Journal of Gastrointestinal Surgery最新文献

{"title":"Fat malabsorption and reduced exocrine pancreatic function after gastroesophageal cancer surgery","authors":"L. Blonk,&nbsp;N.J. Wierdsma,&nbsp;H. Hamer,&nbsp;S.S. Gisbertz,&nbsp;M.I. van Berge Henegouwen,&nbsp;D.L. van der Peet,&nbsp;G. Kazemier,&nbsp;J. Straatman","doi":"10.1016/j.gassur.2026.102330","DOIUrl":"10.1016/j.gassur.2026.102330","url":null,"abstract":"<div><h3>Background</h3><div>Patients post-gastroesophageal cancer surgery frequently present with clinical features of malabsorption and are often treated empirically with pancreatic enzyme replacement therapy (PERT). Primary aim was to objectify the presence of fat malabsorption in patients after gastroesophageal surgery and, secondary, to measure exocrine pancreatic function.</div></div><div><h3>Methods</h3><div>Eligible patients were those who underwent gastroesophageal cancer surgery (2017–2021), were at least six months post-surgery, maintained an oral diet, and showed no evidence of recurrent disease. Treatment with PERT was ceased prior to this study. Fecal fat balance test (coefficient of fat absorption, CFA (%)) was used to measure absorption of fat. The CFA was determined by collecting feces over three days to measure daily fecal fat excretion (g/d), along with a four-day (weighted) nutritional diary, to establish the average daily fat intake (g/d). Fat malabsorption was defined as a CFA &lt;85%. Exocrine pancreatic function was measured using fecal elastase-1 (FE-1).</div></div><div><h3>Results</h3><div>We included 90 patients (50 after esophagectomy with gastric tube reconstruction and 40 after (sub)total gastrectomy with Roux-en-Y reconstruction). Fecal analysis were conducted at a median of 17 months (IQR 11–28) post-surgery. A CFA &lt;85% was found in 24% of patients after gastric tube reconstruction, accompanied by low levels of FE-1 in 33%. After Roux-en-Y reconstruction a CFA &lt;85% was present in 43%, of which 71% had low levels of FE-1.</div></div><div><h3>Conclusion</h3><div>Fat malabsorption is common after gastrectomy with Roux-en-Y reconstruction and after esophagectomy with gastric tube reconstruction, partly accompanied by reduced FE-1 levels. Clinicians should remain alert to malabsorption during follow-up and an empirical trial with PERT can be considered, although further studies are needed to evaluate its effects on absorption, symptoms, and quality of life.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 10","pages":"Article 102330"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018562","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":"Are retromuscular repairs always the best option for ventral hernias? Augmented evidence review","authors":"Megan Melland-Smith,&nbsp;Nancy Ly,&nbsp;Sidhant Kalsotra,&nbsp;Marisa H. Blackman,&nbsp;Michael J. Rosen","doi":"10.1016/j.gassur.2026.102539","DOIUrl":"10.1016/j.gassur.2026.102539","url":null,"abstract":"<div><h3>Background</h3><div>Ventral hernias account for over 600,000 repairs performed annually in the United States, and retromuscular repair has long been considered the technical gold standard for ventral hernia repair (VHR). However, whether its benefits extend uniformly across the full spectrum of hernia complexity remains uncertain. This study employs a novel augmented evidence review (AER) methodology, integrating 3 complementary evidence streams, to evaluate whether retromuscular repair is always the optimal approach.</div></div><div><h3>Methods</h3><div>Three evidence streams were analyzed: (i) a retrospective analysis of 35,625 adult patients undergoing elective VHR with sublay mesh placement in the Abdominal Core Health Quality Collaborative registry; (ii) surgeon polling conducted through the International Hernia Collaboration, an international surgeon social media forum; and (iii) artificial intelligence (AI)-generated literature synthesis using OpenEvidence, with all cited sources manually verified.</div></div><div><h3>Results</h3><div>Retromuscular utilization increased with defect size, from 5.0% for defects &lt; 3 cm to 59.2% for defects measuring 5 to 10 cm. Despite representing a more complex cohort (larger defects, more recurrent hernias, and greater contamination), retromuscular repair demonstrated lower clinical recurrence at 1 year (6.2% vs 14.1%), but was associated with higher 30-day morbidity, including surgical site infection, readmission, and reoperation. Surgeon polling similarly identified the 5-to-10-cm range as the threshold at which retromuscular repair becomes strongly preferred (67% of respondents). The AI-literature synthesis reinforced this size-dependent pattern, affirming retromuscular repair's superior recurrence profile for large and complex defects while identifying comparable short-term outcomes with preperitoneal or onlay repair, and lower associated morbidity, for small primary hernias ≤ 6 cm.</div></div><div><h3>Conclusion</h3><div>Retromuscular repair remains an essential technique in ventral hernia surgery and appears to be preferentially utilized for larger and more complex abdominal wall defects. Contemporary evidence, expert opinion, and real-world practice patterns do not support a universal retromuscular strategy for all ventral hernias. Instead, mesh plane selection should be individualized according to hernia characteristics, patient factors, and operative objectives, with retromuscular reconstruction reserved for scenarios in which its unique reconstructive advantages are most likely to improve long-term outcomes.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 10","pages":"Article 102539"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663627","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":"Real-world impact of first-line nivolumab plus chemotherapy on conversion surgery and survival outcomes in advanced gastric and esophagogastric junction cancer: a propensity score-matched analysis.","authors":"Akihiko Sano, Nobuhiro Nakazawa, Kengo Kuriyama, Takuhisa Okada, Takuya Shiraishi, Yuji Kumakura, Akiharu Kimura, Makoto Sakai, Ken Shirabe, Hiroshi Saeki","doi":"10.1016/j.gassur.2026.102532","DOIUrl":"10.1016/j.gassur.2026.102532","url":null,"abstract":"<p><strong>Background: </strong>Conversion surgery, namely curative-intent resection for patients with initially unresectable stage IV gastric or esophagogastric junction cancer whose tumors become resectable after systemic therapy, has become an important treatment strategy. However, the selection criteria for conversion surgery in the era of first-line nivolumab remain unclear.</p><p><strong>Methods: </strong>This single-institutional retrospective study included 140 patients who received systemic chemotherapy for advanced gastric or esophagogastric junction cancer. Data were compared between treatments with and without first-line nivolumab, and 1:2 propensity score matching was performed to adjust for baseline tumor burden and metastatic status. Predictors of conversion surgery were evaluated using logistic regression, and survival outcomes were analyzed using Kaplan-Meier and Cox regression models.</p><p><strong>Results: </strong>Conversion surgery was performed in 22 (15.7%) patients. The conversion surgery rate was significantly higher in patients receiving first-line nivolumab than in those receiving chemotherapy alone, both before and after propensity score matching (41.7% vs 8.3%; P =.001). In a multivariate analysis, the use of nivolumab as a first-line treatment was an independent predictor of conversion surgery both before and after matching. Minimally invasive surgery was performed in 12 (54.5%) patients, 9 of whom had received nivolumab. In the multivariate analysis of the propensity score-matched population, first-line nivolumab and male sex were favorable prognostic factors for advanced gastric cancer.</p><p><strong>Conclusion: </strong>First-line nivolumab-based chemotherapy may increase the likelihood of conversion surgery in patients with advanced gastric or esophagogastric junction cancer. Although conversion surgery was associated with improved progression-free survival, its impact on overall survival remains uncertain.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102532"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592037","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":"Complications after enhanced-view totally extraperitoneal ventral hernia repair: An augmented evidence review integrating Abdominal Core Health Quality Collaborative registry outcomes, published evidence, and expert-priority polling","authors":"Jorge Daes,&nbsp;Sidhant Kalsotra,&nbsp;Marisa H. Blackman","doi":"10.1016/j.gassur.2026.102501","DOIUrl":"10.1016/j.gassur.2026.102501","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced-view totally extraperitoneal (eTEP) repair enables minimally invasive retromuscular and preperitoneal mesh placement while avoiding contact with intraperitoneal mesh. Reported complication rates differ depending on the definition and data source. We developed an augmented evidence review (AER) to address \"What are the key tips to avoid common eTEP complications?\"</div></div><div><h3>Methods</h3><div>The AER integrated 3 evidence streams: (i) empiric, the Abdominal Core Health Quality Collaborative, including elective adult eTEP-consistent ventral hernia repairs with 30-day follow-up (N = 8434; October 2013 to December 2025); (ii) social media, an International Hernia Collaboration (IHC) expert poll ranking prioritized eTEP hazards; and (iii) artificial intelligence (AI), OpenEvidence synthesis with manual source verification. Outcomes were classified as consequential (readmission, reoperation, surgical site infection [SSI], surgical site occurrence or infection [SSO/I], and prolonged length of stay [LOS]) vs nonconsequential/burden. Adjusted analyses compared transeversus abdominis release (TAR) vs no-TAR and robotic vs laparoscopic approaches.</div></div><div><h3>Results</h3><div>The incidence of 30-day outcomes was as follows: readmission, 2.4%; reoperation, 1.3%; SSI, 1.1%; any SSO, 9.5%; and SSO/I, 1.8%. Defect width showed strong graded associations with adverse outcomes, with SSO/I rising from 0.5% (&lt;4 cm) to 4.6% (&gt;10 cm). In adjusted models, TAR was strongly associated with a LOS ≥ 2 days (odds ratio, 3.51; 95% CI, 2.96–4.16) but not with readmission or reoperation. After adjustment, the laparoscopic approach was not independently associated with the primary consequential endpoints compared with the robotic approach. The IHC poll prioritized posterior-layer disruption with intraparietal or internal herniation (29%), crossover-related linea alba injury (27%), midline bulging (23%), and trocar-exit bleeding (18%). OpenEvidence synthesis identified plane discipline and posterior-layer closure as primary prevention strategies, which were concordant with IHC poll priorities.</div></div><div><h3>Conclusion</h3><div>In a large cohort of elective minimally invasive surgery extraperitoneal sublay procedures, 30-day high-consequence events were uncommon, and most postoperative issues reflected nonprocedural wound occurrences. Defect width is the primary risk factor. Registry outcomes, expert polling, and AI synthesis all support eTEP as a safe and effective approach when performed with disciplined plane control and mechanism-based prevention strategies.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 10","pages":"Article 102501"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308416","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":"Trends in Cyst Size of Resected Intraductal Papillary Mucinous Neoplasms Over Time-Has the Evolution of the International Association of Pancreatology (IAP) Guidelines Impacted Surgical Thresholds.","authors":"Paul Wong, Tommaso Pollini, Sophia Hernandez, Letizia Todeschini, Ajay V Maker","doi":"10.1016/j.gassur.2026.102620","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102620","url":null,"abstract":"<p><strong>Background: </strong>International consensus guidelines have informed the management of intraductal papillary mucinous neoplasms (IPMNs) and introduced high risk stigmata and worrisome features that risk stratify lesions beyond only cyst size. In this study, we sought to understand whether these clinical considerations have impacted surgical selection criteria at United States hospitals.</p><p><strong>Methods: </strong>The National Cancer Database (2004-2021) was queried to identify all patients that underwent resection for non-invasive and invasive IPMNs. Patients with missing cyst size data were excluded. The cohort was divided into time periods reflecting the succession of IAP guidelines: Pre-Fukuoka (2004-2011), Fukuoka (2012-2016), Revised Fukuoka (2017-2021).</p><p><strong>Results: </strong>Of 3,580 resected IPMNs, invasive pathology was identified in 44% of all lesions, increasing to 48% when applying the Revised Fukuoka guidelines (Fukuoka 40%, Pre-Fukuoka 43%, p<0.001). While median cyst size of all resected IPMNs remained similar throughout the three eras, median size of non-invasive lesions progressively increased (2.6cm to 3.0cm, p=0.001), and that of invasive IPMNs decreased over time (3.1cm to 2.8cm, p<0.001). The proportion of resected non-invasive cysts ≥3cm increased over time (46%-52%-55%, p<0.001); however, the opposite was true for invasive lesions (57%-50%-48%, p=0.013). These trends were agnostic to hospital type (academic vs. non-academic), and non-academic hospitals had a greater proportion of non-invasive IPMNs ≥3cm (55% vs. 49%, p=0.026).</p><p><strong>Conclusions: </strong>The size of resected noninvasive IPMNs has increased over time, whereas the size of invasive lesions has progressively decreased. This trend may reflect improved, guideline concordant recognition of malignant risk features, including reduced reliance on cyst size alone.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102620"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110967","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":"Local excision and adjuvant radiation versus radical surgery for early-stage low-risk rectal cancer.","authors":"Phillip J Williams, Danish Ali, Emma Bradley, Shannon L McChesney, Alexander T Hawkins, Aimal Khan","doi":"10.1016/j.gassur.2026.102617","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102617","url":null,"abstract":"<p><strong>Background and objectives: </strong>Total mesorectal excision for early-stage rectal adenocarcinoma provides maximal oncologic control but is associated with impaired quality of life. Local excision with adjuvant chemoradiotherapy may be an acceptable alternative approach while minimizing morbidity. This study compares overall survival of patients with low-risk pT2N0/x rectal adenocarcinoma treated with total mesorectal excision and those treated with local excision and adjuvant chemoradiotherapy. We hypothesized that there would be not be a statistically significant difference in overall survival between these two groups.</p><p><strong>Methods: </strong>The National Cancer Database (2004-2020) was queried for patients with cT1N0 and cT2N0 rectal adenocarcinoma who underwent surgery and had pT2N0 or pT2Nx tumors. Patients with tumors that lacked high-risk features were included in a low-risk cohort. Patients were classified by treatment: total mesorectal excision, local excision with adjuvant chemoradiotherapy, or local excision only. The primary outcome of overall survival was compared using Kaplan-Meier survival analysis and Cox proportional hazard regression.</p><p><strong>Results: </strong>8484 patients were included. 6815 (80.3%) underwent total mesorectal excision, 685 (8.1%) local excision with adjuvant chemoradiotherapy, and 984 (11.6%) local excision alone. Median follow-up was 62.1 months. Among patients with low-risk cancer (47.4%), overall survival was similar between total mesorectal excision and local excision with adjuvant chemoradiotherapy (HR 1.25, 95% CI 0.91-1.72).</p><p><strong>Conclusions: </strong>In patients with low-risk pT2N0/x rectal adenocarcinoma, a statistically significant difference in overall survival was not observed between treatment with total mesorectal excision and local excision with adjuvant chemoradiotherapy. This finding supports the conduction of prospective trials to futher evaluate this research question.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102617"},"PeriodicalIF":2.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081034","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":"Invited Commentary on: Impact of Post-operative Superior Mesenteric/Portal Vein Stenosis on Survival Outcomes among Pancreatic Head Adenocarcinoma Patients Undergoing Pancreaticoduodenectomy with Combined Venous Resection Following Neoadjuvant Chemoradiotherapy: A Single-center Retrospective Study.","authors":"Alex M Roch","doi":"10.1016/j.gassur.2026.102612","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102612","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102612"},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030686","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":"Developing Consensus for Colorectal QI Research: A Delphi Study.","authors":"Megan Obi, Arielle Kanters, Rebecca Gunter, Stefan D Holubar, Scott Steele, David Liska, Kristen Ban","doi":"10.1016/j.gassur.2026.102604","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102604","url":null,"abstract":"<p><strong>Purpose: </strong>Data are essential to guide meaningful quality improvement (QI) in colorectal surgery. The goal of this Delphi study is to achieve consensus from experts on which data are most important to guide quality improvement efforts in colorectal surgery.</p><p><strong>Study design: </strong>A two- round modified Delphi study via survey questionnaire was conducted using a panel of 34 colorectal surgeon experts. Scoring was done with a 9-point Likert scale. A median score ≥7 defined consensus and a median score of ≤3 was defined as inappropriate.</p><p><strong>Results: </strong>Response rate after each round was 61.8% (21/34) and 90.5% (19/21) respectively. Of the 63 outcome and process measures analyzed at the end of round 2, consensus was reached on a total of 52 (73.2%) process and outcome measures and 3 (4.2%) were deemed inappropriate.</p><p><strong>Conclusion: </strong>Measures achieving the highest consensus were outcomes that are collected in NSQIP. Additional unexpected process measures were also highly valued amongst experts. Hospitals participating in NSQIP can add these data elements as custom variables to engage in more targeted, meaningful QI projects as appropriate.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102604"},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030663","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":"Gastric Electrical Stimulation in Post-Bariatric Patients: A Case Series on Non-Standard Lead Placement.","authors":"William Sebastian, Qichen Deng, Emily Rienzo, Michael Meseha, Jillian Cassidy, Seth Kipnis","doi":"10.1016/j.gassur.2026.102609","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102609","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102609"},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030726","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":"External Validation and Recalibration of the Boey and PULP Scores in a Contemporary Cohort With Peptic Ulcer Perforation.","authors":"İbrahim Doğan, Serdar Çoban, Ezgi Sönmez, Veysi Gökyer, Serpil Sevimli Deniz","doi":"10.1016/j.gassur.2026.102607","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102607","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Boey and Peptic Ulcer Perforation (PULP) scores were developed to predict mortality following perforated peptic ulcer (PPU), but their performance may vary when applied to contemporary populations with different case mix and baseline risk. Their performance for clinically relevant postoperative outcomes and the potential role of model updating remain uncertain. This study externally validated established prognostic scores and evaluated their discrimination, calibration, decision-analytic net benefit, and the potential effect of score-based recalibration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective single-center cohort study included 286 consecutive patients who underwent emergency surgery for PPU. The primary outcome was postoperative complications according to the Clavien-Dindo classification, while secondary outcomes included intensive care unit (ICU) admission and 30-day mortality. The discriminatory performance of the Boey, PULP, American Society of Anesthesiologists (ASA), and Charlson Comorbidity Index (CCI) scores was assessed using receiver operating characteristic (ROC) analysis. Calibration, decision curve analysis, score-based logistic recalibration, and the incremental prognostic value of the neutrophil-to-lymphocyte ratio (NLR) were also evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median age was 34 years, 88.1% of patients were male, and the 30-day mortality rate was 2.8%. Postoperative complications occurred in 25.2% of patients, and 11.5% required ICU admission. For postoperative complications, the PULP score demonstrated the highest discrimination (AUC, 0.713; 95% CI, 0.646-0.778), followed by the Boey score (AUC, 0.668; 95% CI, 0.600-0.734). For ICU admission, the Boey score showed the highest discrimination (AUC = 0.840), followed by the PULP score (AUC = 0.827). The ASA classification and CCI showed AUC values of 0.801 and 0.736, respectively. Direct comparison of the PULP and Boey scores showed no statistically significant difference in discrimination for either postoperative complications (P = 0.081) or ICU admission (P = 0.549). Calibration mismatch was observed in the original score-based models, whereas logistic recalibration improved agreement between predicted and observed risks. Decision curve analysis showed greater net benefit for the disease-specific scores across selected threshold probabilities, while addition of NLR did not significantly improve predictive performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this contemporary low-mortality surgical cohort, the Boey and PULP scores retained useful discriminatory ability but showed calibration mismatch when applied to outcomes beyond their original development setting. Local recalibration improved agreement between predicted and observed risks, illustrating the importance of model updating when established prediction tools are transported across populations with different baseline risks. These recalibrated models should b","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102607"},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030657","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}