International journal of surgery最新文献

{"title":"Commentary on \"Polyethylene terephthalate microplastics exposure enhances the risk of ulcerative colitis: insights from multiomics integration, machine learning, and molecular docking reveal intestinal toxicity mechanisms\".","authors":"Yalong Chen, Xudong Tian, Yanlong Li","doi":"10.1097/JS9.0000000000005123","DOIUrl":"10.1097/JS9.0000000000005123","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13290-13291"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing diagnostic approach and oncologic risk in surgically resected lung cancer: propensity-matched analysis of intraoperative versus percutaneous biopsy by tumor location and morphology.","authors":"Younggi Jung, Eunjue Yi, Sung Ho Hwang, Sungho Lee, Jae Ho Chung","doi":"10.1097/JS9.0000000000005106","DOIUrl":"10.1097/JS9.0000000000005106","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains the leading cause of cancer-related death, and earlier detection has increased the demand for accurate histological diagnosis While percutaneous transthoracic needle biopsy (PCNB) and surgical biopsy are widely used, concerns remain about PCNB-related tumor dissemination and recurrence. These risks are influenced by tumor location and morphology, which affect procedural feasibility and oncologic outcomes. This study investigated the association between biopsy method and recurrence-free survival (RFS) in surgically resected lung cancer and evaluated how tumor characteristics may identify subgroups at higher risk.</p><p><strong>Materials and methods: </strong>Medical records of 363 patients with surgically resected primary lung cancer who underwent preoperative PCNB (<i>n</i> = 221) or intraoperative surgical biopsy (<i>n</i> = 142) at a tertiary center between 2015 and 2020 were retrospectively reviewed. Patients were grouped according to biopsy methods and compared. Demographics, preoperative chest CT findings such as consolidation to tumor ratio (CTR) and intralobar tumor location, pathologic findings, and recurrences were evaluated.</p><p><strong>Results: </strong>In the propensity-matched cohort (103 patients per group), multivariate analysis showed male (HR 2.11), current smoking (HR 2.12), central tumors (HR 5.47), and higher CTR (HR 16.6) as independent predictors of reduced RFS, whereas PCNB itself was not (<i>P</i> = 0.16). CTR and tumor location remained important risk factors in both groups. Notably, locoregional and pleural recurrences were more frequent in the PCNB group, although not statistically significant. Five-year RFS was significantly lower in the PCNB group (85.0% vs. 74.3%, <i>P</i> = 0.013), with the negative impact of higher CTR and central tumors being more pronounced in the PCNB group.</p><p><strong>Conclusion: </strong>PCNB was not an independent risk factor for recurrence. However, its association with higher rates of locoregional and pleural recurrence along with a trend toward decreased RFS in tumors with adverse CT features suggests careful clinical consideration when choosing biopsy method.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13168-13178"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Commentary on \"The modified clipped ligation of intersphincteric fistula tract (clipped-LIFT) for high transsphincteric/suprasphincteric fistula\".","authors":"Shuang Hao, Jingen Lu","doi":"10.1097/JS9.0000000000005058","DOIUrl":"10.1097/JS9.0000000000005058","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12967-12968"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing surgical decision-making for lung adenocarcinoma by preoperatively identifying pathological high-risk factors: retrospective development and prospective validation of a deep learning model.","authors":"Xincheng Li, Jianhua Liu, Xiangyu Meng, Jun Lu, Wei Feng, Jing Zhou, Bin Hu, Xiumei Hu, Ying Ji","doi":"10.1097/JS9.0000000000005084","DOIUrl":"10.1097/JS9.0000000000005084","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate identification of pathological high-risk factors (PHRFs) in early-stage lung adenocarcinoma (LUAD) is critical for optimizing surgical decision-making. However, reliance on intraoperative frozen section (FS) assessment is limited by insufficient sensitivity. This study aimed to retrospectively develop and prospectively validate a deep learning model (a knowledge-based graph convolutional network, KB-GCN) based on preoperative CT scans to identify PHRFs in LUAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively developed and externally validated a KB-GCN using two cohorts (A: 268 patients/297 lesions for training and internal validation; B: 68 patients/75 lesions for external validation). We then conducted a pre-registered, single-center, prospective observational validation in 200 consecutive surgical candidates with early-stage LUAD. Before prospective enrollment, the model architecture, weights, preprocessing pipeline, and the decision threshold (0.40, determined from the retrospective phase) were locked. For each patient, a preoperative prediction was generated before intraoperative FS and final pathology (FP); the clinical team was blinded to the model output. The performance of the locked model and FS was compared with FP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In retrospective validation, the KB-GCN model achieved an area under the curve (AUC) of 0.92 (95% CI: 0.86-0.97) in the internal validation cohort and 0.88 (95% CI: 0.81-0.94) in the external validation cohort. The KB-GCN model outperformed all 6 compared classical 2D/3D CNN models (best comparative AUC: 0.79). In prospective validation, intraoperative FS achieved an overall sensitivity of 59% and accuracy of 77% for detecting PHRFs, misclassifying 40.6% (39/96) of PHRF-positive cases. In contrast, the KB-GCN model demonstrated significantly higher overall sensitivity (82%) and AUC (0.83), although with lower specificity (75% vs FS: 92%). The KB-GCN model showed superior performance in part-solid nodules (PSN, AUC: 0.86) and in 2-3 cm tumors (AUC: 0.86), with moderate performance in ≤1 cm tumors (AUC: 0.82) and in 1-2 cm tumors (AUC: 0.79).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study retrospectively developed and, for the first time, prospectively demonstrates that a deep learning model based on preoperative chest CT predicts PHRFs, achieving significantly higher sensitivity for identifying PHRFs in early-stage invasive LUAD than conventional intraoperative FS. Despite slightly lower specificity, the KB-GCN model effectively compensates for the critical sensitivity deficit of FS, particularly for tumors (1-3 cm) containing solid components. Preoperative deep learning assessment combined with intraoperative FS provides thoracic surgeons with more comprehensive and accurate information to optimize surgical decisions (e.g., extent of resection: lobectomy or sublobar resection). Future development requires integrating this preoperative model with intra","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12789-12805"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of ultrasound in the diagnosis and prediction of the severity of abdominal adhesions.","authors":"Chang Liu, Shi-Si Ding, Hui-Hui Chai, Wei-Wei Ren, Hui Zhao, Xiao-Qi Yuan, Ren-Yuan Gao, Guan-Qun Zhang, Ji-Yuan Li, Li-Ping Sun, Chun-Qiu Chen, Hui-Xiong Xu","doi":"10.1097/JS9.0000000000005066","DOIUrl":"10.1097/JS9.0000000000005066","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to construct a preoperative ultrasound prediction model, and compare its diagnostic performance with the existing sliding sign to predict the severity of abdominal adhesions in order to reduce the occurrence of intraoperative complications and shorten the duration of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between June 2020 and June 2022, 100 patients with a history of abdominal surgery were included in this retrospective study. All participants underwent ultrasound examination of five sites on the anterior abdominal wall before surgery. Eighteen sites were excluded because of surgical stomas, etc. Finally, 482 sites were examined by ultrasound, of which 138 (28.6%) were severe adhesions. Based on the intraoperative findings, the patients were divided into two groups: patients with severe adhesions and patients with non-severe adhesions. Finally, the data of 482 abdominal sites examined were randomly divided into a training cohort (70%) and a validation cohort (30%). The least absolute shrinkage and selection operator (LASSO) regression and multivariate binary logistic regression were used to determine the independent influencing factors, thereby constructing a clinical ultrasound prediction model for severe abdominal adhesions. The sensitivity, specificity, positive and negative predictive value (PPV and NPV) and accuracy of the model were calculated. Prediction models were established, and the area under the receiver operating curve (AUC) between models and compared with sliding sign (MA) using the DeLong test to determine the optimal model. At the same time, intraclass correlation coefficient (ICC) was used to evaluate the inter-observer agreement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The LASSO regression showed that wall syndrome, traction sign, deformation of abdominal organs, two-layer peritoneal bright lines, sliding sign (head-foot direction mobility), and examination site were associated with severe adhesions. Multivariate analysis showed that traction sign, two-layer peritoneal bright lines, head-foot direction mobility and examination site (all &lt;i&gt;P&lt;/i&gt; &lt; 0.05) were the independent predictors of severe abdominal adhesion. Based on these predictors, the improved prediction model (referred as MB) was established. It showed that the diagnostic performance of MB was better than MA [AUC&lt;sub&gt;MB&lt;/sub&gt; = 0.943 (95% CI: 0.920-0.967) vs AUC&lt;sub&gt;MA&lt;/sub&gt; = 0.827 (95% CI: 0.920-0.967), &lt;i&gt;P&lt;/i&gt; &lt; 0.001] in the training cohort. The results were validated [AUC&lt;sub&gt;MB&lt;/sub&gt; = 0.873 (95% CI: 0.818-0.928) vs AUC&lt;sub&gt;MA&lt;/sub&gt; = 0.803 (95% CI: 0.755-0.851), &lt;i&gt;P&lt;/i&gt; = 0.005] in the validation cohort. In the training cohort, the MB improved the specificity (22.5%), PPV (22.6%) and the accuracy (13.6%). In the validation cohort, the MB improved the specificity (19.2%), PPV (10.8%) and the accuracy (6.9%). At the same time, the ICC showed that the ultrasonic parameters had high consistency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12636-12648"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of progress: a before and after study on improved survival in pancreatic cancer through evolving multimodal therapy.","authors":"Ting-Kai Liao, Chih-Jung Wang, Wei-Hsun Lu, Ping-Jui Su, Chien-Jui Huang, Yung-Yeh Su, Chih-Chieh Yen, I-Ting Liu, Chia-Jui Yen, Ying Jui Chao, Yan-Shen Shan","doi":"10.1097/JS9.0000000000005024","DOIUrl":"10.1097/JS9.0000000000005024","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer remains one of the deadliest malignancies with poor survival outcomes. This study investigated the influence of evolving multimodal strategies, particularly the increased use of neoadjuvant chemotherapy (NAC) and extended surgical resection, on patient outcomes over the last decade.</p><p><strong>Methods: </strong>This before-and-after study included patients with pancreatic cancer who received curative surgery at a tertiary medical center from 2011 to 2022. The patients were divided into two treatment periods: Period A (2011-2017, <i>n</i> = 154) and Period B (2018-2022, <i>n</i> = 251). Patients were evaluated based on their clinical stage, resectability, treatment strategy, surgical approach, and survival outcomes. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Sensitivity analysis was conducted by propensity score matching to minimize the differences in clinical demographics.</p><p><strong>Results: </strong>NAC use increased significantly from 22.1% in period A to 74.9% in period B (<i>P</i> < 0.001), along with an increase in the use of extended pancreatectomies (31%-58%, <i>P</i> < 0.001). Extended resections provided survival benefits yet were associated with higher major morbidity (20% vs 11%) and 30-day mortality rates (2.1% vs 0.5%). Median OS and PFS improved markedly from A to B for resectable/borderline resectable cases (OS: 19.2-35.5 months; PFS: 8.3-18.6 months; both <i>P</i> < 0.001). Improvements in OS from period A to period B were also observed for patients with locally advanced/metastatic disease (12.3-19.7 months, <i>P</i> < 0.001). Multivariate analysis identified period B, lower CA19-9 levels before surgery, early pathological stage, and adjuvant chemotherapy as independent predictors of survival. Similar results were determined after propensity score matching.</p><p><strong>Conclusion: </strong>The shift toward a multimodal approach significantly improved survival in patients with pancreatic cancer, especially those with resectable and borderline resectable tumors. Although extended pancreatectomy increases surgical risk, the survival benefits support its selective use. Continued refinement of the treatment selection and perioperative care is warranted.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12596-12607"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward personalized management of metastatic PPGL: decoding the implications of the ¹⁷⁷Lu-DOTATATE Phase II interim analysis.","authors":"Tonghu Liu, Junpeng Ji, Zechen Yan","doi":"10.1097/JS9.0000000000005046","DOIUrl":"10.1097/JS9.0000000000005046","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12994-12995"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From prediction to partnership: positioning machine learning as a decision-support tool for nursing risk assessment in postoperative infection prevention.","authors":"Anqi Liu, Jinian Wei, Shaohui Geng","doi":"10.1097/JS9.0000000000005065","DOIUrl":"10.1097/JS9.0000000000005065","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12971-12972"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of 1470-nm diode laser enucleation of the prostate for benign prostatic hyperplasia: a systematic review and meta-analysis.","authors":"Yicheng Guo, Fengze Sun, Lin Wang, Yanwei Zhang, Bin Wang, Chu Liu, Xiaohong Ma, Jitao Wu","doi":"10.1097/JS9.0000000000005104","DOIUrl":"10.1097/JS9.0000000000005104","url":null,"abstract":"<p><strong>Background: </strong>Benign prostatic hyperplasia (BPH) is a common urological condition in aging men, often requiring surgical intervention when medical therapy fails. The 1470-nm diode laser enucleation of the prostate (DiLEP) has emerged as a promising technique, but its efficacy and safety remain to be systematically evaluated.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials (RCTs) investigating 1470-nm DiLEP in the treatment of BPH. Primary outcomes included functional parameters such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR). Secondary outcomes included intraoperative and perioperative indicators (e.g., operative time, hemoglobin decrease, catheterization duration, bladder irrigation time) and complication rates. Effect sizes were synthesized using appropriate fixed- or random-effects models based on heterogeneity, and reported as mean difference (MD) or odds ratios with 95% confidence intervals.</p><p><strong>Results: </strong>Four RCTs involving 533 patients were included. 1470-nm DiLEP was associated with significantly shorter operative time (MD = -24.43, P < 0.0001), reduced hemoglobin loss (MD = -2.77, P = 0.02), shorter bladder irrigation time (MD = -13.23, P < 0.0001), and reduced catheterization duration (MD = -2.29, P < 0.0001). Functional outcomes such as IPSS, QoL, and Qmax were comparable between groups, but DiLEP showed superior reduction in PVR at 6 and 12 months. No significant differences in complication rates were observed.</p><p><strong>Conclusion: </strong>The 1470-nm DiLEP appears to be a safe and effective surgical option for BPH, with advantages in perioperative outcomes and potential mid-term functional benefits, particularly in improving bladder emptying. Further large-scale, long-term RCTs are needed to confirm these findings.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13228-13238"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Diagnostic accuracy of artificial intelligence assisted clinical imaging in the detection of oral potentially malignant disorders and oral cancer: a systematic review and meta-analysis\".","authors":"Weihua Yang, Min He","doi":"10.1097/JS9.0000000000005051","DOIUrl":"10.1097/JS9.0000000000005051","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12953-12955"},"PeriodicalIF":9.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}