1: Survival Non-inferior to Open Surgery Demonstrated: World's First Report on the Efficacy of Minimally Invasive Surgery / 2: Utility of Cancer Gene Panel Testing in Clinical Practice Elucidated
Science of the Month - March 2026
1: Survival Non-inferior to Open Surgery Demonstrated: World's First Report on the Efficacy of Minimally Invasive Surgery
Lancet Gastroenterology & Hepatology.
Takeuchi H, Machida R, Ando M, Tsubosa Y, Kikuchi H, Kawakubo H, Noma K, Ueno M, Tsushima T, Bamba T, Fujita T, Hamai Y, Kakishita T, Daiko H, Koyanagi K, Matsuda S, Kato K, Sasaki K, Kita R, Kitagawa Y.
The standard treatment for resectable esophageal squamous cell carcinoma is esophagectomy, but thoracoscopic surgery was developed to reduce the high surgical invasiveness. While it has been widely shown to offer superior cosmetic results and reduce the incidence of respiratory complications such as pneumonia compared to conventional open esophagectomy, long-term outcomes including overall survival remained an unresolved issue. JCOG1409 is a multicenter randomized phase III trial aimed at verifying the non-inferiority of thoracoscopic surgery compared to open surgery in terms of overall survival. 150 patients were enrolled in each group. The primary analysis demonstrated the non-inferiority of thoracoscopic surgery to open surgery for overall survival, establishing it as a new standard treatment. Furthermore, although the extent of lymph node dissection specified in this trial was identical between the two groups, thoracoscopic surgery showed a trend toward better overall survival. This suggests that precise surgery with magnified visualization via thoracoscopy and the reduction of surgical invasiveness may lead to improved long-term survival. For esophagectomy in esophageal cancer, robot-assisted surgery has been covered by insurance in Japan since 2018 and is spreading rapidly. Further reduction in surgical invasiveness is expected to lead to improved treatment outcomes for esophageal cancer.
(Surgery (General and Gastroenterological): Yuko Kitagawa, Hirofumi Kawakubo; Second Department of Surgery, Hamamatsu University School of Medicine: Hiroya Takeuchi)
2: Utility of Cancer Gene Panel Testing in Clinical Practice Elucidated
Nature Medicine.
Saito Y, Horie S, Kogure Y, Mizuno K, Ito Y, Mizukami Y, Kim H, Tamura Z, Koya J, Funakoshi T, Hirata K, Kataoka K.
In recent years, the development and approval of treatments targeting genetic abnormalities (targeted therapies) have progressed in the field of oncology. To comprehensively detect these genetic abnormalities that serve as therapeutic targets, "cancer gene panel testing" has come into use in clinical settings. In Japan, it has been covered by insurance since 2019, primarily for patients with recurrent or refractory solid tumors who have completed standard treatment. We analyzed the actual status and effects of targeted therapy, as well as patient prognosis, using clinical genomic data from over 50,000 cases where cancer gene panel testing was performed as part of this insurance-covered medical care. As a result, we clarified that patient prognosis improves when genetic abnormalities are detected that are targets for drugs whose efficacy has been demonstrated, including not only drugs approved in Japan but also those unapproved in Japan (Figure: Evidence Levels A and B). Additionally, while the overall introduction rate of targeted therapy based on cancer gene panel testing remained at 8%, it was found to be on an upward trend over time. This introduction rate varied significantly between cancer types, being high in thyroid and lung cancers but low in pancreatic and liver cancers. Furthermore, regarding the utility of pan-cancer biomarkers such as TMB-High, differences were found depending on the cancer type and threshold settings. This study clarifies the utility of cancer gene panel testing in clinical practice and provides important insights for the optimization of cancer genomic medicine.
(National Cancer Center / Internal Medicine (Gastroenterology): Yuki Saito)
Other Published Papers
1: Evaluation of drug-induced lymphocyte stimulation test in mesalazine-associated allergic drug reaction.
J Allergy Clin Immunol Glob.
2025 Dec 17;5(2):100625. doi: 10.1016/j.jacig.2025.100625. eCollection 2026 Mar. PMID: 41561978
Fukasawa N, Kiyohara H, Adachi T, Sugimoto S, Yoshimatsu Y, Murakami S, Mizushima I, Kaieda Y, Takabayashi K, Tsunoda J, Nakamoto N, Fukunaga K, Taguri M, Mikami Y, Kanai T.
2: Nationwide Trends in Coronary Revascularization in Japan, 2017 to 2023: From Decline to Plateau.
Journal of the American College of Cardiology.
2025 December 9; 86(23): 2391-2394. doi: 10.1016/j.jacc.2025.09.1594
Shun Kohsaka, Hiraku Kumamaru, Mitsuaki Sawano, Makoto Mori, Kyohei Yamaji, Aya Saito, Tetsuya Amano, Ken Kozuma, Noboru Motomura