International journal of surgery最新文献

{"title":"Clinical evaluation of real-time artificial intelligence provision of expert representation in indocyanine green fluorescence angiography during colorectal resections: Erratum.","authors":"","doi":"10.1097/JS9.0000000000002317","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002317","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"111 3","pages":"2761"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630389","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 indocyanine green in fluorescence-guided pancreatic surgery: a comprehensive review.","authors":"Andrea Tufo, Anna Caterina Milanetto, Roberto Valente, Enrico Spalice, Loredana Sodano, Claudio Pasquali, Maria Chiara Scandavini, Alessandro Coppola","doi":"10.1097/JS9.0000000000002311","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002311","url":null,"abstract":"<p><p>Pancreatic surgery is a complex and challenging field, with patients facing a high risk of postoperative complications. In recent years, indocyanine green (ICG) has gained prominence as a valuable tool used in various aspects of pancreatic surgery. ICG is a fluorescent dye thatoffers real-time imaging capabilities that enhance the surgeon's ability to accurately localise tumours and critical anatomical structures, thereby improving surgical precision and potentially reducing operative time and complications. One of the most significant advantages of ICG is its ability to provide enhanced visualisation of the biliary tract and vascular structures, which is particularly beneficial in complex pancreatic resections, in which the anatomy can be highly variable and challenging to navigate. Furthermore, ICG can be instrumental in ensuring the adequate perfusion of anastomoses, thereby reducing the risk of postoperative leaks and associated morbidity. This comprehensive review aims to provide an in-depth analysis of the current applications, advantages, and limitations of ICG in pancreatic surgery.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515551","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":"https://doi.org/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 are 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 = dP/dt. The inherent shear forces can stretch biological membranes to release biomolecules such as VEGF and NO. A most favourable 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 (TPS) 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":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-27","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}

{"title":"Development and prospects of natural orifice specimen extraction surgery for colorectal cancer: a review article.","authors":"Xingxiang Huang, Ran Wei, Qinghai Li, Xingfeng Qiu, Peng Li, Weiling He","doi":"10.1097/JS9.0000000000002285","DOIUrl":"10.1097/JS9.0000000000002285","url":null,"abstract":"<p><p>The natural orifice specimen extraction surgery (NOSES) procedure is an innovative approach to treating colorectal cancer that offers several advantages. First, the NOSES technique is minimally invasive, reducing the incidence of postoperative complications such as wound infection and fat liquefaction. Second, it provides excellent pain relief and improves cosmetic outcomes by requiring fewer abdominal incisions, thereby increasing patient satisfaction. Additionally, NOSES provides all of the advantages of minimally invasive surgery and enables patients to recover quickly, helping patients return to their normal lives faster. This approach aligns with the concept of patient-centered care and significantly improves patient quality of life. The positive results noted at both short- and long-term postoperative follow-up indicate that NOSES is a valuable option in cancer care. Despite its many benefits, NOSES has also been challenged by bacteriology, oncology, and ethics. This paper presents a review of recent research progress regarding NOSES in the treatment of colorectal cancer. In this article, we examined the advantages and disadvantages of NOSES in clinical practice and discussed potential issues and solutions.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189055","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":"Prediction Model of the T Cell-mediated Rejection After Liver Transplantation in Children and Adults: A Case-controlled Study.","authors":"Chengbo Ai, Jiulin Song, Chi Yuan, Gang Xu, Jian Yang, Tao Lv, Shuguang Jin, Hong Wu, Bo Xiang, Jiayin Yang","doi":"10.1097/JS9.0000000000002279","DOIUrl":"10.1097/JS9.0000000000002279","url":null,"abstract":"<p><strong>Objective: </strong>T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT.</p><p><strong>Method: </strong>Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1221 LT recipients (1096 adults and 125 children) were obtained from the Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model.</p><p><strong>Result: </strong>The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, P < 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model's curve incorporating these variables for predicting TCMR after LT was 0.713 (95% confidence interval, CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model.</p><p><strong>Conclusion: </strong>This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058920","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":"Intracorporeal versus extracorporeal anastomosis in laparoscopic total gastrectomy: a systematic review and meta-analysis.","authors":"Shafquat Zaman, Mohammad Iqbal Hussain, Maria Kausar, Omar E S Mostafa, Ali Yasen Mohamedahmed, Shahab Hajibandeh, Shahin Hajibandeh, Ricardo Camprodon, Chaminda Sellahewa","doi":"10.1097/JS9.0000000000002296","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002296","url":null,"abstract":"<p><strong>Background: </strong>To evaluate outcomes of intracorporeal (IOJ) versus extracorporeal (EOJ) oesophagojejunostomy following laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer.</p><p><strong>Methods: </strong>A comprehensive search of various electronic databases was conducted. Comparative studies of IOJ versus EOJ following LTG in patients with gastric malignancy were included. Primary outcomes were anastomotic leak, anastomotic bleeding, and anastomotic stricture formation. Secondary outcomes included operative time, length of hospital stay (LOS), volume of intra-operative haemorrhage, number of harvested lymph nodes, time to flatus, time to soft diet, intra-abdominal infection, pulmonary infection, surgical site infection (SSI), duodenal stump leak, pancreatic fistula occurrence, postoperative ileus, re-operation, and mortality. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale was used to assess risk of bias.</p><p><strong>Results: </strong>Seventeen non-randomised studies enrolling 2,960 patients divided between an IOJ (n = 1430) and EOJ (n = 1530) group were included. IOJ was associated with significantly lower risk of anastomotic stricture (P = 0.01), volume of intra-operative bleeding (P = < 0.001), and SSI (P = 0.04) compared to EOJ. No difference was found in anastomotic leak (P = 0.93); anastomotic bleeding (P = 0.35); operative time (P = 0.63); LOS (P = 0.30); lymph node yield (P = 0.17); time to first flatus (P = 0.77); time to resumption of soft diet (P = 0.32); intra-abdominal infection (P = 0.22); pulmonary infection (P = 0.45); duodenal stump leak (P = 0.46); pancreatic fistula occurrence (P = 0.16); and paralytic ileus (P = 0.59), re-operation (P = 0.50), and mortality (P = 0.23) between the two groups.</p><p><strong>Conclusions: </strong>LTG for gastric malignancy with IOJ may be associated with lower risk of anastomotic stricture and SSI compared to the extracorporeal approach. However, future adequately powered randomized studies are needed to compare the two techniques.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515802","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":"How is 3D modeling in metabolic surgery utilized and what is its clinical benefit: a systematic review and meta-analysis.","authors":"Henry Douglas Robb, Aksaan Arif, Rithvik Mahadev Narendranath, Bibek Das, Khaled Alyaqout, William Lynn, Yasser Abul Aal, Hutan Ashrafian, Matyas Fehervari","doi":"10.1097/JS9.0000000000002301","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002301","url":null,"abstract":"<p><strong>Background: </strong>Three-dimensional (3D) modeling is an emerging technology in surgery, with applications in operative planning, surgical education, and patient engagement. Metabolic surgery, the most effective treatment for obesity, is increasingly prevalent leading to new complex clinical challenges. This systematic review aims to understand the use of 3D modeling in metabolic surgery and its impact on clinical outcomes.</p><p><strong>Methods: </strong>Following a registered protocol (PROSPERO: XXX), a comprehensive search using MEDLINE, Embase, and CENTRAL Cochrane Library was conducted. Eligible papers underwent screening and full-text review. A qualitative thematic analysis was performed alongside meta-analyses on available volumetric data. Results were reported as directed by the PRISMA guidelines.</p><p><strong>Results: </strong>Twenty-nine studies were included, with most at Level II evidence (n = 19, 66%). Studies focused on operative planning and surgical practice (90%, n = 26) and were subdivided into preoperative planning (14%, n = 4), postoperative diagnosis (31%, n = 9), and postoperative assessment and prediction (45%, n = 13). Only three papers addressed surgical education (10%). 3D modeling for patient education was unexplored. To assess 3D modeling's cross-study consistency, pooled meta-analyses on preoperative and postoperative 3D gastric volumetry and abdominal circumference were performed. Average preoperative stomach volume was 794.93 mL (95% confidence interval [CI]: 518.61-1071.26 mL). Postoperative LSG and RYGB/OAGB gastric volumes were 171.71 mL (95% CI: 113.37-288.58 mL) and 35.73 mL (95% CI: 29.32-42.14 mL) respectively. Average abdominal circumference was 120.04 cm (95% CI: 100.72-139.35 cm). All volumes were consistent with published data.</p><p><strong>Conclusions: </strong>This systematic review highlighted the accuracy of 3D modeling for volumetric assessments and its developing role in surgical planning and training. However, its potential benefits in AR or 3DP models, in patient education or for answering bariatric surgical debates using 3D volumetric studies remain underutilized.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515801","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":"Laparoscopic simulation training improves operating room performance of surgical residents: a multicenter randomized trial (NOVICE).","authors":"Michael Thomaschewski, Reinhard Vonthein, Tobias Keck, Tilman Laubert, Claudia Benecke","doi":"10.1097/JS9.0000000000002304","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002304","url":null,"abstract":"<p><strong>Background: </strong>Learning basic laparoscopic skills can be efficiently performed ex vivo in a safe environment using simulation devices. However, in many countries, the broad and mandatory implementation of ex vivo laparoscopic simulation training in surgical residency is still lacking. The aim of the study was to evaluate the efficacy of laparoscopic basic skills simulation training on the surgical performance of residents during their first laparoscopic procedures in the operating room.</p><p><strong>Methods: </strong>This was a multicenter, prospective, randomized, two-arm, single-blind trial. The study recruited first-year surgical residents (NOVICE) with no previous personal experience in laparoscopic surgery. After the participants had performed their first laparoscopic cholecystectomy, they were randomized into two groups: the intervention group underwent six weeks of standardized laparoscopic basic skills simulation training (Lübeck Toolbox Curriculum), whereas the control group did not. After six weeks, both groups performed a second cholecystectomy. The videotapes of the first and second cholecystectomies were evaluated blinded based on the Global Operative Assessment of Laparoscopic Skill (GOALS) score. The primary endpoint was the changes in the GOALS scores between the first and second cholecystectomies.</p><p><strong>Results: </strong>22 surgical residents from 11 surgical clinics in Germany were included, and 4 residents dropped out. The median improvement in the LTB-Curriculum group between CHE I and CHE II was 8.5 GOALS score points in contrast to 2 points in the control group. This difference was statistically significant (95%CI: 1-15 points, P = 0.013).</p><p><strong>Conclusion: </strong>Ex-vivo training in basic laparoscopic skills significantly improved the surgical performance of residents during their first laparoscopic cholecystectomies in the operating room.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492067","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 for anastomotic leakage and its impact on survival outcomes in radical multivisceral surgery for advanced ovarian cancer: an AGO-OVAR.OP3/LION exploratory analysis.","authors":"Fabian Trillsch, Bastian Czogalla, Sven Mahner, Verena Loidl, Alexander Reuss, Andreas du Bois, Jalid Sehouli, Francesco Raspagliesi, Werner Meier, David Cibula, Alexander Mustea, Ingo B Runnebaum, Barbara Schmalfeldt, Giovanni Aletti, Rainer Kimmig, Giovanni Scambia, Felix Hilpert, Annette Hasenburg, Uwe Wagner, Philipp Harter","doi":"10.1097/JS9.0000000000002306","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002306","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage is a significant complication following bowel resection in cytoreductive surgery for ovarian cancer. Previous studies have highlighted the detrimental effects of anastomotic leakage on patients' postoperative course. However, there is still a lack of precise identification of the high-risk population and established strategies for preventing its occurrence.</p><p><strong>Materials and methods: </strong>Patients who underwent bowel resection within the surgical phase III trial AGO-OVAR.OP3/LION investigating the impact of systematic pelvic and paraaortic lymphadenectomy in cytoreductive surgery for primary ovarian cancer were included in this analysis. All patients in the AGO-OVAR.OP3/LION trial had undergone complete cytoreduction with no macroscopic residual disease. We analyzed the occurrence of anastomotic leakage regarding surgical procedure (non-lymphadenectomy vs. lymphadenectomy and non-stoma vs. stoma) using the Fisher test. Risk factors for anastomotic leakage and its prognostic impact on survival were analyzed.</p><p><strong>Results: </strong>Overall rate of anastomotic leakage was 7.1%. Notably, the Non-lymphadenectomy subgroup had a lower anastomotic leakage rate of 3.0% compared to the lymphadenectomy subgroup (11.2%, P = 0.005). The use of protective stoma placement resulted in an anastomotic leakage rate of 5.5% regardless of lymphadenectomy compared to the Non-Stoma subgroup (7.5%, P = 0.78). Increased blood loss (odds ratio [OR] 1.04 per 100cc, 95% confidence interval [CI] 1.0001-1.09) and lymphadenectomy (OR 3.67, 95% CI 1.41-11.40) were associated with a higher risk of anastomotic leakage. Although anastomotic leakage demonstrated a numerical detrimental impact on median progression-free survival (PFS) (18 months with anastomotic leakage vs. 19 months with Non-anastomotic leakage, hazard ratio [HR] 0.86; 95% CI 0.5 to 1.4, P = 0.53) and median overall survival (OS) (31 months with anastomotic leakage vs. 58 months with Non-anastomotic leakage, HR 0.69; 95% CI 0.4 to 1.2, P = 0.17), the differences were not statistically significant.</p><p><strong>Conclusion: </strong>Anastomotic leakage rates were lower in the Non-lymphadenectomy arm, the current standard of care. Blood loss and lymphadenectomy, as surrogate markers for extensive surgery, were associated with increased risk for anastomotic leakage. These findings highlight the importance of strategies to reduce surgical complexity and perioperative risk to improve clinical outcomes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483047","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":"Liver resection versus radiofrequency ablation for solitary small hepatocellular carcinoma measuring≤3cm: a systematic review and meta-analysis.","authors":"Ming Yang, Guangjun Li, Kunlin Chen, Youwei Wu, Ting Sun, Wentao Wang","doi":"10.1097/JS9.0000000000002302","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002302","url":null,"abstract":"<p><strong>Background: </strong>Controversy remains regarding liver resection (LR) and radiofrequency ablation (RFA) for patients with single hepatocellular carcinomas (HCCs) measuring 3 cm or less. The purpose of our study was to compare the prognosis between LR and RFA in patients with solitary HCCs ≤3 cm.</p><p><strong>Methods: </strong>The meta-analysis followed the PRISMA guidelines and the Cochrane Handbook. All RCTs and cohort studies that compared LR versus RFA in patients with solitary HCCs≤3 cm were comprehensively searched in the PubMed, Cochrane Library, Embase, and Web of Science databases up to 30 January 2024. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS).</p><p><strong>Results: </strong>A total of 6356 patients with solitary HCCs≤3 cm and 5829 patients with solitary HCCs≤2 cm from 39 included studies were analyzed (LR = 5759, RFA = 6426). The present meta-analysis of two RCTs showed no statistically significant difference in OS between LR and RFA. However, the meta-analysis of cohort studies revealed that, compared with RFA, LR conferred a superior OS advantage (HR = 0.80, 95% CI: 0.68-0.93, P = 0.005). There was a significant improvement in the DFS rate with LR over RFA (HR = 0.63, 95% CI: 0.49-0.81) and in the RFS rate (HR = 0.65, 95% CI: 0.55-0.76). Compared with RFA, LR resulted in better OS (HR = 0.73, 95% CI: 0.54-0.97), DFS (HR = 0.74, 95% CI: 0.67-0.82) and RFS (HR = 0.71, 95% CI: 0.57-0.90) in patients with a solitary HCC lesion ≤2 cm.</p><p><strong>Conclusions: </strong>Evidence from cohort studies suggested that in patients with a solitary HCC lesion ≤ 3 cm, LR is preferable to RFA. Additional RCTs are needed to confirm the validity of this evidence.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":""},"PeriodicalIF":12.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492091","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}