Ejso最新文献

{"title":"Synchronous hepatectomy and splenectomy for patients with BCLC stage 0/A hepatocellular carcinoma and clinically significant portal hypertension: A multicenter retrospective cohort study.","authors":"Tianyin Shao, Hongwei Huang, Qi Cheng, Feng Xia, Zhanguo Zhang, Songqing He, Deyu Li, Bangde Xiang, Cuncai Zhou, Bin Wang, Bo Li, Liping Liu, Decai Yu, Changchun Cai, Hongqiang Yang, Bin Jiang, Guandou Yuan, Zhongqiu Li, Zhan Lu, Hengxin Zou, Guanqi Zhang, Yufu Peng, Bing Han, Chaowen Xiao, Yuanqiu Li, Xuehan Shen, Jun Yu, Xinkang Liu, Jinpeng Wang, Zhiwei Zhang, Xiaoping Chen","doi":"10.1016/j.ejso.2025.110351","DOIUrl":"10.1016/j.ejso.2025.110351","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is restricted by high costs and donor shortages, necessitating exploration of alternative treatments for hepatocellular carcinoma (HCC) with significant portal hypertension (CSPH). This study examined whether synchronous hepatectomy and splenectomy (HS) improves survival over hepatectomy (H) in patients with BCLC stage 0/A HCC and CSPH.</p><p><strong>Methods: </strong>A total of 525 patients with BCLC stage 0/A HCC and CSPH from 12 centers were under review. Among these, 300 patients underwent H (H group) and 225 underwent HS (HS group). Propensity score matching resulted in 157 matched pairs of patients. The study compared both short-term and long-term outcomes between the two groups.</p><p><strong>Results: </strong>The HS group had higher rates of massive intraoperative bleeding (15.3 % vs. 6.4 %), abdominal bleeding (5.1 % vs. 0.6 %), and portal vein thrombosis (14.0 % vs. 3.8 %), but no significant differences in 30-day mortality or overall morbidity. In terms of long-term outcomes, the HS group showed better overall survival (59.0 vs. 48.0 months, P = 0.031) and recurrence-free survival (41.0 vs. 28.0 months, P = 0.017), with lower incidences of variceal bleeding (1.9 % vs. 7.6 %) and liver failure mortality (3.8 % vs. 13.4 %). Multivariate analysis identified splenectomy as a significant prognostic factor for improved OS and RFS.</p><p><strong>Conclusion: </strong>HS could be a reasonable alternative for patients with BCLC stage 0/A HCC and CSPH. This combined therapeutic strategy enhances long-term survival through various mechanisms while maintaining an acceptable level of perioperative risk.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110351"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of subcutaneous tunnel-assisted periareolar incision versus conventional uniportal video-assisted thoracoscopic surgery (VATS) for pulmonary nodules: A prospective, randomized, controlled trial.","authors":"Zhenyuan Yang, Maohui Chen, Jianghong Wu, Guanglei Huang, Taidui Zeng, Hongmu Li, Shuliang Zhang, Chun Chen, Chunyu Zhou, Bin Zheng","doi":"10.1016/j.ejso.2025.110353","DOIUrl":"10.1016/j.ejso.2025.110353","url":null,"abstract":"<p><strong>Introduction: </strong>Recent investigations into subcutaneous tunneled periareolar incisions for thoracoscopic pulmonary resection have established procedural safety and feasibility. Nevertheless, a critical gap persists in prospective evidence. To address this, we conducted a prospective controlled trial comparing perioperative complications and incisional cosmetic outcomes between single-port pulmonary resection performed via subcutaneous tunneled periareolar approaches versus conventional lateral thoracic approaches.</p><p><strong>Materials and methods: </strong>174 patients were randomized 1:1 to either the subcutaneous tunnel periareolar incision group or the conventional single-port group. All demographic, perioperative and follow-up data were prospectively collected and analyzed according to the standardized protocol.</p><p><strong>Results: </strong>Neither group required intraoperative conversion to multi-port or open chest surgery. Operative duration was significantly longer in the periareolar incision group (P < 0.05). No statistically significant difference in postoperative complications was observed between the cohorts (P = 0.686). Compared to the conventional single-port approach, the periareolar incision group exhibited significantly reduced rates of clinically significant pain. The results of POSAS scale showed that the scar evaluation results were better in the periareolar incision group. Incisional cosmesis satisfaction was significantly higher in female patients who underwent periareolar incision than in those who underwent conventional single-port approach (P < 0.001), while there was no similar finding in male patients (P = 0.222). All patients reported minimal or no alterations in nipple sensitivity, with no significant functional impact on daily activities.</p><p><strong>Conclusion: </strong>The subcutaneous tunneled periareolar approach for single-port thoracoscopic resection demonstrates equivalent safety to conventional VATS while conferring superior cosmetic outcomes.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110353"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative review of the role of a national society of surgical oncology.","authors":"Ibifunke Pegba-Otemolu, Tim Zijlstra","doi":"10.1016/j.ejso.2025.110349","DOIUrl":"10.1016/j.ejso.2025.110349","url":null,"abstract":"<p><strong>Background: </strong>National societies of surgical oncology (NSSOs) are integral to the coordination and promotion of high-quality cancer surgery. However, their functions vary internationally, and some countries lack a formal society. This study aimed to explore the leadership of NSSO and to describe the scope of their activities, with a view to guiding surgeons with an interest in establishing a NSSO.</p><p><strong>Methods: </strong>A purposive sampling strategy was used to identify leaders of NSSOs. Semi-structured interviews were conducted and analysed using thematic analysis. The Standards for Reporting Qualitative Research (SRQR) framework guided reporting. Additionally, key recommendations were tabulated to assist countries interested in establishing an NSSO.</p><p><strong>Results: </strong>Nine expressions of interest were received; six NSSO leaders participated in interviews, representing Belgium, Brazil, Germany, Italy, the Netherlands, and the United Kingdom. Five of these are European countries and members of the European Society of Surgical Oncology (ESSO). Thematic analysis identified seven core domains of activity: dissemination of knowledge, improvement of patient outcomes, research promotion, capacity building, financing, fostering collaboration, and member engagement.</p><p><strong>Conclusion: </strong>NSSOs play a pivotal role in advancing equitable and high-quality cancer surgery at national and international levels. Comparative research is warranted to assess the impact of NSSOs on patient outcomes and health system performance. These findings may inform efforts in countries currently without a national surgical oncology society.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110349"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing robot-assisted minimally invasive gastrectomy (RAMIG) for gastric cancer in a European tertiary referral center.","authors":"Lianne Triemstra, Cas de Jongh, Hylke J F Brenkman, Bas L A M Weusten, Jan Erik Freund, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1016/j.ejso.2025.110342","DOIUrl":"10.1016/j.ejso.2025.110342","url":null,"abstract":"<p><strong>Background: </strong>Our European tertiary referral center implemented robot-assisted minimally invasive gastrectomy (RAMIG) in September 2020, following experience with robot-assisted esophagectomy and multiquadrant surgery using the DaVinci Xi robot. RAMIG implementation was evaluated.</p><p><strong>Methods: </strong>This single-center prospective cohort study compared 111 MIG patients (2014-2023) with the initial 75 RAMIG patients (2020-2023), operated by two experienced robotic upper-GI surgeons. After propensity-score-matching, surgical, oncological, and textbook outcomes for overall/distal/total RAMIG and MIG were compared. Cumulative sum (CUSUM) analysis assessed learning curves for operating time and nodal yield. Additionally, the transition from laparoscopic-circular stapled (MIG/RAMIG) to robot-assisted handsewn anastomosis (RAMIG-only) was evaluated.</p><p><strong>Results: </strong>After propensity-score-matching, 75 RAMIG and 75 MIG patients were analyzed; 68% underwent total gastrectomy, and 78% neoadjuvant therapy. Postoperative complications, blood loss, hospitalization, R0-resections, and textbook outcomes were similar between groups (p>0.05). Distal RAMIG showed longer median operating time (214 versus 191 min; p=0.032), but less severe complications (13 % versus 38 % grade≥3A; p = 0.041). Total RAMIG showed higher median nodal yield (35 versus 22 nodes; p < 0.001). CUSUM-analysis showed plateaus for distal/total RAMIG at cases 10 and 24 for operating time, and 8 and 17 for nodal yield. Robot-assisted handsewn esophagojejunostomy seemed to show reduced anastomotic leakage (9% versus 28%), postoperative complications (45% versus 59%), and 30-day mortality (0% versus 5%).</p><p><strong>Conclusions: </strong>Implementing RAMIG in our tertiary referral center resulted in similar perioperative outcomes with improved nodal yield, despite longer operating times. The robotic technique facilitated modification to handsewn esophagojejunostomy. Short learning curves (8-24 cases) for experienced robotic surgeons support adaption towards RAMIG.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110342"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing prognostic accuracy in gastric cancer: The TNrrM staging system versus the AJCC TNM system.","authors":"Hao-Xiang Zhang, Ze-Ning Huang, Xing-Qi Zhang, Yi-Hui Tang, Yu-Qin Sun, Cai-Ming Weng, Chao-Hui Zheng, Ping Li, Chang-Ming Huang, Jian-Xian Lin, Jian-Wei Xie","doi":"10.1016/j.ejso.2025.110362","DOIUrl":"10.1016/j.ejso.2025.110362","url":null,"abstract":"<p><strong>Background: </strong>An accurate staging system is crucial for the management of gastric cancer (GC) patients. This study aimed to propose a novel staging system (TNrrM) based on the regional lymph node ratio (rLNR), defined as the ratio of the number of metastatic lymph nodes (LNs) to the number of examined LNs within each LN station.</p><p><strong>Methods: </strong>The study included 3263 GC patients, with 2143 in the development set and 1120 in the validation set. For each patient, the rLNR for each LN station was calculated, and the total rLNR was obtained by summing the rLNR values of all LN stations. Optimal cut-off values for total rLNR were determined using X-tile to define the Nrr staging system. Based on combinations of T and Nrr staging, 5-year overall survival (OS) curves were generated, and the TNrrM staging system was defined by grouping stages with similar prognosis.</p><p><strong>Results: </strong>The prognostic value of TNrrM was compared with the 8th edition of the AJCC TNM staging system, showing that TNrrM staging had higher AUC values for predicting 12- to 60-month OS, better calibration, and an increased net benefit as revealed by decision curve analysis (DCA). Stratified analysis demonstrated that TNrrM staging could effectively distinguish subgroups within TNM IIB to IIIC stagings.</p><p><strong>Conclusion: </strong>Incorporating the rLNR, the TNrrM staging system significantly enhances prognostic accuracy for GC patients compared with the AJCC TNM system, with similar results found in the validation set.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110362"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic role of peritoneal lavage cytology: Proposal for staging laparoscopy criteria in biliary tract cancer.","authors":"Yoshiyuki Shibata, Atsushi Oba, Gaku Shimane, Tatsunori Miyata, Jun Tauchi, Hayato Baba, Aya Maekawa, Kosuke Kobayashi, Yoshihiro Ono, Takashi Sasaki, Masato Ozaka, Naoki Sasahira, Hiromichi Ito, Yosuke Inoue, Yu Takahashi","doi":"10.1016/j.ejso.2025.110369","DOIUrl":"10.1016/j.ejso.2025.110369","url":null,"abstract":"<p><strong>Background: </strong>The role of radical resection for CY-positive BTC remains controversial and needs reassessment in the era of effective multi-agent chemotherapy. To evaluate the clinical significance of peritoneal lavage cytology (CY) in the perioperative management of biliary tract cancer (BTC) and propose novel staging laparoscopy (SL) criteria.</p><p><strong>Methods: </strong>We reviewed the medical records of 782 patients with BTC, excluding those with cancer of the papilla of Vater. Patients were classified based on CY and metastatic (M) status.</p><p><strong>Results: </strong>Among 782 BTC patients, 38 (4.9 %) were CY-positive. Patients were categorized as follows: CY1M0 resected group (n = 10, 1.3 %), CY0M0 resected group (n = 637, 81.5 %), M1 resected group (n = 50, 6.4 %), and M1 unresected group (n = 70, 9.0 %). The postoperative median overall survival was 58.8, 19.5, 19.3, and 13.5 months respectively (p < 0.001). Postoperative recurrence occurred in 9 patients (90.0 %), 306 patients (48.0 %), and 43 patients (86.0 %) in the CY1M0, CY0M0, and M1 resected group, respectively. Multivariate analysis of pre- and intra-operative factors revealed that CY positivity was independently associated with postoperative recurrence (odds ratio, 7.18; 95 % confidence interval, 1.28-134.83; p = 0.022), along with other significant factors. A combination of cT3/T4 and cN-positive status was the good indicator of staging laparoscopy, achieving a detection rate of 28.8 % and accuracy of 85.2 %.</p><p><strong>Conclusion: </strong>CY positivity is associated with postoperative recurrence and poor prognosis and can be considered equivalent to M1 status. Staging laparoscopy may be indicated for patients with a combination of cT3/T4 and cN positivity.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110369"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of pathological response in predicting the benefit of adjuvant therapy after neoadjuvant chemoimmunotherapy in patients with esophageal cancer.","authors":"Maohui Chen, Yizhou Huang, Rujing Zhang, Bingqiang Cai, Yongcong Zhang, Chuanquan Lin, Shuliang Zhang, Taidui Zeng, Chun Chen, Bin Zheng","doi":"10.1016/j.ejso.2025.110360","DOIUrl":"10.1016/j.ejso.2025.110360","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemoimmunotherapy has demonstrated significant survival benefits in esophageal squamous cell carcinoma (ESCC), but the value of postoperative adjuvant therapy remains controversial. Tumor regression grade (TRG) serves as a crucial pathological indicator of response to neoadjuvant treatment, yet its role in guiding adjuvant therapy is unclear. This study aimed to investigate the prognostic significance of TRG in postoperative adjuvant therapy.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included 169 thoracic ESCC patients who underwent R0 resection after neoadjuvant chemoimmunotherapy between January 2019 and December 2022. Patients were stratified into TRG 0-1 (good response) and TRG 2-3 (poor response) groups. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models.</p><p><strong>Results: </strong>With a median follow-up of 34 months, adjuvant immunotherapy significantly improved 3-year overall survival (OS) compared to no adjuvant therapy (82.1 % vs. 66.3 %, p = 0.042), though no significant difference in disease-free survival (DFS) was observed. Subgroup analysis revealed that adjuvant therapy notably improved OS in patients with TRG 0-1 (93.2 % vs. 73.3 %, p = 0.015), but not in TRG 2-3. Multivariate analysis confirmed adjuvant immunotherapy as an independent protective factor in TRG 0-1 (HR = 0.22, p = 0.015), while vascular invasion was an adverse factor in TRG 2-3. Additionally, patients with pathological lymph node involvement (yPN+) benefited from adjuvant immunotherapy (HR = 0.41, p = 0.019).</p><p><strong>Conclusion: </strong>TRG and lymph node status may serve as valuable markers to identify ESCC patients who benefit from adjuvant immunotherapy, facilitating personalized postoperative treatment strategies.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110360"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical implications of advanced cancers in low- and middle-income countries: Challenges, opportunities, and call to action.","authors":"Nashivai E Kivuyo, Daniel W Kitua, Mungeni A Misidai, Fransia A Mushi, Ally H Mwanga, Obadia V Nyongole, Larry O Akoko","doi":"10.1016/j.ejso.2025.110368","DOIUrl":"10.1016/j.ejso.2025.110368","url":null,"abstract":"<p><strong>Background: </strong>Surgical intervention remains a cornerstone of cancer management. In low- and middle-income countries (LMICs), however, the high burden of advanced-stage cancers presents distinct clinical, logistical, and ethical challenges for surgeons working in resource-constrained environments. This review aims to examine how advanced-stage cancer impacts surgical oncology practice in LMICs, and to identify practical, context-specific strategies that surgeons can adopt to navigate these challenges, optimize patient outcomes, and strengthen cancer surgery delivery in resource-limited settings.</p><p><strong>Methods: </strong>This narrative review draws on peer-reviewed literature published between 2000 and 2025, identified through purposive searches in PubMed, Scopus, and Google Scholar. Keywords included \"advanced cancer,\" \"surgery,\" \"low- and middle-income countries,\" and \"oncology workforce.\" Articles were selected based on relevance to the surgical management of advanced cancers in LMICs, with a focus on real-world clinical challenges, system-level barriers, and potential solutions.</p><p><strong>Results: </strong>Surgeons in LMICs contend with advanced-stage presentations, limited diagnostic and treatment infrastructure, inadequate subspecialty training, and constrained perioperative support. These factors often restrict curative options and complicate surgical decision-making and outcomes. Nonetheless, opportunities exist for surgeons, including contributing to early detection, advocating for timely referrals, and spearheading local clinical protocols. Surgeons can also lead in capacity building, multidisciplinary collaboration, and context-specific research to inform policy and practice.</p><p><strong>Conclusion: </strong>While the management of advanced-stage cancer in LMICs presents complex challenges, surgeons have a vital role in bridging gaps in care.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110368"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Optimal timing of surgery after neoadjuvant chemoradiotherapy in rectal cancer: A retrospective analysis.","authors":"Parsa Torkaman, Ali Hosseini","doi":"10.1016/j.ejso.2025.110316","DOIUrl":"10.1016/j.ejso.2025.110316","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110316"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of active warming interventions in preventing perioperative hypothermia and its complications in cancer patients: A systematic review and meta-analysis.","authors":"Saili Wu, Yingxue Bao","doi":"10.1016/j.ejso.2025.110329","DOIUrl":"10.1016/j.ejso.2025.110329","url":null,"abstract":"<p><strong>Background: </strong>Perioperative hypothermia is a common complication during cancer surgeries, associated with adverse outcomes such as shivering, prolonged recovery, and increased length of stay (LOS). This systematic review and meta-analysis aimed to assess the effectiveness of active warming interventions in preventing perioperative hypothermia and its complications.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, articles published up to 2025 January 2, were searched in Scopus, PubMed, Web of Science, and Cochrane Library databases. Outcomes measured included perioperative core body temperature, shivering, blood losing, and LOS. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with funnel plots and Egger's test. Meta-regression and subgroup analyses explored potential predictors of effectiveness.</p><p><strong>Results: </strong>Out of 2650 records, 20 articles were included. Active warming techniques improved core body temperature, with a Standard Mean Difference (SMD) of 0.65 at 30 min, increasing to 2.14 at 180 min. Shivering incidence was significantly reduced, with risk differences ranging from -0.12 to -0.25 across interventions. LOS was reduced by an average of 6 h, with a significant difference observed in combined interventions (SMD = -0.80, 95 % CI: 1.23 to -0.37). Heterogeneity was high for pharmaceutical interventions (I² > 75 %), whereas it remained low for non-pharmacological interventions (I² < 50 %). Meta-regression revealed participant mean age, %male, BMI, and surgery duration cannot significantly predict the SMD between the two groups.</p><p><strong>Conclusion: </strong>Although, the results of this study show active warming interventions can be effective in preventing perioperative hypothermia complications, more studies with larger samples and higher quality are needed.</p><p><strong>Study registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420250651763.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"110329"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}