{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:40:09Z","timestamp":1787593209806,"version":"build-2736575974"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gastric Cancer"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study assessed the impact of an institutional certification system that was newly introduced by the Japanese Gastric Cancer Association on short-term surgical outcomes in patients with gastric cancer using data from the National Clinical Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of distal gastrectomy and total gastrectomy procedures performed between January 2020 and December 2022 was conducted. The institutions were classified into three categories: type A, type B, and non-certified institutions, in decreasing order of certification stringency. The primary outcome was the incidence of grade\u2009\u2265\u2009IIIa postoperative complications based on the Clavien\u2013Dindo classification system. The secondary outcome was surgery-related mortality. Logistic regression with risk adjustment, estimated using generalized estimating equations, was used to account for intra-cluster correlation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was no significant difference in the risks of distal gastrectomy-related complications across the three institution types. However, type A- (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.31\u20130.49) and type B-certified institutions (OR 0.59, 95% CI 0.49\u20130.71) had a significantly lower mortality risk than non-certified ones. On the other hand, Type A- (OR 1.25, 95% CI 1.09\u20131.44) and type B-certified institutions (OR 1.17, 95% CI 1.03\u20131.33) had higher risks of postoperative total gastrectomy-related complications than non-certified ones. Nevertheless, type A- (OR 0.41, 95% CI 0.29\u20130.58) and type B-certified institutions (OR 0.67, 95% CI 0.51\u20130.88) had significantly lower surgery-related mortality risks than non-certified ones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Certified institutions demonstrated lower surgical mortality risks, highlighting the benefits of the certification system and the importance of institutional quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10120-025-01694-8","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T07:08:41Z","timestamp":1767424121000},"page":"415-423","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative study of the short-term outcomes of gastric cancer surgery between Japanese Gastric cancer association-certified and non-certified institutions: a retrospective cohort analysis using a national database in Japan"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4563-8940","authenticated-orcid":false,"given":"Tomoyuki","family":"Matsunaga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Endo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koshi","family":"Kumagai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Kanaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisato","family":"Kawakami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Kusano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoji","family":"Kushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhiro","family":"Fujishiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensei","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaki","family":"Yoshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Doki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Kakeji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"1694_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. 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The department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical S\u00e0rl. Koshi Kumagai has received honoraria from Abbott Japan LLC, Medtronic Japan Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., Nobelpharma Co., Ltd., Nutri Co., Ltd., the Japan Surgical Association, Zeon Medical Inc., and Zeria Pharmaceutical Co., Ltd. Hisato Kawakami has received consulting or advisory fees from Astellas Pharma Inc., AbbVie GK, and Daiichi-Sankyo Co., Ltd.; honoraria from Bristol-Myers Squibb Co., Ltd., Ono Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., MSD K.K., Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Merck Biopharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., Yakult Pharmaceutical Industry (Takata Pharmaceutical Co., Ltd.), Otsuka Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Novartis International AG, Bayer Yakuhin Ltd., Amgen Inc., Astellas Pharma Inc., and Nippon Kayaku Co., Ltd.; and research funding from Bristol-Myers Squibb Co., Ltd., Taiho Pharmaceutical Co., Ltd., Kobayashi Pharmaceutical Co., Ltd., Astellas Pharma Inc., and Eisai Co., Ltd. Kensei Yamaguchi has received honoraria from Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co., Ltd., Bristol-Myers Squibb K.K., Eli Lilly Japan K.K., Taiho Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Merck Biopharma Co., Ltd., and Astellas Pharma Inc. The other authors declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Institutional Review Board of Tottori University (24A161) and was conducted in accordance with the ethical standards of the institutional research committee and the latest version of the Declaration of Helsinki. We obtained informed consent for this study using an opt-out method posted on the website, which was approved by the Institutional Review Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}