Surgery最新文献

{"title":"Cover 1(with editorial board)","authors":"","doi":"10.1016/S0039-6060(25)00211-9","DOIUrl":"10.1016/S0039-6060(25)00211-9","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109359"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for readers","authors":"","doi":"10.1016/S0039-6060(25)00213-2","DOIUrl":"10.1016/S0039-6060(25)00213-2","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109361"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editors' note","authors":"Caitlin W. Hicks MD, MS, FACS, FAHA, DFSVS, Steven D. Wexner MD, PhD","doi":"10.1016/j.surg.2025.109356","DOIUrl":"10.1016/j.surg.2025.109356","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109356"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of psychosocial risk factors with acute outcomes of elective cancer resection in the United States","authors":"Konmal Ali,&nbsp;Amulya Vadlakonda BS,&nbsp;Sara Sakowitz MPH, MS,&nbsp;Adedunmola P. Adewale BS,&nbsp;Syed Shaheer Ali,&nbsp;Melissa Justo MD,&nbsp;Ayesha Ng MPH,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109354","DOIUrl":"10.1016/j.surg.2025.109354","url":null,"abstract":"<div><h3>Background</h3><div>Psychosocial risk factors, including psychiatric disorders, substance use, limited cognitive comprehension, and low socioeconomic or uninsured status, are increasingly recognized in cancer care. However, their independent effects on acute postoperative outcomes after elective cancer surgery remain unclear. This study evaluates the association between psychosocial risk factors and clinical and financial outcomes in patients undergoing cancer resections.</div></div><div><h3>Methods</h3><div>All adult (≥18 years) records entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, and colon cancer were tabulated from the 2016–2021 Nationwide Readmissions Database. After entropy balancing, multivariable regression models were developed to ascertain the independent association of psychosocial risk factors. with mortality, complications, length of stay, and nonhome discharge.</div></div><div><h3>Results</h3><div>Of ∼655,376 patients, 223,035 (34.2%) were considered to comprise psychosocial risk factors. Relative to others, the psychosocial risk factors cohort was more commonly female (51.9 vs 47.1%, <em>P</em> &lt; .001), and had a greater Elixhauser Comorbidity Index (4 [3–5] vs 3 [2–4], <em>P</em> &lt; .001). Both groups most frequently underwent resection for colectomy (51.9% vs 51.1%%, <em>P</em> &lt; .001), yet those with psychosocial risk factors had greater rates of lobectomy (27.8% vs 25.8%, <em>P</em> &lt; .001), compared with their counterparts. After entropy balancing, psychosocial risk factors were linked to greater odds of mortality (adjusted odds ratio, 1.43, 95% confidence interval, 1.31–1.57), respiratory (adjusted odds ratio, 1.25; 95% confidence interval, 1.21–1.31) and infectious (adjusted odds ratio, 1.17; 95% confidence interval, 1.12–1.21) complications. Furthermore, patients with psychosocial risk factors faced incrementally increased resource use.</div></div><div><h3>Conclusion</h3><div>Psychosocial risk factors independently predict adverse clinical and financial outcomes after elective cancer operations. Systematic screening for psychosocial risk factors may facilitate targeted interventions to improve care for high-risk patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109354"},"PeriodicalIF":3.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated surgical valve replacement for tricuspid regurgitation: An international multicenter study","authors":"Massimo Baudo MD ,&nbsp;Besart Cuko MD ,&nbsp;Julien Ternacle MD ,&nbsp;Elena Magrini MS ,&nbsp;Olivier Busuttil MD ,&nbsp;Nabil Dib MD ,&nbsp;Serge Sicouri MD ,&nbsp;Louis Labrousse MD, PhD ,&nbsp;Thomas Modine MD, PhD ,&nbsp;Basel Ramlawi MD","doi":"10.1016/j.surg.2025.109370","DOIUrl":"10.1016/j.surg.2025.109370","url":null,"abstract":"<div><h3>Background</h3><div>Although the management of tricuspid regurgitation during mitral surgery is standardized, the approach to patients with isolated tricuspid regurgitation is less clearly defined. This study examined the surgical outcomes of patients who underwent isolated surgical tricuspid valve replacement at 2 medical centers, providing insights into the postoperative and midterm outcomes.</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed data from 2 tertiary cardiac surgery centers. All patients underwent isolated surgical tricuspid valve replacement between 2010 and 2023. The primary end point included 30-day and midterm survival. The secondary end points included postoperative and valve-related complications.</div></div><div><h3>Results</h3><div>A total of 64 patients were included. The mean age was 58 ± 17 years, and 51.6% (33/64) were male patients. The median European System for Cardiac Operative Risk Evaluation II, TRISCORE, and Model for End-Stage Liver Disease scores were 2.16 [1.38–3.42], 3.00 [1.00–4.00], and 10.50 [9.00–16.25], respectively. More than 60% of the procedures were conducted on a beating heart. Thirty-day mortality was 7.8%. European System for Cardiac Operative Risk Evaluation II underestimated mortality, whereas the Model for End-Stage Liver Disease score was a more reliable predictor. Ten patients finally received a permanent pacemaker upon discharge. The overall survival rates at 1 and 6 years were 88.8 ± 4.0% and 80.3 ± 7.3%, respectively. Freedom from tricuspid valve reintervention rates at 1 and 6 years were 96.2 ± 2.6% and 75.0 ± 9.6%, respectively.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that isolated surgical tricuspid valve replacement can be undertaken without exposing patients to an excessively high mortality risk. Risk assessment using specific scores may be useful in this regard. Nevertheless, these patients are at risk of postoperative complications, particularly permanent pacemaker implantation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109370"},"PeriodicalIF":3.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The smallest suffer stroke: Understanding stroke and treatment patterns in children with blunt cerebrovascular injury within the Trauma Quality Improvement Program database","authors":"Catherine C. Dawson-Gore MD, MSc ,&nbsp;Emily K. Myers MD ,&nbsp;Emily H. Cooper MS ,&nbsp;Lauren L. Evans MD ,&nbsp;Steven G. Schauer DO ,&nbsp;Shannon Acker MD","doi":"10.1016/j.surg.2025.109353","DOIUrl":"10.1016/j.surg.2025.109353","url":null,"abstract":"<div><h3>Background</h3><div>Stroke rate and treatment patterns for children with blunt cerebrovascular injury are not well-described. There exists a gap in knowledge of how children with blunt cerebrovascular injury are treated, the stroke rate associated with antithrombotic therapy, and the optimal time to start treatment.</div></div><div><h3>Methods</h3><div>A retrospective review of the Trauma Quality Improvement Program database was conducted from 2016 to 2022 for children with blunt injury (&lt;18 years) with blunt cerebrovascular injury. Analysis of all children with blunt cerebrovascular injury and subgroups of children without traumatic brain injury, as well as those without contraindications to antithrombotic therapy (no traumatic brain injury, solid-organ injury, or blood transfusion within 24 hours) was performed. Stroke rate and treatment patterns were compared between age groups (0–6, 7–11, 12–14, 15–17 years) and injury grades.</div></div><div><h3>Results</h3><div>Among 685,631 blunt injured children, 2,336 incurred blunt cerebrovascular injury (0.34%). Stroke rate was greatest in the youngest patients (6.2% 0–6 years; 2.0% 7–11 years) who had the lowest rates of antithrombotic therapy. Fifty-two percent of patients received no antithrombotic therapy during their hospitalization. Children who received antithrombotic therapy had greater rates of stroke compared with those untreated (6.1% vs 2.1%, <em>P</em> &lt; .001) regardless of age group. Low-molecular weight heparin was the most common antithrombotic therapy (28.2%) followed by heparin (14.2%), and aspirin (5.1%).</div></div><div><h3>Conclusion</h3><div>Children aged 0–11 years had the greatest rates of stroke and were least likely to receive antithrombotic therapy. More than one half of children did not receive antithrombotic therapy. Patients who received antithrombotic therapy had greater stroke rates than untreated patients, which may reflect antithrombotic therapy given after stroke occurred. Treatment guidelines are needed for children with blunt cerebrovascular injury.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109353"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study","authors":"Yuran Dai MD ,&nbsp;Jingyue Fu MD ,&nbsp;Xiaozhi Lu MD ,&nbsp;Yazhou Wang PhD, MD ,&nbsp;Kai Zhang MD ,&nbsp;Kuirong Jiang PhD, MD ,&nbsp;Yi Miao PhD, MD ,&nbsp;Jishu Wei PhD, MD","doi":"10.1016/j.surg.2025.109355","DOIUrl":"10.1016/j.surg.2025.109355","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic fistula is a major cause of late postpancreatectomy hemorrhage; however, it is not always accompanied by a postoperative pancreatic fistula, indicating other potential etiologies and characteristics. We investigated the role of clinically relevant postoperative pancreatic fistula in grade C postpancreatectomy hemorrhage and its potential as a classification criterion.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we identified patients who developed grade C postpancreatectomy hemorrhage with or without concomitant clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy at the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2023. The patients' demographics, bleeding patterns, and outcomes were retrieved from their medical records and analyzed.</div></div><div><h3>Results</h3><div>Overall, 90 patients with grade C postpancreatectomy hemorrhage (52 [57.8%] with clinically relevant postoperative pancreatic fistula) were included in this study. Patients with clinically relevant postoperative pancreatic fistula had longer bleeding intervals (13.5 vs 7 days; <em>P</em> = .007). Although the gastroduodenal artery stump (32.7%) was the most common bleeding site in the fistula group, the hepatic artery and its branches (23.7%) and other bleeding points in the surgical area (23.7%) were predominant in the non-fistula group (<em>P</em> = .041). The fistula group had a greater mortality rate (38.5% vs 10.5%; <em>P</em> = .003), longer median length of hospital stay (42 vs 30 days; <em>P</em> = .047), longer intensive care unit stay (2 vs 0 days; <em>P</em> = .004), and greater hospitalization costs (RMB 283,632.73 vs RMB 189,087.6; <em>P</em> = .004).</div></div><div><h3>Conclusion</h3><div>The bleeding patterns and outcomes of grade C postpancreatectomy hemorrhage with and without concomitant clinically relevant postoperative pancreatic fistula varied. Therefore, postoperative pancreatic fistula could be considered as a new classification criterion for late postpancreatectomy hemorrhage.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109355"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of immune infiltration in colorectal cancer: Development of a histopathology-related immunoscore via multiplexed immunohistochemistry","authors":"Shiqi Zhou MD ,&nbsp;Zhaofu Qin MS ,&nbsp;Shunv Cai MD ,&nbsp;Ting Ma MS ,&nbsp;Luyi Lin MD ,&nbsp;Longhai Feng MD ,&nbsp;Xinyi Gao MD ,&nbsp;Dening Ma MD","doi":"10.1016/j.surg.2025.109350","DOIUrl":"10.1016/j.surg.2025.109350","url":null,"abstract":"<div><h3>Background</h3><div>Our objective was to evaluate the prognostic value of immune infiltration within the intratumoral and peritumoral tissues and to establish a novel histopathology-related immunoscore associated with postoperative colorectal cancer prognosis.</div></div><div><h3>Methods</h3><div>In the tissue microarrays, a total of 104 patients with colorectal cancer were enrolled and randomly assigned to the derivation cohort (<em>n</em> = 61) or the validation cohort (<em>n</em> = 43). Eighteen prognostic immune biomarkers in both intratumoral and peritumoral tissues were examined by the multiplexed immunohistochemistry method, with quantification performed through digital pathology. The histopathology-related immunoscore score was constructed using least absolute shrinkage and selection operator Cox analysis by selected immune features. On the basis of the Cox regression analysis, 3 predictive models were established. Harrell C-statistics were used to assess the performance of those models.</div></div><div><h3>Results</h3><div>The area under the curve was 0.743 (confidence interval, 0.457–1.000) in the derivation cohort and 0.739 (confidence interval, 0.538–0.940) in the validation cohort. Subsequently, the groups were classified on the basis of the optimal cutoff value, with the high-risk group exhibiting a poorer prognosis. Furthermore, 3 predictive clinical models were constructed, incorporating the significant risk factors and histopathology-related immunoscore score. The first model incorporating both histopathology-related immunoscore score and statistically significant factors identified through univariate analysis demonstrated superior predictive capability for survival across all 3 models, with an area under the curve of 0.852 and C-index of 0.837.</div></div><div><h3>Conclusion</h3><div>The histopathology-related immunoscore score offers a novel means of estimating of survival in patients with colorectal cancer. These findings indicated that the immunoscore and the clinical factors might serve as complementary tools to TNM staging to improve the accuracy of patient survival prediction.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109350"},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nomogram for predicting early biliary complications in adult liver recipients of deceased donor grafts: Integrating artery resistive index and clinical risk factors","authors":"Zepeng Lin MD ,&nbsp;Xue Ma MS ,&nbsp;Haibin Ji MD ,&nbsp;Yibo Hou MD ,&nbsp;Xiaoshun He MD, PhD ,&nbsp;Xiaofeng Zhu MD, PhD ,&nbsp;Anbin Hu MD, PhD","doi":"10.1016/j.surg.2025.109352","DOIUrl":"10.1016/j.surg.2025.109352","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to identify predictors of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed adult patients who underwent liver transplantation from January 2016 to December 2021 using deceased donor grafts in our center. Patients were randomly divided into training and validation cohorts (7:3 ratio). A nomogram was developed using least absolute shrinkage and selection operator logistic regression for feature selection, followed by a 2-way stepwise approach in multivariate logistic regression. Model performance was assessed with the C-index, receiver operating characteristic area under the curve, calibration curves, and decision curve analysis.</div></div><div><h3>Results</h3><div>A total of 757 patients were included, of whom 76 developed early biliary complications. Least absolute shrinkage and selection operator binary logistic analysis showed that postoperative day 1 arterial resistance index, acute rejection, acute-on-chronic liver failure, hepatic artery thrombosis, recipient body mass index, and donor age were independent predictors of biliary complications within 90 days. A nomogram was established on the basis of these factors. The C-index for the final nomogram was 0.822. The area under the curve in the training cohort was 0.837 (95% confidence interval, 0.780–0.893) and 0.771 (95% confidence interval, 0.677–0.865) in the validation cohort. Calibration curves demonstrated good agreement between predicted and actual outcomes. Decision curve analysis confirmed the clinical utility of the nomogram.</div></div><div><h3>Conclusion</h3><div>Low arterial resistance index (≤0.57) on the first postoperative day is a predictor of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts. The nomogram provides a practical tool for predicting complications and guiding clinical decisions.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109352"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combat orthopedic trauma care: Challenges and innovations in Ukraine's wartime response","authors":"Caroline S. Epstein MD ,&nbsp;Grygorii Prokhorenko MD ,&nbsp;Dmytro Los MD ,&nbsp;Roman Pavchak MD","doi":"10.1016/j.surg.2025.109313","DOIUrl":"10.1016/j.surg.2025.109313","url":null,"abstract":"<div><div>Orthopedic trauma care in Ukraine, shaped by the ongoing conflict since the Donbas invasion in 2014 and further intensified by the 2022 Russian invasion, reflects the complexity of treating modern wartime injuries in the face of resource constraints and evacuation challenges. Ukrainian medical teams have to the greatest extent possible adhered to Western medical standards, using a tiered care system that spans from the point of injury, to forward surgical teams leading, finally to advanced procedures in tertiary facilities. However, resource shortages and delayed evacuations have led to significant complications, including tourniquet-related kidney injury and limb amputations. These realities compel the need for innovation in medical protocols and sustained international support to address the demands of conflict-zone care.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109313"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}