Surgery最新文献

{"title":"Completion of preoperative chemotherapy and surgical outcome in patients with stenotic colon cancer without obstruction: A cohort study","authors":"Jinquan Zhang MD ,&nbsp;Siqi He MD ,&nbsp;Xiaolin Wu MD ,&nbsp;Runxian Wang MD ,&nbsp;Huabin Hu MD ,&nbsp;Jianwei Zhang MD ,&nbsp;Jianping Wang MD ,&nbsp;Yanhong Deng MD ,&nbsp;Zerong Cai MD ,&nbsp;Ruoxu Dou MD","doi":"10.1016/j.surg.2025.109533","DOIUrl":"10.1016/j.surg.2025.109533","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence has shown an oncologic benefit of preoperative chemotherapy for patients with locally advanced and metastatic colon cancer. However, some patients present with stenosis that blocks the colonoscope but without symptomatic obstruction. Whether the stenosis will progress to obstruction during chemotherapy is unknown, and this uncertainty may encourage unnecessary diversion or stenting, or impede optimal treatment.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 465 consecutive patients with endoscopically stenotic colon cancer without symptomatic obstruction in a quaternary referral center from 2013 to 2020. Patients were grouped into upfront surgery (361) and preoperative chemotherapy (104). Clinical courses of patients receiving preoperative chemotherapy were described, with expedited surgery as the primary outcome.</div></div><div><h3>Results</h3><div>Obstruction or perforation occurred in 25 of 104 (24.0%) patients receiving preoperative chemotherapy, of which 11 discontinued chemotherapy and received expedited surgery, and 14 resumed chemotherapy after stent or medical treatment. In total, 93 (89.4%) patients received elective surgery after preoperative chemotherapy. In addition, the preoperative chemotherapy group demonstrated a 41.3% objective response rate.</div></div><div><h3>Conclusion</h3><div>Three of 4 patients with stenotic colon cancer without symptomatic obstruction can complete preoperative chemotherapy uneventfully. Expedited surgery was needed in 10.6% because of obstruction or perforation during chemotherapy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109533"},"PeriodicalIF":3.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549914","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":"Prediction of the need for surgery in infants with necrotizing enterocolitis: A systematic review and meta-analysis","authors":"Xiaolong Xie MD ,&nbsp;Jiao Pei MD ,&nbsp;Li Zhang MD ,&nbsp;Yang Wu MD","doi":"10.1016/j.surg.2025.109526","DOIUrl":"10.1016/j.surg.2025.109526","url":null,"abstract":"<div><h3>Background</h3><div>Surgical necrotizing enterocolitis is associated with high rates of mortality and morbidity. However, there is a lack of consensus on the optimal candidates for surgical interventions. Accurate identification of the need for surgery is crucial for improving clinical outcome. The aim of this study was to evaluate the diagnostic performance of predictors of surgical intervention for neonates with necrotizing enterocolitis.</div></div><div><h3>Method</h3><div>PubMed, Embase, and the Cochrane Database of Systematic Reviews were searched. We included studies that assessed the prediction of the need for surgical intervention in infants with necrotizing enterocolitis. We performed a meta-analysis of diagnostic accuracy of predictors (including clinical, laboratory, radiologic, and ultrasonographic parameters) by analyzing the pooled sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio and area under the receiver operating characteristic curve.</div></div><div><h3>Results</h3><div>A total of 53 studies with 6,046 participants were included in this review. Pooled analyses were performed for 13 predictive factors. Abdominal distention had a high sensitivity (93%) and low specificity (26%), whereas abdominal wall erythema showed a low sensitivity (30%) and high specificity (93%). Thrombocytopenia was highly specific (85%) but poorly sensitive. Both signs of fixed intestinal loop and portal venous gas on radiography showed excellent specificities, although their sensitivities were poor. Ascites on sonography had a relatively good overall predictive performance with pooled area under the receiver operating characteristic curve of 0.84.</div></div><div><h3>Conclusion</h3><div>The diagnostic performance of the investigated predictors of surgical necrotizing enterocolitis varied greatly. Several predictors showed promise in identifying optimal candidates to receive surgery for necrotizing enterocolitis and appropriate integration of these parameters would be useful.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109526"},"PeriodicalIF":3.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523528","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":"Trends in surgical treatment for ulcerative colitis in the era of biologics – A population-based study using German diagnosis-related groups data","authors":"Maximilian Berlet MD,&nbsp;Kamacay Cira MD,&nbsp;Alissa Jell MD,&nbsp;Christian Stoess MD,&nbsp;Helmut Friess MD,&nbsp;Dirk Wilhelm MD,&nbsp;Daniel Reim MD,&nbsp;Marie-Christin Weber MD,&nbsp;Philipp-Alexander Neumann MD","doi":"10.1016/j.surg.2025.109511","DOIUrl":"10.1016/j.surg.2025.109511","url":null,"abstract":"<div><h3>Background</h3><div>The development of biologics has significantly advanced treatment of ulcerative colitis. However, their impact on the number of surgical cases and complication rates has not been clearly established. The aim of this study was first to describe trends and case numbers for surgery in the era of advanced therapies and second to analyze developments in surgical techniques and complications during that era.</div></div><div><h3>Methods</h3><div>A population-based analysis was performed on nationwide German hospital discharge data (diagnosis-related groups) to assess temporal trends in surgery for ulcerative colitis from 2008 to 2018. All inpatients with a diagnosis of ulcerative colitis (<em>International Classification of Diseases</em>, <em>Tenth Revision</em>, codes K51.0-K51.9) were included. Data from the German Federal Institute for Drugs and Medical Devices were examined to characterize the biologics market in Germany.</div></div><div><h3>Results</h3><div>The study included 522,705 in-hospital cases with a diagnosis of ulcerative colitis. An increase in marketing authorizations for biologics was noted during the study period (1,227 cumulative total in 2021). Partial colon resections declined in absolute numbers (631 in 2008 vs 585 in 2018; <em>P</em> = .003) and relative proportion (1.5% to 1.1%; <em>P</em> &lt; .00001). Conversely, rates of colectomies increased (0.43% to 0.95%; <em>P</em> &lt; .00001) and proctocolectomy rates were stable (0.93% in 2008 and 1.1% in 2018; <em>P</em> = .249). Within the study period the rate of minimally invasive surgery increased (14.5% to 65.6%), with a significant decrease in conversion rates (15.4% to 7.6%; <em>P</em> = .00395). Complication rates were significantly lower for laparoscopic compared with open surgery (17% ± 4.6% vs 31.1% ± 2.0%; odds ratio, 0.46, 95% confidence interval, 0.41–0.52; <em>P</em> &lt; .00001).</div></div><div><h3>Conclusion</h3><div>Despite the increasing availability of biologic therapies, the rates of colectomy and proctocolectomy for ulcerative colitis did not decrease during the study period.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109511"},"PeriodicalIF":3.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517528","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":"Tracking patients with lower-extremity fracture in a trauma registry who develop an infection after discharge","authors":"Bryant W. Oliphant MD, MBA, MSc ,&nbsp;Laura J. Gerhardinger MA ,&nbsp;Scott E. Regenbogen MD, MPH ,&nbsp;Edward C. Norton PhD ,&nbsp;John W. Scott MD, MPH ,&nbsp;Robert J. Winchell MD ,&nbsp;Anna N. Miller MD ,&nbsp;Mark R. Hemmila MD","doi":"10.1016/j.surg.2025.109522","DOIUrl":"10.1016/j.surg.2025.109522","url":null,"abstract":"<div><h3>Background</h3><div>Lower-extremity fracture infections in patients with trauma represent a substantial burden; however, quality improvement initiatives are limited to the acute hospital admission, for a complication that often develops after discharge. We tracked patients with a lower-extremity fracture who developed an infection after discharge from their index trauma center admission and characterized factors associated with this complication using collaborative quality initiative data.</div></div><div><h3>Methods</h3><div>Trauma collaborative quality initiative data (1/2018–9/2022) were analyzed from 35 American College of Surgeons Committee on Trauma–verified Level 1 and Level 2 trauma centers and were linked to insurance claims to create a longitudinal patient record. Inpatient and postdischarge lower-extremity fracture infection rates and the location of subsequent follow-up were captured. Multivariable logistic regression assessed the factors associated with developing a postdischarge infection.</div></div><div><h3>Results</h3><div>There were 11,017 patients with a lower-extremity fracture and 380 (3.4%) developed an infection after discharge, and very few during the index trauma center admission. An open injury increased the probability of an infection by 3.61 percentage points, along with male sex (0.93 percentage points) and multiple medical comorbidities. Almost two-thirds of the infections were diagnosed at a location other than the index trauma center.</div></div><div><h3>Conclusion</h3><div>The overwhelming majority of lower-extremity fracture infections occur after discharge from the index trauma center, and most patients seek care at another location. Known risk factors for developing an infection were confirmed in this large population-based cohort. We successfully linked trauma registry patients with insurance claims to create a longitudinal patient record, which will allow for further studies in this population.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109522"},"PeriodicalIF":3.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522559","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":"Transcatheter compared with surgical mitral valve intervention in patients with end-stage renal disease","authors":"Esteban Aguayo MD ,&nbsp;Oh Jin Kwon MD ,&nbsp;Allison Chavarria NP ,&nbsp;Soo-Min Lee NP ,&nbsp;Arjun Chaturvedi ,&nbsp;Kevin Tabibian BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109493","DOIUrl":"10.1016/j.surg.2025.109493","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with end-stage renal disease are at increased risk for developing mitral valve calcification and dysfunction. The present study evaluated clinical and financial outcomes of transcatheter compared with surgical mitral valve replacement/repair in patients with end-stage renal disease using a national cohort.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of all adult patients with end-stage renal disease receiving isolated surgical mitral valve replacement/repair or transcatheter mitral valve replacement/repair in the Nationwide Readmissions Database (2016–2021). Outcomes included in-hospital mortality, 30-day nonelective readmissions, complications, hospitalization costs, length of stay, and nonhome discharge. Entropy balancing and multivariable regressions adjusted for intergroup differences, with results reported as adjusted odds ratios and 95% confidence intervals.</div></div><div><h3>Results</h3><div>Among 3,782 patients with end-stage renal disease, 12.8% underwent transcatheter mitral valve replacement/repair, with use significantly increasing from 49 cases in 2016 to 122 cases in 2021 (NPTrend &lt; 0.001). Patients undergoing transcatheter mitral valve replacement/repair were older (70 vs 58 years, <em>P</em> &lt; .001) and had greater rates of atrial fibrillation (57.8 vs 46.8%, <em>P</em> &lt; .001) and mitral stenosis (21.7 vs 8.6%, <em>P</em> &lt; .001). After entropy balancing and risk adjustment (with surgical mitral valve replacement/repair as reference), transcatheter mitral valve replacement/repair did not alter the odds of in-hospital mortality (adjusted odds ratio, 1.70; confidence interval, 0.96–2.99), 30-day readmissions (adjusted odds ratio, 0.99; confidence interval, 0.62–1.59), or hospitalization costs (β −$4.4K, confidence interval, −$20.3K to $11.6K). Transcatheter mitral valve replacement/repair was associated with reduced odds of blood transfusion (adjusted odds ratio, 0.45; confidence interval, 0.29–0.72), infectious (adjusted odds ratio; 0.53, confidence interval, 0.32–0.88) and respiratory (adjusted odds ratio, 0.34; confidence interval, 0.24–0.47) complications, and non-home discharge (adjusted odds ratio; 0.29, confidence interval, 0.17–0.50).</div></div><div><h3>Conclusion</h3><div>In conclusion, our study underscores the evolving landscape of mitral valve interventions, highlighting the complementary roles of surgical mitral valve replacement/repair and transcatheter mitral valve replacement/repair. The increasing adoption of transcatheter mitral valve replacement/repair reflects its favorable safety profile and improved discharge outcomes, particularly in elderly and high-risk patients. Future research should focus on further evaluating long-term outcomes and exploring strategies to enhance the cost-effectiveness and accessibility of both interventions.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109493"},"PeriodicalIF":3.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517573","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":"Retained foreign bodies after major operations: Trends, risk factors, and associated outcomes","authors":"Barzin Badiee ,&nbsp;Saad Mallick MD ,&nbsp;Konmal Ali ,&nbsp;Melissa Justo MD ,&nbsp;Sona Mahrokhi MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109513","DOIUrl":"10.1016/j.surg.2025.109513","url":null,"abstract":"<div><h3>Background</h3><div>Retained foreign bodies are rare complications of surgical practice that are associated with adverse events and increased health care costs. While previous work has reported on the incidence of retained foreign bodies, updated national data evaluating contemporary trends as well as risk factors and associated outcomes remain limited.</div></div><div><h3>Methods</h3><div>The 2018–2022 National Inpatient Sample was used to identify all hospitalizations entailing major cardiac, gastrointestinal, genitourinary, neurosurgical, orthopedic, thoracic, and vascular operations. Patients were categorized based on the presence of a retained foreign body. Multivariable regression models were developed to evaluate the association of retained foreign bodies with risk factors and outcomes of interest.</div></div><div><h3>Results</h3><div>Of an estimated 26,333,269 surgical hospitalizations, 4,570 (0.017%) carried a concomitant diagnosis for a retained foreign body. The proportion of cases with a retained foreign body decreased from 1/5,400 to 1/6,000 cases from 2018 to 2022 (<em>P</em> &lt;.001). Relative to cardiac operations, gastrointestinal (adjusted odds ratio, 2.26; 95% confidence interval, 1.63–3.13), thoracic (adjusted odds ratio; 3.22, 95% confidence interval, 2.05–5.10), vascular (adjusted odds ratio, 2.78; 95% confidence interval, 1.89–4.10), and multicavity (adjusted odds ratio, 2.10; 95% confidence interval, 1.50–2.93) operations were associated with greater odds of retained foreign body occurrence. Moreover, treatment at hospitals with small-bed size was linked to reduced likelihood of retained foreign body event (adjusted odds ratio, 0.79; 95% confidence interval, 0.65–0.95), whereas care at hospitals in the Western United States was associated with increased odds (adjusted odds ratio, 1.29; 95% confidence interval, 1.05–1.59). Retained foreign body occurrence was also associated with a greater risk of complications, prolonged hospital stay, and increased hospitalization costs.</div></div><div><h3>Conclusion</h3><div>Despite a declining incidence of retained foreign bodies, further efforts focused on standardized safety protocols and technological solutions are needed to achieve zero-incidence prevention.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109513"},"PeriodicalIF":3.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517529","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":"Predictors of return to work after traumatic injury: Associations of employment with long-term patient-reported outcomes","authors":"Joseph A. Kern MD ,&nbsp;James Reese MD ,&nbsp;Diane N. Haddad MD, MPH ,&nbsp;Justin Hatchimonji MD, MSCE ,&nbsp;Erin Dawson MD, MPH ,&nbsp;Mark Seamon MD ,&nbsp;Elinore J. Kaufman MD, MSHP","doi":"10.1016/j.surg.2025.109529","DOIUrl":"10.1016/j.surg.2025.109529","url":null,"abstract":"<div><h3>Background</h3><div>After traumatic injury, patients face significant physical, psychosocial, and economic barriers to recovery. In this study, we evaluate return to work as an indicator of holistic recovery and hypothesized that patients with stronger baseline social support would be more likely to be employed at follow-up.</div></div><div><h3>Methods</h3><div>From October 2019 - July 2024, we prospectively collected data on employment, social support and Patient-Reported Outcomes Measurement Information System-29 domains (depression, anxiety, physical function, sleep disturbance, fatigue, ability to participate in social roles, pain intensity, and pain interference in daily activity) for adult trauma patients admitted to an urban, academic, level-1 trauma center. Participants were screened at the time of injury and had at least 1 follow-up at 6 or 12 months. Injury characteristics were collected from the institutional trauma registry. Using multivariate logistic regression analysis, we assessed relationships between follow-up employment status, baseline social support, and follow-up Patient-Reported Outcomes Measurement Information System-29 domains.</div></div><div><h3>Results</h3><div>Complete data were available for 310 patients, with 175 patients employed at baseline. In total, 54.2% of these patients reported return to work at 6- or 12-month follow-up. No significant differences were identified between employment and social support at baseline, 6- or 12-month follow-up. In multivariable analysis, employment was associated with better pain intensity scores (odds ratio, 0.77 [0.65–0.92], <em>P</em> = .003) and physical function (odds ratio, 0.30 [0.12–0.75], <em>P</em> = .01)</div></div><div><h3>Conclusion</h3><div>Post-injury return to employment was not associated with social support. However better patient-reported outcomes were associated with return to employment. Employment may be an important marker of recovery after injury and a pathway to economic stability and social recovery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109529"},"PeriodicalIF":3.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502374","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 dementia with adverse outcomes after emergent hernia repair","authors":"Sidney Hinks ,&nbsp;Esteban Aguayo MD ,&nbsp;Sara Sakowitz MS, MPH ,&nbsp;Oh Jin Kwon MD ,&nbsp;Shamieh Banihani MD ,&nbsp;Kevin Tabibian BS ,&nbsp;Arjun Chaturvedi ,&nbsp;Areti Tillou MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109494","DOIUrl":"10.1016/j.surg.2025.109494","url":null,"abstract":"<div><h3>Background</h3><div>As the prevalence of dementia within an aging population increases, its impact on surgical outcomes, particularly in emergent settings, is a growing concern. We aimed to evaluate the association between dementia and outcomes after emergent hernia repair.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed of patients (≥65 years) undergoing nonelective hernia repair using the Nationwide Readmissions Database from 2016 to 2021. Patients were stratified on the basis of pre-existing dementia. Entropy balancing and multivariable regressions were used to assess the risk-adjusted association between dementia and in-hospital mortality, perioperative complications, nonhome discharge, and nonelective 30-day readmission.</div></div><div><h3>Results</h3><div>Of an estimated 137,755 patients undergoing emergent hernia repair, 8.2% had dementia. When compared with others, patients with dementia were generally older (82.7 vs 76.1 years), less commonly female (50.1 vs 53.0%) and more frequently insured by Medicare (94.0 vs 89.6%) (all <em>P</em> &lt; .05). In addition, they had a greater burden of comorbidities (Elixhauser index: 3 [2–5] vs 3 [2–4]), including psychiatric disorders (17.8 vs 10.0%) (both <em>P</em> &lt; .05). After entropy balancing and multivariable adjustment, dementia was associated with an increased risk of in-hospital mortality (adjusted odds ratio, 1.29; 95% confidence interval, 1.12–1.49). Additionally, dementia was independently associated with a greater likelihood of overall perioperative complications (adjusted odds ratio, 1.41; 95% confidence interval, 1.32–1.50), non-home discharge (adjusted odds ratio, 2.98; 95% confidence interval, 2.80–3.18), and readmission (adjusted odds ratio, 1.11; 95% confidence interval, 1.01–1.22).</div></div><div><h3>Conclusion</h3><div>Dementia appears to be associated with inferior outcomes after emergent hernia repair, especially among elderly patients. Our findings highlight the need for heightened perioperative management and targeted strategies to optimize care in this population.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109494"},"PeriodicalIF":3.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489332","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":"Development and validation of a preoperative risk prediction model for severe complications and very early recurrence after liver resection for hepatocellular carcinoma","authors":"Jun Kawashima MD ,&nbsp;Yutaka Endo MD, PhD ,&nbsp;Mujtaba Khalil MD ,&nbsp;Selamawit Woldesenbet PhD ,&nbsp;Miho Akabane MD ,&nbsp;Andrea Ruzzenente MD, PhD ,&nbsp;Francesca Ratti MD ,&nbsp;Hugo Marques MD ,&nbsp;Sara Oliveira MD ,&nbsp;Jorge Balaia MD ,&nbsp;François Cauchy MD ,&nbsp;Vincent Lam MD ,&nbsp;George Poultsides MD ,&nbsp;Minoru Kitago MD, PhD ,&nbsp;Irinel Popescu MD, PhD ,&nbsp;Guillaume Martel MD ,&nbsp;Ana Gleisner MD ,&nbsp;Thomas J. Hugh MD ,&nbsp;Luca Aldrighetti MD, PhD ,&nbsp;Itaru Endo MD, PhD ,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon)","doi":"10.1016/j.surg.2025.109527","DOIUrl":"10.1016/j.surg.2025.109527","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to develop and externally validate a preoperative model for predicting the risk of severe complications and very early recurrence after liver resection for hepatocellular carcinoma.</div></div><div><h3>Methods</h3><div>Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma between 2000 and 2023 were identified using a multi-institutional international database. Preoperative characteristics were assessed in relation to severe complications (defined as complications with a Clavien-Dindo classification III or greater) and very early recurrence (recurrence within 6 months after surgery) using multivariable analysis. Predictive models for severe complications and very early recurrence were developed and externally validated.</div></div><div><h3>Results</h3><div>Among 969 patients, 97 patients (10.0%) experienced severe complications, and 116 patients (12.0%) developed very early recurrence. On multivariable analysis, American Society of Anesthesiologists class &gt;2 and greater albumin-bilirubin score were associated with severe complications. Meanwhile, a greater albumin-bilirubin score and higher tumor burden score were associated with very early recurrence. A predictive model for very early recurrence was able to stratify patients relative to their risk for recurrence: low-risk (6-month recurrence-free survival, 94.1%), medium-risk (6-month recurrence-free survival, 86.0%), and high-risk (6-month recurrence-free survival, 67.1%). A total of 74 patients (7.6%) had an unfavorable risk profile (severe complication risk ≥30% and high-risk for very early recurrence). The discriminative accuracy of the severe complications (training: area under the curve, 0.69; external validation: area under the curve, 0.80) and very early recurrence (training: C-index: 0.65; external validation: C-index: 0.71) models were favorable (see online calculator: <span><span>https://junkawashima.shinyapps.io/HCC_comp_VER/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>An easy-to-use online calculator stratified patients relative to short- and long-term risks, identifying a subset of patients at a high risk of severe complications and very early recurrence who were unlikely to benefit from surgical resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109527"},"PeriodicalIF":3.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489331","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: A long road to mastery.","authors":"Niccolò Napoli, Michael Ginesini, Ugo Boggi","doi":"10.1016/j.surg.2025.109514","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109514","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109514"},"PeriodicalIF":3.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512514","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}