Surgery最新文献

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109758","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109758","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109758"},"PeriodicalIF":2.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252879","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":"Perioperative multidrug-resistant bacteria impair clinical outcome after pancreatic surgery: Missed targets of antibiotic prophylaxis","authors":"Julia Noll MD ,&nbsp;Hannah Roosen ,&nbsp;Moritz Fritzenwanker MD ,&nbsp;Anca-Laura Amati MD ,&nbsp;Jacqueline Braun MD ,&nbsp;Martin Schneider MD ,&nbsp;Winfried Padberg MD ,&nbsp;Andreas Hecker MD ,&nbsp;Martin Reichert MD","doi":"10.1016/j.surg.2025.109717","DOIUrl":"10.1016/j.surg.2025.109717","url":null,"abstract":"<div><h3>Background</h3><div>Multidrug-resistant bacteria represent major concerns in perioperative medicine. The extent to which preoperative colonization and postoperative detection of multidrug-resistant bacteria affect outcome in pancreatic surgery is largely unknown. Microbiome analyses provide insights into appropriate perioperative antibiotic prophylaxis.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center cohort study of patients who underwent elective pancreatic surgery between January 2018 and December 2022 with a complete set of preoperative screening swabs.</div></div><div><h3>Results</h3><div>Of 212 patients, <em>n</em> = 168 (79.25%) were classified as multidrug-resistant negative, whereas 44 (20.75%) were tested multidrug-resistant positive perioperatively. Among these, 19 had preoperative detection of multidrug-resistant bacteria and 25 had postoperative detection of multidrug-resistant bacteria. No differences in baseline characteristics were observed. Inflammatory parameters, including blood leukocytes and C-reactive protein, were elevated perioperatively in patients who were multidrug-resistant positive. Postoperative outcomes were significantly impaired in patients who were multidrug-resistant positive compared with those who were multidrug-resistant negative, including greater rates of pancreatic fistula (grade B/C), postpancreatectomy hemorrhage, and reoperation (all <em>P</em> &lt; .0001). Major complication rates, length of intensive care, and in-hospital stay were increased (all <em>P</em> &lt; .0001). Progression of pancreatic fistula to hemorrhage and reoperation was particularly high in patients who were multidrug-resistant positive (37.84% vs 3.92%; <em>P</em> &lt; .0001). Subgroup analyses revealed no differences in postoperative outcomes between patients who were preoperatively tested multidrug-resistant positive and those who were postoperatively tested multidrug-resistant positive. High intrinsic or acquired bacterial resistance rates were observed against commonly used perioperative antibiotics in pancreatic surgery, including metronidazole/second-generation cephalosporins or piperacillin/tazobactam.</div></div><div><h3>Conclusion</h3><div>Both preoperative and postoperative colonization with multidrug-resistant bacteria have deleterious effects on postoperative outcomes. Pancreatic fistula is a crucial cause for severe morbidity in patients who are multidrug-resistant positive. Preoperative decolonization, broad-spectrum perioperative antibiotic prophylaxis, and continued postoperative antibiotics should be considered for high-risk pancreatic surgery patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109717"},"PeriodicalIF":2.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252801","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":"Sonographic and pathologic features of malignant hot thyroid nodules: A multi-institutional study.","authors":"Ekaterina L Koelliker, Lauren N Krumeich, Timothy Kravchenko, Matthew M Keamy Blanco, Allison S Letica-Kriegel, Isabel Hsu, Rajshri M Gartland","doi":"10.1016/j.surg.2025.109710","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109710","url":null,"abstract":"<p><strong>Background: </strong>Prior studies indicate that approximately 5% of hot thyroid nodules harbor malignancy. Hot nodules often exhibit suspicious sonographic features despite their typical benign pathology. This study examines the incidence, sonographic characteristics, and surgical pathology of malignancy within hot nodules to guide workup of these nodules, including preprocedure workup for thermal ablation.</p><p><strong>Methods: </strong>Patients at 5 tertiary care centers with solitary toxic nodules or toxic multinodular goiters undergoing thyroidectomy (2017-2024) were included. Using thyroid uptake scan and ultrasonography, hot nodules were matched with sonographic characteristics. Nodules <1 cm and patients without either imaging were excluded. Sonographic features and indications for biopsy were assessed using the Thyroid Imaging Reporting and Data System classification. Kruskal Wallis and tests of proportions were used for analysis.</p><p><strong>Results: </strong>Among 257 patients with 323 hot nodules, 11 (3.4%) nodules were malignant: 9 of 124 (7.3%) solitary toxic nodules and 2 of 199 (1.0%) in multinodular goiters (P = .003). Compared with benign hot nodules, malignant hot nodules were more often solid (90.9% vs 51.6%, P = .01), isoechoic/hyperechoic (81.8% vs 48.4%, P = .04), and biopsied (81.8% vs 41.7%, P = .008). Pathology of malignant hot nodules revealed papillary and follicular cancers with BRAF positivity (36.4%), lymphovascular invasion (45.5%), multifocality (36.4%), and tall cell features (33.3%). Providers recommended completion thyroidectomy for 2 patients and postoperative radioactive iodine for 3.</p><p><strong>Conclusions: </strong>Solitary toxic nodules harbor a higher risk of malignancy than toxic multinodular goiters, and these malignancies can exhibit poor prognostic pathologic features. The 7.3% malignancy rate in resected solitary toxic nodules may support existing recommendations for biopsy prior to thermal ablation of these nodules.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109710"},"PeriodicalIF":2.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252856","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109751","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109751","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109751"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245164","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":"Easing the burden: A pilot study evaluating AI-generated In-Basket message drafts to streamline perioperative endocrine surgical care.","authors":"Katherine R Whitehouse, Ryan T Heslin, Alexis Desir, Rajam Raghunathan, Ana K Islam, Sarah Lallky, Priscilla Philip, Nicole Reedy, Ankeeta Mehta, Megan Parmer, Marlen V Piersall, Sarah C Oltmann, Alan P B Dackiw, Naim M Maalouf, Vivek R Sant","doi":"10.1016/j.surg.2025.109700","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109700","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence can generate accurate and empathetic responses to patient questions about endocrine diseases, but its ability to reduce health care provider (HCP) clinical burden remains unmeasured. We evaluated how artificial intelligence-generated draft messages impact health care provider workload in answering common perioperative endocrine surgery questions.</p><p><strong>Methods: </strong>Health care providers completed a timed survey responding to 20 randomized perioperative endocrine patient In-Basket messages, 10 with blank drafts and 10 with artificial intelligence-generated drafts using GPT-4. Participants could use some, all, or none of the provided draft. Response times were recorded, and text similarity ratio (1.0 = identical) was used to measure the extent of editing. Cognitive load was assessed using raw NASA Task Load Index, and provider satisfaction was elicited.</p><p><strong>Results: </strong>11 health care providers participated. Response time averaged 49 ± 67 seconds per question with artificial intelligence drafts vs 137 ± 115 seconds with a blank draft (P < .001). Artificial intelligence-generated drafts required minimal edits (similarity ratio 0.88 ± 0.24). Mean Task Load Index was lower with artificial intelligence drafts (3.2 ± 1.5 vs 4.4 ± 1.3, P < .001), particularly in mental (P = .02) and temporal (P < .01) demand. Frustration levels were similar (P = .49). Sixty-four percent of respondents were satisfied or extremely satisfied, and 82% wished to integrate this tool into clinical practice. Feedback highlighted the importance of personalization and its usefulness for questions with expected routine responses.</p><p><strong>Conclusion: </strong>Artificial intelligence-generated draft responses to common perioperative patient questions reduced health care provider response time and cognitive load, required minimal edits, and were associated with enhanced health care provider satisfaction and minimal frustration.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109700"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245206","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":"Barbed sutures in ventral hernia repair: A propensity-matched analysis of the Abdominal Core Health Quality Collaborative database","authors":"Luis Arias-Espinosa MD ,&nbsp;Ethan Shyu BS ,&nbsp;Jorge Humberto Rodriguez-Quintero MD ,&nbsp;Xavier Pereira MD ,&nbsp;Gustavo Romero-Velez MD ,&nbsp;Li-Ching Huang PhD ,&nbsp;Athanasios Sevdalis MD ,&nbsp;Ruben Salas MD, FACS ,&nbsp;Tanuja Damani MD ,&nbsp;Flavio Malcher MD, MSc, FACS","doi":"10.1016/j.surg.2025.109715","DOIUrl":"10.1016/j.surg.2025.109715","url":null,"abstract":"<div><h3>Introduction</h3><div>Barbed sutures in ventral hernia repair have been used increasingly. The impact that barbed sutures has on operative time in other procedures is well documented but few reports on ventral hernia repair exist. Furthermore, the use of barbed sutures varies across surgical approaches. The aim of this study was to explore the operative time for ventral hernia repair elucidated by open, laparoscopic, or robotic approach.</div></div><div><h3>Methods</h3><div>Patients who underwent ventral hernia repair with fascial closure from 2020 to 2022 from the Abdominal Core Health Quality Collaborative were included. Propensity score matching 1:1 with covariates of age, American Society of Anesthesiologists class, recurrent, wound status, incisional procedure, hernia width, mesh used and type, mesh location, body mass index capped at 15 to 60, and concomitant procedures was performed by operative approach. The primary outcome of interest was operative time, and secondary outcomes were length of stay, surgical site infections, surgical site occurrences, surgical site occurrences requiring procedural intervention at 30-day follow-up.</div></div><div><h3>Results</h3><div>A total of 2,230 patients were included in propensity score matchings: open ventral hernia repair (<em>n</em> = 1,434), laparoscopic ventral hernia repair (<em>n</em> = 252), and robotic ventral hernia repair (<em>n</em> = 544). Operative time was more frequently &gt;2 hours in robotic ventral hernia repair using nonbarbed sutures (58% vs 47%; <em>P</em> = .006) and was similar for open (60% vs 57%; <em>P</em> = .2) or laparoscopic (15% vs 21%; <em>P</em> = .2) approach. Across all operative modalities, using barbed sutures was strongly associated with fixation of mesh with sutures, closure of fascia in a running fashion, and more versatility in mesh locations, specifically in laparoscopic ventral hernia repair. Open ventral hernia repair had a shorter length of stay in patients with barbed sutures (2 vs 3; <em>P</em> = .003); however, a reoperation was more common in this same group (3% vs 1%; <em>P</em> = .03), specifically for recurrence (1% vs 0%; <em>P</em> = .04). All the other 30-day outcomes were similar across surgical approaches.</div></div><div><h3>Conclusion(s)</h3><div>The usage of barbed sutures was associated with shorter operative time for robotic procedures and appears to influence the overall technique used in ventral hernia repair. Higher complexity laparoscopic ventral hernia repair performed with barbed sutures had a similar operative time to simpler ventral hernia repair performed with nonbarbed sutures. Open ventral hernia repair with barbed sutures might experience an increase in early recurrences. Further studies are needed.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109715"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245305","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":"Sprayable pH-sensitive near-infrared fluorophore for rapid, bright, specific, and safe visualization of human thyroid cancer in orthotopic mouse models.","authors":"Sunidhi Jaiswal, Atsushi Yamashita, Sohee Lee, Siamak Amirfakhri, Jinhui Ser, Satoshi Kashiwagi, Grace Lin, Robert M Hoffman, Maged Henary, Hak Soo Choi, Michael Bouvet","doi":"10.1016/j.surg.2025.109703","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109703","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the primary treatment for thyroid cancer. However, incomplete resection of thyroid cancer can result in local, regional, and distant recurrences that are life threatening. We hypothesized that a topically applied, pH-sensitive near-infrared fluorophore in spray form (PH10) could offer rapid labeling of thyroid tumors, enabling better visualizion of the tumor and its margins.</p><p><strong>Methods: </strong>Cellar uptake inhibition and cytotoxicity studies using PH10 were performed on TPC-1 papillary and TT medullary thyroid cancer cells. Subcutaneous or orthotopic tumors were established by injecting TPC-1 cells in the flanks or thyroid glands of nude mice, respectively, and sprayed with PH10. Fluorescence of the tumor was compared to surrounding tissues. Tumors were harvested for pathologic analysis.</p><p><strong>Results: </strong>The organic anion transporter peptide mediated uptake of PH10 in TPC-1 and TT cells was determined. PH10 exhibited an IC50 value of 13.18 and 17.28 μM in TPC-1 and TT cells, respectively. Both subcutaneous and orthotopic tumors displayed strong near-infrared fluorescence upon spraying PH10 at a concentration of 10 μM on the tumor sites, within 1 minute, contrasting with surrounding tissues. The effective PH10 dose for tumor visualization was well below the IC50. The average tumor to background ratios were 5.5 (±1.47) for subcutaneous tumors (n = 5) and 9.4 (±2.59) for orthotopic tumors (n = 5). Hematoxylin and eosin staining confirmed the tumor characteristics.</p><p><strong>Conclusion: </strong>The pH-sensitive near-infrared fluorophore PH10 brightly, rapidly, specifically, and safely labeled thyroid cancer in mouse models by spraying, demonstrating future clinical promise as a useful agent for improved visualization of thyroid cancer.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109703"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245300","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":"Objective assessment of vascular dysfunction in pheochromocytoma and paraganglioma patients and reversal following curative surgery: Results from prospective PheoCard study.","authors":"Samprati Dariya, Raviraj Singh Ahada, Roopali Khanna, K M M Vishvak Chanthar, Sabaretnam Mayilvaganan, Gyan Chand, Anjali Mishra, Aditya Kapoor, Gaurav Agarwal","doi":"10.1016/j.surg.2025.109704","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109704","url":null,"abstract":"<p><strong>Background: </strong>Hypertension and cardiovascular changes are hallmarks of pheochromocytoma/paraganglioma. Endothelium-dependent flow-mediated vasodilatory response and endothelium-independent nitroglycerin-mediated vasodilatory response, which are linked to cardiovascular mortality, have not been studied in pheochromocytoma/paraganglioma. This study evaluated extent of vascular changes and impaired vasodilatory responses in patients with pheochromocytoma/paraganglioma and their reversal following curative surgery.</p><p><strong>Methods: </strong>This prospective cohort study evaluated flow mediated vasodilatory response and nitroglycerin-mediated vasodilatory response in 40 patients with pheochromocytoma/paraganglioma (at diagnosis; after alpha blockade; 7 days, 3 months, and 6 months postsurgery) and in matched control subjects (at baseline), normalized for confounding factors affecting vasodilatory response. Patients underwent curative open/minimally invasive surgery. Significance of linear changes in vascular indices over time was calculated using appropriate statistical methods.</p><p><strong>Results: </strong>Mean age of patients with pheochromocytoma/paraganglioma (10 normotensive, 6 paraganglioma, 25 male) was 35.4 ± 15.5 years. No patients had persistent hypercatecholaminism; 42.5% remained hypertensive postsurgery. Flow-mediated vasodilatory response and nitroglycerin-mediated vasodilatory response exhibited less vasodilation in study group compared with normotensive and essential hypertensive control subjects. Mean flow-mediated vasodilatory response (%) in pheochromocytoma/paraganglioma cohort increased from 3.4 ± 1.2 at baseline to 5.1 ± 1.8 after alpha blockade and 7.2 ± 1.8, 8.0 ± 2.7, and 9.4 ± 2.9 at 7 days, 3 months, and 6 months postsurgery, respectively, with 6-month values approaching those of healthy control subjects (9.1 ± 4.5, P < .001). Mean nitroglycerin-mediated vasodilatory response (%) improved from 8.0 ± 2.4 (baseline) to 10.7 ± 2.7 after alpha blockade and 13.6 ± 3.3, 16.1 ± 5.2, and 17.0 ± 4.5 (near-normal) at 7 days, 3 months, and 6 months postsurgery, respectively (P < .001).</p><p><strong>Conclusions: </strong>In this first-of-its-kind study performed using objective noninvasive vascular assessment methodology, patients with pheochromocytoma/paraganglioma were found to have impaired endothelium-dependent and endothelium-independent vasodilatory responses. The stunted vasodilatory responses are reversed and normalized following curative resection of catecholamine-secreting tumors.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109704"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245186","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":"Validation of molecular profiling to preoperatively predict aggressive pathologic features in differentiated thyroid cancer.","authors":"Justin Bauzon, Joyce Shin, Gilman Plitt, Rafael Perez-Soto, Michael S Lui, Jee-Hye Choi, Judy Jin, Vikram Krishnamurthy, Eren Berber, Katherine B Heiden, Allan Siperstein, Gustavo Romero-Velez","doi":"10.1016/j.surg.2025.109698","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109698","url":null,"abstract":"<p><strong>Background: </strong>The 2015 American Thyroid Association guidelines stratify recurrence risk of differentiated thyroid cancer using pathologic findings. Aggressive features may reclassify tumors as intermediate-to-high risk in patients initially suitable for lobectomy, warranting completion thyroidectomy. Signatures represent distinct patterns of mRNA expression on the basis of molecular pathway features. This study evaluated whether molecular expression profiles (\"signatures\") could preoperatively differentiate high-risk tumors and potentially guide extent of surgery.</p><p><strong>Methods: </strong>Patients who underwent thyroid nodule molecular testing with the Afirma Genomic Sequencing Classifier and subsequent operative resection from 2017 to 2024 were identified. Using features described on surgical pathology, patients were grouped into ATA guideline-based low-risk or intermediate/high-risk cohorts. Among the signatures assessed, Invasion Score was developed to rule out extrathyroidal extension or extensive vascular invasion, whereas Sodium-Iodide Symporter Expression reflects mRNA production levels of the transmembrane glycoprotein involved in thyroid-iodine uptake. Signatures were compared among cohorts using Mann-Whitney U and Kruskal-Wallis tests. Logistic regression was used for multivariate analysis.</p><p><strong>Results: </strong>Of 445 patients analyzed, 366 were low risk and 79 were intermediate/high risk. Among 30 signatures evaluated, expression varied significantly among study cohorts in 23 (77%). Multivariate analysis demonstrated the Invasion Score signature as predictive of greater American Thyroid Association risk classification (odds ratio, 1.3; 95% confidence interval, 1.1-1.5, P = .005) whereas Sodium-Iodide Symporter Expression was protective (odds ratio, 0.78; 95% confidence interval, 0.63-0.94, P = .015).</p><p><strong>Conclusion: </strong>Multiple signature expression profiles showed marked variation among American Thyroid Association risk classes and may help enhance preoperative prognostication. Although Invasion Score mirrors greater risk pathologic features, upregulated Sodium-Iodide Symporter Expression appears to protect from greater American Thyroid Association risk class, although further studies are needed to confirm.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109698"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245257","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109807","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109807","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109807"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245167","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}