Surgery最新文献

{"title":"Letter to the editor: The propensity score matching paradox does not pose a valid concern for propensity score-matched studies.","authors":"Fei Wan","doi":"10.1016/j.surg.2025.109348","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109348","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109348"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049417","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":"Assessing the role of immunonutrition in enhanced recovery after surgery programs for colorectal surgery: Insights and methodologic considerations.","authors":"Ya-Jie Wang, Yi-Nuo Wang, Mei Feng","doi":"10.1016/j.surg.2025.109366","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109366","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109366"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000519","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}

{"title":"Portal flow modulation by splenic artery ligation to prevent posthepatectomy liver failure: A randomized controlled trial.","authors":"Sunhawit Junrungsee, Witcha Vipudhamorn, Worakitti Lapisatepun, Asara Thepbunchonchai, Anon Chotirosniramit, Warangkana Lapisatepun, Wasana Ko-Iam","doi":"10.1016/j.surg.2025.109351","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109351","url":null,"abstract":"<p><strong>Background: </strong>Posthepatectomy liver failure is a serious clinical issue with high mortality, similar in pathophysiology to small-for-size syndrome seen in liver transplantation. This study evaluates the efficacy of splenic artery ligation in reducing posthepatectomy liver failure in patients with portal venous pressure >15 mm Hg after hepatectomy.</p><p><strong>Methods: </strong>This single-center, randomized controlled trial was conducted from May 2019 to November 2023. Eligible participants were patients scheduled for open hepatectomy for any indication. Patients with a portal venous pressure >15 mm Hg were randomized into splenic artery ligation and control groups in a 1:1 ratio. The primary outcomes were posthepatectomy liver failure grades B and C (International Study group of Liver Surgery criteria), and secondary outcomes included 90-day mortality, comprehensive complication index, and ascites volume.</p><p><strong>Results: </strong>The study was terminated early, before reaching the calculated sample size, because the primary outcome in the intervention group demonstrated statistically significant results. Of the 92 patients, 36 had elevated portal venous pressure, which was associated with greater rates of posthepatectomy liver failure grades B and C (41.67% vs 3.57%, P < .001), increased ascites volume (5,340 mL vs 1,055 mL, P < .001), and a greater comprehensive complication index (20.90 vs 8.70, P < .001). In the randomized subset, splenic artery ligation significantly reduced portal venous pressure and the portal venous pressure-central venous pressure gradient compared with both presplenic artery ligation values and the control group and significantly lowered the incidence of posthepatectomy liver failure grades B and C (16.67% vs 66.67%, P = .006), comprehensive complication index (8.70 vs 20.90, P = .034). Splenic artery ligation was identified as an independent factor in reducing posthepatectomy liver failure (adjusted relative risk, 0.29).</p><p><strong>Conclusion: </strong>Splenic artery ligation is effective in reducing posthepatectomy liver failure in patients with high portal venous pressure after hepatectomy.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109351"},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039804","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":"Comment on: \"Recurrence and treatment trends of pancreatic neuroendocrine tumors\".","authors":"Youbao Huang, Jiesi Lin","doi":"10.1016/j.surg.2025.109349","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109349","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109349"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812450","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":"C-reactive protein-to-albumin ratio predicts outcome of neoadjuvant chemotherapy for colorectal liver metastases: A multicenter prediction model","authors":"Tao Zheng MS ,&nbsp;Yuanyuan Zheng PhD ,&nbsp;Zhenyuan Zhou MS ,&nbsp;Rong Ye MS ,&nbsp;Hangdong Jia MS ,&nbsp;Weijie Chen MS ,&nbsp;Ming Zheng PhD ,&nbsp;Yizhen Chen PhD","doi":"10.1016/j.surg.2025.109334","DOIUrl":"10.1016/j.surg.2025.109334","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant chemotherapy for patients with colorectal liver metastasis often results in varying outcomes. This study aimed to develop a clinical prediction model incorporating the C-reactive protein-to-albumin ratio to determine neoadjuvant chemotherapy efficacy in patients with colorectal liver metastasis</div></div><div><h3>Methods</h3><div>This retrospective study included 1,335 patients with colorectal liver metastasis who received neoadjuvant chemotherapy. Patients were classified into high and low C-reactive protein-to-albumin ratio groups on the basis of an optimal cutoff value. Multivariate regression and Cox proportional hazards models were used to examine associations between clinical factors and progression-free survival. A prediction model was constructed and validated both internally and externally.</div></div><div><h3>Results</h3><div>The optimal C-reactive protein-to-albumin ratio cutoff value was 0.234. Patients with a high C-reactive protein-to-albumin ratio had a greater risk of 3-year disease progression and shorter 5-year survival (both <em>P</em> &lt; .05). The final model incorporated C-reactive protein-to-albumin ratio value, clinical risk score, and tumor differentiation. It demonstrated excellent performance in predicting progression-free survival (C-index = 0.69) and OS (C-index = 0.72), outperforming the clinical risk score alone in both internal and external validations.</div></div><div><h3>Conclusion</h3><div>The C-reactive protein-to-albumin ratio is an effective independent predictor for patients with colorectal liver metastasis receiving neoadjuvant chemotherapy. The clinical prediction model exhibited superior predictive ability, potentially improving individualized treatment decisions patients with colorectal liver metastasis.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109334"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105252","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":"What have we learned about how a hospital's participation in a medicare accountable care organization influences care, cost, and outcomes of patients with gastrointestinal cancer?","authors":"Elizabeth B. Habermann PhD, MPH","doi":"10.1016/j.surg.2025.109342","DOIUrl":"10.1016/j.surg.2025.109342","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109342"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796551","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":"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}