December 2023. Multivariate binary logistic regression was performed to identify independent factors influencing postoperative feeding intolerance. Results: Of the 519 infants enrolled in this retrospective study, 155 (29.9%) were diagnosed with feeding intolerance, while 364 (70.1%) were identified as having feeding tolerance. Compared to infants with feeding tolerance, those with feeding intolerance had lower birth weight, smaller gestational age, and lower Apgar scores (all p &lt; 0.01). A 5 min Apgar &lt; 7 (OR 4.794; 95%CI 1.339–17.156), the interval between diagnosis and surgery (OR 0.973; 95%CI 0.947–1.000), and primary anastomosis resection (OR 0.278, 95%CI 0.139–0.555) were identified as significant factors influencing postoperative feeding intolerance. The results remained consistent after performing propensity score matching analysis. Feeding intolerance may result in prolonged hospital stays, and more complications such as retinopathy of prematurity, intestinal failure-associated liver disease, and intraventricular hemorrhage. Conclusions: A lower 5 min Apgar score, shorter interval from diagnosis to surgery and intestine resection with ostomy are associated with a higher incidence of FI after surgery. FI after NEC surgery can prolong recovery and increase family burden.

Clinical cases of the use of ESPB as a component of combined anesthesia in patients with liver resection operations

This scientific work is devoted to the topical and applied issue of modern anesthesiology – intensive care – rational anesthesia of laparoscopic liver resections. The transformation of surgical access from «open» to minimally invasive – laparoscopic and robot–assisted – encourages anesthesiologists to search for new methods of prolonged postoperative analgesia. The tendency of modern anesthesiology to limit the use of opioids and the popularization of ultrasound technologies expand the scope of application of myofascial blockades in various fields of surgery. The techniques are safe and effective and can be implemented in various groups of patients, in particular in those who has contraindications to neuroaxial block. Currently, the most commonly used method of anesthetic provision is combined anesthesia –general anesthesia and epidural analgesia. It should be remembered about the features of surgical interventions on the liver and the associated risk of developing massive blood loss syndrome, which increases the frequency of post-operative, primarily hemorrhagic complications, after the use of neuroaxial techniques of prolonged analgesia. The sympatholytic effect of local anesthetics with prolonged epidural infusion is well known, in some cases provoking hemodynamic instability, and, as a result, the need for monitoring the patient in the intensive care unit, as well as increasing the length of hospital stay in general. This circumstance contradicts the trend of modern surgery towards rapid and accelerated recovery after surgery. The above together is economically unprofitable and does not meet the requirements of modern protocols. An in-depth analysis of clinical practice led the authors to the idea of using myofascial blocks (in particular, erector spinae plane block), which have positive qualities of neuroaxial techniques, but are characterized by a better safety profile.

P0746 Impact of timing of prophylaxis therapy on post-operative endoscopic recurrence in a real-life cohort of patients whit Crohn’s disease

Abstract Background The optimal timing for initiating biologic therapy after resection surgery (SR) in Crohn's disease (CD) has not been established, and the impact of a delayed start remains unclear, particularly outside the context of clinical trials. Methods Our study aims to assess the impact of the timing of prophylactic biologic therapy initiation on endoscopic recurrence after resection surgery in CD, and to compare prophylactic treatment strategies used in patients already on biological therapy before SR. We conducted a retrospective study evaluating endoscopic outcomes of CD patients who underwent ileo-colonic resection. All patients underwent their first endoscopic evaluation within 6-12 months after surgery to assess POR, using the Rutgeerts score (POR defined as Rutgeerts ≥ 2). All patients received biological therapy for recurrence prevention within 16 weeks after surgery. Results We included 173 patients. Prophylactic biologic therapy was administered to all patients, with initiation within 8 weeks, 8-12 weeks, and 12-16 weeks in 45%, 19%, and 36% of patients, respectively. POR was observed in 50% of the entire cohort. Comparing the timing of prophylaxis therapy initiation in univariate analysis (&amp;lt;8, 8-12, &amp;gt;12 weeks), both initiation &amp;lt;8 and initiation between 8-12 weeks had a significantly lower recurrence rate than initiation &amp;gt;12 weeks (p= 0.004, OR 0.37, 0.18, 0.73, 95% CI and p=0.039, OR 0.40, 0.16, 0.95, 95% CI respectively. Furthermore, for patients already on biologic therapy prior to SR (103), therapy was either maintained unchanged, switched, or swapped in 54%, 18%, and 28% of patients, respectively. We noted that the therapeutic swap was significantly worse (p=0.0009, OR 3.65, 1.42, 10. 1 95%CI) compared with continuation of the same therapy. There was no difference between continuation of the same therapy and treatment switch. In the cohort of patients who were already on biologic therapy prior to SR, when considering treatment strategy, timing of therapy in the multivariate analysis, the swap showed significantly higher POR than maintaining the same therapy and the switch. (OR 3.42, 1.20, 10.5 95% CI, p=0.025) while therapy timing was not significant. All the groups were homogeneous in characteristics and post-operative complications. Conclusion Prophylaxis administered within 12 weeks after resection correlates with a reduced risk of post-operative recurrence. For patients already on biological therapy before the SR, the prophylaxis strategy had a significant impact on POR.

P0537 Prognostic significance of anastomotic lesions in post-operative Crohn’s disease

Abstract Background Endoscopic evaluation (assessed with the Rutgeerts score, RS) offers prognostic information in the postoperative management of Crohn’s disease (CD). The significance of anastomotic lesions (AL) remains unclear. Two scores have been introduced: the POCER index1 (PI), including circumferential extent and depth of anastomotic ulcers, and the UEDA et al score2 (US), classifying 4 categories of lesions at the anastomosis and peri-anastomosis site. This study aims to evaluate the predictive value of PI and the US in a real- life cohort. Methods We conducted a retrospective study including CD patients undergoing ileo-colonic resection. All patients underwent first endoscopic evaluation within 6-12 months to assess endoscopic recurrence (ER), measured with RS, PI and US. ER was defined as RS ≥ 2, PI ≥ 2 or US ≥ intermediate. Clinical recurrence (CR) was assessed at 18-24 months using the HBI. A second endoscopy at 18-24 months was available for a subgroup of patients. Results We included 177 patients, 75% of them with no previous history of surgery. All patients had underwent prophylactic therapy with biologics. At 6-12 months, ER was observed in 91 (51%), 35 (20%) and 51 (28%) of patients, according to RS, PI and US, respectively. CR was observed in 34 patients (18.6%). Among 98 pts (55%) with a second endoscopy, ER was present in 45 pts (45%). Looking the predictive value for CR, a RS ≥2 showed an AUROC of 0.74 (sensitivity 82.7%, specificity 56.9%); PI ≥2 an AUROC of 0.613 (sensitivity 31%, specificity 82.5%) and US ≥ intermediate an AUROC of 0.668 (sensitivity 50%, specificity 74.6%). About ER, a RS ≥2 showed an AUROC of 0.77 (sensitivity 70.9%, specificity 79.07%), a PI≥2 with an AUROC of 0.65 (sensitivity 38.18%, specificity 93.02%) and US an AUROC of 0.74 (sensitivity 49.06%, specificity 93.03%). We performed a subgroup analysis among 108 patients with exclusively AL. For CR, the RS&amp;gt;=2 showed an AUROC of 0.67 (sensitivity 58%, specificity 74%). A PI &amp;gt;=2 predicted CR with an AUROC of 0.66 (sensitivity of 25%, specificity of 92%), while the US with an AUROC of 0.63 (sensitivity of 16%, specificity of 93.4%). Regarding ER, RS&amp;gt;=2 showed an AUROC of 0.667 (sensitivity 45%, specificity 89%), PI an AUROC of 0.63 (sensitivity 20%, specificity 97%) and the US&amp;gt;= intermediate an AUROC of 0.65 (sensitivity 16%, specificity 100%). Conclusion Grading the anastomotic lesions with specific scores seems to improve the prognostic value of the early endoscopic assessment after resection surgery. References 1)De Cruz P, Hamilton AL, Burrell KJ, Gorelik A, Liew D, Kamm MA. Endoscopic Prediction of Crohn’s Disease Postoperative Recurrence. Inflamm Bowel Dis. 2022 May 4;28(5):680-688. doi: 10.1093/ibd/izab134. PMID: 34231852.2) 2)Ueda T, Koyama F, Sugita A, Ikeuchi H, Futami K, Fukushima K, Nezu R, Iijima H, Mizushima T, Itabashi M, Watanabe K, Hata K, Shinagawa T, Matsuoka K, Takenaka K, Sasaki M, Nagayama M, Yamamoto H, Shinozaki M, Fujiya M, Kato J, Ueno Y, Tanaka S, Okita Y, Hashimoto Y, Kobayashi T, Koganei K, Uchino M, Fujii H, Suzuki Y, Hisamatsu T. Endoscopic Lesions of Postoperative Anastomotic Area in Patients With Crohn’s Disease in the Biologic Era: A Japanese Multi-Centre Nationwide Cohort Study. J Crohns Colitis. 2023 Dec 30;17(12):1968-1979. doi: 10.1093/ecco-jcc/jjad116. PMID: 37450892.

P1217 Epidemiology and Temporal Trends of IBD in Central Taiwan

Abstract Background Inflammatory Bowel Disease (IBD), as a chronic inflammatory disease of the gastrointestinal tract, encompasses Crohn's disease (CD) and ulcerative colitis (UC). With industrialization and advancements in healthcare, the prevalence of IBD in Taiwan is on the rise. Methods This study collected data from 593 IBD patients treated at Changhua Christian Hospital and China Medical University Hospital, analyzing the epidemiology of IBD in central Taiwan. Results The cohort included 200 CD and 393 UC patients, with an average age of 40.62 ± 15.08. CD exhibited a higher male proportion than UC (72.50% vs. 62.09%, p = .012). CD patients also had higher rates of appendectomy, bowel resection, and perianal disease surgery before IBD diagnosis, along with increased use of steroids, immunosuppressants, and biologics compared to UC. Over time, Taiwan's UC to CD ratio decreased (≦2005: 2.50; 2006-2015:2.06; 2016-2023:1.76), and CD's L2 location and B3 behavior proportions also declined. The proportion of the UC patients with location E1 was increased. Conclusion Taiwan's IBD population mimics patterns observed in high-income countries, with a declining UC to CD ratio. The reduced L2 location and B3 behavior in CD and suggest improved diagnostic awareness and more comprehensive colonoscopy examinations in Taiwan.

Surgery versus concurrent chemoradiotherapy for stage III non-small cell lung cancer: a retrospective study with propensity score matching

BackgroundNo study has directly compared the outcomes of surgery and concurrent chemoradiotherapy (cCRT) in patients with stage III non-small cell lung cancer (NSCLC) to date. This study aimed to compare the treatment efficacy of complete resection and definitive cCRT.MethodsPatients were recruited in this retrospective study from Yokohama Municipal Citizens’ Hospital between January 2013 and December 2022. We analyzed patients with pathological stage III NSCLC who underwent complete surgical resection and those with clinical stage III NSCLC who underwent definitive cCRT. Propensity score matching was performed to balance baseline clinicopathological factors, and the prognoses of patients in each treatment group were examined using Cox proportional hazards regression.ResultsOf the 923 patients with NSCLC who underwent surgery, 97 with pathologic stage III NSCLC underwent complete resection (surgery group) and 125 with clinical stage III NSCLC underwent cCRT (cCRT group), of whom 54 (43.2%) received consolidation therapy with durvalumab. Overall survival (OS) was significantly higher in the surgery group than in the cCRT group (5-year OS: 60.5% versus 43.0%), hazard ratio [HR] = 0.585, 95% confidence interval [CI]: 0.390–0.877, p = 0.010). However, no significant difference in OS was found between the two groups after propensity score matching (5-year OS: 59.8% versus 48.1%, HR = 0.728, 95% CI: 0.416–1.277, p = 0.268).ConclusionsThe outcomes of the surgery and cCRT groups did not significantly differ in the treatment of stage III NSCLC. Appropriate evaluation of the treatment required should be reviewed on a case-by-case basis.

P0832 Real-world effectiveness of risankizumab in Crohn’s Disease: The UK Experience

Abstract Background Risankizumab is an IL-23 inhibitor which received approval for Crohn’s disease (CD) by the NICE committee in May 2023. Our aim was to evaluate the real-world outcomes of risankizumab in the United Kingdom (UK). Methods We conducted a retrospective, multicentre, cohort study across twenty health boards in the UK, of patients with CD treated with risankizumab between the 1st of January, 2021 and the 1st of November 2024. Our primary outcome was treatment persistence at 6 months. Our secondary endpoints were treatment persistence, steroid-free clinical remission (Harvey-Bradshaw index &amp;lt;5), biomarker remission (CRP ≤5 mg/L and FCAL &amp;lt;250 µg/g), at 3, 6 and 12 months, and if effectiveness was different between ustekinumab naive and exposed patients. Patients who discontinued therapy for any reason were considered treatment-failure for all indices after the time point they ceased therapy. We recorded adverse events, including hospitalisation, bowel resection, infection, and death. Results We identified 558 patients who commenced risankizumab, of which 526 patients had 3 month outcome data available with a median follow-up time of 28 weeks (IQR, 19-41 weeks). The median number of advanced therapy exposures were 3 (2-4), with 90% (475/526) having failed anti-TNF therapy, and 73% (382/526) having failed ustekinumab (Table 1). Treatment persistence was 97.5%, 94.8% and 89.5% at 3, 6 and 12 months (Figure 1). Unadjusted persistence rates for ustekinumab naïve vs ustekinumab exposed patients were 93.8% vs 95.3% and 93.8 % vs 89.3% at 6 and 12 months respectively (p=0.7). Rates of clinical remission were 59% (211/358), 50% (77/154), and 44% (14/32) at 3, 6 and 12 months. Rates of clinical remission for ustekinumab naive vs exposed were 67% (70/104) vs 55% (141/253) and 60% (21/35) vs 47% (56/119) at 3 and 6 months respectively. CRP remission rates were 57% (266/465), 52% (108/208), and 53% (28/53) at 3, 6 and 12 months. FCAL remission rates were 58% (140/243), 48% (55/114), and 44% (17/38) at 3, 6 and 12 months. There was a significant reduction in median HBI, CRP and FCAL during follow-up (Figure 1). We observed that 12% (62) of patients were hospitalised due to symptomatic CD (58) or an implicated adverse event (4). We observed that 3% (17/526) underwent CD related resectional surgery. Adverse events occurred in 16% (85/526) of the cohort. Serious adverse events occurred in 5% (28/526), of which 25 were hospitalisations. Conclusion Risankizumab was effective in a large, real-world, medically refractory CD cohort with excellent short-term persistence and good clinical and biochemical remission rates. Persistence rates were similar between ustekinumab naive and exposed patients, however clinical remission rates were higher in the naive group.