Digestive Surgery最新文献

{"title":"Surgical Management of Colorectal Cancer Peritoneal Metastases: Current Indications, Controversies, and Future Directions.","authors":"Michelle Horowitz, Christopher T Aquina","doi":"10.1159/000552611","DOIUrl":"10.1159/000552611","url":null,"abstract":"<p><strong>Background: </strong>Isolated peritoneal metastases occur in approximately 4-8% of patients with colorectal cancer and are associated with a very poor prognosis with systemic therapy alone. While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have traditionally been a controversial treatment regimen for colorectal cancer peritoneal metastases due to a high rate of morbidity and a perceived limited efficacy, recent studies have confirmed its safety and have demonstrated the ability to achieve long-term survival in carefully selected patients.</p><p><strong>Summary: </strong>This narrative review presents the current indications, controversies, and future directions of CRS, HIPEC, and additional emerging treatment modalities in the surgical management of colorectal cancer peritoneal metastases.</p><p><strong>Key messages: </strong>Peritoneal metastases in colorectal cancer signify a poor prognosis. Management of peritoneal disease includes CRS with or without HIPEC. The use of CRS has been established as an effective treatment modality with acceptable morbidity and long-term quality of life. However, the efficacy of HIPEC continues to be debated. Patient functional status, tumor biology, degree of disease burden, and the feasibility of achieving complete cytoreduction are central to the success of the operation. Emerging treatment options, such as pressurized intraperitoneal aerosolized chemotherapy, represent promising alternative treatment options for patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-15"},"PeriodicalIF":1.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial Colonization in Resected Lymph Nodes during Pancreatic Surgery: A Pilot Study.","authors":"Saadet Coşkun Gürçınar, Ibrahim H Gürçınar, Kathrin Rothe, Alexander Muckenhuber, Carsten Jäger, Rüdiger Göß, Ilaria Pergolini, Carmen Mota Reyes, Okan Safak, Mert Erkan, Helmut Friess, Rouzanna Istvanffy, Güralp O Ceyhan, Ihsan Ekin Demir, Elke Demir","doi":"10.1159/000552484","DOIUrl":"10.1159/000552484","url":null,"abstract":"<p><strong>Introduction: </strong>The detection of bacterial colonization in postoperative pancreatic fistula (POPF) fluid has renewed interest in the role of bacterial translocation during pancreatic surgery. In this context, we hypothesized that peripancreatic lymph nodes (PLNs) might similarly harbor bacterial colonization. This study aimed to investigate the presence of bacteria in these lymph nodes, identify factors potentially contributing to their colonization, and assess the clinical significance of these findings.</p><p><strong>Methods: </strong>In this observational pilot study, PLNs (station 8a) resected during pancreatic surgery were analyzed for bacterial DNA using 16S rDNA-PCR, and the microbiological findings were correlated with detailed perioperative and postoperative clinical data.</p><p><strong>Results: </strong>Between 2019 and 2026, lymph node station 8a was resected and analyzed in 37 patients undergoing pancreatic surgery. Bacterial colonization was found in 3 patients (8.1%). No significant association was observed between lymph node colonization and the type of surgical procedure, histopathological diagnosis, or the development of clinically relevant POPF or other major postoperative complications. All cases with bacterial colonization had undergone preoperative endoscopic retrograde cholangiopancreatography (ERCP; p = 0.230).</p><p><strong>Conclusion: </strong>In this pilot study, bacterial colonization of PLNs was uncommon and was observed only in patients with a history of ERCP. Although no association with POPF was identified, a potential relationship with overall postoperative morbidity cannot be ruled out. Further studies with larger patient cohorts are needed to better define the clinical relevance and underlying mechanisms of lymphatic bacterial translocation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Preoperative Haemoglobin Is a Risk Factor for Clavien-Dindo Grade IV-V and Non-Surgical Complications in Colorectal Cancer Surgery.","authors":"Pekka Peroja, Heikki Huhta, Tero Rautio, Jukka Rintala","doi":"10.1159/000552166","DOIUrl":"10.1159/000552166","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anaemia is common in patients undergoing colorectal cancer surgery, but the association between preoperative haemoglobin (Hb) and postoperative morbidity remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included all 2,374 patients who underwent elective colorectal segmental resection for colorectal cancer at Oulu University Hospital between 2014 and 2024. After exclusions for missing Hb data (n = 49), procedures other than primary curative resection (n = 735), missing complication data (n = 117), and age under 18 years (n = 1), 1,472 patients were analysed. Receiver operating characteristic analysis was used to determine the optimal Hb cut-off, and logistic regression was used to identify factors associated with Clavien-Dindo classification (CDC) grade IV-V complications.</p><p><strong>Results: </strong>Preoperative anaemia was present in 444/859 (51.7%) men and 208/613 (33.9%) women. Overall, 758/1,472 (51.5%) patients developed a postoperative complication. Compared with non-anaemic patients, anaemic patients had higher rates of CDC grade IV-V complications (7.4% vs. 2.6%, p < 0.001) and non-surgical complications (31.4% vs. 20.4%, p < 0.001). The optimal Hb cut-off for CDC grade IV-V complications was 117.5 g/L. Low Hb was associated with severe complications in univariable (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.79-5.10) and multivariable analyses (OR 1.76, 95% CI 1.01-3.05).</p><p><strong>Conclusion: </strong>Low preoperative Hb is an independent risk factor for severe postoperative complications, particularly non-surgical events, after colorectal cancer surgery. Data-driven Hb thresholds may improve preoperative risk stratification.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"116-125"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tube Enteral Feeding-Associated Non-Occlusive Mesenteric Ischemia following Gastric Cancer Surgery: A Retrospective Case Series Analysis.","authors":"Sujit Chyau Patnaik, Thammineedi Subramanyeshwar Rao, Kalidindi Vijaya Venkata Narsimha Raju, Srijan Sandesh Shukla, Pratap Reddy, Arvind Reddy, Prasanthi Suryanarayana, Aditi Komandur, Yogesh Vashist, Syed Nusrath","doi":"10.1159/000551225","DOIUrl":"10.1159/000551225","url":null,"abstract":"<p><strong>Introduction: </strong>Non-occlusive mesenteric ischemia (NOMI) is a rare but lethal complication after gastric cancer (GC) surgery, marked by intestinal hypoperfusion without arterial occlusion. Nonspecific symptoms and rapid deterioration hinder timely diagnosis. This study evaluated outcomes, diagnostic pathways, and management.</p><p><strong>Methods: </strong>We retrospectively reviewed 8 GC patients who developed NOMI (February 2022-January 2024). Collected variables included demographics, surgical details, feeding practices, presentation, imaging, treatment, and outcomes. The primary endpoint was 30-day mortality.</p><p><strong>Results: </strong>NOMI presented a median of 3 days postoperatively (range 2-5). The median age was 63.5 years; 75% were male; all had advanced GC; and 62.5% had gastric outlet obstruction. Common signs were abdominal distension (75%), hypotension (50%), and peritonitis (25%). CT consistently showed small-bowel dilatation, pneumatosis intestinalis, and portal venous gas, mainly in distal jejunum/ileum. Seven patients underwent re-exploration: five required resection. After implementing a modified feeding protocol, cases reduced from seven to one. Thirty-day mortality was 50%, largely from sepsis and multiorgan dysfunction syndrome.</p><p><strong>Conclusion: </strong>In GC patients with feeding jejunostomy, NOMI remains a serious complication. A cautious feeding strategy - deferring feeds during vasopressor support, initiating low-strength kitchen feeds, slow escalation, and early oral intake - was associated with fewer cases. High clinical suspicion, rapid CT, and timely surgery are critical to improve outcomes.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"105-115"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interval Appendicectomy after Conservative Management of Complicated Appendicitis: Balancing Recurrence, Neoplasm Risk, and Surveillance Strategies.","authors":"Rathin Gosavi, Paul McMurrick, William Teoh, Geraldine Ooi, Vignesh Narasimhan","doi":"10.1159/000552093","DOIUrl":"10.1159/000552093","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management (NOM) of complicated appendicitis is increasingly accepted, but the role of interval appendicectomy (IA) remains contentious. Contemporary evidence has shifted decision-making from recurrence risk alone toward age-linked neoplasm risk and radiological features.</p><p><strong>Summary: </strong>Recurrence after successful NOM is commonly reported at 12-24% and is concentrated within the first 6 months. In adults presenting with periappendiceal abscess, appendiceal tumour prevalence rises with age, reaching approximately 5-10% in patients aged 35-39 years and 14-20% in cohorts aged ≥40 years. Interval CT or MRI findings, including dilated or cystic morphology, mural abnormalities, calcification, mucin, or a base mass, identify higher risk patients in whom IA should be prioritised. Colonoscopy is best used selectively, particularly when caecal pathology is suspected, imaging is equivocal, or IA is not planned in older patients.</p><p><strong>Key messages: </strong>IA should generally be considered in patients aged ≥40 years and in those with persistent symptoms or concerning radiological findings, while recognising that decisions must be individualised and made through shared decision-making. Younger patients with complete radiological resolution and no red-flag features can usually be observed with structured imaging follow-up. A risk-stratified clinical algorithm is proposed to guide post-NOM management.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"146-150"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Quality of Systematic Reviews on Treatments for Gastric Cancer: A Cross-Sectional Study.","authors":"Yuning Zhang, Betty H Wang, Billy Z Z Cheng, Claire C W Zhong, Faifai Ho, Vincent C H Chung","doi":"10.1159/000549851","DOIUrl":"10.1159/000549851","url":null,"abstract":"<p><p><p>Introduction: Systematic reviews (SRs) provide crucial evidence for gastric cancer interventions, but their reliability can be compromised by methodological flaws. We aimed to evaluate the methodological quality of SRs on gastric cancer interventions and identify factors affecting their quality.</p><p><strong>Methods: </strong>We searched MEDLINE, APA PsycInfo, Embase, and Cochrane Database of SRs for eligible SRs published between January 2014 and October 2023. The methodological quality was assessed using AMSTAR 2. Multivariable regression analyses were conducted to identify factors influencing quality.</p><p><strong>Results: </strong>Among 119 identified SRs (including 1,305 randomized controlled trials with 233,197 participants), only 2.5% were rated as high quality, while 89.1% were critically low quality. Higher journal impact factor was associated with better performance in addressing heterogeneity (adjusted odds ratio [AOR]: 1.37, 95% confidence interval [CI]: 1.02-1.84), investigating publication bias (AOR: 1.41, 95% CI: 1.03-1.94), reporting conflicts of interest (AOR: 2.85, 95% CI: 1.59-5.11), and establishing protocols (AOR: 3.33, 95% CI: 1.89-5.87). More review authors predicted better statistical methods (AOR: 1.20, 95% CI: 1.03-1.40) and protocol establishment (AOR: 1.31, 95% CI: 1.06-1.63). Recent publications showed improved conflict of interest reporting (AOR: 1.54, 95% CI: 1.09-2.10) and risk of bias assessment (AOR: 1.34, 95% CI: 1.03-1.75). Non-pharmacological SRs better discussed heterogeneity compared to pharmacological (AOR: 0.27, 95% CI: 0.09-0.85) or mixed interventions (AOR: 0.12, 95% CI: 0.03-0.53).</p><p><strong>Conclusion: </strong>The methodological quality of gastric cancer intervention SRs is unsatisfactory. Future SRs should focus on establishing protocols, explaining study design selection, using comprehensive search strategies, documenting excluded studies with reasons, and describing primary studies in detail. </p>.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"35-47"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Optimal Technique to Remove Visible Lesions in Barrett's Esophagus: When to Use Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection?","authors":"Koen Munters, Roos E Pouw, Bas L A M Weusten, Sanne N van Munster","doi":"10.1159/000550636","DOIUrl":"10.1159/000550636","url":null,"abstract":"<p><p><p>Background: The incidence of esophageal adenocarcinoma (EAC) has risen significantly in recent decades, with Barrett's esophagus (BE) as the most important precursor. When a visible lesion is identified within BE, endoscopic resection (ER) is the preferred treatment, providing both histologic staging and curative therapy for dysplasia and low-risk EAC. Summary: Two ER techniques are commonly used: cap-based endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is an extensively studied technique considered safe, effective, and easy to learn. However, due to the cap-based approach, lesions larger than 15-20 mm need to be removed by multiple adjacent resections, so-called piecemeal resection. This may result in remnant tissue in the resection field and may compromise histopathological assessment. In contrast, ESD enables en bloc removal regardless of lesion size. While ESD has also demonstrated safety and efficacy, it is technically more demanding and associated with longer procedure times. For some lesions, there is general agreement on treatment, with ESD preferred for lesions with suspected submucosal invasion, bulky morphology, or fibrosis. Conversely, EMR remains the standard for smaller, superficial lesions without these features. Key Message: A significant grey zone persists, clinical scenarios for which comparative evidence is lacking and consensus on the optimal treatment approach remains unclear. </p>.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"81-90"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Anatomical S7 Segmentectomy: A Standardized Combined Dorsal and Ventral Method.","authors":"Wuqiang Chen, Yingjian Hou, Yuan Jiang, Youzhao He, Wen Xiang, Youyi Liu, Cheng Jin","doi":"10.1159/000550334","DOIUrl":"10.1159/000550334","url":null,"abstract":"<p><strong>Introduction: </strong>Anatomical resection of tumor in liver segment S7 is the most technically challenging procedure in laparoscopic liver hepatectomy due to its deep location and complex vascular structures, which results in a steep learning curve for beginners. We explored a simple and feasible approach: a dorsal approach combined with a dorsoventral method for liver segment S7 resection.</p><p><strong>Methods: </strong>The key innovations we propose through the dorsal approach combined with a dorsoventral method include the following: (1) systematic dissection of the S7 hepatic pedicle through Rouviere's sulcus; (2) parenchymal transection guided by the dorsal ischemic demarcation line of segment S7; (3) advance along the right hepatic vein toward the ventral aspect of segment S7. By decomposing complex maneuvers into three standardized steps (steps 1-3), this protocol significantly reduces technical barriers. The procedural details are meticulously demonstrated in this report to enhance reproducibility.</p><p><strong>Results: </strong>In the preliminary phase of this study, 20 patients were included. All patients underwent surgery smoothly, with no conversion to open surgery and no deaths, and all patients achieved R0 resection. The operation time was 190.0 (178.0-210.0) min, and intraoperative blood loss was 200.0 (150.0-280.0) mL.</p><p><strong>Conclusions: </strong>This method standardizes the laparoscopic S7 segment resection, which, while ensuring precise removal, is expected to reduce the learning curve for surgeons.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"91-99"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for Locally Advanced Pancreatic Ductal Adenocarcinoma: Selection of Patients and Surgical Technique.","authors":"Savio George Barreto, Benjamin Loveday, Anubhav Mittal, Sanjay Pandanaboyana, John Albert Windsor","doi":"10.1159/000550333","DOIUrl":"10.1159/000550333","url":null,"abstract":"<p><p><p>Background: The management of locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) now relies on an integrated, multidimensional assessment that goes beyond just the relationship of the tumour to vascular anatomy. Summary: By combining dynamic imaging, biomarker monitoring, genetic profiling, and thorough physiological evaluation, clinicians can more accurately select patients who are most likely to benefit from aggressive surgical intervention. These patients can then be offered NAT, singly or in combination, and preferably within the context of a clinical trial. The re-staging of patients post-NAT remains a challenge, but in patients who have shown no evidence of tumour growth or metastases and preferably with evidence of biochemical, metabolic, or radiological response and are fit enough, a trial dissection may be indicated. This evolving strategy transforms a disease once considered palliative into one with curative potential in selected patients. In this setting, surgical techniques have also evolved to include artery-first approaches to the SMA and CA, arterial divestment as an alternative to arterial resection, and the triangle operation. Patients with LA-PDAC should be managed in a high-volume centre with experience in treating this type of patient. There is no established role for minimally invasive techniques, including laparoscopic or robotic surgery, with LA-PDAC. Key Messages: Determining the role of surgery for locally advanced pancreatic cancer requires more than just an assessment of the tumour-vasculature relationship. The multidisciplinary selection integrates dynamic imaging, biomarker monitoring, genetic profiling, and physiological evaluation. For some patients, a previous palliative strategy is transformed to a potentially curative one. In this setting, new surgical techniques include an artery-first approach to avoid futile resection, periadventitial dissection instead of arterial resection, and the triangle operation for complete nodal clearance. </p>.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"48-60"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of the Serum Fibrinogen-to-Albumin Ratio as a Preoperative Predictor of High-Grade Dysplasia or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm of the Pancreas.","authors":"Shigeto Ochiai, Naokazu Chiba, Hiroki Yamaguchi, Ryota Suda, Yoshihiro Nagae, Takumi Seichi, Masashi Nakagawa, Takahiro Gunji, Toshimichi Kobayashi, Toru Sano, Yuji Kikuchi, Satoshi Tabuchi, Tetsuo Ishizaki, Shigeyuki Kawachi","doi":"10.1159/000550596","DOIUrl":"10.1159/000550596","url":null,"abstract":"<p><strong>Introduction: </strong>The indications for resection of intraductal papillary mucinous neoplasms (IPMNs) have been optimized according to the high-risk stigmata (HRS) and worrisome features (WFs). However, the proportion of resected IPMNs diagnosed as low grade is not insignificant. This study aimed to investigate whether fibrinogen-to-albumin ratio (FAR) improves the diagnostic ability of high-grade dysplasia (HGD) or invasive carcinoma (IC) in IPMN.</p><p><strong>Methods: </strong>This study included 47 patients who underwent surgery between April 2008 and July 2024. Clinical factors were examined to determine HGD or IC. We also compared the accuracy of predicting HGD or IC between HRS alone and HRS plus FAR.</p><p><strong>Results: </strong>A total of 23 were diagnosed with HGD or IC based on pathological diagnosis. On multivariable analysis, contrasted walled nodules ≥5 mm and FAR ≥0.0833 were significant predictors of HGD or IC. Moreover, the HRS and high FAR (≥0.0833) group had better the positive predictive value and diagnostic accuracy rate.</p><p><strong>Conclusions: </strong>FAR may be a significant predictor of HGD or IC in IPMN. In addition, when combined with HRS, its diagnostic ability as a predictor of HGD or IC may be further improved.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"61-68"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}