International journal of surgery最新文献

{"title":"International consensus recommendations for the RAPID procedure in liver transplantation: The RAPID Consensus ISLS 2023 Zurich Collaborative.","authors":"","doi":"10.1097/JS9.0000000000002145","DOIUrl":"10.1097/JS9.0000000000002145","url":null,"abstract":"<p><strong>Introduction: </strong>Since its beginning in 1963, liver transplantation has significantly advanced, now including transplant oncology. As indications broaden, donor supply reduces. The two-stage RAPID procedure (initially abbreviated as \"Resection And Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy\") has emerged to address the use of small-for-size grafts. However, a comprehensive evaluation of RAPID is essential given its novelty, scarcity, and diverse outcomes reported.</p><p><strong>Methods: </strong>The RAPID Consensus International Society of Liver Surgeons 2023 Zurich initiative established evidence around the RAPID procedure using the Danish Model of Consensus. Engaging an international community of specialists, the initiative ensured multidisciplinary involvement and used the GRADE framework to evaluate the quality of evidence and grade the recommendations.</p><p><strong>Results: </strong>Comprehensive discussions and debates led to internationally recognized recommendations addressing perioperative measures for RAPID. Key recommendations highlighted the significance of standardized nomenclature, specific indications, graft criteria, surgical techniques, optimal interstage timings, and measures to manage potential complications.</p><p><strong>Conclusion: </strong>The consensus provides recommendations for the RAPID procedure, emphasizing transparency and outcome reporting. Establishing dedicated registries can improve care standards, which may ensure the benefits of RAPID by maximizing patient safety and improving outcomes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2766-2772"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189154","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":"Multiparametric MRI and transfer learning for predicting positive margins in breast-conserving surgery: a multi-center study.","authors":"Xue Zhao, Jing-Wen Bai, Sen Jiang, Zhen-Hui Li, Jie-Zhou He, Zhi-Cheng Du, Xue-Qi Fan, Shao-Zi Li, Guo-Jun Zhang","doi":"10.1097/JS9.0000000000002278","DOIUrl":"10.1097/JS9.0000000000002278","url":null,"abstract":"<p><p>This study aimed to predict positive surgical margins in breast-conserving surgery (BCS) using multiparametric MRI (mpMRI) and radiomics. A retrospective analysis was conducted on data from 444 BCS patients from three Chinese hospitals between 2019 and 2024, divided into four cohorts and five datasets. Radiomics features from preoperative mpMRI, along with clinicopathological data, were extracted and selected using statistical methods and LASSO logistic regression. Eight machine learning classifiers, integrated with a transfer learning (TL) method, were applied to enhance model generalization. The model achieved an AUC of 0.889 in the internal test set and 0.771 in the validation set. Notably, TL significantly improved performance in two external validation sets, increasing the AUC from 0.533 to 0.902 in XAH and from 0.359 to 0.855 in YNCH. These findings highlight the potential of combining mpMRI and TL to provide accurate predictions for positive surgical margins in BCS, with promising implications for broader clinical application across multiple hospitals.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"3123-3128"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189102","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":"Risk factors of failure to achieve textbook outcome in patients after pancreatoduodenectomy: a systematic review and meta-analysis.","authors":"Jiajun Yuan, Changjie Du, Hongyu Wu, Tao Zhong, Qilong Zhai, Jialun Peng, Nan Liu, Jinzheng Li","doi":"10.1097/JS9.0000000000002299","DOIUrl":"10.1097/JS9.0000000000002299","url":null,"abstract":"<p><strong>Background: </strong>Pancreatoduodenectomy (PD) represents one of the most technically demanding surgical procedures, characterized by extensive surgical trauma and high perioperative morbidity. Single outcome measures are insufficient to comprehensively assess the surgical quality of PD. Textbook outcome (TO), as an integrated evaluation system incorporating multiple clinical parameters, offers an objective, reliable, and comprehensive assessment of surgical performance. This systematic review and meta-analysis aimed to identify risk factors associated with failure to achieve textbook outcome (non-TO) following pancreatoduodenectomy.</p><p><strong>Materials and methods: </strong>We systematically searched international databases (PubMed, Web of Science, EMBASE, and Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, Weipu Chinese Journals Service Platform, Wanfang Data, and SinoMed) for studies on risk factors of failure to achieve textbook outcome after pancreatoduodenectomy from inception to 31 December 2024. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. Heterogeneity testing, sensitivity analysis, and publication bias assessment were conducted.</p><p><strong>Results: </strong>Ten studies involving 5238 patients were included in this meta-analysis. Among the 18 factors evaluated, five were significantly associated with failure to achieve textbook outcome after pancreatoduodenectomy: preoperative biliary drainage (OR = 2.09, 95%CI [1.30-3.36], P = 0.002), smaller tumor size (OR = 1.36, 95%CI [1.02-1.81], P = 0.04), soft pancreatic texture (OR = 2.25, 95%CI [1.01-5.02], P = 0.05), small pancreatic duct diameter (OR = 2.30, 95%CI [1.62-3.28], P < 0.00001), and increased intraoperative blood loss (OR = 4.14, 95%CI [1.16-14.83], P = 0.03). The remaining 13 factors showed no significant association with failure to achieve textbook outcome.</p><p><strong>Conclusion: </strong>This meta-analysis identified preoperative biliary drainage, tumor morphological characteristics (including size and texture), pancreatic duct diameter, and intraoperative blood loss as key factors affecting the achievement of textbook outcome after pancreatoduodenectomy. These findings may help surgeons identify high-risk patients for failure to achieve textbook outcome, enabling personalized surgical strategies and optimized perioperative management to improve textbook outcome rates.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"3093-3106"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483051","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 commentary on \"The efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: a systematic review and meta-analysis\".","authors":"Wujie Chen, Dihao Lv, Yinglong Huang, Mingxia Ding","doi":"10.1097/JS9.0000000000002276","DOIUrl":"10.1097/JS9.0000000000002276","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"3120-3122"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059006","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":"Maximizing oral intake tolerance in malignant gastric outlet obstruction - a Markov decision tree analysis comparing duodenal stenting, endoscopic ultrasound-guided gastroenterostomy and surgical gastrojejunostomy based on a meta-analysis of randomized controlled trials.","authors":"Koy Min Chue, Benjamin Robert Douglass, Lester Wei Lin Ong, Jeremy Tian Hui Tan, Jonathan Guo Xiang Teh, Martin Putera, Clarence Kah Wai Kwan, Wai Keong Wong, Baldwin Po Man Yeung","doi":"10.1097/JS9.0000000000002303","DOIUrl":"10.1097/JS9.0000000000002303","url":null,"abstract":"<p><strong>Introduction: </strong>Malignant gastric outlet obstruction (GOO) has a significant impact on quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has shown promising results. Traditional isolated outcome measures do not sufficiently address critical considerations for end-of-life patients like oral intake tolerance. This study aimed to determine via a probabilistic approach, the optimal management strategy for GOO patients that maximizes their oral intake tolerance.</p><p><strong>Methods: </strong>A Markov decision model was developed, with input variables based on a systematic review and meta-analysis of randomized controlled trials (RCT) comparing duodenal stenting (DS), EUS-GE and surgical gastrojejunostomy (GJ). A prospective cohort study with a comparator group was also included for EUS-GE model given the scarcity of RCTs. Model assumption was a patient with malignant GOO, with equal probabilities of being allocated to 1 of 3 treatment options. Each data point was evaluated using pooled probabilities from the meta-analysis of clinical outcomes. Primary outcome was successful oral intake tolerance at various time points of 1-6 months post-intervention.</p><p><strong>Results: </strong>Fifteen studies were included into the Markov model. Based on 10 000 simulations in each arm, at a survival of 1-month, DS and EUS-GE had the highest likelihood of oral intake (81.2% and 80.4%) compared to GJ (75.5%). However, at a survival of 6-month, EUS-GE and GJ were better at palliating GOO, with likelihood of oral intake at 23.8% and 25.2%, compared to 21.3% for DS.</p><p><strong>Conclusion: </strong>For patients with a prognosis of more than 1-month, a surgical GJ, or EUS-GE if technical expertise is available, is preferred for GOO palliation.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"3006-3019"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492093","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":"Intra- and early postoperative predictors of delirium risk in cardiac surgery: results from the prospective observational FINDERI study.","authors":"Paul T Itting, Monika Sadlonova, Manuel J Santander, Maria Knierim, Carlotta Derad, Thomas Asendorf, Christopher M Celano, Niels Hansen, Hermann Esselmann, Stephanie Heinemann, Charlotte Eberhard, Melanie Hoteit, Mirjam F Schröder, Ingo Kutschka, Jens Wiltfang, Christine A F von Arnim, Hassina Baraki","doi":"10.1097/JS9.0000000000002265","DOIUrl":"10.1097/JS9.0000000000002265","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a severe complication following cardiac surgery and is associated with increased morbidity and mortality. The impact of intra- and early postoperative factors on the occurrence of POD following cardiac surgery remains controversial. To close this gap, we investigated intra- and early postoperative factors and their predictive values for POD.</p><p><strong>Methods: </strong>We performed a prospective observational study that aimed to FIND DElirium RIsk factors (FINDERI) for patients undergoing elective cardiac surgery. POD was assessed using the Confusion Assessment Method algorithm. Intra- and early postoperative factors were extracted from electronic medical records and reviewed by cardiac surgeons. To identify potential predictors of POD, we used univariate and multivariate logistic regression along with machine learning (ML) with ten-fold cross-validation.</p><p><strong>Results: </strong>In our study cohort of 490 patients, 106 screened positive for POD (21.6%). In the multivariate analysis, we found a positive association between POD occurrence and age ( P < 0.001), duration of surgery ( P = 0.027), combined (versus isolated) surgical procedures ( P = 0.024), opening of the cardiac chambers ( P = 0.046), and ventilation time ( P < 0.001). The ML-based decision tree identified a two level-algorithm including ventilation time and aortic cross-clamping time, with an AUC of 0.7116 ( P = 0.0002) in the validation set. In the ML-based LASSO regression analysis, we identified ventilation time, administration of erythrocyte concentrates (EC), and usage of cardiopulmonary bypass (CPB) as predictors of POD, with an AUC of 0.7407 ( P < 0.0001) in the validation set.</p><p><strong>Conclusion: </strong>The results of this analysis highlight the associations between ventilation time, aortic cross-clamping time, administration of EC, and usage of CPB and POD. Additionally, they suggest that the optimization of surgical protocols has the potential to reduce POD risk in individuals undergoing cardiac surgery.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2872-2885"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189098","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":"Artificial intelligence predicts multiclass molecular signatures and subtypes directly from breast cancer histology: a multicenter retrospective study.","authors":"Xiangyang Zhang, Yang Chen, Changjing Cai, Yifeng Wang, Jun Tan, Zijie Fang, Le Wei, Zhuchen Shao, Liwen Wang, Tiezheng Qi, Yihan Liu, Zhaohui Jiang, Yin Li, Ying Han, Tibera Kagemulo Rugambwa, Shan Zeng, Haoqian Wang, Hong Shen, Yongbing Zhang","doi":"10.1097/JS9.0000000000002220","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002220","url":null,"abstract":"<p><p>Detection of biomarkers of breast cancer incurs additional costs and tissue burden. We propose a deep learning-based algorithm (BBMIL) to predict classical biomarkers, immunotherapy-associated gene signatures, and prognosis-associated subtypes directly from hematoxylin and eosin stained histopathology images. BBMIL showed the best performance among comparative algorithms on the prediction of classical biomarkers, immunotherapy related gene signatures, and subtypes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"111 4","pages":"3109-3114"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063921","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":"Surgery and technical skill decay: a literature review.","authors":"Marta de Andres Crespo, Panagis Michael Lykoudis, Fiona Pwint-Oo Myint, Pasquale Berlingieri","doi":"10.1097/JS9.0000000000002313","DOIUrl":"10.1097/JS9.0000000000002313","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of surgical trainees are taking time out of clinical training for research, parental leave or other interests. A comprehensive review was carried out to evaluate the current evidence on whether and how such time results in surgical skill decay.</p><p><strong>Methods: </strong>A PubMed, Embase, Web of Science, and Cochrane Library search was performed using the phrase: (\"skills decay\" OR \"skills fade\") AND \"surgery.\" All relevant literature was analyzed and summarized.</p><p><strong>Results: </strong>A total of 41 relevant articles were identified. The skills that are most adversely affected by time out of training are technical operative skills and, within those, speed and accuracy in operations. Factors that affect skill decay include the complexity of the task itself, the degree of overlearning (i.e., the skill of the surgeon prior to time out of training) and the retention interval (i.e., the length of time for which the trainee is out of training and whether or not spaced practice is carried out). The articles suggest that simulation may be of assistance in mitigating skill decay; however, this has yet to be fully investigated.</p><p><strong>Conclusions: </strong>As an increasing number of surgical trainees are taking time away from clinical training for academic research, higher degrees, parental leave, or other interests, further research is required to investigate how to mitigate the resulting surgical skill decay, potentially through the use of simulation.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630384","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":"Response to \"A commentary on 'Leveraging diverse cell-death patterns to predict the prognosis and drug sensitivity of triple-negative breast cancer patients after surgery'\".","authors":"Jindong Xie, Xinpei Deng, Anli Yang, Shaoquan Zheng, Yuhui Tang, Yi Xie, Junsheng Zhang, Hailin Tang, Wenkuan Chen, Yutian Zou, Xiaoming Xie","doi":"10.1097/JS9.0000000000002298","DOIUrl":"10.1097/JS9.0000000000002298","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"3138-3139"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189161","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 interaction of shock waves with biological tissue - momentum transfer, the key for tissue stimulation and fragmentation.","authors":"Othmar Wess, Juergen Mayer","doi":"10.1097/JS9.0000000000002261","DOIUrl":"10.1097/JS9.0000000000002261","url":null,"abstract":"<p><strong>Background: </strong>Shock waves in medicine have gained enormous importance and have spread since 1980, and the first kidney stone was successfully fragmented in a patient in Munich. Meanwhile, the spectrum of medical applications of shock waves ranges from powerful fragmentation of kidney stones to diverse indications such as wound healing, chronic pelvic pain, spasticity, erectile dysfunction, and others, to neuro-stimulation in the context of Alzheimer's disease. A comprehensive working mechanism for this diverse field of medical indications is still missing.</p><p><strong>Objective: </strong>Investigation of the physical basis of the working mechanism of shock waves in medical applications.</p><p><strong>Methods: </strong>We developed a model based on the mechanical forces generated by the momentum transfer at the acoustic interfaces of different layers of biological tissue. The generated forces are strong enough to crash brittle material and provide an adequate mechanical stimulus to activate mechano-transduction and mechano-sensory-transduction with nerve stimulation, thereby affecting the neural memory function of the central nervous system.</p><p><strong>Results: </strong>The key to generating appropriate forces in the millisecond range is the mechanism of momentum transfer at the interfaces between tissue layers with different acoustic impedances. According to Newton's laws of motion, a change in momentum (momentum transfer) generates force F = d P /d t . The inherent shear forces can stretch biological membranes to release biomolecules such as vascular endothelial growth factor and nitric oxide. A most favorable feature of this mechanism is the selective effect on soft tissue interfaces and small tissue inhomogeneities to generate small forces in the range of few (≤10) Newton to stimulate tissue and nerve cells, while the same shock wave can generate forces ≥200 Newton and more on hard tissue interfaces such as bones or stones.</p><p><strong>Conclusion: </strong>The mechanism of momentum transfer is the basis for mechano-transduction and mechano-sensory transduction. It offers the opportunity to stimulate peripheral nerves and modify the motor reflex patterns of \"pathologic\" reflexes by hyper stimulation. The new technique of transcranial pulse stimulation may be based on direct stimulation and reactivation of neurons in the brain. Momentum transfer is the basic physical mechanism and the initiator for successive biological processes in medical shock wave therapy.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2810-2818"},"PeriodicalIF":12.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515803","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}