• Shohei Komatsu, Tianyuan Wang, Kazuki Terashima, Yusuke Demizu, Makoto Anzai, Masaki Suga, Tomohiro Yamashita, Osamu Suzuki, Tomoaki Okimoto, Ryohei Sasaki, and Takumi Fukumoto.
• From the Department of Surgery, Divisions of Hepato-Biliary-Pancreatic Surgery (Komatsu, Fukumoto), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
• J. Am. Coll. Surg. 2024 Jan 1; 238 (1): 119128119-128.

BackgroundParticle therapy has favorable dose distribution and high curability. However, radiotherapy for malignant tumors adjacent to the gastrointestinal tract is contraindicated owing to its low tolerance. To overcome this, combination treatment with surgery to make a space between the tumor and adjacent gastrointestinal tract followed by particle therapy has been developed. Several materials have been used for the spacer and recently, we developed the absorbable polyglycolic acid (PGA) spacer, which has been used since 2019. This study is the first report of consecutive case series of spacer placement surgery using the PGA spacer.Study DesignFifty consecutive patients undergoing spacer placement surgery with the PGA spacer were evaluated. Postoperative laboratory data, morbidity related to the treatment, and spacer volume after treatment were evaluated.ResultsThere were no treatment-related deaths, and all but 2 patients completed combination treatment. The median ratios of postoperative PGA spacer volume to the pretreatment volume were 96.9%, 87.7%, and 74.6% at weeks 2, 4, and 8, respectively. The spacer volume was maintained at 80% at 7 weeks and was predicted to be 50% at 15 weeks and 20% in 24 weeks.ConclusionsSpacer placement surgery using the PGA spacer was feasible and tolerable. The PGA spacers maintained sufficient thickness during the duration of subsequent particle therapy. Combination treatment using the PGA spacer is innovative and has the potential to become a new standard curative local treatment.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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