Surgery最新文献

{"title":"Evolving surgical techniques for hepatolithiasis: A retrospective analysis of 164 liver resections at a Western center","authors":"Agostino Maria De Rose MD, PhD,&nbsp;Francesco Taliente MD,&nbsp;Elena Panettieri MD, PhD,&nbsp;Giovanni Moschetta MD,&nbsp;Francesco Belia MD,&nbsp;Francesco Ardito MD, PhD,&nbsp;Felice Giuliante MD","doi":"10.1016/j.surg.2025.109330","DOIUrl":"10.1016/j.surg.2025.109330","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the outcomes of liver resection for primary intrahepatic lithiasis in a Western population, emphasizing the evolution of surgical techniques, including minimally invasive surgery, and their impact on patient outcomes.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 164 patients who underwent liver resection for primary intrahepatic lithiasis at the Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. Data included demographics, surgical techniques, complications, and long-term outcomes. Minimally invasive surgery was introduced and progressively adopted, and its outcomes were compared with open surgery using propensity score matching. This represents the largest Western dataset on liver resection for primary intrahepatic lithiasis published to date.</div></div><div><h3>Results</h3><div>Liver resections were predominantly unilateral (96%) and commonly targeted the left liver (65%). Minimally invasive surgery use increased to 60% in the most recent period, showing reduced morbidity and shorter hospital stays compared with open surgery. Postoperative complications included bile fistula (16%) and septic events (30%). Independent risk factors for bile fistula were previous cholangitis (odds ratio, 4.7; <em>P</em> = .006) and major hepatectomy (odds ratio, 7.8; <em>P</em> = .002). Septic complications were associated with previous cholangitis (odds ratio, 2.3; <em>P</em> = .026), bilateral lithiasis (odds ratio, 4.0; <em>P</em> = .010), and major hepatectomy (odds ratio, 3.5; <em>P</em> = .003), with minimally invasive surgery providing a protective effect (odds ratio, 0.34; <em>P</em> = .028). Long-term follow-up revealed a 20% recurrence rate, linked to incomplete intraoperative stone clearance (hazard ratio, 2.645; <em>P</em> = .019) and biliary fistula (hazard ratio, 2.799; <em>P</em> = .016). Cholangiocarcinoma occurred in 6.6%, underscoring the need for surveillance.</div></div><div><h3>Conclusion</h3><div>Liver resection is an effective, curative treatment for primary intrahepatic lithiasis in Western populations. Minimally invasive surgery advancements significantly improve short-term outcomes, bridging the East-West gap in primary intrahepatic lithiasis management and highlighting the importance of individualized surgical approaches.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109330"},"PeriodicalIF":3.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746420","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":"Navigating the learning curve of robotic pancreatoduodenectomy: Competency, proficiency, and mastery in a first-generation robotic surgeon with established open pancreatic expertise.","authors":"Niccolò Napoli, Michael Ginesini, Emanuele Federico Kauffmann, Linda Barbarello, Fabio Caniglia, Francesca Costa, Carlo Lombardo, Vittorio Grazio Perrone, Virginia Viti, Gabriella Amorese, Ugo Boggi","doi":"10.1016/j.surg.2025.109347","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109347","url":null,"abstract":"<p><strong>Objective: </strong>This study delineates the learning curve of robotic pancreatoduodenectomy for first-generation surgeons, using the Comprehensive Complication Index to assess patient outcomes.</p><p><strong>Background: </strong>Robotic pancreatoduodenectomy is a promising alternative to open pancreatoduodenectomy, but patient safety and quality of outcomes during the learning phase remain critical.</p><p><strong>Methods: </strong>We retrospectively analyzed 313 consecutive robotic pancreatoduodenectomies performed by a single surgeon. The cumulative-sum method defined the learning curve, and Comprehensive Complication Index, adjusted for robotic pancreatoduodenectomy difficulty by PD-ROBOSCORE, was the dependent variable.</p><p><strong>Results: </strong>The median PD-ROBOSCORE was 8 (4.8-10.9), and the median Comprehensive Complication Index was 29.6 (20.9-39.5). At 90 days, severe morbidity and mortality rates were 24% and 5.4%, respectively. Three learning phases were identified: competency (63 procedures), proficiency (176), and mastery (263). Early phases involved simpler cases, whereas later phases showed greater complexity and a higher proportion of patients with ASA scores >2. Pancreatic cancer cases tripled in phases 2 and 3. Each phase showed progressive reductions in operative time and Comprehensive Complication Index. The mastery phase demonstrated further improvements in Comprehensive Complication Index, lymph node harvest, and margin status. Compared with proficiency, mastery saw improved outcomes in delayed gastric emptying, harvested lymph nodes, and R1 rates in pancreatic cancer. Operative time was longer, but morbidity and mortality remained stable.</p><p><strong>Conclusion: </strong>The robotic pancreatoduodenectomy learning process involves competency, proficiency, and mastery phases. Structured training programs may accelerate this learning curve, but high procedural volumes are essential to improve outcomes. Future studies should account for surgeon experience and case complexity when evaluating robotic pancreatoduodenectomy outcomes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109347"},"PeriodicalIF":3.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781095","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":"Letter to the editor: Predicting suicide risk in patients with digestive system tumors: A retrospective cohort study.","authors":"Pincheng Luo, Cheong Wong Ho, Yanxue Lian","doi":"10.1016/j.surg.2025.109170","DOIUrl":"10.1016/j.surg.2025.109170","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109170"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383323","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":"Letter to the editor regarding: \"Emodin alleviates intestinal ischemia/reperfusion-induced lung injury by upregulating HO-1 expression via PI3K/AkT pathway\".","authors":"Liqi Li","doi":"10.1016/j.surg.2024.07.053","DOIUrl":"10.1016/j.surg.2024.07.053","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"108766"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146385","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":"Letter to the editor regarding \"Vulnerable populations and the emergency ventral hernia: A retrospective cohort study\".","authors":"Guangli Cao, Huade Luo, Xiaoyan Hu, Yingying Kong","doi":"10.1016/j.surg.2024.09.011","DOIUrl":"10.1016/j.surg.2024.09.011","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"108849"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475285","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":"Enabling future military medical education and training","authors":"Richard W. Thomas MD, DDS, MSS, FACS ,&nbsp;Jason L. Turner MD","doi":"10.1016/j.surg.2025.109315","DOIUrl":"10.1016/j.surg.2025.109315","url":null,"abstract":"<div><div>Major advances in injury care have been fostered as a natural consequence of war. Likewise, the culmination of each conflict has been associated with a subsequent decrement in trauma care knowledge and experience secondary to the impact of competing health care priorities, loss of institutional knowledge, and perhaps, most importantly, a lack of lead emphasis. This lack of emphasis by senior civilian and military leaders to effectively advocate for resources has left our US military medical forces ill-prepared to respond to the next pandemic, terrorist attacks, natural disasters, or war. For us to fight and win our nation's wars, we must have immediate support to continue to evolve and improve our medical capabilities. An essential aspect of US military medicine is the partnerships with foreign nations that enable the sharing of lessons learned and technologies that enhance health care delivery during conflicts. Only through appropriate allocation of resources, continuing partnerships between the United States and our international medical partners, and the development and application of new technologies will US military medicine be able to adequately support the warfighter in future conflicts with near-peer adversaries.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109315"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738214","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":"Reply to the letter to the editor: Predicting suicide risk in patients with digestive system tumors: A retrospective cohort study.","authors":"Weibo Li, Longjiang Chen, Wei Wang, Hong Zhou, Lulu Zhai","doi":"10.1016/j.surg.2025.109266","DOIUrl":"10.1016/j.surg.2025.109266","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109266"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477120","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 population-based analysis of primary colonic lymphoma: Patterns of care and outcomes","authors":"Lindsay L. Welton MD ,&nbsp;Julia F. Kohn MD ,&nbsp;Alexander M. Troester MD ,&nbsp;Wyatt Tarter MS ,&nbsp;Schelomo Marmor PhD, MPH ,&nbsp;Jacob C. Cogan MD ,&nbsp;Genevieve B. Melton MD, PhD ,&nbsp;Paolo Goffredo MD","doi":"10.1016/j.surg.2025.109346","DOIUrl":"10.1016/j.surg.2025.109346","url":null,"abstract":"<div><h3>Background</h3><div>Primary colorectal lymphoma is a rare malignancy (∼1%) with a rising incidence over the last 3 decades. Treatment is not standardized and includes combinations of chemotherapy, surgery, and radiation. The aim of this study was to describe patterns of care and outcomes of primary colorectal lymphoma in a US population-based cohort.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results Database was queried to identify adults diagnosed with primary colorectal lymphoma, 2000–2015. Logistic regression and cox proportional hazard models estimated the effects of patient factors on treatment received, and survival, respectively.</div></div><div><h3>Results</h3><div>Of 1,721 patients (52% aged ≥65 years, 62% male, 80% White) 21% underwent chemotherapy alone, 31% surgery only, 22% surgery + chemotherapy, 8% radiation, and 18% no treatment. Multinomial analysis showed age, race, marital status, stage, histology, and lymphoma location were significantly associated with treatment received. No treatment was associated with older age. Proximal lesions more often underwent surgery + chemotherapy. After adjustment, factors associated with worse overall and disease-specific survival included age, sex, race, stage, and histology. No treatment was associated with lower overall survival when compared to chemotherapy, whereas surgery + chemotherapy had better prognosis.</div></div><div><h3>Conclusion</h3><div>In this population-based cohort, ∼20% of patients did not receive any treatment, which was associated with increasing age and worse survival. Patients with proximal lesions were more likely to undergo surgery + chemotherapy, with improved prognosis, possibly suggesting localized disease amenable to surgical resection and systemic treatment may lead to better oncologic outcomes, and elderly and Black individuals had worse survival rates, suggesting potential disparities extending to these subsets of patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109346"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725387","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 significance of the cachexia index for patients with perihilar cholangiocarcinoma","authors":"Katsuya Sakashita MD ,&nbsp;Shimpei Otsuka MD, PhD ,&nbsp;Ryo Ashida MD, PhD ,&nbsp;Katsuhisa Ohgi MD ,&nbsp;Yoshiyasu Kato MD, PhD ,&nbsp;Hideyuki Dei MD ,&nbsp;Akifumi Notsu PhD ,&nbsp;Katsuhiko Uesaka MD, PhD ,&nbsp;Teiichi Sugiura MD, PhD","doi":"10.1016/j.surg.2025.109344","DOIUrl":"10.1016/j.surg.2025.109344","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic value of the preoperative cachexia index for patients with perihilar cholangiocarcinoma remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 236 patients who underwent radical resection for perihilar cholangiocarcinoma from September 2002 to December 2020. The cachexia index was calculated as follows: (skeletal muscle index × albumin level)/neutrophil-to-lymphocyte ratio, with sex-specific cutoff values determined via receiver operating characteristic curves on the basis of 3-year survival data. Clinicopathologic characteristics and survival outcomes were compared between the low-cachexia index (<em>n</em> = 95) and high-cachexia index (<em>n</em> = 141) groups. Multivariable analyses were performed to identify prognostic factors for overall survival and relapse-free survival.</div></div><div><h3>Results</h3><div>The low-cachexia index group was characterized by greater carbohydrate antigen 19–9 level (56 vs 31 U/mL, <em>P</em> = .024) and greater proportion of preoperative biliary drainage (84% vs 70%, <em>P</em> = .013). The low-cachexia index group underwent vascular resection and reconstruction more frequently (47% vs 29%, <em>P</em> = .006) and had a greater rate of lymph node metastasis (54% vs 35%, <em>P</em> = .005). The median overall survival and relapse-free survival times of the low-cachexia index group were significantly worse than those of the high-cachexia index group (overall survival, 29.0 vs 47.4 months, <em>P</em> &lt; .001; relapse-free survival, 17.2 vs 33.1 months, <em>P</em> &lt; .001). Multivariable analysis revealed that a preoperative cachexia index (hazard ratio for overall survival, 0.95, <em>P</em> = .008; hazard ratio for relapse-free survival, 0.95, <em>P</em> = .017) and high preoperative carbohydrate antigen 19-9 level (hazard ratio for overall survival, 1.01, <em>P</em> = .002; hazard ratio for relapse-free survival, 1.01, <em>P</em> = .012) were prognostic factors.</div></div><div><h3>Conclusion</h3><div>The cachexia index may be a useful biomarker for the prediction of tumor aggressiveness and prognosis before perihilar cholangiocarcinoma resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109344"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725500","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":"Letter to the editor on: \"The effects of socioeconomic status on complex ventral hernia repair operative decision-making and outcomes\".","authors":"Zain Ul Abideen, Areena Fatima, Muhammad Junaid","doi":"10.1016/j.surg.2025.109338","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109338","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109338"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744001","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}