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Article History

Received: 14 December 2025

Accepted: 23 March 2026

First Online: 27 April 2026

Declarations

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: Tomohiro Yamaguchi received honoraria for lectures from Johnson and Johnson, Medtronic, and Intuitive, Inc.; Jun Watanabe received honoraria for lectures from Covidien Japan, Johnson and Johnson, TERUMO, Eli Lilly, and Takeda Pharmaceuticals and received research funding from Covidien Japan TERUMO, and Stryker Japan outside of the submitted work.; Fumihiko Fujita received honoraria for lectures from Johnson and Johnson.; Takeshi Naitoh received honoraria for lectures from Johnson and Johnson and Medtronic. Shoma Sasaki, Daichi Kitaguchi, Masaaki Ito, Keitaro Tanaka, Hiroki Hamamoto, Atsushi Nishimura, Ryo Inada, Hiroki Takahashi, Masashi Miguchi, Hajime Kayano, and Ichiro Takemasa declare no conflicts of interest to disclose.

: The study was conducted in accordance with the Ethical Guidelines for Medical and Biological Research Involving Human Subjects of the Japanese Ministry of Health, Labor, and Welfare. The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. The Central Institutional Review Board of Osaka Medical and Pharmaceutical University, Approval No. 2022–092-2; the Ethics Committee of the National Cancer Center Hospital East, Approval No. 2022–333. Informed consent was obtained from the participants and/or guardians using an opt-out method. The ICAN study was registered in the UMIN Clinical Trials Registry System in 2022 (UMIN000047994).