Langenbeck's Archives of Surgery最新文献

{"title":"Frailty assessment for risk stratification in pancreatic surgery.","authors":"Michael C Frey, Elena Krombholz, Annatina Weber, Silvan Patalong, Tilo Niemann, Andrea Wirsching, Antonio Nocito","doi":"10.1007/s00423-025-03849-8","DOIUrl":"10.1007/s00423-025-03849-8","url":null,"abstract":"<p><strong>Purpose: </strong>Pancreatic cancer usually affects the elderly as 70% of new diagnoses are made in patients older than 65 years. A risk factor for postoperative complications is the accumulation of comorbidities and functional decline, which together define \"frailty\". The aim of the current study was to assess the impact of frailty on postoperative recovery after pancreatic surgery.</p><p><strong>Methods: </strong>Data of consecutive patients undergoing pancreatic resections between January 2015 and December 2023 were retrospectively analyzed. Postoperative complications were graded according to the Clavien-Dindo Classification (CD), Comprehensive Complication Index (CCI) and complications specific to pancreatic resections as recommended and published by the International Study Group of Pancreatic Surgery. The modified frailty index (mFI) was defined by 11 variables. A mFI score above 0.27 defined frailty according to previous literature.</p><p><strong>Results: </strong>A pancreatic resection was performed in 190 patients of which 27 (14%) were classified as frail. Male gender was associated with frailty (78%, p = 0.003). Frailty was associated with an increased rate of preoperative biliary drainage. Although intensive care stay was increased in the frail group (median 3 vs. 1 day; p = 0.005), total length of hospital stay was not affected. Frailty was associated with an increased rate of postoperative pancreatic fistula (POPF) grade C (11% vs. 2%, p = 0.038), and a higher comprehensive complication index (26 vs. 12; p = 0.015). Total hospitalization costs were increased for frail patients with 58'022 CHF compared to 44'126 CHF for non-frail patients (p = 0.09).</p><p><strong>Conclusion: </strong>Assessment of frailty should be implemented for preoperative risk stratification, since frailty is associated with higher morbidity after pancreatic resections.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"263"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959367","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":"Visual analysis of research hot topics and trends of clinical decision support system based on CiteSpace.","authors":"Shujia Wang, Li Yu","doi":"10.1007/s00423-025-03843-0","DOIUrl":"10.1007/s00423-025-03843-0","url":null,"abstract":"<p><strong>Background: </strong>Clinical decision support system (CDSS) mainly refers to a computer application system that uses relevant and systematic clinical knowledge and patients' basic information, as well as medical information, to strengthen medical-related decisions/actions and improve medical quality and medical service level.</p><p><strong>Objective: </strong>To analyze research status, hot topics and developmental trends, and to provide references for future research in this field.</p><p><strong>Methods: </strong>CiteSpace was used to conduct scientific measurement and visualization analysis of relevant literature from 1969 to 2023 in the Web of Science core collection database.</p><p><strong>Results: </strong>A total of 2473 documents were included, and the number of publications increased exponentially (y = 1.3073e^0.1636x), and the attention to this field has gradually increased. The research frontier trends mainly focus on the combination of CDSS and artificial intelligence, as well as the development and exploration of deep learning models for different application environments. With the continuous development of science and technology, the prospect of combining artificial intelligence with CDSS is very promising.</p><p><strong>Conclusion: </strong>This study reveals an in-depth and comprehensive perspective for CDSS study, and provides researchers with valuable information on the current status, hot topics, and cutting-edge trends in this field.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"261"},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959322","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":"Postoperative ileus after emergency surgery for acute bowel obstruction: a case-control study of predictors and impact on recovery.","authors":"Anca-Laura Amati, Niklas Kümmel, Nicoleta Negruta, Martin Reichert, Thilo Schwandner, Julia Noll, Jaqueline Braun, Veronika Grau, Sebastian Petzoldt, Andreas Hecker","doi":"10.1007/s00423-025-03851-0","DOIUrl":"10.1007/s00423-025-03851-0","url":null,"abstract":"<p><strong>Purpose: </strong>Acute bowel obstruction (ABO) is a common indication for emergency abdominal surgery, often performed on a severely dilated intestine with compromised barrier function. The recovery of bowel motility in this acute setting differs from elective surgery and remains insufficiently investigated. Yet, its understanding is crucial for improving perioperative care in surgical emergencies. This study aimed to identify risk factors for postoperative ileus (POI) after emergency surgery for ABO and to explore its impact on postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 466 patients who underwent emergency surgery for ABO between 2014 and 2020, of whom 156 developed POI. POI was defined as the absence of postoperative bowel movement requiring intravenous prokinetic therapy following an insufficient response to initial conservative measures, including oral laxatives. Perioperative predictors for POI were identified by univariate and multivariate logistic regression. The association between POI and adverse postoperative outcomes was examined using correlation analysis.</p><p><strong>Results: </strong>Multivariate analysis revealed male sex (p = 0.0009), chronic steroid therapy (p = 0.0064), high postoperative SOFA score (p = 0.0037), and elevated CRP levels on postoperative day two (p = 0.048) as independent predictors for POI. Patients with POI had significantly higher rates of postoperative respiratory (p < 0.0001) and surgical complications (p = 0.0014).</p><p><strong>Conclusion: </strong>Our findings suggest sex-dependent differences and an involvement of inflammatory processes in bowel function recovery following emergency surgery for ABO. POI in this setting is associated with increased risk of postoperative respiratory complications and surgical morbidity. These results highlight the need for targeted preventive strategies and form a solid foundation for future prospective studies aimed at optimizing perioperative care and reducing POI-related morbidity in surgical emergencies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"260"},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959215","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":"Analysis of the effect of laparoscopic temporary long-tunneled external ventricular drainage in patients with post-traumatic brain injury hydrocephalus.","authors":"Mingtao Chang, Jianfa Chen, Xia Qin, Hua Yang","doi":"10.1007/s00423-025-03814-5","DOIUrl":"https://doi.org/10.1007/s00423-025-03814-5","url":null,"abstract":"<p><strong>Objective: </strong>To study the clinical effect of laparoscopic temporary long-tunneled external ventricular drainage(LT-LTEVD) and conventional laparoscopic ventriculoperitoneal shunt(CL-VPS) in patients with post-traumatic brain injury hydrocephalus(PTH).</p><p><strong>Methods: </strong>This study was a prospective study. We analyzed the clinical data of 52 patients with PTH admitted to our department from October 2018 to October 2021.All cases were randomly divided into two groups, and performed LT-LTEVD and CL-VPS respectively. The catheterization time, remission time of intracranial hypertension, hospital stay, therapeutic effectiveness and complications rate were compared between groups.</p><p><strong>Results: </strong>The therapeutic effect of LT-LTEVD group (92.31%) was higher to that of CL-VPS group(65.38%), with statistical significance. Except the catheterization time, remission time of intracranial hypertension and hospital stay of CL-VPS group were significantly higher to those of the LT-LTEVD group, with statistical significance. The incidence of complications such as intracranial infection, shunt, obstruction and poor healing in the CL-VPS group(30.77%) was higher than that in LT-LTEVD group(7.69%), with statistical significance.</p><p><strong>Conclusion: </strong>The preliminary results of this study showed that in the treatment of patients with PTH, LT-LTEVD could potentially have a positive effect. However, future researches are needed to clarify these preliminary results.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"259"},"PeriodicalIF":1.8,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959366","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":"Partial resection of rectum for rectal GIST by posterior approach.","authors":"Makoto Hasegawa, Wataru Sakamoto, Hiroki Yago, Takahiro Sato, Misato Ito, Takuro Matsumoto, Daisuke Ujiie, Shun Chida, Hirokazu Okayama, Motonobu Saito, Tomoyuki Momma, Koji Kono","doi":"10.1007/s00423-025-03845-y","DOIUrl":"https://doi.org/10.1007/s00423-025-03845-y","url":null,"abstract":"<p><strong>Objective: </strong>The standard surgical treatment for gastrointestinal stromal tumors (GISTs) is local resection. Colorectal GISTs, which account for 5-10% of all GISTs, tend to develop in the lower rectum, making transabdominal approaches both difficult and invasive. We perform partial resection of rectum by posterior approach for rectal GISTs. We herein present our surgical procedure of posterior approach and retrospectively analyze the efficacy and safety of this approach.</p><p><strong>Methods: </strong>In this retrospective case series study from 2018 to 2023, data were collected from patients who underwent partial resection of rectum by posterior approach for rectal GIST. Patient characteristics, surgical outcomes, complications, prognosis and presence/absence of low anterior resection syndrome (LARS) were collected.</p><p><strong>Results: </strong>Four male patients with rectal GIST were included. The median age was 50.5 years, and all patients were male. The median operation time was 203.5 min, the median intraoperative blood loss was 30 mL, and the median initial tumor diameter was 29.5 mm. One patient underwent diverting ileostomy, and the ileostomy was closed one year after surgery. Complete pathological resection was achieved in all cases. Postoperative complications were observed in one patient: outlet obstruction of the diverting ileostomy and LARS; there were no other postoperative complications including anastomotic leakage. No recurrence was observed in the median follow-up of 33.5 months.</p><p><strong>Conclusions: </strong>This study demonstrated that posterior approach is safe, associated with a low incidence of LARS, and facilitates complete resection, making it a valuable surgical option for rectal GISTs.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"258"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959261","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":"Prophylactic abdominal drainage in pancreatic surgery: an updated systematic review and meta-analysis.","authors":"Luís Felipe Leite, Luiz F Costa de Almeida, Samuel Menezes, Isabella Romagnoli, Daniel Dourado Striquer, Marcos Belotto","doi":"10.1007/s00423-025-03763-z","DOIUrl":"https://doi.org/10.1007/s00423-025-03763-z","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic abdominal drainage has been widely used in pancreatic surgery to mitigate postoperative morbidity. Nonetheless, recent evidence suggests that a no-drain policy presents similar results to routine drainage. Therefore, we conducted an updated meta-analysis on this topic to provide up to date clinical recommendations.</p><p><strong>Methods: </strong>This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562683). A comprehensive search of Embase, MEDLINE, CENTRAL, and Web of Science was conducted up to June 2024. Included studies were RCTs comparing prophylactic drainage with no-drain strategies in pancreatic surgery. The ROB-2 tool and GRADE system were used for quality assessment.</p><p><strong>Results: </strong>Five RCTs with 1,337 patients (676 with drainage, 661 without) met inclusion criteria. Overall, no significant differences were observed in morbidity, major morbidity, intra-abdominal abscess, wound infection, hemorrhage, or reintervention rates between the two groups (moderate certainty evidence). Notably, the no-drain group had significantly lower 90-day mortality (RR 0.22; 95% CI 0.06-0.75; P < 0.05, moderate certainty evidence). In patients at low risk for POPF, prophylactic drainage was associated with a higher risk of developing POPF (RR 4.32; 95% CI 1.27-14.64; P < 0.05, low certainty evidence). No significant differences were found in patients at moderate or high risk for POPF.</p><p><strong>Discussion: </strong>Current evidence indicates that a no-drain policy is associated with comparable safety and efficiency outcomes to prophylactic drainage in pancreatic surgery, with similar mortality and morbidity profiles. In regards to CR-POPF incidence, a no drain policy is a non-inferior approach for PD, while in DP, prophylactic drainage is associated with a higher incidence of fistulas.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"255"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959372","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":"Efficacy of tranexamic acid in reducing perioperative blood transfusions and thrombosis in liver surgery: a systematic review and meta-analysis.","authors":"Tianchi Yu, Zheyu Shen, Ziqi Wang, Qiuqi Feng, Renfei Zhu","doi":"10.1007/s00423-025-03839-w","DOIUrl":"https://doi.org/10.1007/s00423-025-03839-w","url":null,"abstract":"<p><strong>Introduction: </strong>Preventing bleeding during the perioperative period is critically important in liver surgery and mismanagement can raise the need for transfusions as well as the rates of morbidity and death. Tranexamic acid (TXA) has been shown to effectively decrease perioperative bleeding in patients with trauma, some studies have also shown that TXA plays the same role in liver surgery. The effectiveness of TXA in hepatectomy and liver transplantation was reassessed in this meta-analysis of randomized controlled trials, which included recently published studies.</p><p><strong>Methods: </strong>The PubMed, Web of Science, and Embase databases were comprehensively searched to identify studies that were published from January 1947 to September 2024. Results related to transfusion requirements, incidents of thromboembolism, and the number of deaths were retrieved from the included studies. The data were quantified using random effects models.</p><p><strong>Results: </strong>A total of 1674 patients were included in the seven studies. The results showed no discernible difference between the TXA and control groups regarding the reduction in perioperative transfusion needs (OR 0.24; 95% CI 0.03 ~ 1.87) and the final mortality rate (OR 0.99; 95% CI 0.48 ~ 2.06) during hepatectomy and transplantation, however, TXA increased the incidence of thromboembolism (OR 1.74; 95% CI 1.01 ~ 3.01).</p><p><strong>Conclusions: </strong>TXA does not reduce perioperative transfusion requirements during liver resection and transplantation and has no significant effect on the final mortality rate; however, TXA does increase the incidence of thromboembolic events.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"254"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959309","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":"Redirecting venous flow from the superior mesenteric vein to the inferior mesenteric vein in resections for locally advanced pancreatic cancer.","authors":"S K Burgdorf, M Pai, N H Habib, J H Storkholm","doi":"10.1007/s00423-025-03818-1","DOIUrl":"https://doi.org/10.1007/s00423-025-03818-1","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcome of ligation of the superior mesenteric vein (SMV) and redirection the venous flow through the inferior mesenteric vein (IMV) in selected patients with pancreatic cancer.</p><p><strong>Background: </strong>Radical surgery is the only potentially curable treatment of pancreatic cancer. Tumor-invasion of the SMV and its attributes will in some cases make it impossible to reconstruct the venous flow.</p><p><strong>Methods: </strong>Consecutive patients with pancreatic cancer operated between January 2019 and December 2022 were included. Selected patients eligible for venous flow reversal after systemic chemotherapy were offered surgical exploration.</p><p><strong>Results: </strong>Eleven patients were offered surgery and nine of these went through radical resection with redirection of the venous flow through the IMV. True histological R0 resection was achieved in 6 (67%) patients. No 30- nor 90-days mortality was recorded. Median overall survival was 23.2 ± 11.5 months.</p><p><strong>Conclusion: </strong>Redirecting venous flow through the IMV while sacrificing the SMV during pancreatic resection is a safe procedure and may provide the opportunity for curative resection in otherwise unresectable patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"257"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959374","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":"Mesenteric approach for borderline resectable pancreatic head cancer: a 13-Year retrospective cohort study.","authors":"Fang-Fei Wang, Qiang He, Shao-Cheng Lyu","doi":"10.1007/s00423-025-03803-8","DOIUrl":"10.1007/s00423-025-03803-8","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the value of mesenteric approach for borderline resectable pancreatic head cancer(BRPHC).</p><p><strong>Methods: </strong>According to the inclusion and exclusion criteria, the data of 203 patients with borderline resectable pancreatic head cancer(BRPHC) who underwent radical pancreatoduodenectomy in our center from January 2011 to December 2023 were retrospectively analyzed. After detecting the superior mesenteric artery in infracolic compartment to judge that there was vascular invasion but it met the borderline resection criteria, the blood supply was cut off first, then the tissues and organs were resected. And the invaded vessels were resected and reconstructed or replaced, then conventional anastomosis was performed. All patients were divided into mesenteric approach group and conventional approach group according to the operation method. The outcome measures were operation completion, perioperative conditions and overall prognosis. The follow-up time was up to February 2025.</p><p><strong>Results: </strong>All 203 patients successfully completed the operation without perioperative death, and confirmed as pancreatic ductal adenocarcinoma by pathological examination. Overall and grouped prognosis: The overall survival rates and disease-free survival rates of 1-, 2-, and 5-year were 51.9%, 25.0%, 8.5% and 28.4%, 12.9%, 3.9% (Fig. 1). The 1-, 2-, and 5-year survival rates of patients in two groups were 62.1%, 40.3%, 21.7% and 44.1%, 14.7%, 1.8% (P = 0.000, X² = 20.927) (Fig. 2A); The 1-, 2-, and 5-year disease-free survival rates in two groups were 44.9%, 24.5%, 8.2% and 20.8%, 7.5%, 1.9% (P = 0.006, X² = 7.457) (Fig. 2B).</p><p><strong>Conclusion: </strong>The mesenteric approach in infracolic compartment can improve the prognosis of patients with borderline resectable pancreatic head cancer, prolong the postoperative survival time of patients, and reduce the recurrence.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"256"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959119","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":"\"Two-stage resection of synchronous liver metastases in colorectal cancer leads to a survival benefit: a retrospective comparative cohort study\".","authors":"Sebastian Lünse, Anne von Ruesten, Constanze Schneider, Stephan Gretschel, Andreas Loew, René Mantke","doi":"10.1007/s00423-025-03840-3","DOIUrl":"https://doi.org/10.1007/s00423-025-03840-3","url":null,"abstract":"<p><strong>Purpose: </strong>Colorectal cancer is the third most common cancer worldwide, with 15-25% of patients presenting synchronous liver metastases (UICC stage IV). Surgical resection remains crucial, but the optimal sequence for managing synchronous metastases is debated. This study evaluates the impact of different surgical strategies on survival in colorectal cancer patients with liver-only metastases (CRLM) and identifies factors influencing mortality.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed CRLM patients from German cancer registries in Brandenburg and Berlin from 2017 to 2022, grouped by surgical treatment sequence: simultaneous primary tumor resection (PTR) and liver resection, PTR before liver resection, or liver resection before PTR. Kaplan-Meier and Cox regression analyses evaluated overall survival (OS) and the impact of systemic therapy and patient characteristics.</p><p><strong>Results: </strong>Among 23,394 colorectal cancer patients, 209 met inclusion criteria. Simultaneous resection was performed in 45% (N = 93), PTR before liver resection in 43% (N = 90), and liver resection first in 12% (N = 26). PTR before liver resection showed the best 5-year OS (68% vs. 53% for simultaneous surgery; HR 0.44, 95% CI = 0.22-0.88, p = 0.020). Simultaneous resection had the highest 30-day mortality (6.5%, N = 6). Postoperative chemotherapy significantly improved 5-year OS (66% vs. 57% for no chemotherapy; HR 0.45, 95% CI = 0.22-0.95, p = 0.036). Excluding 30-day mortality, survival differences diminished.</p><p><strong>Conclusion: </strong>Primary tumor resection before liver resection appears to improve long-term survival in CRLM patients. Simultaneous resection should be carefully considered due to increased mortality, particularly in older patients with lower performance status undergoing major liver surgery. Postoperative chemotherapy enhances survival, emphasizing the need for tailored treatment strategies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"253"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959324","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}