Oncological Significance of Proximal Resection Margin Length in Proximal Gastric and Gastroesophageal Junction Adenocarcinoma: A Single-center Retrospective Analysis - Turkish Journal of Surgical Oncology

Background: We evaluated associations of CT-defined sarcopenia and myosteatosis with complicated acute left-sided colonic diverticulitis (ALCD) and their incremental discrimination beyond clinical characteristics and inflammatory markers. Methods: This retrospective single-center cohort included 164 adults hospitalized with CT-confirmed ALCD. L3 skeletal muscle index (SMI) and attenuation classified patients as having neither abnormality, CT-defined sarcopenia only, myosteatosis only, or both abnormalities. Complicated ALCD was defined as World Society of Emergency Surgery (WSES) CT stage ≥ 1A. Multivariable logistic regression and bootstrap internal validation of discrimination and calibration were performed. An additional sensitivity analysis used WSES stage ≥ 1B. Results: Complicated ALCD occurred in 93/164 patients (56.7%). Proportions differed across the four phenotypes (34.7%, 48.0%, 61.5% and 78.4%; overall p < 0.001). A separate analysis showed a positive trend with the number of muscle abnormalities (0, 1 or 2; p < 0.001). After adjustment, myosteatosis alone (aOR, 4.27; 95% CI, 1.34–13.62) and both abnormalities (aOR, 9.27; 95% CI, 2.85–30.17) remained independently associated with complicated ALCD, whereas CT-defined sarcopenia alone did not. Adding muscle phenotypes to a clinical reference model containing age, sex, ASA class, ACCI, WBC and CRP increased the apparent AUC from 0.837 to 0.877 (apparent ΔAUC, 0.040; 95% CI, 0.004–0.078). Optimism-corrected AUCs were 0.812 and 0.845 (corrected ΔAUC, 0.033). The phenotype-extended clinical model had an optimism-corrected calibration slope of 0.806, indicating residual overfitting. Associations for myosteatosis and the combined phenotype were also observed using WSES stage ≥ 1B. Twelve-month CT-confirmed repeat attacks occurred in 11/121 evaluable patients (9.1%), without phenotype differences (p = 0.553). Conclusions: Myosteatosis and the combined phenotype were associated with complicated ALCD and added discriminatory information beyond the clinical reference model. Residual overfitting and the absence of external validation limit clinical application; clinical net benefit remains unestablished.

Objective: The inferior mesenteric vein (IMV) is an important component of the portal venous system; however, normative developmental data during childhood remain limited. This study aimed to evaluate age- and sex-related changes in IMV caliber using contrast-enhanced computed tomography in a pediatric population. Methods: Radiologic images of 200 subjects aged 1–20 years were included in the examination. Terminal (IMV1), intermediate (IMV2), and pelvic (IMV3) calibers of the IMV were measured. Ratios of vessel calibers to the transverse diameter of the first lumbar vertebral body (L1TD) were calculated. In addition, the drainage pattern of the IMV was recorded. Results: L1TD, IMV1, IMV2, and IMV3 demonstrated significant age-related changes (p < 0.001). All IMV calibers increased from infancy to the postpubescent period. Among the calculated ratios, IMV1/L1TD and IMV3/L1TD demonstrated significant age-related variation (p < 0.05), whereas IMV2/L1TD remained relatively stable throughout childhood and adolescence (p > 0.05). No significant sex-related differences were observed for most parameters, although IMV3 was significantly greater in males than in females (p = 0.043). The splenic vein was the most common termination site of the IMV (47.5%), followed by the superior mesenteric vein (29.5%) and the splenomesenteric confluence (23.0%). Conclusions: The present study provides normative age-specific values for IMV caliber and IMV-to-L1TD ratios in the pediatric population. These data may facilitate the radiological assessment of IMV-related abnormalities and provide a practical reference for routine computed tomography evaluation of the pediatric mesentericoportal venous system.