Surgery最新文献

{"title":"Risk assessment of lymph node metastasis in early gastric cancer patients with vagus nerve–preserving gastrectomy: A multiple centers potential analysis in China","authors":"Xinyu Wang MD ,&nbsp;Xiangyu Wang MD ,&nbsp;Qi You MD ,&nbsp;Kun Yang MD ,&nbsp;Zhiqiang Liu MD ,&nbsp;Zuli Yang MD ,&nbsp;Tong Zhou MD ,&nbsp;Yong Li MD ,&nbsp;Yi Zeng MD ,&nbsp;Haitao Hu MD ,&nbsp;RuPeng Zhang MD ,&nbsp;Han Liang MD ,&nbsp;Tao Zhang MD ,&nbsp;Yantao Tian MD ,&nbsp;Zaisheng Ye MD ,&nbsp;Bin Ke MD ,&nbsp;Jingyu Deng MD","doi":"10.1016/j.surg.2025.109411","DOIUrl":"10.1016/j.surg.2025.109411","url":null,"abstract":"<div><h3>Background</h3><div>Vagus nerve–preserving gastrectomy is gaining popularity for early gastric cancer treatment. This study assesses vagus nerve–preserving gastrectomy's perioperative safety and impact on postoperative quality of life, and explores vagus nerve–associated lymph node metastasis to create a risk model for enhanced therapy.</div></div><div><h3>Methods</h3><div>Clinicopathologic data from 1,210 early gastric cancer patients across 11 Chinese centers were analyzed, and the data of 800 patients with follow-up information and 48 patients who underwent vagus nerve–preserving gastrectomy for validation were collected. Propensity score matching was applied to the analysis of perioperative safety and quality of life in vagus nerve–preserving gastrectomy patients. A 6-point risk assessment model was devised and validated to evaluate the risk of vagus nerve–associated lymph node metastasis after vagus nerve–preserving gastrectomy in early gastric cancer patients.</div></div><div><h3>Results</h3><div>Vagus nerve–preserving gastrectomy patients had shorter postoperative stays, quicker drainage cessation, and fewer incidences of diarrhea, acid reflux, and postoperative gallstones. Additionally, key independent risk factors for vagus nerve–associated lymph node metastasis included tumor size, differentiation type, invasion depth, and lymphatic vessel invasion. Using these factors, a 6-point risk assessment model was established. The values of the area under the receiver operating characteristic curve for the model were 0.796, 0.806, 0.808, and 0.829 in the training cohort, internal validation cohort, external validation cohort, and vagus nerve–preserving gastrectomy cohort, respectively. The model effectively differentiated between high- and low-risk groups in terms of postoperative survival.</div></div><div><h3>Conclusions</h3><div>Vagus nerve–preserving gastrectomy can improve the patients' postoperative quality of life and ensure safety in the perioperative period. The vagus nerve–associated lymph node metastasis risk assessment model is a crucial tool in guiding the selection of optimal surgical procedures and treatment strategies for early gastric cancer patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109411"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941172","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":"Clustering of burns with other types of injury in patients younger than 10 years of age","authors":"Gabrielle Kang-Auger MD, MSc(c) ,&nbsp;Daniel E. Borsuk MD, MBA, FRCSC, FACS ,&nbsp;Andrée-Anne Roy MD, MSc, FRCSC ,&nbsp;Aimina Ayoub MSc ,&nbsp;Nathalie Auger MD, MSc, FRCPC ,&nbsp;Gabriel Côté-Corriveau MD, MSc, FRCPC","doi":"10.1016/j.surg.2025.109409","DOIUrl":"10.1016/j.surg.2025.109409","url":null,"abstract":"<div><h3>Background</h3><div>Childhood burns may cluster with other trauma, but the relationship between burns and other injuries is poorly understood. The objective of this study was to determine the association between burns and other types of injury hospitalization in children younger than age 10 years.</div></div><div><h3>Methods</h3><div>We carried out a multicenter cohort study of 4,262 patients aged younger than 10 years with burns who were matched with 40,518 controls in Quebec, Canada. The main exposure measure was a burn requiring hospital treatment. The main outcome was hospitalization for other types of injury anytime between birth and age 10 years. We used Cox regression models adjusted for patient characteristics to assess the association (hazard ratio; 95% confidence interval) between burns and risk of other injury hospitalization.</div></div><div><h3>Results</h3><div>Patients with burns had a greater rate of hospitalization for other types of injury than controls (7.6 vs 5.1 per 1,000 person-years), equivalent to 1.46 times greater risk (95% confidence interval, 1.29–1.65). Compared with controls, patients with burns were 1.61 times more likely to have an injury hospitalization between age 0 and &lt;5 years (95% confidence interval, 1.39–1.88) and 1.25 times more likely between age 5 and &lt;10 years (95% confidence interval, 1.02–1.52). Patients with burns were 4.74 times more likely to have been hospitalized for a maltreatment injury before their burn (95% confidence interval, 2.68–8.38).</div></div><div><h3>Conclusion</h3><div>Children with burns are at high risk of hospitalization for other injuries before age 10 years. A better understanding of how pediatric injuries cluster with burns may help prevent child trauma.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109409"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941749","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":"Response to letter to the editor on: “Prognostic relevance of lymph node metastasis in pancreaticoduodenectomy for distal cholangiocarcinoma: Rational extent and number-based nodal classification for regional lymphadenectomy”","authors":"Yuki Hirose MD, PhD,&nbsp;Jun Sakata MD, PhD,&nbsp;Tatsuya Nomura MD, PhD,&nbsp;Kabuto Takano MD, PhD,&nbsp;Kazuyasu Takizawa MD, PhD,&nbsp;Kohei Miura MD, PhD,&nbsp;Hirosuke Ishikawa MD, PhD,&nbsp;Koji Toge MD, PhD,&nbsp;Takuya Ando MD, PhD,&nbsp;Shun Abe MD, PhD,&nbsp;Yusuke Kawachi MD,&nbsp;Hiroshi Ichikawa MD, PhD,&nbsp;Yoshifumi Shimada MD, PhD,&nbsp;Toshifumi Wakai MD, PhD, FACS","doi":"10.1016/j.surg.2025.109400","DOIUrl":"10.1016/j.surg.2025.109400","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109400"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080424","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":"Retrospective analysis of surgical pancreatic necrosectomy outcomes in patients with and without obesity","authors":"Roberto J. Valera MD ,&nbsp;Mir Shanaz Hossain MD ,&nbsp;Ronit Patnaik MD ,&nbsp;Cesar Valdivieso MD ,&nbsp;Lisandro Montorfano MD ,&nbsp;Albert Parlade MD ,&nbsp;Toms Augustin MD ,&nbsp;R. Matthew Walsh MD ,&nbsp;Conrad H. Simpfendorfer MD ,&nbsp;Mayank Roy MD","doi":"10.1016/j.surg.2025.109410","DOIUrl":"10.1016/j.surg.2025.109410","url":null,"abstract":"<div><h3>Background</h3><div>Acute necrotizing pancreatitis is associated with high morbidity and mortality. This study aims to compare surgical necrosectomy outcomes in acute necrotizing pancreatitis between patients with and without obesity.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed for all patients who underwent surgical necrosectomy via a minimally invasive approach or an open approach over a 10-year period at a large US healthcare system. Patients were divided into 2 groups: those with obesity (body mass index ≥30 kg/m²) and those without obesity (body mass index &lt;30 kg/m²). The primary end point was the incidence of early complications or postoperative death within 30 and 90 days. The secondary end point was the incidence of long-term complications.</div></div><div><h3>Results</h3><div>In total, 80 patients were included with 36 (45%) with obesity, and 44 (55%) without obesity. A total of 52 patients (65%) had an open approach and 28 (35%) had an minimally invasive approach. The average age was 54.79 ± 15.25 years, and the median follow-up time was 83.5 days (interquartile range, 40.25–149.75 days). The median body mass index of the patient group with obesity was 34.55 kg/m² (interquartile range, 31.55–40.61), and that for the patient group without obesity was 25.97 kg/m² (interquartile range, 23.22–28.35 kg/m²) (<em>P</em> ≤ .0001). Days from admission to surgical intervention was longer in obese patients but it was not statistically significant (44.50 [interquartile range, 12–88] vs 27 [interquartile range, 15–42.5], <em>P</em> = .831). 30 and 90-day complication rates and mortality were similar between the groups.</div></div><div><h3>Conclusion</h3><div>Operative outcomes of pancreatic necrosectomy in patients with obesity appears to be comparable with patients without obesity. Surgical pancreatic necrosectomy can be performed safely, effectively, and in a similar time frame regardless of the presence of obesity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109410"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941151","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":"SHapley Additive exPlanations (SHAP)-based, multivariate machine-learning techniques with external validation: Construction of a preoperative interpretable predictive model for intestinal resection of incarcerated inguinal hernia","authors":"Zheqi Zhou MD ,&nbsp;Cong Tong MD ,&nbsp;Yiliang Li MD ,&nbsp;Aikebaier Aili PhD ,&nbsp;Maimaitiaili Maimaitiming MD ,&nbsp;Tao Hong MD ,&nbsp;Mirezati Maimaiti MD ,&nbsp;Yusujiang Tusuntuoheti MD ,&nbsp;Kelimu Abudureyimu MD ,&nbsp;Likun Yan MD","doi":"10.1016/j.surg.2025.109406","DOIUrl":"10.1016/j.surg.2025.109406","url":null,"abstract":"<div><h3>Background</h3><div>Currently, there are a lack of effective tools for preoperative risk assessment of intestinal resection in patients with inguinal incarcerated hernia. The purpose of this study is to investigate the variable characteristics associated with intestinal resection and develop an interpretable preoperative prediction model, aiming to assist clinicians in preoperative risk for intestinal resection in patients with inguinal incarcerated hernia.</div></div><div><h3>Methods</h3><div>The data from 2 medical institutions were retrospectively collected, and they were grouped according to whether intestinal resection was performed intraoperatively and the pathologic results. Lasso and multifactor logistic regression screened variables, and 10 machine-learning algorithms built and validated the model, with evaluation using the confusion matrix and SHapley Additive exPlanations value.</div></div><div><h3>Results</h3><div>Lasso regression and multifactorial logistic regression analyses showed that peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein were the key characteristic variables. The area under curve of models constructed by 10 algorithms in the external validation set were all above 0.8, and the k-nearest neighbor algorithm had the most comprehensive model performance. The constructed model exhibits good predictive performance on the external validation set.</div></div><div><h3>Conclusion</h3><div>Accurate preoperative prediction of intraoperative intestinal ischemia in patients with incarcerated inguinal hernia is crucial. This study identified peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein as characteristic variables for predicting intraoperative intestinal ischemia in these patients. The constructed prediction model can assist clinicians in more accurately assessing intestinal viability during surgery, offering valuable insights for evaluating intestinal resection risk.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109406"},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937435","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":"OptLung: An online predictive model for optimizing therapeutic strategies for second primary lung cancer in cancer survivors","authors":"Tingting Tang MD ,&nbsp;Guang Li MD ,&nbsp;Junwen Pei MD ,&nbsp;Hangyan Du MD ,&nbsp;Fei Ding MD ,&nbsp;Jianjun Wang MD ,&nbsp;Guangliang Duan MD","doi":"10.1016/j.surg.2025.109376","DOIUrl":"10.1016/j.surg.2025.109376","url":null,"abstract":"<div><h3>Background</h3><div>Advances in cancer detection and treatment have significantly improved survival rates and led to an increasing prevalence of the second primary lung malignancy among cancer survivors. The prognosis and optimal treatment strategies of second primary lung malignancy differ substantially from those of first primary lung cancers. Existing prognostic models primarily focus on the first primary lung cancers and offer limited guidance for personalized treatment strategies to patients with second primary lung malignancy.</div></div><div><h3>Methods</h3><div>We identified patients with second primary lung malignancy who met the inclusion criteria in the Surveillance, Epidemiology, and End Results database. Machine learning models, including classification trees, K-nearest neighbors, gradient boosting machine, neural network, and random forest, were developed to predict 1- to 5-year overall survival and cancer-specific survival. The dataset was split into training and testing sets (8:2 ratio), and the model performance was evaluated using area under the curve, accuracy, sensitivity, specificity, precision, F1 scores, and Brier scores. By comparing survival outcomes between the concordant group (patients whose treatments aligned with model recommendations) and the discordant group (patients whose treatments did not), the ability of models to recommend optimal therapeutic strategy was validated.</div></div><div><h3>Results</h3><div>Among 32,370 patients with second primary lung malignancy from the Surveillance, Epidemiology, and End Results database, factors associated with worse prognosis included older age, male sex, White race, unmarried status, nonadenocarcinoma histology, advanced T and N stages, and advanced American Joint Committee on Cancer stage. Conversely, smaller tumor size, surgical intervention, chemotherapy, and radiotherapy were associated with improved prognosis. The gradient boosting machine model exhibited superior predictive performance for overall survival and cancer-specific survival and achieved area under the curve values exceeding 0.84 across all time points. Therapeutic recommendations from models proved effective because the concordant group demonstrated significantly better overall survival and cancer-specific survival than the discordant group. To enhance the clinical applicability of treatment recommendations by machine-learning models, an interactive web-based tool, OptLung (<span><span>https://hznuduan.shinyapps.io/OptLung/</span><svg><path></path></svg></span>), was developed.</div></div><div><h3>Conclusion</h3><div>This study used machine-learning models to accurately predict the survival curve of patients with second primary lung malignancy. These models built a user-friendly web-based platform where clinicians can obtain the optimal therapeutic strategy for patients with second primary lung malignancy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109376"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937541","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 \"Differential MYC and PROM1 mRNA isoform expression in breast invasive carcinoma as biomarkers for subtyping and prognosis\".","authors":"Chang Liu, Shidi Yuan, Zhichun Liu","doi":"10.1016/j.surg.2025.109401","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109401","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109401"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062272","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 literature review on the role of artificial intelligence–based chatbots in patient education in colorectal surgery","authors":"Laura Garcia Garcia MD ,&nbsp;Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Lakshmi Linkeshwaran ,&nbsp;Anjelli Wignakumar MBBS, BSc (Hons) ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109393","DOIUrl":"10.1016/j.surg.2025.109393","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence–based chatbots are becoming increasingly used in patient education, in the realm of colorectal diseases. Perhaps, not surprisingly, concerns about the appropriateness of chatbot answers have been raised by healthcare professionals. Numerous studies have explored the utility and accuracy of chatbots in providing information in several clinical disciplines. This review aimed to summarize the findings of published studies, highlighting the strengths and limitations of chatbots used in medical education for colorectal surgery.</div></div><div><h3>Methods</h3><div>We searched MEDLINE via PubMed and Scopus in February 2025 for original articles evaluating artificial intelligence–based chatbots in patient education related to colorectal surgery, categorizing them into 3 groups: colorectal cancer, inflammatory bowel diseases, and other colorectal conditions.</div></div><div><h3>Results</h3><div>We identified 15 studies, 9 assessed chatbot utility in patient education in colorectal cancer, 4 assessed their utility in inflammatory bowel diseases, 1 involved benign anal conditions, and another involved intestinal stomas. Our findings indicated that chatbots, particularly ChatGPT, can improve patient education by providing accessible information on common questions. However, we also identified several limitations of the ability of chatbots to address complex medical issues which underscored that these tools may complement rather than replace professional medical guidance.</div></div><div><h3>Conclusion</h3><div>Chatbots may be useful for patient education related to simple and basic information, but not in complex and patient-specific settings. Future research should focus on refining chatbot algorithms to enhance the accuracy and depth of their responses, ensuring they effectively support patient education while maintaining the crucial role of healthcare providers.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109393"},"PeriodicalIF":3.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928834","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":"Comprehensive comparison of technical performance, surgical outcomes, and oncologic prognosis between remnant gastric cancer and primary upper-third gastric cancer in the era of minimally invasive surgery: A pooled analysis of 3 prospective trials","authors":"Dong Wu MD ,&nbsp;Qing Zhong PhD ,&nbsp;Zhi-quan Zhang MD ,&nbsp;Shu-Qin Liu MD ,&nbsp;Tao-yuan Qiu MD ,&nbsp;Jun-yu Chen MD ,&nbsp;Yi-ming Jiang MD ,&nbsp;Guang-tan Lin PhD ,&nbsp;Zhi-yu Liu PhD ,&nbsp;Zhi-xin Shang-guan MD ,&nbsp;Yu-qin Sun MD ,&nbsp;Chao-Hui Zheng PhD ,&nbsp;Ping Li PhD ,&nbsp;Jian-Wei Xie PhD ,&nbsp;Jian-Xian Lin PhD ,&nbsp;Qi-Yue Chen PhD ,&nbsp;Chang-Ming Huang MD, FACS","doi":"10.1016/j.surg.2025.109395","DOIUrl":"10.1016/j.surg.2025.109395","url":null,"abstract":"<div><h3>Background and Objective</h3><div>To compare the technical performances and short- and long-term outcomes of laparoscopic total gastrectomy for remnant gastric cancer and primary upper gastric cancer.</div></div><div><h3>Methods</h3><div>This prospective study (FUGES-004 study) enrolled 50 remnant gastric cancer patients who underwent laparoscopic total gastrectomy at Fujian Medical University Union Hospital between June 2016 and June 2020 (ClinicalTrials.gov identifier: NCT02792881). Propensity score matching (1:2) was used to select upper gastric cancer patients who underwent laparoscopic total gastrectomy in the FUGES-001 and FUGES-002 studies. Technical performance was assessed using the General Error Reporting Tool, Objective Structured Assessment of Technical Skills (OSATS), and Intraoperative Complication Classification.</div></div><div><h3>Results</h3><div>After matching, 46 remnant gastric cancer and 92 upper gastric cancer patients were included in the final analysis. Abdominal adhesions in the epigastrium, central abdomen, and bowel-to-bowel regions were more severe in the remnant gastric cancer group (<em>P</em> &lt; .001). The remnant gastric cancer group had more technical errors and intraoperative adverse events (especially grade I bleeding) during surgery (<em>P</em> &lt; .05). However, the Objective Structured Assessment of Technical Skills scores were comparable between the remnant gastric cancer and upper gastric cancer groups (30.8 vs 31.0, <em>P</em> = .799). Although the severe postoperative complication rates were similar between the 2 groups (<em>P</em> = .333), the postoperative complication rate was significantly higher in the remnant gastric cancer group (28.3% vs 7.6%, <em>P</em> = .001). Additionally, the long-term oncologic outcomes (including 3-year disease-free survival, overall survival, and recurrence pattern) were comparable between the remnant gastric cancer and upper gastric cancer groups (log-rank <em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Although the long-term oncologic outcomes were comparable between the groups, the remnant gastric cancer group had more intraoperative errors and adverse events and higher postoperative complication rates than the upper gastric cancer group. For complex remnant gastric cancer cases, laparoscopic total gastrectomy may serve as an effective therapeutic option. However, experienced surgeons at high-volume centers should exercise caution when performing laparoscopic total gastrectomy and implement more rigorous perioperative management strategies.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109395"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918340","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":"Neoadjuvant chemotherapy improves overall survival in stage III but not in stage II colon cancer: A propensity score–matched analysis of the National Cancer Database","authors":"Nir Horesh MD ,&nbsp;Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Michael R. Freund MD ,&nbsp;Zoe Garoufalia MD ,&nbsp;Rachel Gefen MD ,&nbsp;Peige Zhou MD ,&nbsp;Arun Nagarajan MD ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109389","DOIUrl":"10.1016/j.surg.2025.109389","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant chemotherapy has been recently suggested for advanced colon cancer, but little is known about the impact on short-term outcomes and overall survival. In this study, we aimed to evaluate the effect of neoadjuvant chemotherapy on survival in stage II-III colonic adenocarcinoma.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the colon cancer US National Cancer Database from 2006 to 2019 was performed. Patients treated with neoadjuvant chemotherapy were matched using propensity score to controls (ratio 1:1). The primary outcome was 5-year overall survival.</div></div><div><h3>Results</h3><div>In total, 1,275 patients (1.3%) with clinical stage II-III colonic adenocarcinoma received neoadjuvant chemotherapy. After matching, the neoadjuvant chemotherapy group included 783 patients. The restricted mean 5-year overall survival in the neoadjuvant chemotherapy group was significantly higher compared with controls (48.9 vs 44.9 months, <em>P</em> = .003). Stratified by disease stage, neoadjuvant chemotherapy was associated with a significantly longer overall survival (47.5 vs 41.2 months; <em>P</em> = .001) in stage III while showing an equivalent overall survival in stage II (50.3 vs 48.6 months; <em>P</em> = .2). The benefit in overall survival was pronounced in stage T4 and positive nodal disease. Cox regression analysis in patients with stage III revealed that neoadjuvant chemotherapy was associated with a 21% reduction in mortality risk (hazard ratio, 0.79; 95% confidence interval, 0.65–0.96; <em>P</em> = .01). Neoadjuvant chemotherapy was associated with lower rates of 30-day readmission (3.5% vs 7.4%, <em>P</em> = .001), 30-day mortality (0.9% vs 3.8%, <em>P</em> &lt; .001), and 90-day mortality (2.9% vs 8.5%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Preoperative neoadjuvant chemotherapy is associated with improved overall survival in patients with stage III colon cancer, mainly in patients with T4 disease.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109389"},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922582","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}