Surgery最新文献

{"title":"Refining endoscopic submucosal dissection decision-making: Insights into risk stratification for early colorectal cancer.","authors":"Yumei Zhong, Rui Lai, Xinmin Deng","doi":"10.1016/j.surg.2025.109162","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109162","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109162"},"PeriodicalIF":3.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365998","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 to support, substantiate, improve, or challenge diversity, equity, and inclusion (DEI) policies in the biomedical sciences.","authors":"Jaime A Teixeira da Silva","doi":"10.1016/j.surg.2025.109166","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109166","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109166"},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256436","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":"Characteristics and role of surgery in nonagenarians with colorectal cancer: SEER database analysis","authors":"Rachel Gefen MD ,&nbsp;Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Zoe Garoufalia MD ,&nbsp;Nir Horesh MD ,&nbsp;Justin Dourado MD ,&nbsp;Steven D. Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.109161","DOIUrl":"10.1016/j.surg.2025.109161","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages, nonagenarian patients with cancer are more frequently treated. This study aimed to assess the characteristics of colon and rectal cancer in patients aged ≥90 years and to evaluate the role of surgical intervention in this age group.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included nonagenarian patients with colon and rectal cancer identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020. We assessed the characteristics of nonagenarian patients with colon and rectal cancer and compared patients who underwent surgery with patients who did not undergo surgery. The main outcome measure was the effect of having surgery on overall survival and cancer-specific survival in nonagenarian patients.</div></div><div><h3>Results</h3><div>A total of 23,149 nonagenarian patients were included, 65.2% of whom were female. The most common sites of cancer were the right colon (47.9%), the left colon (21.1%), and the rectum (19.1%). Early-stage colon and rectal cancer (stage I or II) accounted for 48.2% of cases. Approximately 30% of patients did not undergo any surgical intervention. Of the 89.2% patients who died, the cause was colon and rectal cancer in 42.9%. An 18- and 11-month survival benefit from having surgery was found in overall and cancer-specific survival, respectively. When stratified by tumor-node-metastasis stage, this survival benefit was more prominent in early-stage disease.</div></div><div><h3>Conclusion</h3><div>Our study indicates that nonagenarian patients with colon and rectal cancer had increased survival if they underwent surgery when compared to patients who were not surgically treated. Physicians should consider treating nonagenarian patients according to their preferences and wishes, general condition, and disease stage.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109161"},"PeriodicalIF":3.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of perioperative immunonutrition with anastomotic leak among patients undergoing elective colorectal surgery within a robust enhanced recovery after surgery program","authors":"Samuel A. Younan MD ,&nbsp;Danish Ali MD ,&nbsp;Alexander T. Hawkins MD, MPH ,&nbsp;Joel F. Bradley III MD ,&nbsp;M. Benjamin Hopkins MD ,&nbsp;Timothy Geiger MD, MMHC ,&nbsp;Jennifer Jayaram MSN, APRN-BC ,&nbsp;Aimal Khan MD","doi":"10.1016/j.surg.2025.109159","DOIUrl":"10.1016/j.surg.2025.109159","url":null,"abstract":"<div><h3>Background</h3><div>Immunonutrition supplementation has been shown to reduce the risk of surgical infectious complications; however, its effect on decreasing anastomotic leak rates, in the context of an otherwise robust Enhanced Recovery After Surgery (ERAS) program, remains unclear. This study aims to assess the association between perioperative immunonutrition supplementation and anastomotic leak in an elective Enhanced Recovery After Surgery colorectal surgical population.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-institution cohort study consisting of adult patients enrolled in an Enhanced Recovery After Surgery pathway and undergoing elective colorectal surgery from 2018 to 2023. Immunonutrition supplementation was defined as a 10-day perioperative supply of commercially available nutritional shakes. Relevant demographic covariates, preoperative characteristics, and operative methods were identified and analyzed. Multivariable logistic regression was performed to determine the association of immunonutrition with anastomotic leak.</div></div><div><h3>Results</h3><div>A total of 708 patients were included in the study, of which <em>n</em> = 400 (56.5%) received perioperative immunonutrition. Patients who received immunonutrition were more likely to be older (median age 57.9 vs 55.7), male (52.7% vs 44.8%), have a higher body mass index (27.7 vs 26.3), and less likely to be current smokers (9.8% vs 16.2%). On adjusted analysis, there was no association between immunonutrition use and anastomotic leak (odds ratio = 0.96, 95% confidence interval = 0.45, 2.08), 30-day readmission (odds ratio = 0.97, 95% confidence interval = 0.60, 1.57), or length of stay (β = .40, 95% confidence interval = –0.06, 0.86)</div></div><div><h3>Conclusion</h3><div>We did not observe an association between perioperative immunonutrition supplementation and postoperative anastomotic leak, suggesting that the role of immunonutrition within a comprehensive Enhanced Recovery After Surgery program for elective colorectal surgery may warrant further evaluation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109159"},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of postoperative visits for detecting complications in pediatric patients","authors":"Alyssa Stetson MD, MPH ,&nbsp;Tommy Kim BS ,&nbsp;Raissa Li BS ,&nbsp;David Chang MPH, PhD ,&nbsp;Cassandra Kelleher MD","doi":"10.1016/j.surg.2025.109158","DOIUrl":"10.1016/j.surg.2025.109158","url":null,"abstract":"<div><h3>Background</h3><div>Long wait times for new patient visits can delay necessary care and lead to patient dissatisfaction. Minimizing nonessential scheduled follow-up visits may increase surgeons’ availability to see new patients. Postoperative clinic visits are typically scheduled to detect complications. However, there is limited data on how often postoperative complications are diagnosed during scheduled follow-up visits versus during other encounters. We examined whether complications were routinely detected during scheduled follow-up visits after low-risk procedures in healthy children.</div></div><div><h3>Methods</h3><div>A single-center observational study was performed using Current Procedural Terminology/International Classification of Diseases codes and a chart review. Our cohort included patients who underwent appendectomy, inguinal hernia repair, pyloromyotomy, or circumcision between 2016 and 2023. A scheduled follow-up visit was defined as a postoperative clinic visit with a surgeon that was made ≥3 days before the clinic visit date and within 8 weeks of surgery. A complication that was diagnosed at an encounter other than the scheduled follow-up visit was defined as an “uncaptured complication.” The primary exposure was provider scheduled follow-up visit rate, and the primary outcome was rate of uncaptured complications.</div></div><div><h3>Results</h3><div>In total, 2,676 patients were included. Surgeon scheduled follow-up visit rate was categorized as low versus high based on the mean scheduled follow-up visit rate of 63%. The median rate of uncaptured complications for physicians with both a low scheduled follow-up visit rate and a high scheduled follow-up visit was 1.4% (<em>P</em> = .99). Even on adjusted analysis, high scheduled follow-up visit rate was not protective against uncaptured complications. Only procedure type and younger age were predictive of incidence of uncaptured complications.</div></div><div><h3>Conclusion</h3><div>Routine scheduled follow-up visits after low-risk operations in healthy children do not effectively capture postoperative complications. Implementing a culture of follow-up as needed could increase surgeon availability to see new patients in ambulatory clinics.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109158"},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144631","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: “Team member familiarity and team effectiveness in the operating room: The mediating effect of mutual trust and shared mental models”","authors":"Jingjing Zhang MM,&nbsp;Xiuqin Ni MM","doi":"10.1016/j.surg.2024.09.034","DOIUrl":"10.1016/j.surg.2024.09.034","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108884"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508440","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: “Effectiveness of intraoperative nerve monitoring in reducing rates of recurrent laryngeal nerve injury in aerodigestive and cardiovascular pediatric surgery”","authors":"Karuna Dewan MD, FACS","doi":"10.1016/j.surg.2024.09.022","DOIUrl":"10.1016/j.surg.2024.09.022","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108865"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547584","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":"Effect of systemic FOLFOXIRI plus bevacizumab treatment of colorectal peritoneal metastasis on local and systemic immune cells","authors":"Catharina Müller MD ,&nbsp;Andrea Macher-Beer MD ,&nbsp;Hanna Birnleitner MSc ,&nbsp;Marlene Rainer MD ,&nbsp;Monika Sachet PhD ,&nbsp;Rudolf Oehler PhD ,&nbsp;Thomas Bachleitner-Hofmann MD","doi":"10.1016/j.surg.2024.09.025","DOIUrl":"10.1016/j.surg.2024.09.025","url":null,"abstract":"<div><h3>Aim</h3><div>The immune system plays a crucial role in the outcome of colorectal cancer. Systemic chemotherapies modulate the immune cell composition. Little is known about these changes in peritoneal metastasized colorectal cancer. Thus, we aimed to characterize local and systemic immune cells in the course of systemic chemotherapy.</div></div><div><h3>Methods</h3><div>We included in total 20 patients with peritoneal metastasized colorectal cancer in our exploratory study. Initially, we investigated the peripheral blood cell distributions before and after systemic chemotherapy in a set of 11 retrospectively collected samples. Then, a prospective clinical cohort was set up to evaluate local and systemic immune cell distribution in detail (<em>n</em> = 9). Tumor tissue, peritoneal fluid, and peripheral blood were collected. The main immune cell subtypes were characterized using flow cytometry and immunohistochemistry, respectively.</div></div><div><h3>Results</h3><div>Neutrophils and the neutrophil-to-lymphocyte ratio significantly declined in response to systemic chemotherapy while circulating T cells increased (CD8⁺ <em>P</em> = .015, CD4⁺ <em>P</em> = .041). In peritoneal fluid, we observed a decrease of CD25⁺/FOXP3⁺/CD4⁺ regulatory T cells (<em>P</em> = .049) without loss of their ability to produce interferon gamma. T-cell infiltration in the tumor microenvironment showed a considerable variability between patients. However, the number of tumor-infiltrating CD8⁺ lymphocytes was not significantly changed by the application of systemic chemotherapy. Neither tumor cells nor lymphocytes or macrophages showed noteworthy expression of PD1 or PD-L1.</div></div><div><h3>Conclusion</h3><div>Our data show that immune cell distribution after systemic chemotherapy changes in peripheral blood. Interestingly, in peritoneal fluid only the inhibitory Treg population decreased and local T cells within peritoneal metastases remain unaffected. These data indicate little to no effect of systemic chemotherapy on the local immune system, supporting the need for new therapeutic options.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108868"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The path ahead: Navigating the changing diversity, equity, and inclusion landscape","authors":"Courtney Collins MD ,&nbsp;Marie L. Crandall MD, MPH","doi":"10.1016/j.surg.2024.09.049","DOIUrl":"10.1016/j.surg.2024.09.049","url":null,"abstract":"<div><div>The Supreme Court's ruling against the use of race as a consideration for higher education admissions programs has had a profound impact on diversity, equity, and inclusion efforts at many of our academic institutions. Many of us who understand the value of diversity in business and health care and who value equity are now confronted with a changing political landscape. Given these challenges and changes with respect to diversity, equity, and inclusion policies, it will be important for the surgical community to better codify the aspects of diversity that are beneficial and not specific to race, such as ability to overcome adversity, or the richness of the lived experience. It will become increasingly important to engage legislative bodies and implement institutional strategies to ensure the best outcomes for our patients and support an increasingly diverse surgical workforce.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108913"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710971","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":"Does obesity matter in patients receiving venoarterial extracorporeal membrane oxygenation? The U-shaped relationship between body mass index and mortality after extracorporeal cardiopulmonary resuscitation","authors":"Chen-Hsu Pai MD ,&nbsp;Jung-Chi Hsu MD, PhD ,&nbsp;Lian-Yu Lin MD, PhD ,&nbsp;Chih-Hsien Wang MD, PhD ,&nbsp;Ling-Yi Wei MD ,&nbsp;Nai-Hsin Chi MD, PhD ,&nbsp;Shu-Chien Huang MD, PhD ,&nbsp;Hsi-Yu Yu MD, PhD ,&nbsp;Nai Kuan Chou MD, PhD ,&nbsp;Ron-Bin Hsu MD, PhD ,&nbsp;Yih-Sharng Chen MD, PhD","doi":"10.1016/j.surg.2024.10.019","DOIUrl":"10.1016/j.surg.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>The impact of obesity on the prognosis of patients receiving venoarterial extracorporeal membrane oxygenation remains unclear. This study examines the association between body mass index and in-hospital mortality among patients on venoarterial extracorporeal membrane oxygenation support.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled adult patients who received venoarterial extracorporeal membrane oxygenation support, which included extracorporeal cardiopulmonary resuscitation, at National Taiwan University Hospital between 2010 and 2021. Patients were classified as follows: underweight (body mass index &lt;18.5), normal weight (18.5≤ body mass index &lt;24), overweight (24≤ body mass index &lt;27), class I obesity (27≤ body mass index &lt;30), class II obesity (30≤ body mass index &lt;35), and class III obesity (body mass index ≥35). Multivariable Cox regression with spline models was employed.</div></div><div><h3>Results</h3><div>The study included 1,329 patients; of these, 670 underwent extracorporeal cardiopulmonary resuscitation, and the overall mortality rate was 61.6%. Multivariable Cox regression revealed that class III obesity was significantly associated with higher mortality (hazard ratio 2.11, 95% confidence interval 1.48–3.02, <em>P</em> = .001), particularly in the extracorporeal cardiopulmonary resuscitation subgroup (hazard ratio 2.71, 95% confidence interval 1.71–4.29, <em>P</em> &lt; .001). No significant association was observed in the non–extracorporeal cardiopulmonary resuscitation subgroup (hazard ratio 1.29, 95% confidence interval 0.70–2.36, <em>P</em> = .415). Although underweight patients initially exhibited higher mortality (hazard ratio 1.77, 95% confidence interval 1.12–2.80, <em>P</em> = .015), this effect was attenuated after adjusting the confounders (hazard ratio 1.46, 95% confidence interval 0.91–2.35, <em>P</em> = .119). Kaplan-Meier analysis indicated that class III obesity was associated with the highest in-hospital mortality, followed by the underweight group (log-rank <em>P</em> = .009).</div></div><div><h3>Conclusion</h3><div>Obesity increased mortality in patients who underwent venoarterial extracorporeal membrane oxygenation, but this was primarily due to a nonlinear U-shaped distribution between body mass index and in-hospital mortality observed in patients receiving extracorporeal cardiopulmonary resuscitation. Further studies are needed to clarify the causal factors underlying these associations.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108928"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}