Journal of Gastrointestinal Surgery最新文献

{"title":"Balloon dilatation vs self-expandable metal stents placement for benign gastric outlet obstruction","authors":"Yan Liu , Gaofeng Liu , Yonghua Bi , Jinjun Sun","doi":"10.1016/j.gassur.2026.102352","DOIUrl":"10.1016/j.gassur.2026.102352","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102352"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093120","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 hepatic artery infusion pump placement with replaced common hepatic artery origin","authors":"Bhavya Bansal , Sharona Ross , Iswanto Sucandy","doi":"10.1016/j.gassur.2026.102367","DOIUrl":"10.1016/j.gassur.2026.102367","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102367"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180630","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":"Comparison outcomes between laparoscopic choledocholithotripsy and laparoscopic cholecystectomy and preoperative endoscopic retrograde cholangiopancreatography with sphincterotomy and laparoscopic cholecystectomy in patients with choledocholithiasis and cholelithiasis: an up-to-date meta-analysis","authors":"Jia-Hui Chen ,&nbsp;Yu-Tien Chen ,&nbsp;Kian-Hwee Chong ,&nbsp;Chao-Hsu Li ,&nbsp;Ping Ho ,&nbsp;Chieh-Wen Lai ,&nbsp;Tzu-Rong Peng","doi":"10.1016/j.gassur.2026.102351","DOIUrl":"10.1016/j.gassur.2026.102351","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic choledocholithotripsy (or laparoscopic common bile duct exploration [LCBDE]) with laparoscopic cholecystectomy (LC) and preoperative endoscopic sphincterotomy (EST) followed by LC are established treatment strategies for concomitant choledocholithiasis and cholelithiasis. However, the comparative efficacy, safety, and cost-effectiveness of these 1-stage vs 2-stage approaches remain uncertain, particularly with recent advances in minimally invasive interventions.</div></div><div><h3>Methods</h3><div>A systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted between January 2000 and December 2024. Randomized controlled trials (RCTs) comparing LCBDE + LC with EST + LC in patients with confirmed or suspected common bile duct (CBD) stones were included. Of note, 2 reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration tool. Meta-analyses were performed using Review Manager software (version 5.4.1; Cochrane Informatics and Knowledge Management Department, Nordic Cochrane Centre) with random-effects models to calculate odds ratios (ORs) or mean differences (MDs) with 95% CIs. The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024610284).</div></div><div><h3>Results</h3><div>Overall, 16 RCTs involving 1576 patients were included (778 in the LCBDE + LC group and 798 in the EST + LC group). EST + LC achieved a higher CBD stone clearance rate (OR, 1.72 [95% CI, 1.14–2.60]; <em>P</em> =.01). No significant differences were observed in the overall complications (OR, 0.66 [95% CI, 0.42–1.03]; <em>P</em> =.07) or mortality (OR, 0.22 [95% CI, 0.02–1.93]; <em>P</em> =.17). LCBDE + LC resulted in lower recurrence (OR, 0.27 [95% CI, 0.11–0.69]; <em>P</em> =.006) and reduced costs (MD, −2059.35 United States dollar [95% CI, −2720.55 to −1398.16]; <em>P</em> &lt;.00001). Hospital stay and residual stone rates were comparable between the 2 groups.</div></div><div><h3>Conclusion</h3><div>EST + LC provides a higher rate of CBD stone clearance, whereas LCBDE + LC offers advantages in reducing recurrence and overall costs. Both approaches are safe and effective. Treatment choice should be individualized based on institutional expertise, resource availability, and patient-specific considerations.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102351"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097095","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":"Treatment delays and outcomes in pregnancy-associated cancer: a multicenter analysis","authors":"Azza Sarfraz,&nbsp;Selamawit Woldesenbet,&nbsp;Odysseas P. Chatzipanagiotou,&nbsp;Abdullah Altaf,&nbsp;Areesh Mevawalla,&nbsp;Mujtaba Khalil,&nbsp;Zayed Rashid,&nbsp;Shahzaib Zindani,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102357","DOIUrl":"10.1016/j.gassur.2026.102357","url":null,"abstract":"<div><h3>Background</h3><div>Management of pregnancy-associated cancers (PACs)—malignancies diagnosed during pregnancy or within 1 year postpartum—poses unique clinical challenges. Treatment decisions must balance maternal cancer control with fetal safety, yet little is known about how cancer treatment timing varies between pregnant and nonpregnant individuals or how PACs affect obstetric and neonatal outcomes. Understanding these associations is critical to improve care strategies for this vulnerable population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using Epic Cosmos, a large multicenter United States electronic health record database. The primary “cancer” cohort included individuals aged 18 to 49 years diagnosed as having cancer between January 2018 and December 2022. These individuals were categorized by pregnancy status at diagnosis: gestational PAC, postpartum PAC, or nonpregnant. A secondary “maternal” cohort comprised individuals with viable deliveries during the same period; gestational PAC pregnancies were matched 1:4 with cancer-unexposed pregnancies. Primary outcomes were time from cancer diagnosis to initiation of surgery, radiotherapy, and chemotherapy. Secondary outcomes included 30-day surgical complications, mortality, readmissions, and obstetric and neonatal outcomes such as cesarean delivery, preterm birth, low birth weight, and 5-min appearance, pulse, grimace, activity, and respiration (Apgar) scores.</div></div><div><h3>Results</h3><div>Among 38,345 individuals in the cancer cohort (median age, 43 years; IQR, 38–47), most were White (n = 26,594; 71.3%) and married (n = 19,230; 51.5%). Gestational PAC was associated with 15% longer time to surgery (adjusted rate ratio [aRR], 1.15; 95% CI, 1.13–1.17), 28% longer time to radiotherapy (aRR, 1.28; 95% CI, 1.27–1.29), and 29% shorter time to chemotherapy initiation (aRR, 0.71; 95% CI, 0.70–0.72) than nonpregnant controls. Postpartum PAC was associated with 13% shorter time to surgery (aRR, 0.87; 95% CI, 0.86–0.88) and 30% shorter time to chemotherapy (aRR, 0.70; 95% CI, 0.70–0.71). In the maternal cohort, gestational PAC was associated with higher odds of cesarean delivery (adjusted odds ratio [aOR], 1.21; 95% CI, 1.04–1.41), preterm birth (aOR, 3.79; 95% CI, 3.15–4.56), low birth weight (aOR, 3.08; 95% CI, 2.50–3.77), and low 5-min Apgar scores (aOR, 1.86; 95% CI, 1.20–2.82).</div></div><div><h3>Conclusion</h3><div>PAC was associated with delays in locoregional treatment and increased maternal and neonatal morbidity, underscoring the need for coordinated multidisciplinary care to optimize outcomes for women with PACs.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102357"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119211","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 “Colorectal cancer T-stage, size at diagnosis, and presentation 2017–2023: an analysis using Veterans Affairs data”","authors":"Kishankumar Mahida ,&nbsp;Snehal Rajendra Jagtap","doi":"10.1016/j.gassur.2026.102366","DOIUrl":"10.1016/j.gassur.2026.102366","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102366"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197700","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":"Defining a new 6-factor Charlson Comorbidity Index utilizing data points available in the American College of Surgeons National Surgical Quality Improvement Program for patients undergoing pancreatoduodenectomy","authors":"John Christopher Polanco-Santana ,&nbsp;João P.G. Kasakewitch ,&nbsp;Kaique Filardi ,&nbsp;Scott C. Fligor ,&nbsp;Manuel Castillo-Angeles ,&nbsp;Tara S. Kent","doi":"10.1016/j.gassur.2025.102319","DOIUrl":"10.1016/j.gassur.2025.102319","url":null,"abstract":"<div><h3>Background</h3><div>The Charlson Comorbidity Index (CCI) is widely used in surgical research to summarize patients’ baseline comorbidities. However, large surgical databases, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), lack key CCI components, limiting its applicability. Developing a modified CCI (mCCI) using available ACS-NSQIP variables could improve baseline risk stratification for patients undergoing pancreatoduodenectomy (PD). This study aimed to define such an mCCI and evaluate its performance compared with that of the conventional CCI.</div></div><div><h3>Methods</h3><div>This was a 2-phase retrospective study that included patients who underwent PD. In the derivation phase, our institutional ACS-NSQIP database (2015–2021) was used to construct the mCCI, with scores reweighted to the observed 14-point maximum. The Spearman rank correlation was used to evaluate the relationship between CCI and mCCI. The nationwide ACS-NSQIP database (2022) was used for external validation. Unadjusted logistic regression models were constructed to predict discharge disposition and postoperative complications. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC)/receiver operating characteristic curve analysis with AUCs compared with the DeLong test.</div></div><div><h3>Results</h3><div>A total of 333 institutional and 4867 national patients who underwent PD were included. In the derivation cohort, the mCCI was strongly correlated with the CCI (<em>r</em> = 0.85; <em>P</em> &lt;.001). For discharge disposition, both indices yielded an AUC of 0.74. For postoperative complications, AUCs were 0.50 for CCI and 0.55 for mCCI. Similar trends were observed in external validation. No significant differences were found in the discriminatory capacities between the models.</div></div><div><h3>Conclusion</h3><div>mCCI is a reasonable alternative to account for baseline comorbidities in patients undergoing PD using the ACS-NSQIP database. Further studies should refine weighting schemes across diverse populations to optimize mCCI performance.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102319"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889214","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":"Rendezvous robotic endoscopic retrograde cholangiopancreatography for complex Mirizzi","authors":"Akanksha Talwar ,&nbsp;Zhi Ven Fong ,&nbsp;Irving A. Jorge","doi":"10.1016/j.gassur.2026.102369","DOIUrl":"10.1016/j.gassur.2026.102369","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102369"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180705","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":"Renal metastasis to the pancreas: a comprehensive review","authors":"Hassan Aziz ,&nbsp;Aditya Kotla ,&nbsp;Raegen Abbey ,&nbsp;Brandon C. Toliver ,&nbsp;Matthew Gosse ,&nbsp;Nikahat Yasmine ,&nbsp;Yashant Aswani ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102347","DOIUrl":"10.1016/j.gassur.2026.102347","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic metastases are rare, accounting for 2% to 5% of all pancreatic malignancies. Renal cell carcinoma (RCC) is the most common primary cancer that metastasizes to the pancreas and accounts for 30% to 40% of all pancreatic metastatic lesions. Most reported cases involve clear cell RCC (ccRCC), although data regarding pancreatic metastases from non–ccRCC subtypes remain limited. Unlike metastases from other primary tumors, pancreatic metastases from RCC (PM-RCC) often follow a more indolent clinical course and are associated with a relatively favorable prognosis, suggesting distinct underlying biological behavior.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using the MEDLINE/PubMed, Google Scholar, Cochrane Library, and Web of Science databases (January 1993 to May 2025). Eligible studies included full-text articles, case reports, and original research describing RCC metastasis to the pancreas, with an emphasis on the mechanism, diagnosis, treatment, and outcomes.</div></div><div><h3>Results</h3><div>The disproportionate tendency of kidney cancer to metastasize to the pancreas is best explained by the “seed and soil” hypothesis, reflecting a selective affinity between RCC cells and the pancreatic microenvironment. PM-RCC are usually metachronous, often occurring many years after nephrectomy, and are frequently asymptomatic and discovered incidentally on surveillance imaging. Characteristic imaging findings include hypervascular lesions on contrast-enhanced computed tomography or magnetic resonance imaging. Histopathologic confirmation is crucial, as PM-RCC have a markedly better prognosis than primary pancreatic neoplasms. Surgical resection remains the mainstay of treatment of isolated disease, with a 5-year survival rate exceeding 50%. In the era of targeted immunotherapy, systemic treatments further improve outcomes, with the median overall survival surpassing that of patients with extrapancreatic metastases.</div></div><div><h3>Conclusion</h3><div>PM-RCC are a unique clinical and biological entity characterized by indolent progression, favorable survival, and a strong response to surgical and targeted therapies. Understanding the molecular and microenvironmental mechanisms underlying this selective organotropism may refine therapeutic strategies and provide insights into the broader principles of metastatic disease.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102347"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093107","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":"Comparative analysis of outcomes and costs of lung and esophageal resection: epidural analgesia vs peripheral nerve block","authors":"Qaidar Alizai,&nbsp;Azza Sarfraz,&nbsp;Odysseas P. Chatzipanagiotou,&nbsp;Areesh Mevawalla,&nbsp;Meher Angez,&nbsp;Abdulaziz Elemosho,&nbsp;Peter Kneurtz,&nbsp;Desmond D’Souza,&nbsp;Robert Merritt,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102354","DOIUrl":"10.1016/j.gassur.2026.102354","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic epidural analgesia (EA) has historically been a key component of multimodal analgesia after open thoracotomy. EA use has decreased over time, however, and peripheral nerve blocks (PNBs) are increasingly used as alternatives. This study aimed to compare outcomes among patients receiving EA versus PNB as part of a lung or esophageal operative procedure.</div></div><div><h3>Methods</h3><div>Adult patients who received EA or PNB as part of a lung or esophageal operative procedure from 2016 to 2020 were identified in the Nationwide Readmissions Database. Outcomes included complications, 90-day readmission, mortality, length of stay (LOS), and hospitalization costs. Patients were stratified according to analgesia type and 1:2 propensity score matching (PSM) adjusted for patient, surgical, and hospital characteristics. Multivariate regression was used to address residual confounding.</div></div><div><h3>Results</h3><div>Among 8668 patients, 738 (8.5%) received EA, and 7930 (91.5%) received PNB. After PSM (N = 2110; 721 in the EA group vs 1389 in the PNB group), EA remained associated with longer LOS (β = 1.12 days [95% CI, 0.85–1.39]) and higher index admission (β = $3630 [95% CI, $2061–5199]) and total 90-day costs (β = $4808 [95% CI, $3230-$6386]) (all <em>P</em> &lt;.001). In site-stratified multivariate models, EA was associated with higher median 90-day costs after esophageal resection ($12,487) and lung resection ($2970) and longer LOS (esophagus: β = 1.93; lung: β = 1.00 days). In addition, EA was associated with higher odds of ileus after esophageal resection (adjusted odds ratio, 18.47). Other complications, readmission, and 90-day mortality did not differ (all <em>P</em> &gt;.05).</div></div><div><h3>Conclusion</h3><div>EA was associated with a longer hospital stay and higher median costs than PNB, with no differences in clinical outcomes. These findings support the use of PNB as an equally safe and more cost-conscious analgesic strategy in thoracic surgery.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102354"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100291","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 unusual cause of dysphagia: a giant pedunculated esophageal lipoma","authors":"Rui Zhong,&nbsp;Kui Zhao","doi":"10.1016/j.gassur.2026.102356","DOIUrl":"10.1016/j.gassur.2026.102356","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102356"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105929","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}