Journal of Gastrointestinal Surgery最新文献

{"title":"Sociocultural Determinants of Hepatocellular Carcinoma Prevention Behaviors Among Non-Hispanic Black and Hispanic Adults in the United States.","authors":"Sebastian O Ekenze, Charalampos M Charalampou, Qaidar Alizai, Timothy M Pawlik","doi":"10.1016/j.gassur.2026.102644","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102644","url":null,"abstract":"<p><strong>Background: </strong>Prevention is critical to reduce hepatocellular carcinoma (HCC) burden, however, sociocultural influences on engagement in HCC preventive behaviors among populations at elevated risk are rarely examined together. We sought to evaluate sociocultural factors associated with HCC preventive behaviors among Non-Hispanic Black (NHB) and Hispanic adults.</p><p><strong>Methods: </strong>Pooled 2015-2024 NHIS data were used to identify NHB and Hispanic adults. HCC prevention behaviors included hepatitis B (HBV) vaccination, hepatitis C (HCV) testing, alcohol risk reduction, healthy weight, and physical activity. Survey-weighted logistic regression estimated associations between sociocultural factors and prevention behaviors adjusted for demographic, socioeconomic, healthcare access, and immigration factors.</p><p><strong>Results: </strong>Among 74,162 adults (NHB: 44.7%, n=33,166; Hispanic: 55.3%, n=40,996), HBV vaccination was lower among individuals aged 45-64 compared with those aged 18-30 years old (aOR 0.38; 95%CI 0.34-0.42), whereas college graduates had higher vaccine uptake (aOR 2.01; 95%CI 1.70-2.38). Adults aged 31-44 years were more likely to get tested for HCV (aOR 1.88; 95%CI 1.57-2.26). Alcohol moderation was higher among women (aOR 2.01; 95%CI 1.81-2.22) and lower among Hispanic than NHB adults (aOR 0.53; 95%CI 0.46-0.60). Higher education attainment was associated with healthy weight (aOR 1.56; 95%CI 1.38-1.77). Immigration status modified racial/ethnic prevention patterns (interaction p=0.009); long-term foreign-born noncitizen Black adults had higher vaccination rates (aOR 3.50; 95%CI 1.37-8.94).</p><p><strong>Discussion: </strong>Engagement in HCC prevention behaviors among NHB and Hispanic adults was strongly affected by age, education, insurance coverage, healthcare access, and immigration context, highlighting structural influences on prevention opportunities. Equity-focused strategies expanding vaccination, screening, and lifestyle interventions are required.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102644"},"PeriodicalIF":2.8,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An outermost-layer-oriented medial approach to facilitate margin-negative distal transection in gastric cancer with duodenal invasion: a single-centre retrospective cohort study.","authors":"Shengbo Sun, Guangxing Li, Wenchang Wang, Guowei Zhao, Chuanji Han, Qing Gong, Leiming Hong, Jin Cao","doi":"10.1016/j.gassur.2026.102642","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102642","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer with duodenal invasion (Duo+) presents a distinct surgical challenge because adequate distal-margin clearance must be achieved without compromising duodenal stump safety. Standardised laparoscopic strategies for this setting remain poorly defined.</p><p><strong>Methods: </strong>In this single-centre retrospective cohort study, we evaluated the technical feasibility and observed outcomes of an integrated extended-mobilisation and margin-control strategy in 500 patients undergoing laparoscopic distal gastrectomy with D2 lymphadenectomy for stage II-III gastric adenocarcinoma. The cohort included 90 patients with duodenal invasion (Duo+) and 410 without duodenal invasion (Duo-). In Duo+ cases, the strategy comprised extended duodenal-bulb mobilisation, optimisation of stapler angulation, routine intraoperative frozen-section diagnosis of the distal margin, and reinforcement of the duodenal stump. Outcomes in the Duo- group were reported to provide clinical context rather than to estimate the effect of the strategy relative to conventional mobilisation.</p><p><strong>Results: </strong>Resected duodenal length was greater in Duo+ (median 3 vs 1cm; P<0.001); no distal-margin positivity in either group (0/90 vs 0/410). R0 rates were similar (95.6% vs 96.8%; P=0.78). Estimated blood loss did not differ (75 vs 55mL; P=0.18). Postoperative morbidity was numerically higher in Duo+ but not significant: Clavien-Dindo ≥II (40.0% vs 35.1%; P=0.38), ≥III (10.0% vs 7.1%; P=0.33), pancreatic fistula (5.6% vs 3.4%; P=0.42), duodenal stump fistula (2.2% vs 0.5%; P=0.17). Five-year overall survival was comparable (48% vs 52%; log-rank P=0.45).</p><p><strong>Conclusions: </strong>In this single-centre retrospective series, an integrated extended-mobilisation and margin-control strategy was feasible during laparoscopic distal gastrectomy for gastric cancer with duodenal invasion, and no distal-margin-positive cases were observed among the Duo+ patients. These descriptive findings do not establish superiority or equivalence relative to conventional mobilisation or identify the contribution of any individual component of the strategy. Comparative multicentre studies are required.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102642"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When to Operate After Neoadjuvant Therapy for Borderline Resectable Pancreatic Cancer: A Critical Review and Multidimensional Decision Framework.","authors":"WaiSan Ho, WenChao Xu, JianLu Zhang, JunChao Guo","doi":"10.1016/j.gassur.2026.102640","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102640","url":null,"abstract":"<p><strong>Background: </strong>Surgical timing after neoadjuvant therapy for borderline resectable pancreatic cancer remains difficult because post-treatment imaging may not reliably distinguish residual tumor from fibrosis, whereas tumor biology and patient fitness strongly influence surgical benefit.</p><p><strong>Methods: </strong>We performed a critical narrative review of studies and guidelines addressing surgical timing, radiological response, tumor-marker dynamics, pathological response, and physiological readiness after neoadjuvant therapy for borderline resectable pancreatic cancer.</p><p><strong>Results: </strong>Current evidence supports a multidimensional approach rather than reliance on anatomical imaging alone. Informative tumor-marker trajectories, especially carbohydrate antigen 19-9 when reliable and alternative markers such as Duke pancreatic monoclonal antigen type 2 when carbohydrate antigen 19-9 is non-informative, are central to assessing systemic disease control. Selective use of liver magnetic resonance imaging, diffusion-weighted magnetic resonance imaging, and positron emission tomography-based modalities may help clarify discordant scenarios or detect occult metastatic disease. Patient fitness, including performance status, nutritional reserve, organ function, and recovery from treatment-related toxicity, remains essential before exploration.</p><p><strong>Conclusion: </strong>Surgical timing after neoadjuvant therapy for borderline resectable pancreatic cancer should integrate biology, anatomy, and patient condition. A biology-first multidisciplinary framework may help avoid futile pancreatectomy while preserving timely surgical opportunities for appropriate candidates.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102640"},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Should Ileal Pouch-Anal Anastomosis Be Performed After Inpatient Total Abdominal Colectomy for Acute Medically Refractory Ulcerative Colitis? Experience of 274 Consecutive Patients.","authors":"Olga Lavryk, Munachimso Okafor, Karl Hage, Arielle Kanters, Stefan D Holubar, Leonardo Duraes, Michael Valente, Anthony de Buck van Overstraeten, Jeremy Lipman, Hermann Kessler, David Liska, Scott R Steele","doi":"10.1016/j.gassur.2026.102631","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102631","url":null,"abstract":"<p><strong>Background: </strong>Three-stage ileal pouch-anal anastomosis (IPAA) is commonly performed following total abdominal colectomy (TAC) for severe ulcerative colitis (UC). However, the optimal interval between TAC and pouch construction remains unclear.</p><p><strong>Methods: </strong>A prospectively maintained ileal pouch database (1983-2021) was queried to identify patients with pathologically confirmed UC who underwent three-stage IPAA following urgent TAC for acute disease exacerbation. Patients were stratified by the interval between TAC and IPAA (<6 vs ≥6 months). Baseline characteristics, perioperative outcomes, pouch failure (PF), long-term pouch survival, functional outcomes, and quality of life were compared. Multivariable regression analysis identified factors associated with PF.</p><p><strong>Results: </strong>A total of 274 patients were included; 99 (36%) underwent IPAA within 6 months of TAC and 175 (64%) underwent delayed reconstruction. Patients undergoing delayed reconstruction were older and had a longer disease duration before colectomy. Hospital stay was shorter in the early reconstruction group (6.4 ± 2.4 vs 7.5 ± 4.5 days; p=0.008), whereas postoperative complications and follow-up were comparable. PF rates were similar between the early and delayed groups (5.1% vs 4.0%; p=0.762). Rates of Crohn's disease conversion (6.1% vs 1.7%; p=0.076), long-term pouch survival (log-rank p=0.70), functional outcomes, and quality of life also did not differ. Findings remained consistent using alternative reconstruction intervals and in a sensitivity analysis restricted to the most recent 20-year operative period (1996-2015). Fistula formation, but not reconstruction timing, was independently associated with PF.</p><p><strong>Conclusion: </strong>The interval between TAC and IPAA was not associated with PF, long-term pouch survival, functional outcomes, or quality of life. Reconstruction timing may therefore be individualized according to patient recovery and clinical factors without compromising long-term pouch outcomes.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102631"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforated and Complicated Cholecystitis: A Narrative Review of Diagnosis, Management, and Differentiation from Gallbladder Cancer.","authors":"Elizabeth Callahan, Aida Vanderpuye, Julianna Szuwalski, Nikahat Yasmine, Yashant Aswani, Timothy M Pawlik, Hassan Aziz","doi":"10.1016/j.gassur.2026.102627","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102627","url":null,"abstract":"<p><strong>Introduction: </strong>Perforated cholecystitis is a severe complication of gallbladder inflammation that is associated with substantial morbidity and mortality. Diagnosis is often challenging because clinical and radiographic findings overlap with those of uncomplicated cholecystitis and, in some cases, gallbladder malignancy. This review summarizes the current evidence regarding the diagnosis, imaging, management strategies, outcomes, and differentiation of perforated cholecystitis from gallbladder cancer.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using PubMed and Embase from inception to May 2026. Eligible studies included full-text articles, case reports, and original research describing perforated cholecystitis with an emphasis on diagnosis, treatment, outcomes, and gallbladder cancer mimicry.</p><p><strong>Results: </strong>Gallbladder perforation results from progressive inflammation, ischemia, and mural necrosis, most commonly involving the fundus of the gallbladder. The Niemeier classification categorizes perforations into acute free perforation (Type I), localized perforation with abscess formation (Type II), and chronic perforation with fistula formation (Type III). Advanced age, male sex, diabetes, cardiovascular disease, delayed presentation, and non-operative management were identified as important risk factors. Computed tomography (CT) was the most sensitive diagnostic modality, demonstrating wall defects, pericholecystic collections, abscesses, bilomas, and extraluminal gallstones. Management includes cholecystectomy, percutaneous cholecystostomy, and interval surgery for selected high-risk patients. Evidence regarding the optimal surgical timing remains inconsistent. Chronic perforation and xanthogranulomatous inflammation may closely mimic gallbladder carcinoma on imaging and intraoperative assessment.</p><p><strong>Conclusion: </strong>Perforated cholecystitis is a diagnostically challenging and potentially life-threatening condition. CT imaging is central to diagnosis, while management should be individualized according to the patient status and perforation type. Greater recognition of the features distinguishing perforation from gallbladder malignancy may facilitate earlier diagnosis and improve outcomes. When malignancy is a significant consideration, and the patient's condition permits, consider early referral to an HPB surgeon or multidisciplinary hepatobiliary team to guide further diagnostic evaluation, including tissue acquisition when appropriate, and definitive surgical planning.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102627"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Outcome of Laparoscopic Nissen Fundoplication with or without Fundophrenicopexia in Surgical Management of Hiatal Hernia.","authors":"Mahmoud Eissa, Waleed M Ghareeb, Ahmed Ghanem, Haitham Gabr, Mostafa Abdelazim, Ahmed Hussein","doi":"10.1016/j.gassur.2026.102638","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102638","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) and hiatal hernia frequently coexist, impairing quality of life and often requiring surgical intervention. Laparoscopic Nissen fundoplication (LNF) is the gold standard, but recurrence, dysphagia, and gas-bloat remain concerns. FundophrenicopexiaFundophrenicopexia, fixation of the gastric fundus to the diaphragm, has been proposed to reinforce hiatal closure and reduce recurrence. This study prospectively compared LNF with and without fundophrenicopexia.</p><p><strong>Methods: </strong>A prospective comparative study was conducted at Suez Canal University Hospitals (January 2025-January 2026). Forty patients with hiatal hernia were enrolled into two groups: LNF alone (n=20) and LNF with fundophrenicopexia (n=20). Primary endpoint was hernia recurrence, defined radiologically or endoscopically. Secondary endpoints included GERD-HRQL scores, operative parameters, complications, functional outcomes, and reoperation rates. Patients were followed with structured clinical and endoscopic assessments.</p><p><strong>Results: </strong>Recurrence occurred in 15% of patients undergoing LNF alone versus 0% with fundophrenicopexia (p=0.04)during the follow-up period (11.2±1.8months). Logistic regression confirmed fundophrenicopexiafundophrenicopexia as an independent protective factor (OR=0.18, 95% CI: 0.02-0.95). Failures in the LNF group included wrap migration and disruption, while recurrence in the fundophrenicopexiafundophrenicopexia group was limited to partial herniation. Operative time was longer with fundophrenicopexiafundophrenicopexia (68.5 vs 52.3minutes, p=0.003), but blood loss and conversion rates were similar. Larger hernia size and higher BMI independently predicted recurrence. Quality of life outcomes favored fundophrenicopexiafundophrenicopexia, with lower GERD-HRQL scores (median 3 vs 6, p=0.042) and greater symptom improvement.</p><p><strong>Conclusion: </strong>Fundophrenicopexia was associated with lower recurrence and improved patient‑reported outcomes without increasing dysphagia. This modification may enhance durability and quality of life, particularly in patients with large hernias or elevated BMI, and warrants further evaluation as a potential adjunct in routine hiatal hernia repair.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102638"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose Matters: Incremental Association of Perioperative Blood Transfusion with Morbidity and Mortality After Hepatectomy.","authors":"Faisal Jehan, Mohammed Almeflehi, Aida Vanderpuye, Humza Safdar, Hassan Aziz","doi":"10.1016/j.gassur.2026.102637","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102637","url":null,"abstract":"<p><strong>Background: </strong>Perioperative blood transfusion is associated with adverse outcomes following hepatectomy, but the effect of transfusion volume remains poorly characterized. We evaluated the dose-dependent association of perioperative transfusion on postoperative morbidity and mortality after hepatectomy.</p><p><strong>Methods: </strong>Adult patients undergoing hepatectomy from 2019-2021 were identified from the ACS-NSQIP hepatectomy-targeted database. Patients were stratified by transfusion status and extent of resection (minor versus major hepatectomy). Multivariable logistic regression assessed the independent association between transfusion and 30-day outcomes. A dose-response analysis categorized patients by transfusion volume (0, 1, 2, or ≥3 units).</p><p><strong>Results: </strong>Among 15,139 patients undergoing hepatectomy, 1,599 (10.6%) received perioperative transfusions. Transfusion was more common following major hepatectomy than minor hepatectomy (17.3% vs. 7.8%, p<0.001). After adjustment, transfusion independently increased 30-day mortality following both minor (OR 2.49, 95% CI 1.48-4.19) and major hepatectomy (OR 1.67, 95% CI 1.10-2.53). Transfusion was also associated with increased odds of post-hepatectomy liver failure (minor OR 2.82; major OR 2.11), bile leak (minor OR 1.35; major OR 1.54), pneumonia, prolonged mechanical ventilation, acute renal failure, myocardial infarction, cardiac arrest, and reoperation (all p<0.05). Dose-dependent analysis demonstrated that transfusion of a single unit was not independently associated with increased morbidity or mortality. However, transfusion of two units significantly increased mortality (OR 2.30, 95% CI 1.36-3.88) and morbidity (OR 1.52, 95% CI 1.23-1.88), with further risk escalation among patients receiving ≥3 units.</p><p><strong>Conclusions: </strong>Perioperative transfusion is independently associated with mortality and morbidity after hepatectomy in a dose-dependent manner. Adverse outcomes become apparent at a threshold of two transfused units, supporting restrictive transfusion strategies in hepatic surgery.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102637"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Stage Management of Cholecystocholedocholithiasis: Outcomes of Laparoendoscopic Rendezvous and Laparoscopic Common Bile Duct Exploration at Two Experienced Centers.","authors":"Sergio Riveros, Grecia Artigas, Juan Andrés Díaz, Elizabeth Rivas, Esteban Ruiz, Ricardo Mejía, Erwin Buckel, Allan Sharp, Hugo Ritcher, Marcel Sanhueza, Fernando Pimentel, Fernando Crovari, Nicolás Quezada, Alejandro Brañes","doi":"10.1016/j.gassur.2026.102633","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102633","url":null,"abstract":"<p><strong>Background: </strong>Single-stage management of cholecystocholedocholithiasis can be performed by laparoendoscopic rendezvous (LERV) or laparoscopic common bile duct exploration (LCBDE). We describe outcomes at two experienced centers, each preferentially using one approach.</p><p><strong>Methods: </strong>We retrospectively studied patients treated between January 2016 and December 2023 at two tertiary centers. Baseline characteristics, intraoperative outcomes, and postoperative outcomes were described by institutional approach. An exploratory subgroup analysis compared transcystic and transductal LCBDE with LERV. Continuous variables were compared using the Mann-Whitney U test for two groups and the Kruskal-Wallis test for three groups; categorical variables were compared using chi-square or Fisher's exact tests, as appropriate.</p><p><strong>Results: </strong>A total of 347 patients were included (LCBDE: 169; LERV: 178). LERV patients were older and had higher ASA classification (p < 0.001). Median operative time was 178minutes in LCBDE and 100.5minutes in LERV (p < 0.001). Ductal clearance exceeded 95% in both cohorts. Thirty-day morbidity was 10.7% and 11.2%, respectively (p = 0.862). Median postoperative length of stay was 1 and 2 days, respectively (p < 0.001). Because each center preferentially used one approach, differences in time and stay cannot be attributed to technique alone. Exploratory analysis of transcystic (n = 121) and transductal (n = 48) LCBDE alongside LERV (n = 178) showed differences in operative time and postoperative length of stay. These subgroups differed in anatomy and case complexity. Late biliary events were uncommon, but follow-up duration differed between centers.</p><p><strong>Conclusions: </strong>Both experienced centers achieved high ductal clearance and low postoperative morbidity using their established single-stage approach. Operative time and postoperative length of stay describe outcomes within each institutional practice; this design does not isolate the effect of either technique. Selection should consider biliary anatomy, stone characteristics, and team expertise.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102633"},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of gastric gastrointestinal stromal tumours (GISTs): a tertiary centre experience over 16 years.","authors":"D J Anderson, B Douglass, B Williams, S Shah, F McGivney, C Craig, L S Gall, C K MacKay, Adh MacDonald, M J Forshaw","doi":"10.1016/j.gassur.2026.102628","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102628","url":null,"abstract":"<p><strong>Background: </strong>Complete surgical resection is the mainstay of curative treatment for gastric gastrointestinal stromal tumours (GISTs). This study characterised outcomes of surgical management at a tertiary oesophagogastric centre, comparing operative approaches and examining factors influencing recurrence and disease-related mortality.</p><p><strong>Methods: </strong>Patients undergoing resection for gastric GIST between June 2009 and May 2025 were identified from a prospectively maintained database. Risk was stratified by Miettinen and Lasota (AFIP) criteria. Survival was estimated by Kaplan-Meier and compared by log-rank test; laparoscopic and open wedge resections were compared directly.</p><p><strong>Results: </strong>Eighty-five patients were included. Laparoscopic resection rose from 11.4% (2009-2016) to 48.0% (2017-2025; p=0.001). R0 resection was 94.1%, with no in-hospital mortality and 27.1% morbidity. Over a median 7.2 years, six patients (7.1%) recurred and two (2.4%) died of GIST. Five-year DSS and RFS were 98.5% and 95.9%. Outcomes were risk-stratified: 10-year DSS was 83.3% in high-risk versus 100% in lower-risk disease (p=0.010), and 10-year RFS 69.7% versus 100% (p<0.001). Laparoscopic and open wedge resections were size- and risk-matched, with no excess morbidity, rupture, involved margins, or recurrence after laparoscopy, which extended to tumours of 120mm. Recurrence was associated with tumour size (142 versus 51mm; p=0.018) and rupture (25.0% versus 2.9%; p=0.010).</p><p><strong>Conclusion: </strong>Gastric GIST is managed surgically with low morbidity, no perioperative mortality, and high R0 rates. Recurrence and disease-specific mortality concentrate in high-risk, larger, and ruptured tumours, supporting risk stratification and adjuvant imatinib. Laparoscopic wedge resection carried no oncological penalty in matched tumours.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102628"},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Ischemia-Reperfusion Injury in Liver Transplantation: Molecular Mechanisms.","authors":"Eduardo Montalvo-Javé, Natalia Nuño-Lámbarri, Timothy Pawlik, John Fung","doi":"10.1016/j.gassur.2026.102630","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102630","url":null,"abstract":"<p><strong>Background: </strong>Hepatic ischemia-reperfusion injury (HIRI) remains a major determinant of graft dysfunction and adverse outcomes in liver transplantation, particularly in the context of extended criteria donors. The complex interplay between metabolic disruption, oxidative stress, endothelial dysfunction, and immune activation underlies the pathogenesis of HIRI, yet effective therapeutic strategies remain limited.</p><p><strong>Aim: </strong>To systematically evaluate the molecular mechanisms involved in HIRI and to analyze emerging therapeutic approaches aimed at mitigating liver injury and improving graft outcomes in transplantation settings.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted focusing on experimental and clinical studies addressing the pathophysiology and treatment of HIRI.</p><p><strong>Results: </strong>HIRI is characterized by a biphasic process involving ischemic metabolic failure and reperfusion-induced oxidative and inflammatory injury. Central mechanisms include ATP depletion, calcium overload, ROS and reactive nitrogen species production, endothelial dysfunction, and activation of innate immune responses. Emerging therapies such as activated protein C, complement inhibitors (e.g., C1-esterase inhibitor), and endothelial-protective strategies have demonstrated promise in reducing tissue injury and improving microcirculatory integrity. However, the translation of these findings into consistent clinical benefit remains limited.</p><p><strong>Conclusions: </strong>HIRI is a multifactorial process requiring integrated therapeutic approaches targeting metabolic, inflammatory, and vascular pathways. Future research should focus on identifying primary drivers of injury and optimizing targeted interventions to improve outcomes in liver transplantation.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102630"},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}