Surgery最新文献

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109752","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109752","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109752"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245231","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.2025.109747","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109747","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109747"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245203","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":"Accuracy of the Surgical Risk Preoperative Assessment System (SURPAS) in a broad, elderly (age ≥ 65) patient population","authors":"Haaris Kadri BA ,&nbsp;Ahmad M. Hider MD, MPhil ,&nbsp;William G. Henderson PhD, MPH ,&nbsp;Yi Su MPS ,&nbsp;Michael R. Bronsert PhD, MS ,&nbsp;Thomas N. Robinson MD ,&nbsp;Robert C. McIntyre Jr. MD ,&nbsp;Robert A. Meguid MD, MPH","doi":"10.1016/j.surg.2025.109713","DOIUrl":"10.1016/j.surg.2025.109713","url":null,"abstract":"<div><h3>Background</h3><div>As more operations are performed on older adults, risk assessment for postoperative complications is important to inform patients and providers, especially because older patients have higher complication rates compared with younger patients. The Surgical Risk Preoperative Assessment System, a universal, parsimonious surgical risk calculator, has not yet been evaluated for accuracy in the older patient population.</div></div><div><h3>Methods</h3><div>Data from the American College of Surgeons National Surgical Quality Improvement Program participant use file, 2009–2018, were used to develop the Surgical Risk Preoperative Assessment System models, and data from 2019 to 2020 were used to test the models in all, older, and younger patients. Multiple logistic regression was used with the Surgical Risk Preoperative Assessment System variables (operation <em>Current Procedural Terminology</em> code, American Society of Anesthesiologists class, functional health status, surgeon specialty, emergency status, inpatient or outpatient, and patient age) as independent variables and 12 common postoperative complications as dependent variables. C-indices, Brier scores, and Hosmer-Lemeshow calibration graphs were used for model evaluation.</div></div><div><h3>Results</h3><div>Developmental and testing data had sample sizes of 6,924,709 and 1,929,287, respectively. In the testing data, 37.7% of patients were older. The mean c-index across all outcomes for older patients was 0.800 vs 0.846 for younger patients. The c-index was good to fair (≥0.70) for 11 of the 12 assessed outcomes for the older group. The average Brier score was slightly higher (worse) for older versus younger patients (0.036 vs 0.019). Hosmer-Lemeshow graphs showed good calibration between older and younger patients.</div></div><div><h3>Conclusions</h3><div>The performance of the Surgical Risk Preoperative Assessment System was slightly worse in older versus younger patients but was clinically acceptable.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109713"},"PeriodicalIF":2.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239697","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":"Delayed coloanal anastomosis for rectovaginal fistulas: Insights from a multicenter cohort (GRECCAR)","authors":"Maxime K. Collard MD, PhD ,&nbsp;Jean-Jacques Tuech MD, PhD ,&nbsp;Benjamin Fernandez MD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Jean-Luc Faucheron MD, PhD ,&nbsp;Charles Sabbagh MD, PhD ,&nbsp;Jérome Loriau MD ,&nbsp;Léonor Benhaïm MD, PhD ,&nbsp;Aurore Protat MD ,&nbsp;Gilles Manceau MD, PhD ,&nbsp;Frédéric Marchal MD ,&nbsp;Anaïs Laforest MD ,&nbsp;Simon Derieux MD ,&nbsp;Adeline Germain MD, PhD ,&nbsp;Simone Manfredelli MD ,&nbsp;Arielle Pierre MD ,&nbsp;Diane Mège MD, PhD ,&nbsp;Yann Parc MD, PhD ,&nbsp;Jérémie H. Lefèvre MD, PhD","doi":"10.1016/j.surg.2025.109767","DOIUrl":"10.1016/j.surg.2025.109767","url":null,"abstract":"<div><h3>Background</h3><div>Delayed coloanal anastomosis for treating rectovaginal fistulas focuses on optimizing healing by postponing the coloanal anastomosis until after the vaginal repair. This study aimed to evaluate the success rate, morbidity, and functional outcomes of this strategy.</div></div><div><h3>Methods</h3><div>This retrospective study included all patients who underwent delayed coloanal anastomosis for rectovaginal fistula between 2010 and 2023 across 16 GRECCAR-affiliated colorectal centers.</div></div><div><h3>Results</h3><div>A total of 78 patients (median age: 54.5 years) were included. The main cause of rectovaginal fistula was chronic leakage from colorectal or coloanal anastomosis (67%). The median time interval between the rectovaginal fistula diagnosis and delayed coloanal anastomosis was 9.0 months (interquartile range: 5.0–17.0 months). A total of 40% (31 of 78) of patients underwent delayed coloanal anastomosis after the failure of at least 1 previous treatment attempt. The overall morbidity, major morbidity, and anastomotic leakage occurrence after delayed coloanal anastomosis were 45%, 23%, and 17%, respectively. After a median follow-up of 31 months, the success rate of delayed coloanal anastomosis (healing of rectovaginal fistulas with preservation of bowel continuity) was 81% (63 of 78). No preoperative or intraoperative factors, including pelvic radiotherapy (<em>P</em> = .331) or failure of a previous treatments before delayed coloanal anastomosis (<em>P</em> = .982), were predictive of failure. In cases of anastomotic leakage after delayed coloanal anastomosis, the success rate decreased to 23% (3 of 13) compared with the success rate of 92% (60 of 65) in the absence of anastomotic leakage (<em>P</em> &lt; .001). A total of 42% (24 of 57) of patients reported severe low anterior resection syndrome or remained with a stoma because of poor functional outcomes.</div></div><div><h3>Conclusion</h3><div>Delayed coloanal anastomosis demonstrates a high success rate as high as 81% in treating complex rectovaginal fistulas. However, it is linked to significant postoperative morbidity and functional sequelae.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109767"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222054","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.2025.109773","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109773","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109773"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228693","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":"The impact of adrenalectomy on metabolic outcomes of patients with mild autonomous cortisol secretion defined by low-dose dexamethasone suppression testing.","authors":"Alexa Lisevick Kumar, Sophie Dream, Tahseen Shaik, Kara Doffek, Ryan Conrardy, James W Findling, Ty B Carroll, Catherine D Zhang, Douglas B Evans, Tracy S Wang","doi":"10.1016/j.surg.2025.109775","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109775","url":null,"abstract":"<p><strong>Background: </strong>Up to 50% of patients with adrenal incidentalomas have mild autonomous cortisol secretion, which may increase their cardiometabolic morbidity, compared with patients with nonfunctional adrenal tumors. Studies evaluating cardiometabolic outcomes of patients with mild autonomous cortisol secretion defined by 1-mg dexamethasone suppression testing (cortisol 1.8-5 μg/dL) have demonstrated mixed results. The aim of this study was to assess the metabolic outcomes of patients with mild autonomous cortisol secretion, defined by the 1-mg dexamethasone suppression testing criterion, compared with patients with nonfunctional adrenal tumors who underwent adrenalectomy.</p><p><strong>Methods: </strong>We conducted a single-institution retrospective cohort study comparing adult patients who underwent unilateral adrenalectomy from November 30, 2011, to August 19, 2023, for mild autonomous cortisol secretion (1-mg dexamethasone suppression testing cortisol 1.8-5 μg/dL) or nonfunctional adrenal tumors (1-mg dexamethasone suppression testing cortisol <1.8 μg/dL). Preoperative prevalences and postoperative changes in diabetes mellitus, hypertension, dyslipidemia, and elevated body mass index (≥25) were assessed. Patients were followed from the time of surgery until their last outpatient visit. Multivariable logistic regression was pursued for outcomes that varied between cohorts.</p><p><strong>Results: </strong>A total of 65 patients (53 mild autonomous cortisol secretion and 12 nonfunctional adrenal tumors) were analyzed. Patients with mild autonomous cortisol secretion were older and more likely to have diabetes mellitus than patients with nonfunctional adrenal tumors (odds ratio: 7.81, 95% confidence interval [0.94, 64.96], P = .04). Patients were followed for a median of 28.1 months [11.1, 55.3 months]. Patients with mild autonomous cortisol secretion were more likely to have postoperative weight improvement (odds ratio: 8.31, [0.97, 71.14], P = .03). After adjusting for clinically relevant variables, the 1-mg dexamethasone suppression testing cortisol was predictive of postoperative weight improvement (odds ratio: 1.88, [1.1, 3.65], P = .04).</p><p><strong>Conclusion: </strong>Weight loss should be considered as a potential benefit of adrenalectomy in patients with mild autonomous cortisol secretion.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109775"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228704","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":"Renal function after adrenalectomy in patients with primary aldosteronism.","authors":"Kelly A Stahl, Kimberly M Ramonell, Amoghavarsha Puli, Pouneh K Fazeli, Kelly L McCoy, Sally E Carty, Linwah Yip, Alaa Sada","doi":"10.1016/j.surg.2025.109761","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109761","url":null,"abstract":"<p><strong>Background: </strong>Although adrenalectomy is recommended for unilateral primary aldosteronism, the postoperative effects on renal function remain poorly understood. We evaluated renal function after adrenalectomy and identified risk factors for function decline.</p><p><strong>Methods: </strong>A single-institution retrospective study included adults undergoing adrenalectomy (2002-2024) for unilateral primary aldosteronism on the basis of adrenal venous sampling. Estimated glomerular filtration rate (eGFR)% change was defined as ([baseline eGFR - postoperative eGFR]/baseline eGFR) × 100. Univariate logistic regression assessed estimated glomerular filtration rate decline <60 mL/min/1.73 m² at 12 months.</p><p><strong>Results: </strong>Of 107 patients, the median age was 55 years and 92 (86%) had baseline eGFR ≥60 mL/min/1.73 m² before surgery. eGFR levels were available for 87 patients on postoperative day 1, 64 at 1 month, 43 at 6 months and 47 at 12 months, and eGFR declined from baseline in 37%, 58%, 74% and 66%, respectively. Median eGFR% decline was 13% on postoperative day 1, 18.2% at 1 month, 20.5% at 6 months and 20% at 12 months. One of 15 patients with baseline eGFR <60 required dialysis 3 months postoperatively. Among 92 patients with baseline eGFR ≥60, eGFR dropped <60 in 26% and 32.5% at 1 and 12 months, respectively. After eGFR decline <60 at 1 month, only 1 patient experienced recovery. Variables associated with eGFR decline <60 at 12 months were older age, lateralization index >30, and 1 month eGFR decline <60.</p><p><strong>Conclusion: </strong>After adrenalectomy for unilateral primary aldosteronism, a significant decrease in estimated glomerular filtration rate was observed. Patients should be counseled on the high likelihood of unmasked renal impairment after adrenalectomy and estimated glomerular filtration rate monitoring is recommended for all patients.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109761"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228707","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.2025.109771","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109771","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109771"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228622","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 prospective comparison of sequential versus interval retreatment with radiofrequency ablation for predominantly solid, large-volume benign thyroid nodules.","authors":"Man Him Matrix Fung, Yan Luk, Brian Hung Hin Lang","doi":"10.1016/j.surg.2025.109763","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109763","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation is an effective treatment for benign thyroid nodules. For large nodules ≥20 mL, retreatment within 6 months would lead to a higher volume reduction rate at 12 months than a single treatment. However, the optimal timing of retreatment within the 6-month period has not been determined. This prospective study compared sequential versus interval retreatment with radiofrequency ablation for predominantly solid, large benign thyroid nodules ≥20 mL and identified factors associated with a better volume reduction rate.</p><p><strong>Methods: </strong>Consecutive patients with predominantly (>80%) solid, cytologically benign large thyroid nodules (≥20 mL) that were undergoing radiofrequency ablation at a tertiary endocrine surgery center were recruited for a planned, 2-session radiofrequency ablation treatment. Group I received sequential retreatment in <1 month, whereas group II received interval retreatment in 4-6 months. For each session, the entire nodule was ablated until it was fully covered with echogenic bubbles. The primary outcome was 18-month volume reduction rate = (baseline volume - 18-month volume)/baseline volume × 100%. Complications, compressive symptoms, and cosmetic symptoms were compared.</p><p><strong>Results: </strong>From 2022 to 2023, 31 nodules (group I: 15, group II: 16) from 30 patients were recruited for a total of 62 ablation sessions. Baseline characteristics including nodule volumes (33.5 [25-40] vs 37.2 [23.9-56.1] mL) and symptoms were comparable (P < .05). The overall 12-month and 18-month volume reduction rates were 75.7% (60.4%-80.9%) and 82.7% (64.7%-87.6%). No significant difference in 18-month volume reduction rate was observed between groups (group I: 84.1% [68.1%-88.3%] vs group II: 79.4% [64.7%-87.6%], P = .608). Both groups had significant further nodule shrinkage from 12 months to 18 months (P < .05), at comparable rates (P > .05), and significant improvement in cosmetic and compressive symptoms (P < .001). A higher energy per unit volume delivered at the second ablation session was the only factor associated with an 18-month volume reduction rate of ≥80% (P = .038, odds ratio: 88.3 [1.47-532]). No vocal cord palsy or hematoma occurred, and all patients were discharged on the same day after each treatment session.</p><p><strong>Conclusion: </strong>Continued shrinkage beyond 12 months was observed in large, predominantly solid benign thyroid nodules that received 2-session radiofrequency ablation within 6 months. Varying the time interval to retreatment within 6 months did not affect treatment efficacy. A higher energy per unit volume delivered at the second ablation session was associated with greater volume reduction.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109763"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228577","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":"Allocation of expedited placement livers for transplantation: efficiency at the price of equity?","authors":"Omero Pereira da Costa Filho, Carine Moraes Vignochi","doi":"10.1016/j.surg.2025.109811","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109811","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109811"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228588","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}