Journal of Gastrointestinal Surgery最新文献

{"title":"Palliative management of malignant gastric outlet obstruction. A single-centre analysis of the surgical by-pass and duodenal stenting under endoscopic and fluoroscopic guidance.","authors":"Davide Di Mauro, Eleanor Pearce, Ikechukwu Njere, Shahjehan Wajed, Alex Reece-Smith, Antonio Manzelli","doi":"10.1016/j.gassur.2025.102249","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102249","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102249"},"PeriodicalIF":2.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280337","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 Small Bowel Neuroendocrine Neoplasms in Crohn's Disease: A Multicenter Retrospective Analysis.","authors":"Tommaso Violante, Davide Ferrari, David W Larson, Matteo Rottoli, Ibrahim A Gomaa, Sara A Aboelmaaty, Jyi Cheng, Marco Novelli, Sherief S Shawki, Zoe Garoufalia, Anjelli Wignakumar, Justin Dourado, Steven Wexner, Giacomo Calini, Stefano Cardelli, Margherita Binetti, Luna Sissa, Thorvardur Halfdanarson, Kellie L Mathis","doi":"10.1016/j.gassur.2025.102246","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102246","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is associated with an increased risk of small bowel neuroendocrine neoplasms (SBNENs). However, data on post-surgical outcomes are scarce. This multicenter study aimed to analyze the clinicopathological characteristics, surgical management, and outcomes of patients with CD who underwent surgery for SBNENs.</p><p><strong>Methods: </strong>A multicenter, retrospective analysis was conducted on patients with a history of CD who underwent surgical resection for a small bowel neuroendocrine neoplasm between September 1992 and March 2025. Data on patient and tumor characteristics, surgical details, and postoperative outcomes were collected and analyzed. Time-to-event analysis was used for recurrence and survival rates.</p><p><strong>Results: </strong>The study included 22 patients (63.4% male) with a median age at CD diagnosis of 49 years. An interval of 108 months was noted between CD diagnosis and SBNEN detection. SBNENs were often an incidental finding during surgery (36.4%). The majority of tumors were in the ileum (72.7%), were Grade 2 (72.7%), and presented with nodal metastases (59.1%). Complete surgical resection (R0) was achieved in 90.9% of cases, primarily through an open approach (68.2%). Postoperative morbidity was 50%. Over a median follow-up of 120 months, no local recurrences occurred, but distant recurrence (liver metastases) was observed in 13.6% of patients, with a 9.1% cancer-related mortality rate.</p><p><strong>Conclusions: </strong>Surgical resection for SBNENs in CD patients provides excellent long-term oncologic control, though it is associated with considerable perioperative morbidity. The diagnosis is often delayed or incidental, underscoring the need for increased clinical suspicion and potentially enhanced surveillance strategies in this high-risk population.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102246"},"PeriodicalIF":2.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274505","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":"Impact of the negative endoluminal pressure on gastric healing: an in vivo study","authors":"Francisco Tustumi MD, MSci, PhD,&nbsp;Flávio Henrique Ferreira Galvão MD, PhD,&nbsp;Eric Toshiyuki Nakamura MD, MSci,&nbsp;Marina Alessandra Pereira MD, MSci, PhD,&nbsp;Leonardo Cardili MD, PhD,&nbsp;Venancio Avancini Ferreira Alves MD, PhD,&nbsp;Ulysses Ribeiro Junior MD","doi":"10.1016/j.gassur.2025.102238","DOIUrl":"10.1016/j.gassur.2025.102238","url":null,"abstract":"<div><h3>Background</h3><div>The biological effects of vacuum therapy on gastrointestinal healing remain poorly understood. This work aims to evaluate the effects of negative endoluminal pressure on gastric healing.</div></div><div><h3>Methods</h3><div>34 Wistar rats underwent gastric incision and were allocated into four groups: Group 1 (n = 10), incision only; Group 2 (n = 10), incision plus gastrostomy without vacuum; Group 3 (n = 7), incision plus vacuum therapy at −100 mmHg; and Group 4 (n = 7), at -300 mmHg. Animals remained restrained for 48 hours before euthanasia. Macroscopic and histopathological outcomes—gastritis, hemorrhage, adhesions, leak, mucosal erosion, fibrosis, and angiogenesis—were assessed using semi-quantitative scores. A composite healing score was calculated by summing fibrosis and angiogenesis and subtracting necrosis and hemorrhage.</div></div><div><h3>Results</h3><div>Fibrosis in incisions was higher in the vacuum groups (Groups I/II/III/IV: 80/60/100/100%; <em>P</em> = .016). The necrosis rate was lower in Groups III and IV (Groups I/II/III/IV: 80/100/42.9/28.6%; <em>P</em> = .006). However, Groups III and IV were associated with a higher risk for moderate/severe gastritis (Groups I/II/III/IV: 10/0/100/100%; <em>P</em> &lt; .001) and mucosal erosion (Groups I/II/III/IV: 0/0/100/85.7%; <em>P</em> &lt; .001). The gastritis was more intense in Group IV than in Group III (<em>P</em> &lt; .001). No significant differences were found for adhesions and angiogenesis (<em>P</em> &gt; .05). The overall healing score was higher for Groups III and IV (median score for Groups I/II/III/IV: 0.5/2/3/4; <em>P</em> = .019), and this score did not differ between Groups III and IV (<em>P</em> = .502).</div></div><div><h3>Conclusion</h3><div>Vacuum therapy acts on the initial phases of the healing process, reducing necrosis and increasing fibrosis. Intense negative pressure is associated with severe gastritis and mucosal erosion.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 12","pages":"Article 102238"},"PeriodicalIF":2.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271246","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":"Effect of obesity on intraoperative complications in upper gastrointestinal cancer surgery.","authors":"Raelene Tan, Amos Nepacina Liew, Thomas Coates, M Trauma, Varun Jahagirdar, Eleazar Leong, Paul Cashin, Geraldine Ooi","doi":"10.1016/j.gassur.2025.102248","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102248","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102248"},"PeriodicalIF":2.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274522","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":"The clinical and microbiological burden of gastrointestinal fistulas in patients with infected pancreatic necrosis: a retrospective study.","authors":"Haosu Huang, Zefang Sun, Baiqi Liu, Lu Chen, Dingcheng Shen","doi":"10.1016/j.gassur.2025.102244","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102244","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal fistula (GIF) is a well-recognized complication of infected pancreatic necrosis (IPN), yet evidence on its impact remains limited. This study investigated GIF incidence, risk factors, microbiological profiles, and clinical outcomes in a large cohort of patients with IPN.</p><p><strong>Methods: </strong>We conducted a post-hoc analysis using data from a large prospective database comprising 385 patients with IPN between January 2011 and April 2025. A comparative analysis of the clinical and microbiological characteristics, surgical management, and follow-up data was performed for patients with IPN with and without GIF.</p><p><strong>Results: </strong>Of 385 patients with IPN, 62 (16.1%) developed GIF. Compared to those without GIF, these patients exhibited higher rates of polymicrobial infection (79.0% vs. 59.4%, P=0.004), multidrug-resistant fungi (27.4% vs. 14.9%, P=0.016), Carbapenem-resistant Enterobacteriaceae (CRE)(40.3% vs. 25.1%, P=0.014), Klebsiella pneumoniae (CPKP)(56.5% vs. 32.5%, P<0.001), and fungal infections (40.3% vs. 23.2%, P=0.005). Bloodstream infections from multidrug-resistant organisms (35.5% vs. 15.5%, P<0.001) and CRE (27.4% vs. 6.5%, P<0.001) were also more common. GIF development was associated with more frequent adoption of open necrosectomy (35.5% vs. 14.9%, P<0.001), longer duration of organ failure (median, 10.5 vs. 3 days, P=0.048), higher incidence of SAP (69.4% vs. 55.1%, P=0.038), prolonged hospital stay (median, 96 vs. 75.5 days, P=0.007), and an increased hemorrhage rate (35.5% vs. 18.6%, P=0.003). In addition, mortality was significantly higher in patients with GIF (35.5%, 22 of 62) than in those without GIF (21.7%, 70 of 323; P=0.019). Multivariate analysis revealed multiple organ failure (MOF) as an independent predictor of mortality in patients with GIF (Odds ratio, 27.97; 95% confidence interval, 2.35-332.89; P=0.008).</p><p><strong>Conclusion: </strong>GIF affected 16.1% of IPN patients, associated with adverse outcomes. MOF predicted higher mortality for IPN patients with GIF. CRE, particularly CRKP, is a critical pathogen requiring urgent attention.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102244"},"PeriodicalIF":2.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274508","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":"A Standardized Health System Approach to Ivor Lewis Esophagectomy.","authors":"Luke Meredith, Peter Yang, Hamza Rshaidat, Scott Koeneman, Darshak Thosani, John Jacob, Tyler Grenda, Olugbenga Okusanya, Francesco Palazzo, Karen A Chojnacki, Sung Whang, Nathaniel R Evans","doi":"10.1016/j.gassur.2025.102250","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102250","url":null,"abstract":"<p><strong>Background: </strong>With the robotic approach to Ivor Lewis esophagectomy gaining popularity, concern has been raised regarding a learning curve resulting in increased complication rates. We present the results of a standardized health system approach to Ivor Lewis esophagectomy and the transition to the robotic-assisted technique.</p><p><strong>Methods: </strong>We performed a retrospective review of our institutional database along with individual patient chart review. Patients who underwent Ivor Lewis esophagectomy at our institution from June 1^st, 2017 to July 7^th, 2023 were included. Pre-operative patient characteristics and operative outcomes were recorded. Outcomes of the 60 most recent laparoscopic/thoracoscopic minimally invasive esophagectomy (MIE) were compared to the first 60 robotic-assisted esophagectomies (RAMIE).</p><p><strong>Results: </strong>Over the study period, 145 patients were included for review. There were five Ivor Lewis esophagectomies performed open, 80 laparoscopic/thoracoscopic, and 60 robotic-assisted. Length of stay ranged from 5 to 84 days, with a median of 7 days. Leak from the esophagogastric anastomosis occurred in 5 cases (3.4%). Pulmonary complications occurred in 21 cases (14.5%). There were no 90-day mortality events. In the subset analysis, there was an increased mean operative time in the RAMIE group (443minutes vs. 504minutes, 95% CI -88.1 to -34.2), but no significant differences in perioperative outcomes between the MIE and RAMIE groups.</p><p><strong>Conclusion: </strong>A standardized approach to perioperative management and operative technique can allow for low morbidity and mortality following Ivor Lewis esophagectomy and facilitate transitioning to a robotic-assisted technique without increasing complications.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102250"},"PeriodicalIF":2.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274570","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":"A preoperative prediction model for microvascular invasion in hepatocellular carcinoma based on inflammatory biomarkers.","authors":"En-Min Lan, Ming-Ming Jiang, Bei Wang, Yu-Fei Shao, Rui-Ling Yang, Lei Li, Yu-Ming Gu","doi":"10.1016/j.gassur.2025.102245","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102245","url":null,"abstract":"<p><strong>Background: </strong>The high postoperative recurrence rate of hepatocellular carcinoma (HCC) is closely associated with microvascular invasion (MVI). Inflammatory biomarkers play a crucial role in MVI progression, yet a preoperative prediction model integrating inflammatory biomarkers and clinical characteristics remains lacking. This study aimed to develop and validate a preoperative prediction model for MVI in HCC based on inflammatory factors and tumor features.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 300 HCC patients who underwent radical hepatectomy between 2019 and 2024. Independent predictors were identified via group difference tests, univariate, and multivariate logistic regression analyses. A nomogram model was constructed and evaluated using calibration curves, decision curve analysis (DCA), and receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Poorly-differentiated pathology, tumor diameter ≥ 5cm, des-γ-carboxyprothrombin (DCP) ≥ 90 mAU/mL, and platelet-lymphocyte ratio (PLR) ≥ 150 were identified as independent predictors of MVI. The nomogram exhibited area under the ROC curve (AUC) values of 0.81 (95% confidence interval [CI]: 0.75 - 0.88) in the internal training set and 0.83 (95% CI: 0.73 - 0.94) in the internal validation set (both derived from the same single-center dataset via 7:3 random splitting). Calibration curves showed excellent agreement between predicted and observed probabilities, and DCA confirmed the model's net benefit superiority over no-intervention or all-intervention strategies across a risk threshold range of 0.1 - 0.8.</p><p><strong>Conclusion: </strong>The model integrates inflammatory biomarkers and tumor characteristics. This non-invasive prediction of MVI risk provides a quantitative basis for individualized preoperative treatment strategies. Prospective multicenter validation is warranted to improve its generalizability.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102245"},"PeriodicalIF":2.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274406","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":"Race and Ethnicity Data Missingness in Hepatobiliary and Pancreatic Surgery: Prevalence and Outcomes.","authors":"Amir Ebadinejad, Sophia Xiao, Ashrita Raghuram, Hassan Aziz","doi":"10.1016/j.gassur.2025.102243","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102243","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Racial and ethnic disparities in surgical outcomes are well-documented across various specialties, including hepatopancreatobiliary (HPB) surgery. While efforts to address these inequities have expanded, an underexplored issue is the growing prevalence of missing race and ethnicity data in national surgical registries such as the ACS NSQIP. This study aimed to evaluate the prevalence of missing race and ethnicity data in HPB procedures within NSQIP and to determine whether such missingness is associated with adverse postoperative outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective analysis of the American College of Surgeons NSQIP database from 2019 to 2023, identifying patients who underwent HPB procedures. Patients were stratified into three groups based on the completeness of their demographic data: (1) Race known vs. race missing (RM), (2) Ethnicity known vs. ethnicity missing (EM), and (3) race or ethnicity known vs. both missing (BM). Primary outcomes included any postoperative complication, unplanned reoperation, and 30-day mortality. Multivariable logistic regression models were used to assess associations between BM status and adverse outcomes, adjusting for relevant demographic and procedural covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 72,069 patients who underwent HPB procedures, pancreatic procedures were most common (50.3%), followed by liver (47.7%), and bile duct procedures (2.0%). Of the total cohort, 18.2% (n = 13,106) were classified as RM, 15.6% (n = 11,256) as EM, and 14.2% (n = 10,256) as BM. Over the study period, the proportion of BM patients remained relatively stable, ranging from 18.5% to 23.5%. Patients in the BM group were slightly older (mean age: 63.5 vs. 62.3 years, p &lt; 0.001) and had a lower BMI (27.5 vs. 28.2, p &lt; 0.001) compared to those with complete or partial data. Patients in the BM group had greater unadjusted rates of complications (42.9% vs. 38.1%, p &lt; 0.001), unplanned reoperation (5.0% vs. 3.8%, p &lt;0.001), or mortality (2.0% vs. 1.7%, p = 0.053). On multivariable analysis, BM status was associated with increased odds of postoperative complications (OR: 1.341, 95% CI: 1.283-1.402, p &lt; 0.001), unplanned reoperation (OR: 1.403, 95% CI: 1.268-1.522, p &lt; 0.001) and mortality (OR: 1.194, 95% CI: 1.019-1.400, p = 0.029).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A substantial proportion of HPB procedures in the NSQIP database are affected by missing race and ethnicity data, with the prevalence of BM remaining consistent over the study period. The BM group demonstrated distinct clinical and demographic characteristics. While unadjusted outcomes appeared favorable, BM status was independently associated with higher odds of complications, unplanned reoperation, and mortality. These findings suggest the need for further investigation into the underlying causes of missing demographic data and emphasize the importance of addressing data missingness in efforts to promo","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102243"},"PeriodicalIF":2.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258403","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":"Patient Selection, Utilization Trends, and Short-term Postoperative Outcomes for Minimally Invasive versus Open Resection of Small Bowel Neuroendocrine Tumors.","authors":"Mohammad Saad Farooq, Robert E Roses, Giorgos C Karakousis, Mark S Etherington","doi":"10.1016/j.gassur.2025.102218","DOIUrl":"10.1016/j.gassur.2025.102218","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive surgery (MIS) has been increasingly utilized for the treatment of small bowel neuroendocrine tumors (SBNET). While some studies have found comparable oncologic outcomes for appropriately selected patients undergoing MIS approach, comprehensive perioperative outcomes remain insufficiently characterized in this patient population. We sought to evaluate short-term postoperative outcomes of MIS versus open resection of SBNETs in a large national cohort.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent open or laparoscopic/robotic resection of SBNETs from 2012 to 2022. Postoperative outcomes were compared using univariable and multivariable analyses before and after 1:1 propensity-score matching.</p><p><strong>Results: </strong>Of 2,096 eligible patients, 848 (40%) underwent MIS resections. On multivariable logistic regression of the overall cohort, MIS approach was associated with a significantly lower likelihood of experiencing a postoperative complication (adjusted odds ratio: 0.46, p<0.001). After propensity-score matching, MIS approach was associated with a significantly shorter length of stay (4 vs. 6 days, p<0.001) and fewer skin/soft tissue infections (2.1% vs. 6.8%, p<0.001), urinary tract infections (0.5% vs. 2.4%, p=0.004), occurrences of sepsis (0.2% vs. 1.2%, p=0.038), and blood transfusions (2.4% vs. 4.8%, p=0.019).</p><p><strong>Conclusion: </strong>MIS approaches for SBNET resection are associated with improved short-term perioperative outcomes and, when deemed appropriate based on oncologic considerations, should be part of a surgical oncologist's armamentarium.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102218"},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244537","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":"Robotic abdominoperineal resection for rectal cancer is associated with reduced conversion risk compared with a laparoscopic approach without compromising radial margins.","authors":"Sarah E Rudasill, Rebecca B Tang, Sami Alahmadi, Christy E Cauley, Robert N Goldstone, Hiroko Kunitake, Rocco Ricciardi, Grace C Lee","doi":"10.1016/j.gassur.2025.102173","DOIUrl":"10.1016/j.gassur.2025.102173","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the benefits of robotic vs laparoscopic approaches to abdominoperineal resection for rectal cancer is conflicting. This study aimed to determine whether the robotic approach offers a lower risk of conversion to open surgery and positive radial margins than the laparoscopic approach.</p><p><strong>Methods: </strong>Patients who underwent elective abdominoperineal resection for rectal cancer in the 2016-2022 American College of Surgeons National Surgical Quality Improvement Program proctectomy database were stratified by the laparoscopic vs robotic approach. The primary outcomes were rates of conversion to open surgery and positive radial margins. The secondary outcomes included 30-day readmission and indication. Multivariable regressions were performed to assess outcome associations.</p><p><strong>Results: </strong>Of 3925 patients, 1973 (50.3%) underwent laparoscopic resection, and 1952 (49.7%) underwent robotic abdominoperineal resection. The proportion of robotic cases increased significantly from 2016 to 2022, surpassing laparoscopic surgery (P <.001). Compared with patients who underwent laparoscopic resection, those who underwent robotic resection had a higher body mass index (≥35 kg/m²; 12.1% vs 15.2%, respectively; P <.001) and more frequent flap reconstruction (7.0% vs 11.1%, respectively; P <.001). On univariate analysis, compared with the laparoscopic approach, the robotic approach was associated with fewer conversions to open surgery (12.0% vs 3.6%, respectively; P <.001) but no difference in rates of positive radial margins (9.3% vs 10.1%, respectively; P =.41). Multivariate analysis demonstrated that the robotic approach was associated with decreased conversion rates (odds ratio [OR], 0.24; P <.001) without compromising radial margins (OR, 1.10; P =.46) but increased 30-day readmissions (OR, 1.23; P =.03), most commonly for wound or organ space infections (OR, 1.44; P =.02).</p><p><strong>Conclusion: </strong>Robotic abdominoperineal resection is associated with reduced risk of conversion to open surgery without compromising the circumferential resection margin. However, it is associated with increased readmission, particularly for wound and organ space infections.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102173"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764975","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}