Surgery最新文献

{"title":"Minimally invasive surgery could be attempted with preoperatively predictable difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy: A large multicenter study","authors":"Hanbo Pan MD ,&nbsp;Hang Chen MD ,&nbsp;Weicheng Kong MD ,&nbsp;Zhen Ge MD ,&nbsp;Jiaqi Zhang MD ,&nbsp;Yu Tian MD ,&nbsp;Junwei Ning MD ,&nbsp;Ningyuan Zou MD ,&nbsp;Zhiyuan Bao MD ,&nbsp;Qiyang Qiu MD ,&nbsp;Difan Zhang MD ,&nbsp;Guomo Ruan MD ,&nbsp;Zhichao Pang MD ,&nbsp;Liang Fang MD ,&nbsp;Zongxiang Duan MD ,&nbsp;Weiqiu Jin MD ,&nbsp;Zhongjie Chen MD ,&nbsp;Min Zheng MD ,&nbsp;Chengwei Zhou MD ,&nbsp;Hui Wang MD ,&nbsp;Qingquan Luo MD, FACS, FRCS","doi":"10.1016/j.surg.2025.109458","DOIUrl":"10.1016/j.surg.2025.109458","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant immunochemotherapy has revolutionized the treatment of non–small cell lung cancer. However, it presents significant surgical challenges, leading to controversy over the feasibility and safety of minimally invasive surgery. This study aims to assess the adequacy of minimally invasive surgery and preoperatively predict its difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy.</div></div><div><h3>Methods</h3><div>Initial stage IIA-IIIB (excluding stage T4N2) non–small cell lung cancer patients with neoadjuvant immunochemotherapy undergoing minimally invasive surgery or open thoracotomy at 12 institutions between 2019 and 2024 were retrospectively reviewed. Difficult minimally invasive surgery was defined by conversion to thoracotomy. Propensity score matching was applied to balance baseline characteristics.</div></div><div><h3>Results</h3><div>Of the 571 cases included, propensity score matching led to 240 patients per group. Minimally invasive surgery decreased intraoperative bleeding, shortened postoperative chest tube duration and hospitalization, ameliorated postoperative pain, and reduced postoperative complications compared to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate of 15.8%, and notably, converted minimally invasive surgery achieved similar perioperative outcomes to open thoracotomy. Accumulated surgeons' experiences reduced minimally invasive surgery conversion rates and shortened surgical durations. Additionally, logistic regression identified squamous cell carcinoma, advanced preinduction N stage, preoperative tumor size &gt;5 cm, advanced preoperative stage, and extended resection as independent risk factors for conversion. A nomogram was further established with good performance (area under curve value = 0.804) and clinical utility to predict conversion probability preoperatively. Finally, minimally invasive surgery and open thoracotomy achieved comparable event-free survival and overall survival profiles.</div></div><div><h3>Conclusions</h3><div>Minimally invasive surgery achieved improved perioperative outcomes and similar oncologic efficacies to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate, which would not compromise perioperative outcomes compared with open thoracotomy and could be effectively forecasted by a prediction model.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109458"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184365","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 \"Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases\".","authors":"Yuhang Zhou, Bang Wang, Minhui Xu","doi":"10.1016/j.surg.2025.109465","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109465","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109465"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187969","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: \"Association of mental health assessment with postoperative outcomes following major surgery in older individuals\".","authors":"Mohammadali Ranjbar, Hesam Nozari, Amirhossein Keshavarz","doi":"10.1016/j.surg.2025.109435","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109435","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109435"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187968","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 machine learning–based model for predicting intraoperative blood loss during burn surgery","authors":"Fangqing Zuo MD, MS ,&nbsp;Jiaqing Su MD, MS ,&nbsp;Yang Li MS ,&nbsp;Haiming Xin MD, PhD ,&nbsp;Chunhao Li BN ,&nbsp;Lina Huang BE ,&nbsp;Lijuan Zhang MD ,&nbsp;Junda Li MD ,&nbsp;Zhuo Zeng MD, MS ,&nbsp;Yu Chen BSMT ,&nbsp;Yali Gong MS ,&nbsp;Jing Chen MD, PhD ,&nbsp;Yingying Lan MS ,&nbsp;Yajie Chen BSMT ,&nbsp;Cheng Zhang BSMT ,&nbsp;Yizhi Peng MD, PhD ,&nbsp;Gaoxing Luo MD, PhD ,&nbsp;Zhiqiang Yuan MD, PhD","doi":"10.1016/j.surg.2025.109445","DOIUrl":"10.1016/j.surg.2025.109445","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Intraoperative blood loss is a critical issue in the care of patients with burns. The timely identification of patients at elevated risk for substantial blood loss during surgical procedures is imperative.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Demographic data, laboratory test results, and surgical factors of patients were collected. For predicting intraoperative blood loss &gt;750 mL, the original cohort was randomly divided in an 8:2 ratio, with the larger group allocated for the model development and the smaller for internal validation. Six machine-learning algorithms, including logistic regression, decision tree, random forest, K-nearest neighbor, support vector machine, and extreme gradient boosting were used to develop the prediction models. The performance of the models was assessed by 8 metrics as well as density curve, calibration curve and decision curve. A scoring system was designed to assess the performance efficacy. Validation was conducted in another 2 cohorts. The optimal prediction model acquired. Ultimately, a web-based calculator to estimate the incidence of intraoperative blood loss &gt;750 mL was created.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 395 burn surgeries from 2 hospitals were analyzed, with 245 surgeries for modeling, 89 surgeries for the internal-external validation, and 61 surgeries for the external validation. The model features consist of 8 clinical variables. The random forest model gained the greatest total metrics score of 36, followed by the support vector machine, extreme gradient boosting, K-nearest neighbor, logistic regression, and decision tree models with total scores of 33, 32, 28, 24, and 18, respectively. Specifically, the random forest model performed superior in most metrics compared to the other models, achieving greater accuracy (0.776), recall (0.930), F1 score (0.868), as well as the lowest log loss (0.423), and Brier score (0.142). Meanwhile, the random forest model demonstrated strong performance with an area under the curve of 0.784 (95% confidence interval, 0.779–0.789), ranking second only slightly behind the extreme gradient boosting model, which achieved the greatest area under the curve of 0.785 (95% confidence interval, 0.780–0.790). Other models showed comparatively lower area under the curve values. The density curve, calibration plot, histogram with mean predicted probabilities against counts and decision curve of the random forest model also performed well. In the internal-external validation cohort, the random forest reached the greatest total metrics score of 35. In the external validation cohort, the random forest again secured the greatest composite metrics score, amounting to 38. Overall, the random forest model was found to be the optimal model for predictive accuracy. In addition initial hemoglobin, time to start surgery after burn injury, initial platelets, % total body surface area excised and grafted, and duration of surgery were the fi","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109445"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170653","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 hospital volume with outcomes for reoperative coronary artery bypass grafting","authors":"Baran Khoraminejad BA ,&nbsp;Sara Sakowitz MS, MPH ,&nbsp;Troy Coaston BS ,&nbsp;Giselle Porter BS ,&nbsp;Saad Mallick MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.109441","DOIUrl":"10.1016/j.surg.2025.109441","url":null,"abstract":"<div><h3>Introduction</h3><div>Outcomes following reoperative coronary artery bypass graft surgery are widely underexplored. Evaluating a contemporary national cohort, we assessed acute clinical and financial sequelae following reoperative coronary artery bypass graft surgery at the patient and hospital levels.</div></div><div><h3>Methods</h3><div>The 2016–2021 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for elective isolated coronary artery bypass graft surgery. Patients with a history of coronary artery bypass graft surgery were categorized as ReOp (others: Non-ReOp). Centers in the highest quartile were considered high-volume centers. Multivariable regression models were built to assess the independent association of ReOp with clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of ∼470,546 patients, 5.0% were classified as ReOp. On average, ReOp was older (70 [63–76] vs 67 years [60–73], <em>P</em> &lt; .001), more often female (26.7 vs 21.7%, <em>P</em> &lt; .001), and of a higher Elixhauser comorbidity index (5 [4–7] vs 4 [3–5], <em>P</em> &lt; .001).</div><div>Following risk adjustment, ReOp was linked with comparable likelihood of in-hospital mortality (adjusted odds ratio 0.87, 95% confidence interval 0.74–1.03). However, ReOp faced greater odds of infection (adjusted odds ratio 1.72, 95% confidence interval 1.60–1.85), thromboembolism (1.85, 1.45–2.36), and stroke (1.35, 1.12–1.64). ReOp was also linked with greater costs (β +$9,845, 95% CI 8,888–0,802).</div><div>At high-volume centers, 5.1% of coronary artery bypass graft surgery recipients were ReOp. Reoperation was associated with greater adjusted odds of major complications (adjusted odds ratio 1.19, 95% confidence interval 1.12–1.27) and increased hospitalization expenditures (β +$6,782, 95% confidence interval 5,725–7,837).</div></div><div><h3>Conclusion</h3><div>The increased risk of facing major perioperative outcomes following reoperative coronary artery bypass graft surgery persists at centers despite case volume. Further studies are needed to develop optimal perioperative care pathways for these patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109441"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170654","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: \"The role of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography-derived parameters as prognostic factors in patients undergoing resection for pancreatic ductal adenocarcinoma\".","authors":"Saad Ahmed Mughal, Aman Advani","doi":"10.1016/j.surg.2025.109438","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109438","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109438"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182594","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":"Rethinking turnover times: The right kind of wrong.","authors":"Javier A Blanco, Mitchell H Tsai, Justin S Routman","doi":"10.1016/j.surg.2025.109430","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109430","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109430"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181294","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":"Hyperlipasemia in the immediate postoperative period predicts postoperative pancreatic fistula after pancreatic resections.","authors":"Ughur Aghamaliyev, Jens Werner","doi":"10.1016/j.surg.2025.109433","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109433","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109433"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183560","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":"Invited commentary regarding: Portal flow modulation by splenic artery ligation to prevent posthepatectomy liver failure: A randomized controlled trial.","authors":"Jason Y Wang, Madhukar S Patel","doi":"10.1016/j.surg.2025.109429","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109429","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109429"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180256","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 the letter to the editor: Acceptability of palliative sleeve lobectomy with microscopic margin disease in patients with non-small cell lung cancer: A retrospective study.","authors":"Jianghao Ren, Ruijun Liu","doi":"10.1016/j.surg.2025.109432","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109432","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109432"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182192","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}