Journal of Surgical Research最新文献

{"title":"Report Cards Are Out: Nine Years of Nonoperative Management for Blunt Abdominal Solid Organ Trauma","authors":"Muhammad Haris Khurshid MD, Francisco Castillo Diaz MD, Omar Hejazi MD, Mohammad Al Ma'ani MD, Collin Stewart MD, FACS, Audrey L. Spencer MD, FACS, Tanya Anand MD, MPH, FACS, Anastasia Kunac MD, FACS, Louis J. Magnotti MD, MS, FACS, Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.06.073","DOIUrl":"10.1016/j.jss.2025.06.073","url":null,"abstract":"<div><h3>Introduction</h3><div>There has been a dramatic shift toward nonoperative management (NOM) of blunt abdominal solid organ injuries (ASOIs) with angioembolization (AE). However, there is a lack of evidence assessing temporal trends in AE use, timing of intervention, and how these trends relate to NOM failure and patient outcomes over time. The aim of this study was to assess the trends in time to AE, its association with failure of NOM, and outcomes of these patients across the United States.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 9 y, ending in 2021. We included adult patients (age ≥ 18 y) with blunt ASOI (spleen, liver, and kidney) who underwent AE within 4 h of hospital arrival. Patients who underwent operative intervention before AE were excluded. The primary outcome measured was the failure of NOM. Secondary outcomes included major complications, 24-h mortality, and in-hospital mortality. Multivariable regression analyses were performed to identify the independent effect of every hour delay in time to AE on outcomes.</div></div><div><h3>Results</h3><div>A total of 2203 patients with blunt ASOI who were managed nonoperatively with AE were identified. The mean age was 45, and 68% were male. On arrival, the mean systolic blood pressure was 105, and the median Glasgow coma scale was 15. The median Injury Severity Score and abdominal Abbreviated Injury Scale were 25 and 3, respectively. The median 4-h packed red blood cell, fresh frozen plasma, and platelet requirements were 2, 1, and 0, respectively. Overall, spleen was the most common angioembolized abdominal organ (57.3%), followed by the liver (28.9%) and kidney (13.8%). The median time to AE was 156 [114-195] min. Only 8% of patients underwent AE within the first 60 min of arrival. A significantly decreasing trend over the study period was observed in time to AE (2013:180 min <em>versus</em> 2021:105 min, <em>P</em> < 0.001). Among the study population, 19.7% experienced NOM failure, with a median [interquartile range] time to surgery of 5 [3-11] h. Over the years, there was a significant reduction in NOM failure rates (2013:26.2% <em>versus</em> 2021:8.7%, <em>P</em> < 0.001), major complications (2013:57.5% <em>versus</em> 2021:25.1%, <em>P</em> < 0.001), 24-h mortality (2013:6.8% <em>versus</em> 2021:1.3%, <em>P</em> = 0.006), and in-hospital mortality (2013:16.4% <em>versus</em> 2021:8.1%, <em>P</em> = 0.015). On multivariable regression analyses, every hour delay in time to AE was associated with higher odds of NOM failure (adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI] [1.02-1.16], <em>P</em> = 0.006), major complications (aOR: 1.12, 95% CI [1.02-1.23], <em>P</em> = 0.019), 24-h mortality (aOR: 1.19, 95% CI [1.09-1.52], <em>P</em> = 0.014), and in-hospital mortality (aOR: 1.17, 95% CI [1.01-1.35], <em>P</em> = 0.041).</di","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 49-58"},"PeriodicalIF":1.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Residents’ Experience With a Perinatal Resident Policy: A Qualitative Study","authors":"Catherine M. Wagner MD, MSc ,&nbsp;Mary E. Byrnes PhD, MUP ,&nbsp;Andrew M. Ibrahim MD, MSc ,&nbsp;Jennifer C. Romano MD, MSc ,&nbsp;Lauren A. Szczygiel PhD","doi":"10.1016/j.jss.2025.06.083","DOIUrl":"10.1016/j.jss.2025.06.083","url":null,"abstract":"<div><h3>Introduction</h3><div>In response to increased risk of poor obstetric outcomes in surgical residents, a perinatal resident policy was introduced in 2019 at a single, high-volume academic institution, providing schedule adjustments during the third trimester and up to 12 wk of parental leave. The objective was to evaluate surgical residents’ experiences and perceptions after implementation of a perinatal resident policy.</div></div><div><h3>Methods</h3><div>This qualitative study and analysis was performed from August 2023 to January 2024. Interpretive description was applied to analyze the data. Surgical residents at a single, high-volume academic institution who were at least in their second postgraduate year were eligible to participate. Participants shared their experience with a perinatal resident policy and how the policy was used in a surgical residency.</div></div><div><h3>Results</h3><div>A total of 19/50 eligible (38% response rate) surgical residents (median age: 31, 13 (68%) females, and 5 (26%) with children) were interviewed. Three main themes included (1) tension between leave allowed for board certification versus institutional policy, (2) tension of allowing flexibility in the zero-sum system of residency, and (3) tension between putting oneself first with surgical professional norms. Despite these challenges, residents were supportive of the policy and felt that surgical culture overall benefitted from such policies.</div></div><div><h3>Conclusions</h3><div>This qualitative study found that despite challenges, surgical residents were in support of pregnancy accommodations and parental leave. Although further efforts to overcome barriers to perinatal support are necessary, more programs could consider ways to implement family friendly policies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 71-78"},"PeriodicalIF":1.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711976","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":"Evaluating Clinical Outcomes Across Sex and Ethnicity in Patients With Early-Stage Non-small Cell Lung Cancer (NSCLC)","authors":"Isheeta Madeka MD ,&nbsp;Annie Ho MS ,&nbsp;Hamza Rshaidat MD ,&nbsp;Sneha Alaparthi MD ,&nbsp;Gregory L. Whitehorn BS ,&nbsp;Anurag Ishwar BS ,&nbsp;Tyler R. Grenda MD ,&nbsp;John Jacob MD ,&nbsp;Nathaniel R. Evans III MD ,&nbsp;Olugbenga T. Okusanya MD","doi":"10.1016/j.jss.2025.06.002","DOIUrl":"10.1016/j.jss.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Although there are well-studied sex and racial/ethnic disparities within lung cancer patients, they do not examine the interface of these inequities. We aim to utilize a national database to evaluate clinical outcomes and disparities within racial/ethnic groups of female patients with early-stage lung cancer.</div></div><div><h3>Methods</h3><div>The 2020 National Cancer Database (NCDB) was queried for patients with clinical stage I non-small cell lung cancer (NSCLC) with known vital status between 2010 and 2019. Patients with carcinoid tumors were excluded. Demographic data, clinicopathologic variables, 30-d, 90-d, 5-y mortality, and 5-y overall survival were analyzed.</div></div><div><h3>Results</h3><div>A total of 344,223 patients met the inclusion criteria, of which 187,588 were female (54.4%). Within ethnic subgroups, 5-y survival was highest among Asian/Pacific Islander women (API) (77.8%) (<em>P</em> &lt; 0.001). API women had the highest rates of surgical resection (75.7%), with higher rates of nodes examined (73.1%) and nodal upstaging (13.4%) (<em>P</em> &lt; 0.001). Black and White women had the lowest rates of 5-y survival (60%, 58.8%) and surgical resection (59.1%, 62.2%) (<em>P</em> &lt; 0.001). API women had the least comorbidities (CCI = 0, 71.1%; <em>P</em> &lt; 0.001) and highest rates of well-differentiated tumors (28.7%, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>API women had the highest survival rates, highest rates of surgical resection with nodal sampling, and low-grade tumors. Black and White women had the lowest rates of overall survival and surgical resection. This disparity in guideline-concordant surgery highlights the importance of acknowledging the racial/ethnic heterogeneity among women with early-stage NSCLC and that female lung cancer patients should not be treated as a monolith.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 59-70"},"PeriodicalIF":1.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711979","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":"Intestinal Volvulus and Geographic Altitude: Nationwide Analysis of Hospitalizations in Peru","authors":"Akram Hernández-Vásquez MD, MSc ,&nbsp;Flavia Rioja-Torres MD ,&nbsp;J. Matías Bardales-Rodríguez MD ,&nbsp;Renato Díaz-Ruiz MD, MSc","doi":"10.1016/j.jss.2025.06.080","DOIUrl":"10.1016/j.jss.2025.06.080","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the geographic distribution of hospitalizations due to intestinal volvulus in Peru during 2023 and to analyze the relationship between geographic altitude and hospitalization rates.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted using the 2023 hospitalizations database from the Superintendencia Nacional de Salud. Cases of intestinal volvulus were identified using the International Classification of Diseases, tenth revision code K56.2. Altitude data, measured in both meters above sea level and feet (ft) using the standard conversion factor (1 m = 3.281 ft). Hospitalization rates were standardized by age using World Health Organization population standards per 100,000 people. Pearson's correlation was used to assess the relationship between altitude and hospitalization rates.</div></div><div><h3>Results</h3><div>A total of 614 hospitalizations due to intestinal volvulus were recorded in 2023, with higher rates observed in men (72.1%) and individuals aged 65 y or older. The highest age-standardized hospitalization rates were reported in Cusco (8.32 per 100,000 people; 95% confidence interval [CI]: 6.88-9.98) and Ayacucho (5.42; 95% CI: 3.91-7.41). Departments located at high altitudes (&gt;3000 meters above sea level or ∼9843 ft) showed the highest rates, with a moderate positive correlation between altitude and age-standardized hospitalization rates (<em>r</em> = 0.65; 95% CI: 0.34-0.83; <em>P</em> &lt; 0.001). The Hospital Antonio Lorena in Cusco reported the highest number of cases (46).</div></div><div><h3>Conclusions</h3><div>Hospitalizations due to intestinal volvulus in Peru are more frequent in high-altitude regions, with a significant positive correlation between altitude and hospitalization rates. These findings suggest that environmental factors associated with high-altitude living may contribute to the occurrence of intestinal volvulus.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 18-25"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702957","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":"Predicting Functional Outcomes in Adult Traumatic Brain Injuries Using the Base Deficit, International Normalized Ratio, and Glasgow Coma Scale Score","authors":"Alexander M. Wong BS,&nbsp;Patrick McGillen MD, MSc,&nbsp;Brynne A. Ichiuji MD,&nbsp;Corey I. Ambrose MD,&nbsp;Steven D. Forman MD,&nbsp;Matthew J. Martin MD","doi":"10.1016/j.jss.2025.06.089","DOIUrl":"10.1016/j.jss.2025.06.089","url":null,"abstract":"<div><h3>Introduction</h3><div>Up to 70% of early deaths in traumatic brain injuries are due to withdrawal of care. However, many of these patients could have made a good recovery. A reliable prognostic indicator would thus be useful for early decision-making. We sought to determine the association between the Base Deficit, International Normalized Ratio, and Glasgow Coma Scale (GCS) (BIG) score and functional outcomes within 1 y postinjury.</div></div><div><h3>Methods</h3><div>A meta-analysis was conducted using the Federal Interagency Traumatic Brain Injury Research Informatics System. Two multicenter prospective studies from 2006 to 2018 were selected. Patients over 17 y old were categorized on if they had a BIG score &gt;8 24 h postadmission and a Glasgow Outcome Scale Extended (GOS-E) &lt;5 1 y postinjury. Univariate and multivariate logistic regressions yielded odds ratios and 95% confidence intervals.</div></div><div><h3>Results</h3><div>In total, 329 patients were identified. One hundred forty-seven patients had a GOS-E &lt;5 while 182 had a GOS-E ≥5. The median BIG score at 24 h was 11.5 for patients with a GOS-E &lt;5 and 6.8 with a GOS-E ≥5 (<em>P</em> &lt; 0.001). A BIG score &gt;8 predicted poor 1-y functional outcomes (OR = 5.29, <em>P</em> &lt; 0.001). The BIG score had a greater sensitivity than GCS (75.5% and 70.7%, respectively) and a comparable negative predictive value (76.2% and 77.1%, respectively).</div></div><div><h3>Conclusions</h3><div>The BIG score is a promising prognostic tool to predict short-term functional outcome in patients with traumatic brain injury. It has a greater ability than GCS to identify patients that may have poor functionality and is comparable discriminating between good and poor functional outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 31-37"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702956","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":"Nodal Metastases in Oncocytic Carcinoma of the Thyroid Are Associated With Decreased Survival","authors":"Maksymillian J. Pilecki MD,&nbsp;Kelly M. Herremans MD, MS,&nbsp;Daniel Neal MS,&nbsp;Michel S. Kabbash MD,&nbsp;Christiana M. Shaw MD,&nbsp;Ibrahim Nassour MD, MSCS,&nbsp;Aditya S. Shirali MD","doi":"10.1016/j.jss.2025.06.072","DOIUrl":"10.1016/j.jss.2025.06.072","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncocytic thyroid carcinoma (OCA) carries a worse prognosis when compared to papillary or follicular thyroid cancer; however, the degree to which OCA is associated with nodal metastases is poorly understood. We sought to determine the predictors of survival in patients with OCA who underwent nodal evaluation.</div></div><div><h3>Methods</h3><div>The National Cancer Database was queried from 2004 to 2020 for patients with OCA who underwent nodal evaluation. Patients who underwent regional lymph node evaluation were included in the analysis. Patient demographics, tumor characteristics, surgical management, and survival were analyzed. Kaplan–Meier and Cox proportional hazards models were used to determine overall survival (OS) rates and estimate the association between nodal disease and survival.</div></div><div><h3>Results</h3><div>There were 12,438 patients with OCA. A total of 3373 patients (27.1%) underwent nodal evaluation, of which 462 (14%) were found to have pathologic nodal metastases. Patients with nodal metastases were more likely to be older, male, Hispanic, treated at an academic facility, have public insurance, have longer median distance to treatment facility and have a larger tumor size, lymphovascular invasion, and positive margins (<em>P</em> &lt; 0.01). Of the patients who underwent surgery, those with nodal metastases had shorter 1-y, 3-y, and 5-y OS. Nodal metastasis is independently associated with worse OS (hazard ratio: 2.7 [95% confidence interval: 2.12, 3.39], <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Nodal metastases were found in 14% of patients with OCA who underwent nodal evaluation and were associated with compromised survival. Identifying patients with increased risk of nodal metastases in patients with a high index of suspicion for OCA will help with surgical decision-making.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 38-48"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711975","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":"Improvement in Burn Care and Outcomes: A Developing World Perspective","authors":"Ayodele O. Iyun FWACS ,&nbsp;Samuel A. Ademola FWACS ,&nbsp;Olayinka A. Olawoye FWACS ,&nbsp;Chinsunum P. Isamah FWACS ,&nbsp;Afieharo I. Michael FWACS ,&nbsp;Rotimi O. Aderibigbe FWACS ,&nbsp;Odunayo M. Oluwatosin FWACS","doi":"10.1016/j.jss.2025.07.002","DOIUrl":"10.1016/j.jss.2025.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Burn care in developing countries faces significant challenges, including a high incidence of major burns and limited treatment infrastructure.</div></div><div><h3>Methods</h3><div>This study is an institutional review of publications on burn injuries between 2001 and 2022, with a focus on organizational changes that may have contributed to improved patient outcomes. The study period was divided into two intervals: 2001-2013 and 2013-2022, with the latter corresponding to the implementation of most institutional reforms. Publications from both periods were reviewed to assess changes in outcomes. The primary outcome measures included overall mortality rate, incidence of inhalation injury, mortality related to inhalation injury and pediatric mortality rate. Publications that did not report any of these outcomes were excluded. Significant organizational changes within the burn unit during the study periods were also documented.</div></div><div><h3>Results</h3><div>Pediatric patients accounted for 45% of the study population. Inhalation injury was observed in 37% and 32% of patients admitted between 2001-2013 and 2013-2022, respectively. The mortality rates among patients with inhalation injuries were 71% and 38% during the periods 2001-2013 and 2013-2022, respectively.</div><div>The pediatric mortality rate declined significantly from 39.5% (114 deaths out of 289 patients) between 2001 and 2013 to 10.2% (27 out of 265 patients) between 2013 and 2022. The Lethal Area 50 in the earlier period was 45%, increasing to 75.6% between 2013 and 2022. The overall mortality rate declined from 42% during 2001-2013 to 19% over the subsequent decade. Organizational strategies associated with these improvements included the establishment of a dedicated burn unit, training of specialized burn nurses, assigning of dedicated burn surgeon, consultant-led daily ward rounds, formation of a multidisciplinary burn team, implementation of standardized care protocols, routine burn audits and patient-centered case reviews.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate a progressive improvement in burn injury outcomes and suggest potential for further advancement.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 26-30"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711978","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":"Objective Performance Indicators Differ Between Expert Versus Novice Surgeons During Robotic Proctectomy","authors":"Mishal Gillani MD ,&nbsp;Usama Waqar MD ,&nbsp;Manali Rupji MS ,&nbsp;Lilia A. Purvis MS ,&nbsp;Mallory C. Shields PhD ,&nbsp;Terrah J. Paul Olson MD ,&nbsp;Glen C. Balch MD ,&nbsp;Yuan Liu PhD ,&nbsp;Seth A. Rosen MD","doi":"10.1016/j.jss.2025.06.088","DOIUrl":"10.1016/j.jss.2025.06.088","url":null,"abstract":"<div><h3>Introduction</h3><div>Objective performance indicators (OPIs), machine learning-enabled metrics calculated from robotic systems data, have potential to offer objective insights into surgical skill. There are limited studies investigating OPIs in colorectal surgery. In this study, we aim to identify OPIs that differ expert and novice surgeons during robotic proctectomy (RP).</div></div><div><h3>Methods</h3><div>Endoscopic videos synchronized to robotic system data were annotated to delineate individual surgical tasks during 30 RPs. We analyzed 541 critical steps: inferior mesenteric artery dissection (78), sigmoid mobilization (167), posterior rectal mobilization (88), and mesorectal dissection (208). OPIs from each step were compared across two expert (&gt;500 robotic procedures) and eleven novice surgeons (&lt;50 procedures).</div></div><div><h3>Results</h3><div>OPIs analyses revealed significant differences between expert and novice surgeons. Across all steps, experts exhibited greater velocity and acceleration for camera, dominant and nondominant arms. During mesenteric artery dissection, experts utilized fewer arm swaps and longer energy activation time. During sigmoid mobilization, experts used fewer arm swaps, shorter camera moving time, fewer camera movements, and less dominant wrist pitch. During rectal mobilization and mesorectal dissection, experts exhibited greater dominant wrist articulation (roll, pitch, and yaw), and longer path length for camera, dominant and nondominant arms. These results identify specific OPIs that designate surgeon expertise during RP.</div></div><div><h3>Conclusions</h3><div>Step-specific OPIs significantly differ between expert and novice surgeons during RP. With further validation, these metrics may serve as objective tools for benchmarking performance, guiding surgical training curricula, and informing credentialing processes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 537-548"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703849","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":"Clinical Efficacy of the Indigo Thrombectomy Catheter in Acute Superior Mesenteric Artery Embolism: A Single-center Retrospective Analysis","authors":"Da Li MD,&nbsp;Xiaosong Zhang MS,&nbsp;Yusheng Wang MS,&nbsp;Hao Tang MS,&nbsp;He Huang MS,&nbsp;Xiaomin Huang BS,&nbsp;Honggang Zhang MD","doi":"10.1016/j.jss.2025.06.074","DOIUrl":"10.1016/j.jss.2025.06.074","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to evaluate the clinical efficacy and safety of the Indigo thrombectomy catheter in the treatment of acute superior mesenteric artery embolism (SMAE).</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective analysis of 15 patients who underwent endovascular thrombectomy using the Indigo Catheter between May 2023 and October 2024. The procedure was performed within 4 h of presentation. Patient baseline characteristics, procedural outcomes, and follow-up data were systematically collected and analyzed.</div></div><div><h3>Results</h3><div>Technical success, defined as complete thrombus removal, was achieved in all 15 patients (100%). The mean procedure duration was 48 min, and the average hospital stay was 8 d. Three patients exhibited preoperative signs of peritonitis and subsequently underwent laparoscopic exploration immediately after thrombectomy, with two requiring bowel resection due to intestinal necrosis. Additionally, one patient, who initially showed no signs of peritonitis, developed the condition on postoperative day 2 and later required bowel resection. All patients who underwent bowel resection survived. However, one patient succumbed during hospitalization due to severe postoperative embolic complications affecting the lower limb and renal artery, despite intensive management. The median follow-up duration for discharged patients was 6 mo (as of January 2025), with no reported recurrence of SMAE or mortality.</div></div><div><h3>Conclusions</h3><div>The Indigo thrombectomy catheter demonstrated high technical success rates and favorable clinical outcomes in the treatment of acute superior mesenteric artery embolism (SMAE). Endovascular thrombectomy may serve as a potential first-line intervention for carefully selected SMAE patients without severe peritonitis. Future multicenter studies with larger cohorts are warranted to further validate the safety and efficacy of this percutaneous strategy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 1-7"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702959","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":"Perspectives on Commission on Cancer Standard 5.8 on Lung Cancer: A Qualitative Study","authors":"Alison S. Baskin MD ,&nbsp;Michael P. Stover MD ,&nbsp;Manvir Bains BS ,&nbsp;Kelsey B. Montgomery MD, MSPH ,&nbsp;Wendelyn M. Oslock MD, MBA ,&nbsp;Kristy K. Broman MD, MPH ,&nbsp;Lesly A. Dossett MD, MPH","doi":"10.1016/j.jss.2025.07.001","DOIUrl":"10.1016/j.jss.2025.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2021, the Commission on Cancer implemented Standard 5.8, which requires that lymph nodes be sampled from ≥1 hilar and ≥3 different mediastinal lymph node stations for all curative-intent lung cancer resections. While 80% compliance is expected of all Commission on Cancer–accredited hospitals, recent data illustrates only half of sites are currently meeting criteria. We evaluated perceived barriers and facilitators in implementing Standard 5.8.</div></div><div><h3>Methods</h3><div>In this multicenter qualitative study, 20 semistructured interviews were conducted across academic and community-based institutions. We interviewed key stakeholders, including thoracic surgeons, pathologists, operating room staff, a cancer liaison physician, and clinical data analysts. Thematic analysis was facilitated by the tailored implementation for chronic disease checklist.</div></div><div><h3>Results</h3><div>Themes were mapped to six tailored implementation for chronic disease domains. Most participants felt the guideline was not burdensome and did not alter their clinical practices. Although many agreed that a minimum threshold for lymph node evaluation should exist, some participants were uncertain of the supporting evidence and identified potential technical and clinical barriers to implementation. Interdisciplinary collaboration was a key facilitator to compliance, as well as alignment with professional society guidelines. Higher compliance rates were thought to be driven by increased monitoring and performance feedback, in addition to departmental leadership and support.</div></div><div><h3>Conclusions</h3><div>Mixed opinions regarding Standard 5.8 align with currently low national compliance rates. Participants emphasized the need for additional evidence to support the standard, underscoring the importance of future prospective studies. Support for strong interdisciplinary communication, regularly scheduled feedback, endorsement by cardiothoracic societies and departmental leadership may improve compliance.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 8-17"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702958","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}