Journal of Surgical Research最新文献

{"title":"The Association of Blood Transfusion With Free Flap Survival and Thrombosis: A Review and Meta-Analysis","authors":"Karolina Anuszkiewicz MD ,&nbsp;Artur Furga MD ,&nbsp;Piotr Stogowski MD, PhD ,&nbsp;Magdalena Graczyk MD ,&nbsp;Jerzy Jankau MD, PhD","doi":"10.1016/j.jss.2025.12.012","DOIUrl":"10.1016/j.jss.2025.12.012","url":null,"abstract":"<div><h3>Introduction</h3><div>As risk factors of free flap loss related to the patient are unmodifiable, proper perioperative protocol is crucial. Perioperative blood transfusion (PBT) may be associated with an increased risk of medical complications, prolonged length of stay, and an increased risk of surgical site infection. The question of this study is whether PBT in free flap reconstructions may be associated with flap failure and anastomosis thrombosis.</div></div><div><h3>Methods</h3><div>Preferred Reporting Items Systematic Review and Meta-Analysis protocol was used, and the literature search was performed on Pubmed, Embase, and Scopus. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. Meta-analysis was performed.</div></div><div><h3>Results</h3><div>Fifteen articles were enrolled in the study, representing 7871 patients. Statistically significant risk ratios (RRs) were observed, indicating PBT was associated with an increased risk of both anastomosis thrombosis (RR 1.71, 95% confidence interval [CI] 1.12-2.59) and flap failure (RR 2.02, 95% CI 1.25-3.26). Further analysis led to the division of three subgroups due to the operation site. For breast reconstruction, the RR was 7.96 (95% CI 4.00-15.81) for flap failure and 2.94 (95% CI 1.88-4.61) for anastomosis thrombosis. For head and neck reconstruction, the RR were 1.22 (95% CI 0.86-1.73) and 1.02 (95% CI 0.59-1.75), respectively. In the mixed group, RR was 2.23 (95% CI 1.06-4.58) for flap failure and 1.23 (95% CI 0.59-2.56) for anastomosis thrombosis.</div></div><div><h3>Conclusions</h3><div>Although overall PBT is associated with a higher incidence of flap necrosis and anastomosis thrombosis, this association is statistically significant only in breast reconstruction. Further prospective studies focusing on specific flap surgery types are warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 14-24"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911837","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":"In-Person and Virtual Interview Format for General Surgery Residency From an Applicant Perspective","authors":"Maya Hammoud MD,&nbsp;Adam Ayoub BS,&nbsp;Robert Sawyer MD,&nbsp;Saad Shebrain MD","doi":"10.1016/j.jss.2025.12.034","DOIUrl":"10.1016/j.jss.2025.12.034","url":null,"abstract":"<div><h3>Introduction</h3><div>While residency interviews have historically been in person, the majority of residency interviews transitioned to virtual interviews (VTIs) due to the COVID-19 pandemic. Since that time, in-person interviews (IPIs) have slowly been reintroduced. This study assesses applicant perceptions of VTI <em>versus</em> IPI formats.</div></div><div><h3>Methods</h3><div>Applicants to a single general surgery residency program were surveyed regarding factors that were important for ranking the programs, experience with IPI and VTI platforms, experience at our institution, and decision-making in choosing the program for interview and ranking. Primary outcomes evaluated were the differences between IPI and VTI from an applicant perspective.</div></div><div><h3>Results</h3><div>Of the 229 applicants interviewed at our institution and ranked for 18 y-1 positions in the 2022-23, 2023-24, and 2024-2025 match cycles, 61 applicants (27%) responded with complete data to our survey (23 IPI, 30 VTI). Applicants in both groups (IPI <em>versus</em> VTI) reported fellowship prospects after graduation and geographic location to be important or extremely important in ranking programs (87.1%. <em>versus</em> 80.0%, <em>P</em> = 0.347). Applicants reported similar overall experiences at our institution. Candidates were more satisfied with in-person preinterview meeting with residents (93.5% IPI <em>versus</em> 63.3% VTI, <em>P</em> = 0.0043) and in-person hospital tours (80.6% IPI <em>versus</em> 53.3% VTI, <em>P</em> = 0.0244). More than half of applicants who interviewed virtually agreed or strongly agreed that financial considerations impacted their format selection, compared to one-third in the IPI (<em>P</em> = 0.221). Finally, more virtual interviewees agreed/strongly agreed that they would not have interviewed if not offered that format compared to IPI (30% VTI, 9% IPI, <em>P</em> = 0.11).</div></div><div><h3>Conclusions</h3><div>Overall, from the applicant perspective, there are few statistically significant differences between IPI and VTI. IPI is associated with better experiences at preinterview social events and during the hospital tours, but there was no difference in applicants’ abilities to rank the program based on interview format. Both IPI and VTI should continue to be offered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 359-365"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046770","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":"Journal of Surgical Research","authors":"","doi":"10.1016/S0022-4804(26)00039-9","DOIUrl":"10.1016/S0022-4804(26)00039-9","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Page iii"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188647","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":"Reimaging High-grade Blunt Hepatic Injuries: Revisiting the Role of Routine Surveillance in Modern Nonoperative Management","authors":"Caitlyn Braschi MD ,&nbsp;Paul Brosnihan MD ,&nbsp;Lara Senekjian MD ,&nbsp;Philip Brennan MD ,&nbsp;Janelle Cyprich MD ,&nbsp;Jessica A. Keeley MD","doi":"10.1016/j.jss.2025.12.016","DOIUrl":"10.1016/j.jss.2025.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic liver injuries are associated with significant morbidity and mortality. The value of routine postinjury imaging surveillance is uncertain, as is whether this value increases with higher grade injuries.</div></div><div><h3>Methods</h3><div>A multicenter retrospective review was performed at two level I trauma centers from 2015 to 2020. Adults with American Association for the Surgery of Trauma grades II-V liver lacerations following blunt trauma were included. Reimaging patterns, need for reintervention, and 30-d outcomes of grades II/III injuries (“lower grade liver injuries,” LGLI) were compared to grades IV/V (“higher grade liver injuries,” HGLI).</div></div><div><h3>Results</h3><div>A total of 229 patients were included, 69.9% with LGLI and 30.1% with HGLI. Overall mortality was 15.3%. HGLI were more likely to be reimaged (69.2% <em>versus</em> 32.7%, <em>P</em> &lt; 0.001). Comparing lower grade to higher grade injuries, there was no difference in time to reimaging (4 <em>versus</em> 4 d, <em>P</em> = 0.523). Patients with HGLI had more liver-specific complications (23.1% <em>versus</em> 2.0%, <em>P</em> &lt; 0.001) and required more reinterventions (19.2% <em>versus</em> 2.6%, <em>P</em> &lt; 0.001). Length of stay was longer (median 6 (interquartile range 4-13) <em>versus</em> median 10 (interquartile range 5-21), <em>P</em> = 0.044), and 30-d mortality was higher (27.5% <em>versus</em> 10.0%, <em>P</em> &lt; 0.001) for HGLI. In multivariate analysis controlling for extrahepatic injuries, HGLI (odds ratio 3.10, 95% confidence interval 1.38-6.94, <em>P</em> = 0.006) and initial operative or Interventional Radiology management (odds ratio, 4.66; 95% confidence interval, 2.18-9.99, <em>P</em> &lt; 0.001) were independently associated with reimaging.</div></div><div><h3>Conclusions</h3><div>A majority of patients with higher grade liver injuries undergo repeat imaging in the first several days postinjury and 19% require reintervention. Given the high rate of reintervention, routine imaging surveillance should be considered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 318-322"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035045","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":"Survival and Risk Factors in Interpersonal Injuries: A Secondary Ecosocial Study","authors":"Juan Sanjuan MD ,&nbsp;Alberto Federico García MD, MSc ,&nbsp;María Isabel Gutiérrez-Martínez MD, MSc, PhD ,&nbsp;Gustavo Adolfo Villegas-Gomez MD","doi":"10.1016/j.jss.2025.12.014","DOIUrl":"10.1016/j.jss.2025.12.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Interpersonal injuries are a major public health concern disproportionately affecting young men. This study evaluated survival and risk factors in patients with interpersonal injuries, by applying Krieger's ecosocial model to integrate biological and structural determinants.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted using data from an observational cohort of trauma patients at four referral centers in Cali, Colombia. Patients with interpersonal injuries were classified by mechanism. Macro-level factors (sociodemographics, insurance, and institutional complexity) and microlevel factors (physiology and anatomical severity) were analyzed with Cox regression.</div></div><div><h3>Results</h3><div>Of 856 trauma patients, 539 (61.5%) sustained interpersonal injuries. Crude mortality was 12.8%, with half of the deaths within 72 h. In multivariate models, undetectable systolic blood pressure (hazard ratio [HR], 106.3; 95% confidence interval [CI], 2.97–3799.9; <em>P</em> = 0.011) and Glasgow Coma Scale score of 3 (HR, 29.7, 95% CI, 8.1–108.6; <em>P</em> &lt; 0.001) were strongly linked to mortality. Severe traumatic brain injury (Abbreviated Injury Scale (AIS) 5; HR, 7.6; 95% CI, 1.4–39.8; <em>P</em> = 0.017) and abdominal trauma (AIS 5; HR, 11.5, 95% CI, 2.1–64.3; <em>P</em> = 0.005) increased risk, while thoracic trauma (AIS 3; HR, 0.25; 95% CI, 0.07–0.91; <em>P</em> = 0.035) was protective. Treatment at high-complexity hospitals reduced mortality (HR, 0.09; 95% CI, 0.02–0.46; <em>P</em> = 0.004). Patients with no or subsidized insurance had lower mortality than those in the contributory regime, suggesting structural determinants shape survival.</div></div><div><h3>Conclusions</h3><div>Trauma survival depends on both physiological severity and structural factors. Strengthening trauma systems and reducing inequities are essential, with the ecosocial framework offering a valuable lens for trauma epidemiology and policy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 75-88"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927869","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":"Effects of Local and Systematic Administration of Adipose Tissue–Derived Stem Cells to Intestinal Anastomosis in Intestinal Ishemic Rerfusion Injury: Ani̇mal Experi̇ment Model","authors":"İbrahim Doğan MD ,&nbsp;Bahar Kartal PhD ,&nbsp;Bülent Cavit Yüksel MD ,&nbsp;Umut Fırat Turan MD ,&nbsp;Metin Bozkaya MD ,&nbsp;Gökçe Yağmur Summak ,&nbsp;Ömür Besbinar PhD ,&nbsp;Açelya Yilmazer PhD ,&nbsp;Sadettin Er MD","doi":"10.1016/j.jss.2025.12.023","DOIUrl":"10.1016/j.jss.2025.12.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Intestinal ischemia-reperfusion (IR) injury compromises anastomotic healing and may weaken anastomotic integrity. Adipose tissue–derived stem cells (AD-SCs) have been shown to enhance tissue regeneration through angiogenic and anti-ischemic effects. This study aimed to evaluate the impact of local and systemic AD-SC administration on anastomotic healing and strength following intestinal IR injury using histopathological parameters and bursting pressure measurements.</div></div><div><h3>Methods</h3><div>Thirty male Wistar Albino rats were randomly assigned to three groups (<em>n</em> = 10 each): control, local AD-SC, and systemic AD-SC. IR injury was induced by clamping the superior mesenteric artery, followed by intestinal resection and anastomosis. Local or systemic AD-SCs (1 × 10⁶ cells in 1.5 mL phosphate-buffered saline) were administered according to group allocation. On postoperative day 7, serum hydroxyproline levels, bursting pressures, and semiquantitative histological scores (ischemic necrosis, vascular proliferation, re-epithelialization, and collagen density) were assessed. Ordinal histological outcomes were analyzed using Kruskal–Wallis tests with Dunn's post hoc comparisons.</div></div><div><h3>Results</h3><div>Six animals died before the end point, leaving 24 rats for analysis. Bursting pressures and serum hydroxyproline levels did not differ significantly among groups. However, systemic AD-SC administration significantly improved all histological parameters compared with the control group, exhibiting lower ischemic necrosis and higher vascular proliferation, re-epithelialization, and collagen density (<em>P</em> &lt; 0.05 for each). Local AD-SCs produced intermediate improvements but did not differ significantly from controls in some parameters. Effect sizes indicated moderate to very large differences favoring systemic administration.</div></div><div><h3>Conclusions</h3><div>Systemic AD-SC administration enhanced multiple histological markers of anastomotic healing following intestinal IR injury, whereas local administration produced more modest effects. Although bursting pressures and serum hydroxyproline levels did not significantly differ, the histopathological findings suggest that systemic AD-SCs may provide a broader therapeutic benefit in promoting anastomotic integrity in ischemic bowel conditions. Further experimental studies incorporating direct leak outcomes are warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 290-299"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030165","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":"Operative Management of Meconium Ileus With Needle Injection of N-Acetylcysteine","authors":"Utsav M. Patwardhan MD ,&nbsp;Chakshu Soni MPH ,&nbsp;Sindhu Mannava MD MS ,&nbsp;Insiyah Campwala MD ,&nbsp;Alexandra Vacaru BS ,&nbsp;James Cope BMed ,&nbsp;S.V. Soundappan MD ,&nbsp;Donald Moores MD ,&nbsp;Andrei Radulescu MD ,&nbsp;Barrett P. Cromeens DO, PhD ,&nbsp;Paul Waltz MD ,&nbsp;Gerald Gollin MD","doi":"10.1016/j.jss.2025.12.001","DOIUrl":"10.1016/j.jss.2025.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The operative management of meconium ileus in infants often includes enterotomy or appendectomy with N-acetylcysteine (NAC) instillation. Some have adopted an approach whereby NAC is instead injected directly into the meconium-bearing ileum at multiple sites with a small-gauge needle. We hypothesized that this technique would facilitate the mobilization of meconium without an enterotomy or even appendectomy.</div></div><div><h3>Methods</h3><div>A retrospective study of neonates who underwent operative management of meconium ileus at 6 hospitals in the United States and Australia between 2010 and 2021 was conducted. Outcomes after NAC instillation at multiple sites with a 27G needle injection <em>versus</em> enterotomy or the appendiceal stump were assessed. The primary outcomes were operative duration and time to full enteral feedings.</div></div><div><h3>Results</h3><div>Inclusion criteria were met in 52 patients and 9 (17.3%) underwent needle injection of NAC. Meconium was evacuated via the appendiceal stump (33%) or colon and passed via rectum (67%) in all patients in whom NAC was injected via a needle but in only 4 (9%) of those who were administered NAC via an enterotomy. Time to first stool, first enteral feeding, goal enteral feedings, and postoperative length of stay did not differ based on the operative approach. The median operative time in the needle injection group was significantly shorter (90 <em>versus</em> 133 min, <em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>Needle injection of NAC appears to be safe and effective in clearing inspissated meconium in neonates who required operative management. It obviated the need for enteral violation in the majority of cases and resulted in reduced operative time.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 9-13"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882676","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":"Manually Abstracted versus Electronic Health Record Data for Surgical Quality Improvement","authors":"James L. Galloway MD ,&nbsp;Vivi W. Chen MD, MPH ,&nbsp;Jennifer Kramer PhD, MPH ,&nbsp;Tracey Rosen MSPH ,&nbsp;Yongquan Dong MS ,&nbsp;Peter A. Richardson PhD ,&nbsp;Nader N. Massarweh MD, MPH","doi":"10.1016/j.jss.2025.12.018","DOIUrl":"10.1016/j.jss.2025.12.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Manually abstracted variables are considered the gold standard within national surgical quality improvement (QI) programs. However, because of the resources associated with manual data abstraction, opportunities to automate data collection could have numerous benefits for surgical QI. The goal of this study is to describe the accuracy and concordance of Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP) electronic health record (EHR) variable correlates (derived using EHR data) when compared to manually abstracted VASQIP variables.</div></div><div><h3>Methods</h3><div>This was a national, cross-sectional analysis of VASQIP and VA Corporate Data Warehouse (i.e., EHR) data (2016-2020). EHR-derived VASQIP variable correlates were created from Corporate Data Warehouse and compared to manually abstracted VASQIP variables for the same cases. The primary measure of agreement was Cohen's kappa. Sensitivity, specificity, positive predictive value, and negative predictive value were also calculated for each variable with addition of exact match proportion for lab variables. Strong agreement was considered kappa ≥80%.</div></div><div><h3>Results</h3><div>Among 533,164 cases across 113 hospitals for 429,163 unique patients, data were evaluated for five variable domains (race and ethnicity, preoperative risk factors, intraoperative factors, labs, and postoperative complications). Kappa for race and ethnicity ranged from 91.1 to 99.5%, with a median of 98.1% (IQR, 95.3-99.5%). Preoperative risk factors ranged from −0.1 to 83.0%, with a median of 28.6% (interquartile range [IQR], 12.7-53.9%). Preoperative labs ranged from 72.2 to 95.9% with a median of 91.9% (IQR, 89.9–93.3%). Intraoperative factors ranged from 0.0 to 99.5%, with a median of 93.9% (IQR, 9.9-97.3%). Postoperative complications ranged from 3.9 to 53.2%, with a median of 15.1% (IQR, 7.1-29.6%).</div></div><div><h3>Conclusions:</h3><div>Apart from postoperative complications, data collection for many VASQIP variables could potentially be automated using EHR-derived correlates with a high level of accuracy. This could minimize the resources associated with manual data collection and increase the timeliness and robustness of surgical QI programs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 136-145"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927330","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 of the Traditional Chinese Medicine “Seven-Step Method” With Sleep Support Braces in Managing Postoperative Upper Limb Lymphedema After Breast Cancer Surgery: A Randomized Trial","authors":"Chengwen Shao MMed ,&nbsp;Hongmei LV MMed ,&nbsp;Hengchang Liu MD ,&nbsp;Liangyou Zhao MD ,&nbsp;Na Zhang MD","doi":"10.1016/j.jss.2025.12.031","DOIUrl":"10.1016/j.jss.2025.12.031","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative upper limb lymphedema affects 32%-55% of breast cancer patients and impairs quality of life. Standard treatments, including education and exercise, are often insufficient. In 2014, the U.S. NIH recommended complex decongestive therapy. Recently, integrating traditional Chinese medicine (TCM) meridian theory into complex decongestive therapy has led to the “Seven-Step Method,” which shows encouraging outcomes. The objective of this study was to evaluate the efficacy of the TCM Seven-Step Method combined with sleep braces compared to conventional care in improving limb function and quality of life in breast cancer patients with postoperative upper limb lymphedema.</div></div><div><h3>Methods</h3><div>One hundred thirty-six patients randomized (<em>n</em> = 68 per arm) to conventional care or TCM “Seven-Step Method” + sleep braces applied daily over 6 wks. Outcomes included limb circumference, DASH, VRS pain, QOL-BREF scores, and satisfaction.</div></div><div><h3>Results</h3><div>At weeks 2, 4, and 6, the intervention group showed significantly greater reductions in limb circumference. DASH, VRS pain, and QOL-BREF scores also improved significantly, with higher satisfaction than controls.</div></div><div><h3>Conclusions</h3><div>The TCM Seven-Step Method combined with sleep braces significantly improves limb function, reduces pain, and enhances quality of life in breast cancer patients with lymphedema, offering an effective complementary therapy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 272-280"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030114","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":"Liver Remnant Hypertrophy: A Model-Based Evaluation of Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Liver Venous Deprivation","authors":"Savannah R. Smith MD ,&nbsp;Sarah M. Cheney MD ,&nbsp;Juan M. Sarmiento MD, FACS","doi":"10.1016/j.jss.2025.12.043","DOIUrl":"10.1016/j.jss.2025.12.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients undergoing major hepatectomy require a future liver remnant (FLR) of at least 30%. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are hypertrophy techniques for inadequate FLR. We sought to evaluate the cost-effectiveness of these techniques in patients with FLR &lt;30%.</div></div><div><h3>Methods</h3><div>Via Markov modeling, we assessed clinical and economic outcomes of ALPPS and LVD. Quality-adjusted life years (QALYs), costs (2022 USD), and incremental cost-effectiveness ratios (ICERs) were assessed. We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters.</div></div><div><h3>Results</h3><div>LVD resulted in 0.60 QALYs and $42,500; ALPPS accumulated 0.58 QALYs and $126,500. LVD was therefore preferred in the base case. Though LVD reduced costs, fewer simulated patients achieved hepatectomy due to disease progression while awaiting hypertrophy. If time to adequate hypertrophy for LVD was &lt;30 d, LVD substantially increased QALYs compared to ALPPS.</div></div><div><h3>Conclusions</h3><div>LVD and ALPPS are both acceptable techniques. LVD is preferred from a cost-effectiveness standpoint; however, if time to adequate hypertrophy were reduced or patient selection optimized to ensure at least 90% of LVD patients achieve hepatectomy, LVD would substantially improve QALYs while still saving costs compared to ALPPS.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 379-386"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078506","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}