Journal of Surgical Research最新文献

{"title":"Is Definitive Closure Always Needed After Open-Window Thoracotomy for Post-Lung Resection Empyema?","authors":"Toshiyuki Nagata, Go Kamimura, Takuya Tokunaga, Shouichiro Morizono, Yuto Nonaka, Aya Takeda, Koki Maeda, Masaya Aoki, Kazuhiro Ueda","doi":"10.1016/j.jss.2026.07.055","DOIUrl":"10.1016/j.jss.2026.07.055","url":null,"abstract":"<p><strong>Introduction: </strong>Open-window thoracostomy is a recognized treatment for postresection empyema, especially when complicated by bronchopleural fistula (BPF). However, the necessity of definitive closure surgery remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 24 patients who developed empyema after anatomical lung resection and underwent open-window thoracostomy at our institution between April 2010 and March 2024. We evaluated factors associated with spontaneous closure of BPF and the empyema cavity, as well as the clinical indications for definitive surgical closure.</p><p><strong>Results: </strong>BPF was present in 17 of the 24 patients (71%). Among them, 10 experienced spontaneous fistula closure, while two required surgical closure. Smaller fistula size (<5 mm) was significantly associated with spontaneous closure, whereas the absence of contralateral aspiration pneumonia showed a trend toward spontaneous closure but did not reach statistical significance. Definitive closure of the empyema cavity was performed in 11 patients and was more common in those with higher body mass index and a better general condition. Of the 13 patients who did not undergo definitive closure, the cavity closed spontaneously in five. Notably, negative-pressure wound therapy was significantly associated with spontaneous cavity closure (80% versus 12.5%, P = 0.032). Patients who had undergone pneumonectomy failed to achieve cavity closure within 2 y, whereas 87.5% of those who had undergone lesser resections did.</p><p><strong>Conclusions: </strong>Spontaneous closure of BPF and the empyema cavity is possible, particularly in patients with small fistulas and no history of pneumonectomy. Negative-pressure wound therapy appears beneficial in promoting spontaneous healing, supporting a tailored, patient-specific approach to managing postresection empyema.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"326 ","pages":"1059-1067"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880887","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":"Temporal Declines in Accuracy of the Donor Risk Index for Liver Transplantation.","authors":"Wei San Loh, Courtney M Rentas, Seth A Waits, Michael J Englesbe, Kyle H Sheetz","doi":"10.1016/j.jss.2026.08.010","DOIUrl":"10.1016/j.jss.2026.08.010","url":null,"abstract":"<p><strong>Introduction: </strong>The Liver Donor Risk Index (LDRI) has long served as the principal tool for quantifying donor risk in liver transplantation, integrating donor and graft characteristics to estimate graft failure. However, shifts in donor demographics and the widespread adoption of machine perfusion technologies may have reduced its relevance to contemporary practice. We therefore evaluated the contemporary predictive performance of the LDRI for 90-d graft survival.</p><p><strong>Methods: </strong>Using the UNOS registry, we examined 49,220 liver transplant recipients across three time periods, replicating the methodology from the original LDRI study to assess whether donor characteristics from the modern transplant era (2018-2024) retained predictive value for 90-d graft survival.</p><p><strong>Results: </strong>In modern transplant eras, graft survival differences across LDRI categories were minimal, and multiple modeling strategies using over 250 donor features failed to identify strong predictors of 90-d graft failure, with uniformly limited accuracy and generalizability (AUC = 0.58).</p><p><strong>Conclusions: </strong>Our findings demonstrate that 90-d graft failure is influenced less by donor attributes alone and more by the dynamic interplay between donor, recipient, and procedural factors. This study further calls into question the ongoing relevance of donor-based risk models in contemporary liver transplantation.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"326 ","pages":"1068-1074"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887762","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":"Corrigendum to 'Oncogenic Role of EEPD1 via Protein Kinase B Phosphorylation in Colorectal Cancer'.","authors":"Ruiya Ma, Tadanobu Shimura, Chengzeng Yin, Yaxuan Huang, Takahito Kitajima, Shinji Yamashita, Koki Higashi, Yuki Sato, Mikio Kawamura, Yuhki Koike, Yoshiki Okita, Masaki Ohi, Xueming Zhang, Yoshinaga Okugawa, Yuji Toiyama","doi":"10.1016/j.jss.2026.06.062","DOIUrl":"10.1016/j.jss.2026.06.062","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"1163"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549514","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":"Association for Academic Surgery Presidential Address: Interwoven Missions Empowering All Academic Surgeons.","authors":"Brenessa Lindeman","doi":"10.1016/j.jss.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.jss.2026.09.001","url":null,"abstract":"<p><p>This 2026 Presidential Address for the Association for Academic Surgery was delivered on February 4, 2026. It addresses the topic of understanding the value that academic surgeons create across the missions of clinical care, research, and education, as well as how the clinical mission has become outsized in many academic medical centers. The analogy of braided suture is used to demonstrate the essential and interconnected nature of the three academic missions, and the address concludes through exploration of models to better measure academic contributions apart from clinical care.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061300","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":"Risk Factors for Early Intestinal Resection in Pediatric Crohn's Disease: A Nationwide Cohort Study.","authors":"Dorina Bajzát, Marcell Imrei, Rita Nagy, Andrea Párniczky, Noémi Gede, Péter Hegyi, Anna Karoliny, Judit Szentannay, Judit Czelecz, Áron Cseh, Nóra Judit Béres, Melinda M Tóth, Márta Kovács, Ildikó Guthy, Natália Lásztity, Orsolya Kadenczki, Erzsébet Szakos, Dániel Szűcs, Noémi Vass, András Tárnok, Katalin Eszter Müller","doi":"10.1016/j.jss.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.jss.2026.09.015","url":null,"abstract":"<p><strong>Introduction: </strong>Complicated disease affects a substantial proportion of pediatric Crohn's disease (CD) patients and leads to surgery. A subset of children requires intestinal resection shortly after diagnosis. Several risk factors for surgery are known; however, the predictors of these early resections have not been well defined. We aimed to characterize this patient group and identify risk factors associated with early intestinal resections.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients under 18 y diagnosed with CD between 2010 and 2019, based on the Hungarian Pediatric inflammatory bowel disease Registry. We compared those patients who underwent intestinal resection within 6 mo after diagnosis (very early surgery group, VES) with those who did not require resection within 6 mo. Descriptive statistics and logistic regressions were used for the analysis.</p><p><strong>Results: </strong>Out of 1040 newly diagnosed pediatric CD patients, 27 (2.6%) underwent intestinal resection within 6 mo of diagnosis. The mean age of the two groups did not significantly differ. The proportion of females was significantly higher in the VES group (63.0% versus 42.3%, P = 0.03). Multivariate analysis identified abdominal pain without diarrhea (odds ratio [OR]: 5.59; P = 0.02) and higher pediatric CD activity index (OR: 1.05; P = 0.02) as risk factors for VES. Diagnostic delay (OR: 0.99; P = 0.74) and perianal involvement (OR 2.84; P = 0.12) were not predictive for VES.</p><p><strong>Conclusions: </strong>VES is rare in pediatric CD, with a possible female predominance. Higher pediatric CD activity index at diagnosis indicates greater risk for early surgery.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"328 ","pages":"143-149"},"PeriodicalIF":1.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228130","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 Association Between Insurance Type and Financial Toxicity in Older Adult Surgical Patients.","authors":"Ezra S Brooks, Claire Morton, Randall Bloch, Louis L Nguyen","doi":"10.1016/j.jss.2026.06.049","DOIUrl":"10.1016/j.jss.2026.06.049","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical patients often face significant financial strain, termed financial toxicity (FT). Among US adults aged ≥65 years, insurance options include public (Medicare), subsidized private (Medicare Advantage [MA]), and private insurance. We examined FT by insurance coverage in this population.</p><p><strong>Methods: </strong>We analyzed adults ≥65 years with Medicare, MA, or private insurance who underwent inpatient surgery in the Medical Expenditure Panel Survey (2017-2022). FT was defined as difficulty paying medical bills, delaying or skipping medications, or postponing care due to cost. Secondary outcomes included annual out-of-pocket (OOP) costs and total health-care expenditure (THE; OOP plus premiums). Logistic and linear regression models estimated adjusted odds of FT, OOP costs, and THE by insurance type.</p><p><strong>Results: </strong>Among 4089 patients (weighted n = 6.7 million), 21.9% reported FT: 24.6% Medicare, 23.2% MA, and 19.2% private (P = 0.047). The mean OOP costs were $2395 ($2451 Medicare, $2291 MA, and $2452 private; P = 0.72). THE averaged $9243 ($6071 Medicare, $7824 MA, $9975 private; P < 0.001). Compared with Medicare, adjusted odds of FT were similar for MA (odds ratio 1.07, 95% confidence interval [CI] 0.79-1.42) and private insurance (odds ratio 0.89, 95% CI 0.64-1.23). THE was higher for MA (+$1,823, 95% CI $114-$3533) and private insurance (+$3,842, 95% CI $2170-$5513).</p><p><strong>Conclusions: </strong>Despite subsidized insurance, FT remains prevalent among older adult surgical patients. Private and MA plans incur higher total costs than Medicare plans without lowering FT risk. As MA enrollment rises, we must work to understand the driving factors behind patient insurance plan selection and work to optimize it.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471097","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":"Nodal Pathologic Response to Neoadjuvant Systemic Therapy in Clinical N2 and N3 Nonmetastatic Breast Cancer.","authors":"Diana M Jaen, Collin E Dougherty, Kimberly A Helseth, Paige A Harwell, Juan A Santamaria-Barria, Janelle-Cheri Millen","doi":"10.1016/j.jss.2026.05.083","DOIUrl":"https://doi.org/10.1016/j.jss.2026.05.083","url":null,"abstract":"<p><strong>Introduction: </strong>Axillary lymph node dissection is recommended for patients with clinical nodal stage 2-3 (cN2/cN3) breast cancer following neoadjuvant systemic therapy (NST), although some achieve nodal pathologic complete response (ypN0) and may be candidates for surgical de-escalation. Nodal response in this population is not well defined. We aimed to determine the frequency of ypN0 and identify clinicopathologic factors associated with nodal response.</p><p><strong>Methods: </strong>A retrospective cohort study of our institutional cancer registry (2018-2024) included women with clinical T1-T4, N2-N3, and no distant metastasis breast cancer who received NST followed by axillary lymph node dissection. We determined the proportion of patients who achieved ypN0 and compared demographic, clinical, and tumor characteristics between ypN0 and ypN + groups.</p><p><strong>Results: </strong>From 8948 patients with breast cancer, 133 had cN2-cN3 disease and 37 met the inclusion criteria. A total of 15 patients (40.5%) achieved ypN0 after NST, whereas 22 (59.5%) had residual nodal disease. Human epidermal growth factor receptor 2-positive tumors had the highest rate of ypN0 (P = 0.026). Breast pathologic complete response (ypT0) was strongly associated with nodal response: 66.7% of ypN0 patients achieved ypT0 compared with 4.5% of ypN + patients (P < 0.001). Other demographic and clinical features were similar between groups.</p><p><strong>Conclusions: </strong>Over 40% of patients with cN2/cN3 disease achieved ypN0 after NST. Residual nodal disease was more common in human epidermal growth factor receptor 2 -negative tumors and in patients without ypT0, and younger age showed a trend toward improved nodal response. These factors may help guide individualized consideration of axillary surgical de-escalation in selected patients.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422007","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":"Response Regarding: Prehospital Experience for Left Ventricular Assist Devices","authors":"Emily L. Larson MD,&nbsp;Ahmet Kilic MD","doi":"10.1016/j.jss.2026.02.025","DOIUrl":"10.1016/j.jss.2026.02.025","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"321 ","pages":"Page 688"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521127","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":"Cryoanalgesia in Patients Undergoing Surgical Stabilization of Rib Fractures: A Comparative Study","authors":"Alejandro Carmona MD ,&nbsp;Matias Nicolas MD ,&nbsp;Gerardo Tusman MD ,&nbsp;Luzia Toselli MD ,&nbsp;Alejandro García-Pérez MD ,&nbsp;Gastón Bellia-Munzon MD","doi":"10.1016/j.jss.2025.11.061","DOIUrl":"10.1016/j.jss.2025.11.061","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective pain management is crucial to reduce complications and enhance recovery in patients with multiple rib fractures. Although intercostal cryoanalgesia is emerging as a promising strategy to optimize conventional multimodal analgesia in these patients, the literature remains sparse. Since 2019, we have been using cryoanalgesia in surgical stabilization of rib fractures (SSRF), and we hypothesize that it is associated with lower opioid requirements. Thus, we decided to perform a comparative study between patients undergoing SSRF with and without cryoanalgesia.</div></div><div><h3>Methods</h3><div>This retrospective study comprised patients with multiple traumatic rib fractures, who underwent SSRF with multimodal analgesia without cryo (group A) compared with a cohort of similar patients managed with multimodal analgesia with cryo (group B). Multimodal analgesia comprised epidural analgesia, opioids, and nonsteroidal anti-inflammatory drugs. Demographics, severity of pain using the visual analog scale, and median requirement of morphine equivalent dose (MED) were analyzed in both groups. Factors associated with postoperative opioid use were evaluated using descriptive and multivariable analyses.</div></div><div><h3>Results</h3><div>Thirty-six patients were studied, 9 in group A and 27 in group B. Both groups were similar in age, number of rib fracture fixations required, preoperative requirement of opioids, and length of stay. Regarding postoperative opioid consumption, group A required more than twice MED than group B [37.2 mg (interquartile range [IQR] 28.7-47) <em>versus</em> 14.7 mg (IQR 8.25-19.1); <em>P</em> &lt; 0.001]. This difference increased in the outpatient setting [group A: 18.8 mg (IQR 15-27) <em>versus</em> group B: 0.0 mg (IQR 0-3.45); <em>P</em> &lt; 0.001]. The comparison between visual analog scale at discharge also showed significant differences at 7, 14, and 30 d (<em>P</em> &lt; 0.0001) in both groups. In multivariable analysis, only preoperative MED and cryoanalgesia was independently associated with postoperative opioid requirements (R² = 0.58), with cryoanalgesia associated with a mean reduction of 19.9 MED units (95% confidence interval, −28.0 to −11.0).</div></div><div><h3>Conclusions</h3><div>Percutaneous intercostal cryoanalgesia was associated with reduced postoperative and outpatient opioid use and improved pain control in patients undergoing surgical stabilization of rib fractures, supporting its potential role as an adjunct to multimodal analgesia.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"321 ","pages":"Pages 679-685"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774852","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":"On The Cover","authors":"","doi":"10.1016/S0022-4804(26)00260-X","DOIUrl":"10.1016/S0022-4804(26)00260-X","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"321 ","pages":"Page x"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147858175","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}