Journal of Gastrointestinal Surgery最新文献

{"title":"Use of Textbook Outcome as a Quality Metric in Hepatopancreaticobiliary Surgery: A Systematic Review and Meta-Analysis.","authors":"Zaiba Shafik Dawood, Mujtaba Khalil, Usama Waqar, Illiyun Banani, Zayan Alidina, Timothy M Pawlik","doi":"10.1016/j.gassur.2025.102005","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102005","url":null,"abstract":"<p><strong>Background: </strong>Textbook outcomes (TO) represent the optimal course following surgery. To date, no meta-analysis has assessed the pooled TO of patients undergoing hepato-pancreato-biliary (HPB) surgery and the impact of TO achievement on patient outcomes. We sought to conduct a systematic review and meta-analysis to assess TO achievement across different studies, as well as characterize the impact of the achievement of TO on patient related outcomes including the disease-free survival (DFS) and overall survival (OS) METHODS: PubMed, Embase, and Scopus databases were searched (1990-2024). The criteria used to define TO and the median overall TO in HPB surgery were obtained. Additionally, a random effect meta-analysis was conducted to assess the impact of TO achievement on 5-year OS and DFS.</p><p><strong>Results: </strong>Seventy-two studies (517,304 patients) met inclusion criteria. The main criteria used to define TO included absence of re-admission and mortality within 30days after discharge; severe postoperative complications; prolonged hospital stay and negative surgical margin (R0). Of note, the main factors related with achievement of TO were younger patient age and lower American Society of Anesthesiologist score. Overall, median rate of TO achieved across procedures was hepatic-62.0% (IQR:48.0%-69.0%), biliary-54.0% (IQR: 41.0% - 68.0%), combined hepatopancreatic-46.0%(IQR:42.0%-46.5%), pancreatic- 45.0% (IQR:30.5% - 59.0%), liver transplantation-33.0% (IQR: 32.2%-34.0%) and combined hepatobiliary-19.5% (IQR: 16.8% - 22.3%). Achievement of TO was associated with improved odds of 5-year OS and DFS (OR: 1.22 (95% CI: 1.20-1.24) and 1.26 (95% CI: 1.16-1.37) respectively).</p><p><strong>Conclusion: </strong>Overall, hepatic and biliary operations had the highest TO achievement followed by pancreatic procedures. In contrast, hepatobiliary surgery and liver transplantation had the lowest TO. There was significant discrepancy in TO definition across different studies highlighting the need for consensus on the definition of TO.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102005"},"PeriodicalIF":2.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537205","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":"Letter to the Editor regarding \"Bariatric surgery in patients with severe obesity obstructive sleep apnea\".","authors":"Tomoyuki Kawada","doi":"10.1016/j.gassur.2025.102002","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102002","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102002"},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531295","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":"Patients with Class III Obesity are at Elevated Risk of Postoperative Morbidity Following Surgery for Left-Sided Diverticular Disease: A Retrospective Population Level Study.","authors":"Tyler McKechnie, Luke Heimann, Sahil Sharma, Phillip Staibano, Keean Nanji, Richard Garfinkle, Zoe Garoufalia, Aristithes Doumouras, Sameer Parpia, Mohit Bhandari, Cagla Eskicioglu","doi":"10.1016/j.gassur.2025.102004","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102004","url":null,"abstract":"<p><strong>Background: </strong>While obesity is a well-established risk factor for the development of diverticular disease, studies focusing on the impact of body mass index (BMI) on postoperative outcomes require updating. We designed this population-level retrospective cohort study to evaluate the impact of BMI on postoperative outcomes following operative intervention for left-sided diverticular disease.</p><p><strong>Methods: </strong>This was a population-based retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) (September 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. Patients were stratified according to obesity status (i.e., not obese: BMI under 30kg/m²; class I obesity: BMI 30-34.9kg/m²; class II obesity: BMI 35-39.9kg/m²; class III obesity: BMI greater than 40kg/m²). The primary outcome was overall in-hospital postoperative morbidity. Multivariable regression models were fit.</p><p><strong>Results: </strong>There were 33,029 patients identified in the NIS who underwent left-sided colonic resection for diverticular disease. There were 27,212 patients who were not obese, 2,209 patients with class I obesity, 1,710 patients with class II obesity, and 1,898 patients with class III obesity. Patients with class III obesity (i.e., BMI greater than 40), had 72.7% higher odds (95% CI 1.54-1.94) of experiencing in-hospital postoperative morbidity as compared to patients with BMI less than 30. Patients in with class III obesity had 26.9% higher odds (95%CI 0.98-1.65) of experiencing in-hospital postoperative infection, 54.6% higher odds (95%CI 1.35-1.77) of experiencing in-hospital postoperative gastrointestinal complications, and 70.9% higher odds (95%CI 1.48-1.97) of experiencing in-hospital postoperative genitourinary complications as compared to patients with BMI less than 30.</p><p><strong>Conclusion: </strong>Patients with class III obesity undergoing operative intervention for colonic diverticular disease are at increased risk of short-term postoperative morbidity as compared to patients with BMIs under 30.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102004"},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531371","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":"Safety of in-hospital delay of appendectomy - a propensity score matched analysis of 4,900 consecutive patients undergoing surgery for suspected appendicitis.","authors":"A Mair, S Schiele, L Anthuber, M Hoffmann, G Müller, M Anthuber, M Schrempf","doi":"10.1016/j.gassur.2025.102003","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102003","url":null,"abstract":"<p><p>Historically, urgent surgery was advocated in patients with suspected appendicitis for fear of perforation and possible complications. Although recent studies have shown that it is safe to delay surgery under certain circumstances, many studies do not report adjusted data and exclude patients based on risk factors. Furthermore, it is unclear if an ultrasound based diagnostic work-up is sufficient to safely delay surgery. The aim of this large retrospective study was to analyze the risk adjusted association of delayed appendectomy with perforation and complication rate.</p><p><strong>Methods: </strong>Data from consecutive patients undergoing appendectomy for suspected appendicitis at a single institution were reviewed and analyzed. Investigated outcomes were perforation rate and complication rate. Propensity score matching was used to create equal groups with respect to confounding factors and multivariable analysis was performed to control for risk factors and calculate adjusted ORs for in-hospital delay.</p><p><strong>Results: </strong>Between January 2008 and June 2023, 4900 patients underwent appendectomy for suspected appendicitis. Ultrasound imaging was performed in 4754 patients. Multivariable analysis in the propensity score matched data showed no association between a waiting time of more than 12hours and perforation rate (OR 0.93; 95% CI 0.67 - 1.31; p=0.69) or complication rate (OR 0.90; 95% CI 0.62 - 1.30; p=0.56). Similar results were obtained for a waiting time of 18hours and perforation rate (OR 0.96; 95% CI 0.48 - 1.56; p=0.88) or complication rate (aOR 0.97; 95% CI 0.57 - 1.68; p=0.93).</p><p><strong>Conclusion: </strong>This large propensity score matched analysis showed that it is safe to delay surgery by 12 and 18hours, even when diagnostic work-up is based on ultrasound. In patients with risk factors for complications, postponement of the procedure can be considered if it can improve overall conditions or allow the procedure to be performed with a higher level of expertise.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102003"},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531377","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":"Colonic metastasis of primary lung adenocarcinoma","authors":"Ming Zhou ,&nbsp;Zuguang Wu ,&nbsp;Zhiwang Li","doi":"10.1016/j.gassur.2025.102001","DOIUrl":"10.1016/j.gassur.2025.102001","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 102001"},"PeriodicalIF":2.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472552","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 first international experience with histotripsy: a safety analysis of 230 cases","authors":"Chase J. Wehrle ,&nbsp;Kevin Burns ,&nbsp;Evan Ong ,&nbsp;Allison Couillard ,&nbsp;Neehar D. Parikh ,&nbsp;Elaine Caoili ,&nbsp;JaeKeun Kim ,&nbsp;Federico Aucejo ,&nbsp;Andrea Schlegel ,&nbsp;Emily Knott ,&nbsp;Paul Laeseke ,&nbsp;J. Philip Boudreaux ,&nbsp;Philipp von Breitenbuch ,&nbsp;Mikhail Silk ,&nbsp;Mohamed Alassas ,&nbsp;Andrew Guzowski ,&nbsp;Brian Fuller ,&nbsp;Erica Knavel Koepsel ,&nbsp;Brock Hewitt ,&nbsp;Mishal Mendiratta-Lala ,&nbsp;David C.H. Kwon","doi":"10.1016/j.gassur.2025.102000","DOIUrl":"10.1016/j.gassur.2025.102000","url":null,"abstract":"<div><h3>Background</h3><div>Histotripsy is a novel, noninvasive, nonionizing, and nonthermal approach that uses focused ultrasound waves to treat liver tumors. This technology received a de novo Food and Drug Administration grant in late 2023. This study aimed to provide the first report on post-trial real-world clinical safety data.</div></div><div><h3>Methods</h3><div>Safety outcomes within 30 days of histotripsy were collected after obtaining Food and Drug Administration clearance (December 22, 2023 to July 26, 2024). All centers that performed histotripsy were invited to participate in this study. Complications requiring treatment were graded using the Clavien-Dindo classification and Comprehensive Complication Index (CCI).</div></div><div><h3>Results</h3><div>A total of 295 patients underwent histotripsy for 510 tumors at 18 centers. The treated liver tumor types included colorectal metastases (n = 140), neuroendocrine tumors (n = 46), hepatocellular carcinomas (n = 31), pancreatic tumors (n = 30), and breast metastases (n = 26). The most common numbers of tumors treated per procedure were 1 (n = 170), 2 (n = 69), and 3 (n = 37). All 8 liver segments were treated for tumors. Safety data were available for 230 patients from 9 centers. Of note, 12 of 230 patients (5.2%) experienced complications of any grade. Most patients (9 [75%]) had minor cases (Clavien-Dindo grade ≤ II). The median and mean CCIs were 0.00 (IQR, 0.00–0.00) and 0.00 (95% CI, 0.00–0.75). All 3 major complications (Clavien-Dindo grade &gt; II [1.3%]) were death due to disease progression. All 3 patients underwent histotripsy with palliative intent for known advanced intra- and extrahepatic diseases.</div></div><div><h3>Conclusion</h3><div>To the best of our knowledge, this is the first study to report on the real-world therapeutic use of histotripsy for liver tumors. Histotripsy was well tolerated, with few overall complications and rare serious complications, indicating a safety profile that compares favorably with that of other liver-directed and surgical therapies for the treatment of liver tumors. Long-term follow-up data, including oncologic outcomes, were collected.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 102000"},"PeriodicalIF":2.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence patterns and prediction of survival after recurrence for gallbladder cancer","authors":"Giovanni Catalano ,&nbsp;Laura Alaimo ,&nbsp;Odysseas P. Chatzipanagiotou ,&nbsp;Zayed Rashid ,&nbsp;Jun Kawashima ,&nbsp;Andrea Ruzzenente ,&nbsp;Federico Aucejo ,&nbsp;Hugo P. Marques ,&nbsp;Joao Bandovas ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Shishir K. Maithel ,&nbsp;Minoru Kitago ,&nbsp;Itaru Endo ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2025.101997","DOIUrl":"10.1016/j.gassur.2025.101997","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder cancer (GBC) is associated with a poor prognosis. Recurrence patterns and their effect on survival remain ill-defined. This study aimed to analyze recurrence patterns and develop a machine learning (ML) model to predict survival after recurrence (SAR) of GBC.</div></div><div><h3>Methods</h3><div>Patients who underwent curative-intent resection of GBC between 1999 and 2022 were identified using an international database. An Extreme Gradient Boosting ML model to predict SAR was developed and validated.</div></div><div><h3>Results</h3><div>Among 348 patients, 110 (31.6%) developed disease recurrence during follow-up. The most common recurrence site was local (29.1%), followed by multiple site (26.4%), liver (21.8%), peritoneal (18.2%), and lung (0.05%). The median SAR was the longest in patients with lung recurrence (36.0 months), followed by those with local recurrence (15.7 months). In contrast, patients with peritoneal (8.9 months), liver (8.5 months), or multiple-site (6.4 months) recurrence had a considerably shorter SAR. Patients with multiple-site recurrence had a worse SAR than individuals with single-site recurrence (6.4 vs 11.10 months, respectively; <em>P</em> =.014). The model demonstrated good performance in the evaluation and bootstrapping cohorts (area under the receiver operating characteristic curve: 71.4 and 71.0, respectively). The most influential variables were American Society of Anesthesiologists classification, local recurrence, receipt of adjuvant chemotherapy, American Joint Committee on Cancer T and N categories, and developing early disease recurrence (&lt;12 months). To enable clinical applicability, an easy-to-use calculator was made available (<span><span>https://catalano-giovanni.shinyapps.io/SARGB</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>Except for lung recurrence, SAR for GBC was poor. A subset of patients with less aggressive disease biology may have favorable SAR. ML-based SAR prediction may help individuate candidates for curative re-resection when feasible.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101997"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458243","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 peptic ulcer: to close or patch – a century-old controversy","authors":"Khalid Mahmoud,&nbsp;Mohamad K. Abou Chaar,&nbsp;Daniel Stephens,&nbsp;John M. Zietlow,&nbsp;Stephanie F. Heller,&nbsp;David Turay,&nbsp;Veljko Strajina","doi":"10.1016/j.gassur.2025.101993","DOIUrl":"10.1016/j.gassur.2025.101993","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to determine which surgical technique is associated with more favorable outcomes for the repair of perforated peptic ulcers.</div></div><div><h3>Methods</h3><div>A retrospective medical record review of patients who underwent surgery for perforated peptic ulcers at the Mayo Clinic Rochester campus between 2004 and 2021 was performed.</div></div><div><h3>Results</h3><div>The final analysis included 277 patients: 182 underwent suture closure of the perforation, 55 underwent patch-only repair, 15 underwent gastrectomy with reconstruction, 14 underwent wedge resection, and 11 underwent other techniques. No leaks were observed in patients who underwent stapled wedge resection. Among patients who underwent repair of the perforation (n = 237), 3 variables associated with the leak on univariate analysis were included in a logistic regression model. All 3 variables were independently associated with a leak: lack of suture closure of the perforation (odds ratio [OR], 7.0; 95% CI, 2.5–19.1), immunosuppression (OR, 5.5; 95% CI, 1.7–17.6), and lactate levels (OR, 1.4; 95% CI, 1.1–1.7).</div></div><div><h3>Conclusion</h3><div>When both sutured and patch-only closure techniques are feasible for a perforated peptic ulcer, sutured closure is associated with a lower risk of leakage. However, given our study’s retrospective, single-institution nature, the findings should be interpreted with caution.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101993"},"PeriodicalIF":2.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433286","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":"Calcified pancreatic cyst in a woman without history of pancreatitis","authors":"Cordelia Muir ,&nbsp;Priya Vasan ,&nbsp;Chirag S. Desai","doi":"10.1016/j.gassur.2025.101994","DOIUrl":"10.1016/j.gassur.2025.101994","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101994"},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425549","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":"Efficacy of robot-assisted pancreaticoduodenectomy with left posterior approach for pancreatic head cancer with venous invasion","authors":"Kosuke Kobayashi,&nbsp;Yosuke Inoue,&nbsp;Yu Takahashi","doi":"10.1016/j.gassur.2025.101996","DOIUrl":"10.1016/j.gassur.2025.101996","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101996"},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425550","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}