Surgery最新文献

{"title":"Corrigendum to \"Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis\" [Surgery 175 (2024) 1518-1523].","authors":"Amir Humza Sohail, Samuel L Flesner, Kevin A Martinez, Hoang Nguyen, Christian Martinez, Ivan B Ye, Bisharah H Jrisat, Amal Rohail, Mohammed A Quazi, Tulio Brasileiro Silva Pacheco, Caroline Elizabeth Williams, Umar F Bhatti, Abu Baker Sheikh, Aman Goyal","doi":"10.1016/j.surg.2026.110229","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110229","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110229"},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864427","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":"Corrigendum to \"Enhanced Recovery After Surgery (ERAS) Society 2025 guidelines for perioperative care in elective colorectal surgery\" [Surgery 184 (2025) 109397].","authors":"Ulf O Gustafsson, Tim A Rockall, Steven Wexner, Kwang Yeong How, Sameh Emile, Allison Marchuk, William J Fawcett, Marianna Sioson, Bernhard Riedel, Rani Chahal, Angie Balfour, Gabriele Baldini, E Joline de Groof, Stefano Romagnoli, Miquel Coca-Martinez, Fabian Grass, Mary Brindle, Martin Hubner","doi":"10.1016/j.surg.2026.110225","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110225","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110225"},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864440","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":"Mortality and clinical outcomes in patients with mild autonomous cortisol secretion: Adrenalectomy versus nonoperative management.","authors":"Niranjna Swaminathan, Zhixing Song, Peter Abraham, Andrea Gillis, Jessica Fazendin, Herbert Chen, Brenessa Lindeman","doi":"10.1016/j.surg.2026.110238","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110238","url":null,"abstract":"<p><strong>Background: </strong>Mild autonomous cortisol secretion (MACS) is the most common hormonal abnormality in adrenal incidentalomas, but the benefits of adrenalectomy remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using a multi-institutional database (2011-2024) to analyze patients with adrenal incidentalomas and mild autonomous cortisol secretion, defined as cortisol levels between 1.8 and 5 μg/dL after a 1 mg dexamethasone suppression test. Cox proportional hazards models with propensity score matching for demographic and comorbidities were used to compare hazard ratios and 95% confidence intervals for mortality and metabolic outcomes between adrenalectomy and nonoperative management.</p><p><strong>Results: </strong>We identified 1,954 patients with mild autonomous cortisol secretion. Among them, 296 (15.1%) underwent adrenalectomy, whereas 1,658 (84.9%) received nonoperative management. After 1:1 propensity score matching, 291 patients remained in each group with balanced baseline characteristics. The cohort was predominantly female (64.9%) and White (71.1%), with a mean age of 62 ± 13 years. The mean follow-up duration was 1,367 ± 1,185 days in the adrenalectomy group and 1,315 ± 1,227 days in the nonoperative group. Adrenalectomy was associated with a lower hazard of mortality (hazard ratio, 0.34; 95% confidence interval, 0.27-0.36) and new-onset diabetes (hazard ratio, 0.49; 95% confidence interval, 0.25-0.97). No significant differences were observed in the incidence of cerebral infarction (hazard ratio, 0.58; 95% confidence interval, 0.24-1.43), ischemic heart disease (hazard ratio, 0.83; 95% confidence interval, 0.54-1.28), fractures (hazard ratio, 0.72; 95% confidence interval, 0.37-1.41), or hypertension (hazard ratio, 1.23; 95% confidence interval, 0.79-1.93). However, in a sensitivity analysis excluding patients with adrenocorticotropic hormone >20 pg/mL, adrenalectomy was not associated with a survival benefit.</p><p><strong>Conclusion: </strong>Adrenalectomy in mild autonomous cortisol secretion patients with cortisol levels between 1.8 and 5 μg/dL after a 1-mg dexamethasone suppression test is associated with reduced mortality and a lower risk of new-onset diabetes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110238"},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857329","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":"Influence of complications on patient-reported outcome measures in 5,312 prospectively registered abdominal wall reconstructions using propensity score matching.","authors":"Emanuele Lo Menzo","doi":"10.1016/j.surg.2026.110215","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110215","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110215"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842982","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":"Impact of surgical approach on gastric cancer surgery based on textbook outcome: Open, laparoscopic, and robotic surgery-A retrospective cohort study.","authors":"Elisenda Garsot Savall, Arantxa Clavell, Sebastià Videla, Natalia Pallarès, Cinta Hierro, Cristina Bugés, Sergio Alonso, Marta Viciano","doi":"10.1016/j.surg.2026.110205","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110205","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer surgery is evolving toward minimally invasive techniques such as laparoscopic and robotic gastrectomy. This study assesses surgical quality through the textbook outcome, a composite measure reflecting optimal perioperative results. We compared textbook outcome achievement across open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy, and its association with 1-year mortality.</p><p><strong>Methods: </strong>A retrospective cohort of patients with gastric or esophagogastric junction cancer undergoing curative gastrectomy between 2014 and 2023 at a tertiary center was analyzed. Surgical approaches included open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy. Textbook outcome was used to evaluate surgical quality. Inverse probability weighting balanced baseline characteristics across groups. Multivariable logistic regression and weighted Cox models explored associations between surgical approach, textbook outcome, and 1-year mortality.</p><p><strong>Results: </strong>Two hundred patients were included: 53 open gastrectomy, 103 laparoscopic gastrectomy, and 44 robotic gastrectomy. After inverse probability weighting adjustment, minimally invasive approaches showed superior outcomes. Textbook outcome was achieved in 31.4% (95% confidence interval: 15.2%-53.9%) of open gastrectomy, 56.8% (95% confidence interval: 46.5%-66.6%) of laparoscopic gastrectomy, and 68.6% (95% confidence interval: 51.5%-81.8%) of robotic gastrectomy patients, mainly due to higher R0 resection rates and adequate lymphadenectomy (≥15 nodes). Hospital stay was shorter in laparoscopic gastrectomy and robotic gastrectomy. Achieving textbook outcome was independently associated with higher 1-year survival across all approaches.</p><p><strong>Conclusion: </strong>This is the first Western study evaluating surgical quality using textbook outcome across gastrectomy approaches. Both laparoscopic gastrectomy and robotic gastrectomy achieved higher textbook outcome rates than open gastrectomy, with robotic gastrectomy showing the best outcomes, largely driven by improved oncological resection. Textbook outcome achievement correlated with significantly improved 1-year overall survival.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110205"},"PeriodicalIF":2.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724029","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":"Influence of complications on patient-reported outcome measures in 5,312 prospectively registered abdominal wall reconstructions using propensity score matching.","authors":"Rudolf van den Berg, Anand G Menon, Pieter J Tanis, Jean-Francois Gillion","doi":"10.1016/j.surg.2026.110161","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110161","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures provide essential insight into postoperative recovery, yet the impact of specific complications on patient-reported domains after incisional hernia repair remains poorly understood.</p><p><strong>Methods: </strong>Patients who underwent incisional hernia repair between 2011 and 2025 were identified from the French Hernia-Club registry. All complications were recorded within 30 days postoperatively. Those with surgical site infections, surgical site occurrences, or occurrences requiring procedural intervention (Clavien-Dindo grade III) were propensity score matched to controls without complications. Repeated measures regression models assessed associations between complication type and pain (visual analog scale), analgesic use, postoperative discomfort, functional outcomes, and limitations in daily life.</p><p><strong>Results: </strong>A total of 5,312 patients were analyzed (surgical site infection n = 185; surgical site occurrence n = 409; surgical site occurrence requiring procedural intervention n = 222). Surgical site infections were associated with higher pain intensity (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.53-1.83, P < .001), more postoperative discomfort (OR 4.21, 95% CI 1.31-13.5, P = .016), worse functional outcomes (OR 0.45, 95% CI 0.32-0.65, P < .001), and greater limitations in daily life (OR 2.60, 95% CI 1.74-3.89, P < .001). Surgical site occurrences showed increased pain (OR 1.17, 95% CI 1.10-1.25, P < .001), more discomfort (OR 2.61, 95% CI 1.34-5.09, P < .001), and worse function (OR 0.54, 95% CI 0.45-0.62, P < .001). Surgical site occurrences requiring procedural interventions were associated with higher pain scores (OR 1.24, 95% CI 1.11-1.39, P < .001), greater discomfort (OR 5.39, 95% CI 1.34-21.6, P < .001), worse function (OR 0.31, 95% CI 0.23-0.42, P < .001), and increased limitations in daily life (OR 2.40, 95% CI 1.59-3.61, P < .001). Although patient-reported outcome measures improved over time, they remained worse than controls.</p><p><strong>Conclusion: </strong>Postoperative complications after incisional hernia repair are independently associated with worse patient-reported outcomes. However, differences between surgical site infection, surgical site occurrence, and surgical site occurrence requiring procedural intervention are modest, and all complication types show broadly similar detrimental effects. These findings highlight the importance of incorporating complication-specific patient-reported outcome measure data into quality improvement and patient counseling.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110161"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692153","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":"Robotic pancreatoduodenectomy in elderly individuals: An international multicenter propensity score-matched study by the PANFRAIL Collaborative group.","authors":"Tiziana Marchese, Valentina Valle, Benedetto Ielpo, Marcello Giuseppe Spampinato, Annalisa Comandatore, Leonardo Borgioli, Pier Cristoforo Giulianotti, Luca Morelli","doi":"10.1016/j.surg.2026.110153","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110153","url":null,"abstract":"<p><strong>Introduction: </strong>As life expectancy rises, more elderly patients are considered for major abdominal surgeries. Pancreatoduodenectomy in octogenarians remains challenging because of comorbidities and reduced physiological reserve. Although minimally invasive techniques such as robotic surgery may offer advantages, evidence specific to this elderly population is scarce. This study aimed to evaluate surgical outcomes in patients aged ≥80 years undergoing pancreatoduodenectomy and to compare perioperative results between robotic and open approaches.</p><p><strong>Material and methods: </strong>This multicenter retrospective study included consecutive patients aged ≥80 years who underwent robotic or open pancreatoduodenectomy across 37 international centers between January 2012 and December 2024. Propensity score matching (1:1) was performed, yielding 2 comparable cohorts of 109 patients each. Perioperative outcomes were analyzed and compared.</p><p><strong>Results: </strong>Robotic pancreatoduodenectomy was associated with longer operative time (441 vs 375 minutes, P < .001) but significantly lower estimated blood loss (266 vs 565 mL, P < .001). Compared with the open group, the robotic approach showed lower rates of overall postoperative complications (52.2% vs 70.6%, P = .013), clinically relevant postoperative pancreatic fistula (9.3% vs 29.4%, P < .001), median comprehensive complication index (16 vs 24, P = .027), and shorter hospital stay (13 vs 21 days, P = .002). No significant differences were observed in 30-day (4.6% vs 6.4%, P = .180) or 90-day mortality (5.5% vs 6.4%, P = .769).</p><p><strong>Conclusions: </strong>Robotic pancreatoduodenectomy appears safe and is associated with improved perioperative outcomes in octogenarians. When performed in experienced centers, the robotic approach may represent a preferable option in this elderly population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110153"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692221","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":"Organ procurement organization utilization of portable hypothermic oxygenated machine perfusion in liver transplantation: The first US experience.","authors":"Christine E Haugen, Muhammad Bilal Moeen-Ud-Din, Abdalla M Hadhoud, Achintya Kaw, James R Butler, James V Guarrera, Sherry Quire, Ralph C Quillin","doi":"10.1016/j.surg.2026.110177","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110177","url":null,"abstract":"<p><strong>Background: </strong>Advanced machine perfusion techniques have increased the use of hard-to-place organs, effectively changing the liver transplantation landscape. Liver transplantation machine perfusion has been driven largely by industry or individual transplant centers. We describe the implementation of a portable, organ procurement organization-initiated hypothermic oxygenated machine perfusion strategy for liver transplantation as a proof of concept.</p><p><strong>Methods: </strong>Surgeons and staff at a regional organ procurement organization (Indiana Donor Network) were trained to use and cannulate liver allografts using a portable hypothermic oxygenated machine perfusion platform. We evaluated all liver transplantations recovered and placed on hypothermic oxygenated machine perfusion (N = 18) by the Indiana Donor Network for the University of Cincinnati from November 2023 to July 2025. Propensity score matching was used to match organ procurement organization-initiated hypothermic oxygenated machine perfusion cases with a control cohort.</p><p><strong>Results: </strong>Among the 18 recipients, the median age was 57 years (50-63) with a Model for End-Stage Liver Disease score of 15.5 (13.5-21.5). Twelve (67.7%) were donation after circulatory death donors. Median time from cross-clamp to hypothermic oxygenated machine perfusion initiation was 105 minutes (84.3-118.5) and hypothermic oxygenated machine perfusion time was 443.5 minutes (293-530.3). One recipient developed an early bile leak, another developed an anastomotic biliary stricture, a third experienced early allograft dysfunction, and a fourth had acute cellular rejection. None of the recipients had ischemic cholangiopathy. Patient and graft survival were 100% at 449 days (274.5-570.5). Post-transplant outcomes and 6-month patient survival were comparable between the organ procurement organization-initiated hypothermic oxygenated machine perfusion and liver transplantation center-initiated hypothermic oxygenated machine perfusion recipients.</p><p><strong>Conclusion: </strong>In the first reported US series describing organ procurement organization-initiated portable hypothermic oxygenated machine perfusion for liver transplantation, recipients experienced excellent outcomes with use of medically complex donors and long preservation times. This series demonstrates that implementation and adoption of organ procurement organization-initiated portable machine perfusion strategy with local donor recovery for liver transplantation is possible.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110177"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616751","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":"Invited commentary: OPO-initiated machine perfusion as a path to more equitable liver transplantation.","authors":"Bonnie O Wong, Shimul A Shah","doi":"10.1016/j.surg.2026.110174","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110174","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110174"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616775","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":"Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy","authors":"Giovanni Taffurelli MD, PhD ,&nbsp;Isacco Montroni MD, PhD ,&nbsp;Federico Ghignone MD ,&nbsp;Francesca Sivieri MD ,&nbsp;Davide Zattoni MD ,&nbsp;Giacomo Frascaroli MD ,&nbsp;Federico Mazzotti MD ,&nbsp;Giampaolo Ugolini MD, PhD","doi":"10.1016/j.surg.2025.110053","DOIUrl":"10.1016/j.surg.2025.110053","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (&lt;80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.</div></div><div><h3>Results</h3><div>Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index &gt;6 in 68.3% vs 22.3%, <em>P</em> &lt; .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, <em>P</em> = .002). Disease-free survival was comparable (55.2 vs 54.6 months, <em>P</em> = 1.000), but overall survival was lower in older patients (62 vs 91 months, <em>P</em> &lt; .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index &gt;6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.</div></div><div><h3>Conclusions</h3><div>Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110053"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980612","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}