Journal of Gastrointestinal Surgery最新文献

{"title":"Gastric metastasis from Merkel cell carcinoma","authors":"Juliana Maria Napoli, Felipe Higuera, Fernando Gabriel Wright","doi":"10.1016/j.gassur.2024.101925","DOIUrl":"10.1016/j.gassur.2024.101925","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101925"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829106","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 national perspective on palliative interventions for malignant gastric outlet obstruction","authors":"Ayesha P. Ng,&nbsp;Joseph E. Hadaya,&nbsp;Yas Sanaiha,&nbsp;Nikhil L. Chervu,&nbsp;Mark D. Girgis,&nbsp;Peyman Benharash","doi":"10.1016/j.gassur.2024.101884","DOIUrl":"10.1016/j.gassur.2024.101884","url":null,"abstract":"<div><h3>Background</h3><div>Of note, 15% to 20% of patients with duodenal or periampullary malignancies develop gastric outlet obstruction (GOO). Although small randomized trials have reported more rapid recovery and shorter hospital stay with endoscopic stenting (ES), limited studies have evaluated outcomes at a national level. The current study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) vs ES in malignant GOO.</div></div><div><h3>Methods</h3><div>Adults with malignant GOO treated with ES or GJ were identified in the 2016–2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariate regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission.</div></div><div><h3>Results</h3><div>Of 8186 patients with GOO, 5603 (68.4%) underwent ES, and 2583 (31.6%) underwent GJ. The cohorts were similar in age, female/male sex, and comorbidities. However, patients who underwent GJ were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between patients who underwent GJ and those who underwent ES. GJ was associated with greater odds of blood transfusion (adjusted odds ratio [AOR], 1.74; 95% CI, 1.37–2.21) and postoperative TPN use (AOR, 3.76; 95% CI, 2.64–5.35). Furthermore, patients who underwent GJ experienced a significant increment of &gt;$15,800 in costs and &gt;6.9 days in LOS. In subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable among palliation strategies.</div></div><div><h3>Conclusion</h3><div>ES seems to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101884"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639045","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":"Association between sex-specific criteria for visceral obesity and surgical site infection after gastrectomy","authors":"Shinichiro Shiomi ,&nbsp;Wataru Gonoi ,&nbsp;Kotaro Sugawara ,&nbsp;Satoru Taguchi ,&nbsp;Shouhei Hanaoka ,&nbsp;Mariko Kurokawa ,&nbsp;Nobuhiko Akamatsu ,&nbsp;Shohei Inui ,&nbsp;Koichi Yagi ,&nbsp;Haruki Kume ,&nbsp;Osamu Abe ,&nbsp;Yasuyuki Seto","doi":"10.1016/j.gassur.2024.101919","DOIUrl":"10.1016/j.gassur.2024.101919","url":null,"abstract":"<div><h3>Background</h3><div>High visceral fat area (VFA), estimated by computed tomography (CT), is reportedly associated with surgical site infection (SSI) in patients who undergo gastrectomy for gastric cancer (GC). Given that fat distributions vary markedly according to sex, sex-specific definitions of visceral obesity should be applied. This study investigated the optimal sex-specific thresholds for VFA at the L3 level to assess the risk of SSI after gastrectomy.</div></div><div><h3>Methods</h3><div>This study included 828 patients (564 males and 264 females) who underwent curative gastrectomy. Intra-abdominal or incisional infectious complications with Clavien-Dindo scores ≥ 2 were defined as SSIs. Receiver operating characteristic (ROC) analyses were used to determine the optimal sex-specific VFA cutoffs to extract patients with obesity who are at risk of developing SSI. In addition, logistic regression analyses were performed, and the corrected Akaike information criterion (AICc) was calculated to compare the capability to evaluate the possibility of SSI of our sex-specific VFA-based criteria vs the conventional VFA-based or body mass index (BMI)-based criterion.</div></div><div><h3>Results</h3><div>SSI developed in 59 males and 16 females. Optimal VFA thresholds were 119.3 cm² for males and 57.2 cm² for females. Multivariate analyses revealed visceral obesity, as defined by the sex-specific criteria, to be an independent risk factor for SSI (odds ratio, 2.74; 95% CI, 1.62–4.66; <em>P</em> &lt;.01). The logistic regression model with our sex-specific criteria yielded a better AICc (456.4) than the conventional (461.8) or BMI-based (467.0) criterion for obesity.</div></div><div><h3>Conclusion</h3><div>Sex-specific criteria can enhance the capability of VFA to assess the risk of SSI after gastrectomy, compared with the non–sex-specific criterion.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101919"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769554","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":"Laparoscopic surgery for gastric gastrointestinal stromal tumor in the age of Enhanced Recovery After Surgery","authors":"Mohammad S. Farooq ,&nbsp;Valentina Mattfeld ,&nbsp;Neha Shafique ,&nbsp;Gracia M. Vargas ,&nbsp;John T. Miura ,&nbsp;Giorgos C. Karakousis","doi":"10.1016/j.gassur.2024.101920","DOIUrl":"10.1016/j.gassur.2024.101920","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101920"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780342","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":"Delta-integrated relaxation pressures as a new high-resolution manometry metric to predict the positive outcome of laparoscopic Heller-Dor in patients with achalasia","authors":"Andrea Costantini ,&nbsp;Matteo Pittacolo ,&nbsp;Giulia Nezi ,&nbsp;Giovanni Capovilla ,&nbsp;Mario Costantini ,&nbsp;Arianna Vittori ,&nbsp;Matteo Santangelo ,&nbsp;Luca Provenzano ,&nbsp;Loredana Nicoletti ,&nbsp;Francesca Forattini ,&nbsp;Lucia Moletta ,&nbsp;Michele Valmasoni ,&nbsp;Edoardo V. Savarino ,&nbsp;Renato Salvador","doi":"10.1016/j.gassur.2024.101928","DOIUrl":"10.1016/j.gassur.2024.101928","url":null,"abstract":"<div><h3>Background</h3><div>There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score is used to define clinical outcomes. However, objective metrics are lacking. This study aimed to identify whether any high-resolution manometry (HRM) parameters may be useful in predicting a positive outcome after laparoscopic Heller-Dor (LHD).</div></div><div><h3>Methods</h3><div>Patients who underwent LHD between 2012 and 2022 were enrolled. The patients were divided according to the outcome: the success group (SG) and the failure group (FG). In addition to the common HRM parameters, we measured the difference between pre- and postoperative integrated relaxation pressures (∆-IRPs). A receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of each HRM parameter.</div></div><div><h3>Results</h3><div>Of note, 336 patients (92.3%) were classified in the SG, and 28 patients (7.7%) were classified in the FG. No difference was found in terms of manometric types, symptom duration, and history of previous treatments. Preoperative lower esophageal sphincter (LES) pressure and IRP were higher in the SG than in the FG (41 vs 35 mm Hg [<em>P</em> =.03] and 33 vs 26 mm Hg [<em>P</em> =.002], respectively). The postoperative LES metrics were similar between the 2 groups, except for the ∆-IRP that was higher in the SG (23 mm Hg [IQR, 15–31]) than in the FG (14 mm Hg [IQR, 9–17]) (<em>P</em> =.0002). In the univariate analysis, age, LES preoperative pressure, IRP, and ∆-IRP were factors able to predict a positive clinical outcome. In the multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (odds ratio, 0.94; 5%–95% CI, 0.89–0.99). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.5 mm Hg (sensibility of 71% and specificity of 70%).</div></div><div><h3>Conclusion</h3><div>Our data showed that the ∆-IRP with a threshold of 16.5 mm Hg could represent a new objective tool for predicting the long-term positive outcome of LHD in patients with esophageal achalasia.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101928"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824228","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":"First clinical report of the international single-port robotic rectal cancer registry","authors":"John H. Marks ,&nbsp;Hye Jin Kim ,&nbsp;Gyu-Seog Choi ,&nbsp;Luis Andres Idrovo ,&nbsp;Suraj Chetty ,&nbsp;Thais Reif De Paula ,&nbsp;Deborah Keller","doi":"10.1016/j.gassur.2024.101929","DOIUrl":"10.1016/j.gassur.2024.101929","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Rectal cancer surgery remains a significant technical challenge. The development and implementation of a new technology offer hope for more accurate and precise surgery. To evaluate whether single-port robotic (SPr) technology helps achieve this goal, an international SPr registry was established. This study reported short-term clinical and oncologic outcomes from an international SPr registry for rectal cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A review of a prospective international registry of SPr technology approved for colorectal surgery with an investigational design exemption was conducted. Patients with rectal adenocarcinoma who had resection for curative intent using the SPr platform between November 2018 and September 2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncologic, and clinical outcome variables. The main outcome measure was the quality of the total mesorectal excision (TME) specimen. The secondary outcome measures were intraoperative conversion and 30-day postoperative morbidity and mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 113 SPr procedures for rectal cancer were performed at 2 centers by 4 colorectal surgeons. Of note, 9 local excisions were excluded, leaving 104 cases analyzed. The cohort consisted of 53 men (50.96%), had a mean age of 60.00 years (SD, 11.29), and had a body mass index of 25.80 kg/m&lt;sup&gt;2&lt;/sup&gt; (SD, 6.18). The most common T stage was 3 (55 [52.8%]), followed by 2 (19 [18.26%]). More than 60% of patients had preoperative neoadjuvant chemoradiation. The mean tumor distance from the anorectal ring was 2.90 cm (SD, 2.62), and the mean tumor size was 4.52 cm (SD, 1.82). The procedures performed included transanal abdominal transanal/transanal TME (52 [46%]), low anterior resection (49 [43.3%]), and abdominoperineal resection (3 [2.7%]). The mean operating time was 168.0 min (SD, 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.30 cm (SD, 1.31). The TME specimens were complete in 101 cases (97.1%) and near complete in 3 cases (2.9%). The R1 rate was 3.8%, with 3 positive distal margins and 1 positive circumferential margin. Postoperatively, there were 15 total complications, of which 4 were major complications and 11 were minor complications. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This early international experience with the SPr procedure showed that it is a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates observed with other techniques and platforms used in rectal cancer surgery were not demonstrated. An international registry was used to better understand the opportunities and limitations of SPr technology in rectal cancer surgery as the tec","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101929"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824230","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 incidence and temporal trend of appendicitis in children: An analysis from the Global Burden of Disease Study 2021","authors":"Ran He ,&nbsp;Jianxiong Lai ,&nbsp;Ou Jiang ,&nbsp;Jian Li","doi":"10.1016/j.gassur.2024.101935","DOIUrl":"10.1016/j.gassur.2024.101935","url":null,"abstract":"<div><h3>Background</h3><div>Challenges persist in the management of appendicitis in children, but its incidence and temporal trends have been reported in only a few developed countries. This study aimed to comprehensively investigate the incidence and temporal trends of appendicitis in children at the global, regional, and national levels, providing evidence for implementing and scaling up intervention services to reduce adverse health outcomes.</div></div><div><h3>Methods</h3><div>This study downloaded incidence data on appendicitis in children from the Global Burden of Disease 2021. Data on number and rate of appendicitis in children were analyzed at the global, sex, age, sociodemographic, regional, and national levels. The percentage changes and average annual percentage changes were calculated. The association between the sociodemographic index (SDI) and incidence of appendicitis in children was also determined by Pearson correlation analysis.</div></div><div><h3>Results</h3><div>In 2021, the newly diagnosed appendicitis in children was estimated to be 2,193,020, accounting for 12.93% of all cases of appendicitis in the general population. The corresponding incidence rate was estimated to be 109 per 100,000. From 1990 to 2021, the incidence of appendicitis in children increased by 0.3% annually. The incidence varied widely across regions and countries, whereas there was a significant positive association between the incidence rates (R = 0.6620, <em>P</em> &lt;.001) and its percentage changes (R = 0.2234, <em>P</em> =.0013) of appendicitis in children and the SDI.</div></div><div><h3>Conclusion</h3><div>Appendicitis will continue to be a major public health challenge in children worldwide, especially in transitioning countries and regions. A comprehensive description of the incidence and its changing patterns, increasing awareness, and rational resource allocation are needed to reduce the burden of pediatric appendicitis.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101935"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864557","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":"Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?","authors":"Sami Alahmadi ,&nbsp;David L. Berger ,&nbsp;Christy E. Cauley ,&nbsp;Robert N. Goldstone ,&nbsp;William V. Kastrinakis ,&nbsp;Marc Rubin ,&nbsp;Hiroko Kunitake ,&nbsp;Rocco Ricciardi ,&nbsp;Grace C. Lee","doi":"10.1016/j.gassur.2024.101899","DOIUrl":"10.1016/j.gassur.2024.101899","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.</div></div><div><h3>Results</h3><div>Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (<em>P</em> &gt;.05) or rates of incomplete donuts (<em>P</em> =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; <em>P</em> =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; <em>P</em> =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; <em>P</em> =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; <em>P</em> =.94).</div></div><div><h3>Conclusion</h3><div>EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101899"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750972","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 isolated pancreatic myeloid sarcoma","authors":"Long He ,&nbsp;Hongzhen Wei ,&nbsp;Tao Yin","doi":"10.1016/j.gassur.2024.101923","DOIUrl":"10.1016/j.gassur.2024.101923","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101923"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807280","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 evaluation of postoperative adjuvant TACE in preventing HCC recurrence within Milan criteria: A multi-center propensity score matching analysis based on pathological indicators.","authors":"Kun He, Yongqiang Xiao, Shuju Tu, Yourao Li, Zhao Wu, Liping Liu, Wei Shen, Shiyun Bao, Yongzhu He","doi":"10.1016/j.gassur.2025.101978","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101978","url":null,"abstract":"<p><strong>Objective: </strong>Malignant biological behaviors such as microvascular invasion (MVI), satellite nodule formation and poor differentiation can appear in the postoperative pathology of early hepatocellular carcinoma (HCC), which often indicates that it has entered the stage of malignant evolution earlier. This study aimed to evaluate tumor recurrence in HCC patients meeting the Milan criteria who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE) based on postoperative pathological indices.</p><p><strong>Methods: </strong>A retrospective study was conducted on 790 HCC patients within the Milan criteria who underwent hepatectomy across four medical centers, comprising 366 patients treated with PA-TACE and 424 patients without PA-TACE. To reduce selection bias, propensity score matching (PSM) at a 1:1 ratio was applied, achieving balanced clinical characteristics between the two groups.</p><p><strong>Results: </strong>Patients receiving PA-TACE did not experience more severe adverse events or toxicity-related deaths. After PSM of each subgroup, it was found that patients with MVI (Median time: 37 months vs 17 months, p = 0.010), satellite nodules (Median time: NA vs 14 months, p = 0.018), and Edmondson-Steiner grade III-IV (Median time: NA vs 13 months, p = 0.004) who received PA-TACE had higher recurrence-free survival (RFS). However, patients who were MVI-negative, satellite nodule-negative, and Edmondson-Steiner grade I-II did not benefit from PA-TACE in terms of RFS (All p > 0.05). Patients who received PA-TACE were more likely to undergo liver transplantation, re-hepatectomy, and local ablation after tumor recurrence, whereas patients who did not receive PA-TACE were more likely to receive TACE, chemoradiotherapy, and immunotargeted therapy after tumor recurrence (All p < 0.05).</p><p><strong>Conclusion: </strong>Postoperative pathological indicators can guide the selection of PA-TACE for patients with HCC within the Milan criteria. Patients with MVI, satellite nodules, and Edmondson-Steiner grade III-IV are more suitable for receiving PA-TACE to improve RFS. PA-TACE may alter the recurrence pattern of tumors, rendering them more localized.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101978"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122999","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}