【Objects】Surgical site infection (SSI) in cardiovascular surgery had a great effect on postoperative outcomes. This study examined the current status of SSI and postoperative outcomes used the registered data of the Japan Cardiovascular Surgery Database. 【Methods】 From the registry, we extracted 53,186 cases of thoracic cardiovascular surgery performed under median sternotomy in 2018. According to Japanese Healthcare Associated Infections Surveillance (JHAIS), patients were divided into three groups : CABG with SVG (SVG＋; n=14,246), CABG without SVG (SVG－; n=5,535) , and operations other than CABG (no CABG ; n=33,405). The incidence of deep sternum infection, leg infection, hospital death and hospitalization more than 90 days were examined. 【Results】The incidence of deep sternum infection is 1.4% in all cases, and 1.7％ in SVG＋, 1.2％ in SVG－, and 1.4% in not CABG. In deep sternum infection cases, incidence of hospital death was 24.7% and was higher than no infection cases. Especially, in no CABG group, incidence of hospital death was 30.1％. The long-term hospitalization rate and readmission rate within 30 days of patients with deep sternum infection were also high. 【Conclusion】The incidence of deep sternum infection was low. However, postoperative outcomes in patients with SSI was still bad.

Sarcopenia, characterized by a decline in skeletal muscle mass and muscle strength or physical activity, is now accepted worldwide as a new geriatric syndrome. Recent studies have identified significant associations between preoperative sarcopenia and poor outcomes after various surgeries. This article reviews current status of sarcopenia and perioperative infectious complications mainly in hepato-biliary-pancreatic surgery and liver transplantation. Aging causes primary sarcopenia, and other conditions such as disuse, malnutrition, organ failure, cancer and surgery itself cause secondary sarcopenia. Most patients who undergo major surgery present with a number of these factors related to sarcopenia. Moreover, due to arrival of the super-aging society, more elderly patients will undergo surgery. Therefore, the significance of sarcopenia for patients undergoing surgery will be more and more important. In my opinion, evaluation and intervention are principles for medical treatment. In the field of rehabilitation and nutritional therapy, accurate evaluation and adequate intervention are crucial. Therefore, not uniform but tailor-made adequate intervention for selected patients is highly recommended considering limited resources and would be a breakthrough to improve outcomes after surgery. In this review, we would like to introduce our perioperative nutritional and exercise intervention based on preoperative evaluation for better outcomes in St Luke’s International Hospital.

We investigated for sarcopenia and the surgical outcomes in 124 patients with esophagectomy. The skeletal muscle index (SMI) diagnostic threshold for sarcopenia was determined using computed tomography. Preoperative sarcopenia was prevalent in 77 patients (62％). The incidence of surgical site infections and infectious morbidity was significantly higher in the sarcopenia group (32.4％ and 40.2％) than in the non-sarcopenia group (P＝0.02 and P＝0.01). The frequency of all complications in the sarcopenia group was significantly higher and was a risk factor in multivariate analysis. Recurrence-free survival was significantly lower in the sarcopenia group, but there was no significant difference in overall survival. Preoperative sarcopenia in patients undergoing esophageal cancer surgery was at high risk of postoperative morbidity and requires careful perioperative management.

At the present with the coming unprecedented ageing society in Japan, sarcopenia accompanied with aging is one of the crucial points to decide the treatment strategy for the patients with gastrointestinal cancer. In this section, we retrospectively evaluated supporting evidence including our studies to clarify the prognostic impact of myopenia or myosteatosis, the prognostic impact of postoperative infectious complication, and correlation between alteration of body composition and postoperative infectious complication, to discuss future perspective for these points in patients with gastrointestinal cancer.

Aim: The effects of nutritional prehabilitation (NP) on the rate of change in skeletal muscle index (SMI) and postoperative outcomes were investigated. Methods: The study subjects included 99 patients who underwent major hepatectomy after portal vein embolization between September 2008 and May 2019. Clinical variables and the rate of change in preoperative SMI were compared between patients with and without NP. Among the patients who underwent NP, the occurrence of postoperative complications was compared between those with increased and decreased SMI. Results: The rate of change in SMI was higher in patients with NP (n=30) than in those without NP (n=69) (median ＋1.8％ vs. ＋0.1％, P=0.038). Among the patients who underwent NP, the occurrence of postoperative organ/space surgical site infection (14％ vs. 56％, P=0.032) and liver failure (14％ vs. 56％, P=0.032) was lower and length of hospitalization was shorter (17 days vs. 24 days, P=0.033) in patients with increased SMI (n=21) than in those with decreased SMI (n=9). Conclusion: NP was considered to be a useful strategy to increase SMI and reduce postoperative complications.

Sarcopenia was advocated by Rosenberg in 1989, and the diagnostic criteria were enacted in 2010 by the European Working Group (European Working Group on Sarcopenia in Older People (EWGSOP)). Currently, in Japan, AWGS 2019 by the Asian Working Group for Sarcopenia (AWGS) is often used for the definition of sarcopenia. There are many reports that the short-term prognosis after surgery deteriorates in sarcopenia patients. Only infectious complications in elderly gastrointestinal surgery, there are some reports of a link between sarcopenia and infectious complications in colorectal cancer surgery and pancreaticoduodenectomy. When not limited to the elderly or when the decrease in skeletal muscle mass is used as an index, there are papers reporting the relationship with sarcopenia and infectious complications. Our preliminary study of gastrointestinal surgery in the elderly found no association between sarcopenia and postoperative infectious complications.

Although tuberculous peritonitis has decreased due to improved public health measures and reduced overall tuberculosis prevalence due to advances in treatment, it is one of the diseases that require an emergent operation. An 82-year old man was admitted to our hospital with abdominal pain and vomiting. The diagnosis of strangulation ileus was posed, and an emergent laparotomy was performed. Ten months prior, he was diagnosed with pulmonary tuberculosis and tuberculous peritonitis and was treated with anti-tuberculosis drugs. Furthermore, he had a history of oral steroid intake and abdominal surgery. Healthcare workers wore N95 masks and performed the surgery in a standard operating room. The cause of the strangulation was adhesions. The operation showed multiple white nodules in the mesentery, of which one was removed and analyzed, and revealed Mycobacterium tuberculosis. After confirming that there was no postoperative infectivity, the negative pressure chamber management was canceled. Although tuberculous peritonitis is generally considered non-infectious, it is essential to take precautions against infection due to aerosol generation during abdominal surgery. It is necessary to pay attention to the medical history, distinguish tuberculous peritonitis from peritonitis cases of unknown etiologies, and have a nosocomial infection control manual for emergency surgery.