笹沼 英紀

PURPOSE: There is limited awareness of work-related musculoskeletal disorders (MSDs) in Japan, despite the high ergonomic risks for surgeons. We conducted this study to investigate the prevalence, characteristics, and impact of MSDs on Japanese general surgeons. METHODS: An electronic survey of 136 general surgeons at a Japanese university hospital network used a modified Nordic Musculoskeletal Questionnaire to assess demographics, work factors, MSD symptoms, psychological distress, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and their impact. RESULTS: Based on a 56.6% response rate, we found a high prevalence of chronic (37.7%) and acute (51.9%) MSDs. These disorders frequently impacted surgeons' work (30.0%) and daily life (39.0%), leading to time off (5.2%) and medical intervention (28.6%). Both MSD types correlated significantly with the use of NSAIDs and psychological distress. Notably, neck pain was strongly associated with the use of NSAIDs. The proportion of minimally invasive surgical procedures performed each week was associated significantly with acute, but not chronic, MSDs. CONCLUSIONS: MSDs are highly prevalent among Japanese surgeons, impacting their physical and psychological health. The high symptom prevalence and the strong association between neck pain and NSAID reliance underscore the urgent need for ergonomic interventions and preventive strategies in surgical practice to protect this essential workforce.

<jats:p>Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. While curative resection offers the best chance for long-term survival, the high postoperative recurrence rate suggests a persistent need for effective perioperative therapies. We investigated a multimodal approach, combining sequential lenvatinib with transarterial chemoembolization (TACE), as a presurgical treatment (PST) for resectable HCC. Methods: This retrospective study included 19 patients with technically resectable HCC who underwent the PST protocol followed by surgery between March 2022 and September 2024. The protocol involved four phases: Pre-TACE lenvatinib administration (Pre-LEN), TACE, Post-TACE lenvatinib administration, and surgery. We assessed the feasibility, safety, and pathological response of the protocol. Liver function was evaluated using the albumin-bilirubin (ALBI) score, modified ALBI (mALBI) grade, and tumor response was assessed using the Response Evaluation Criteria in Cancer of the Liver (RECICL). Results: The PST protocol demonstrated high efficacy and safety. The median tumor reduction rate was 22.9%, and the median pathological tumor necrosis rate was 95%. The preoperative overall RECICL response was a complete response in 84.2% of patients. With a median follow-up of 22 months, the 2-year recurrence-free survival rate was 84.6%, and the overall survival rate was 100%. A significant association was found between mALBI grade and the decision to proceed with surgery at two time points: Pre-LEN (p = 0.023) and before surgery (p = 0.006). Conclusion: Presurgical sequential lenvatinib-TACE therapy is a feasible and safe strategy for resectable HCC. This protocol achieved a high pathological response and favorable survival outcomes, suggesting that it may mitigate the risk of early recurrence. Our findings highlight the importance of mALBI grade monitoring for patient selection and provide a rationale for larger, prospective studies.</jats:p>

Fibroblast growth factor receptor (FGFR)2 rearrangements define a distinct molecular subset of intrahepatic cholangiocarcinoma (iCCA) with therapeutic potential using FGFR inhibitors. However, acquired resistance invariably limits long-term efficacy, posing a significant clinical challenge. Sequential targeting with different FGFR inhibitors is an emerging strategy, yet robust evidence, particularly for third-line and beyond, is scarce, and a consensus on optimal sequencing and patient selection remains unreached. Here, we report a case of FGFR2-rearranged iCCA where the patient achieved a radiographic partial response (PR) to tasurgratinib (a third-line FGFR inhibitor) following prior progression on pemigatinib and futibatinib. This case underscores the sustained dependency on the FGFR pathway and highlights the potential clinical utility of rationally sequenced FGFR-targeted therapy even after multiple lines of treatment. More broadly, this report serves as a basis for a current opinion on the evolving landscape of sequential FGFR inhibition in iCCA. We delve into the complexities of acquired resistance, dissect the arguments for and against prolonged FGFR pathway blockade, explore the impact of co-occurring genomic alterations, discuss the controversies, research priorities, and the urgent need for a balanced perspective to guide future clinical practice and trial design in this rapidly advancing but still uncertain field.