Surgery最新文献

{"title":"Evaluation of visual displays to share expected quality of life changes with patients with breast cancer","authors":"Gabriella Annest Canty BS ,&nbsp;Laura Helmkamp MS ,&nbsp;Sarah E. Leslie MPH ,&nbsp;Sudheer Vemuru MD ,&nbsp;Monica Adams PhD ,&nbsp;Madeline G. Higgins MD ,&nbsp;Rebekah A. Davis MPH ,&nbsp;Laura D. Scherer PhD ,&nbsp;Erin Baurle PsyD ,&nbsp;Daniel D. Matlock MD ,&nbsp;Clara Lee MD ,&nbsp;Sarah Tevis MD","doi":"10.1016/j.surg.2025.109770","DOIUrl":"10.1016/j.surg.2025.109770","url":null,"abstract":"<div><h3>Background</h3><div>For patients deciding between mastectomy and breast conserving therapy, the incorporation of expected postoperative patient-reported outcomes may facilitate shared decision-making. We aim to understand how patients interact with a variety of patient-reported outcome display styles to support the development of decision aids for breast surgery.</div></div><div><h3>Methods</h3><div>A multidisciplinary team developed 6 visual displays of patient-reported outcome data in select BREAST-Q domains. Patients with stage 0–III breast cancer treated at an academic institution received questionnaires assessing their preferences for the patient-reported outcome displays. Demographic variables were extracted from the electronic health record. Display rankings were compared using means, standard deviations, and the Plackett-Luce model for ranked data with Bonferroni corrections to account for the pairwise comparisons. Differences in rankings by demographic and cancer variables were assessed by general linear models. Open-ended responses were assessed by thematic analysis.</div></div><div><h3>Results</h3><div>A total of 59 participants completed the questionnaire (Response rate: 17%). Three displays had significantly higher (more preferred) mean ranks without statistically significant differences among them; 2 of the 6 displays had significantly lower (less preferred) ranks. No differences were found between preference for different patient-reported outcome displays and patient demographic or disease-related variables. In open-ended comments, patients reported a preference for simple displays with longitudinal patient-reported outcome data; patients disliked displays that either had too little or too much information.</div></div><div><h3>Conclusion</h3><div>Displays with longitudinal patient-reported outcomes were preferred by patients, whereas displays with multiple BREAST-Q domains were overwhelming and therefore were less preferred. Patients generally preferred 3 to 4 data values per figure. There is no “one size fits all” approach, because several patient-reported outcome displays ranked highly. Further research on how patients interpret multivariable figures is warranted to understand the needs of diverse patient populations.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109770"},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221568","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 comprehensive review of the types and management of stapling failures in colorectal surgery","authors":"Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Justin Dourado MD ,&nbsp;Ebram Salama MD ,&nbsp;Marylise Boutros MD, PhD ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109720","DOIUrl":"10.1016/j.surg.2025.109720","url":null,"abstract":"<div><h3>Introduction</h3><div>Although surgical staplers have significantly advanced the performance of colorectal surgery, stapling failures can compromise surgical outcomes. Understanding the mechanism of these complications and their management is crucial for improving patient safety. This review aims to provide a succinct summary of the existing literature on types and management of stapling failures.</div></div><div><h3>Methods</h3><div>A comprehensive literature review of PubMed and Scopus databases through February 2025 was conducted to identify studies that reported types, mechanisms, detection methods, and management of stapling failures in colorectal surgery. Various types of surgical staplers used in colorectal surgery, including circular and linear staplers for open and laparoscopic procedures, were considered.</div></div><div><h3>Results</h3><div>The incidence of stapling failures in colorectal surgery ranges from 0.02% to 2.3%. Stapling failures encompass a range of mechanical failures and technical errors. Mechanical failures include misfires, jamming, and lockups. Technical failures include misalignment, crossing staple lines, improper selection, and poor technique. Risk factors include patient-related factors such as obesity and diabetes, and surgical factors such as pelvic surgery, emergency procedures, and inadequate rectal mobilization. The consequences of stapling failures include anastomotic leaks, strictures, and bleeding. Systematic detection methods such as the Wexner quadruple assessment help detect stapling misadventures. Management depends on the nature of the complication and intraoperative troubleshooting, and includes reinforcement sutures, anastomotic revision, and fecal diversion.</div></div><div><h3>Conclusion</h3><div>Surgeons must be well-versed in preventing and addressing stapling failures to optimize patient outcomes. Recognizing risk factors, implementing systematic intraoperative assessments, and applying appropriate management strategies are critical to improving surgical outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109720"},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221569","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":"Mesh removal in groin hernia surgery: A long-term nationwide population-based register study","authors":"Maria Melkemichel MD, PhD ,&nbsp;Hanna De la Croix MD, PhD ,&nbsp;Pär Nordin MD, PhD","doi":"10.1016/j.surg.2025.109766","DOIUrl":"10.1016/j.surg.2025.109766","url":null,"abstract":"<div><h3>Background</h3><div>Nowadays, groin hernia repair with mesh is a gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the prevalence and risk factors for mesh removal due to foreign body reaction and mesh infection after groin hernia repair.</div></div><div><h3>Method</h3><div>This is an observational nationwide population-based register study with the use of prospectively collected data from the Swedish Hernia Register. All patients 15 years or older with a groin hernia repair registered between 1992 and 2022 were eligible. The primary outcome was the prevalence of re-surgery with mesh removal. The secondary outcome was risk factors for re-surgery with mesh removal.</div></div><div><h3>Results</h3><div>Of 363,664 groin hernia repairs during this 30-year-long study period, 211 (0.06%) had a re-surgery with mesh removal. The proportion of female groin hernia repairs was higher in the mesh removal group (15.2%) compared with the nonmesh removal group (7.9%). The adjusted multivariable Cox regression analysis for the risk of re-surgery with mesh removal demonstrated significantly increased hazard ratios for female (2.80, confidence interval: 1.70–4.63), emergency (3.43, confidence interval: 1.94–6.03), open anterior mesh (2.76, confidence interval: 1.61–4.72), and combined anterior/posterior mesh (predominately mesh plugs) (3.98, confidence interval: 1.84–8.57) groin hernia repairs, and for patients below the total median of 63 years (2.61, confidence interval: 1.78–3.81).</div></div><div><h3>Conclusion</h3><div>The groin tissue's tolerance for an implanted mesh after a groin hernia repair can be considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Female sex, younger patients, emergency repairs, and mesh plugs were most evident associated risk factors for such re-surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109766"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213853","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":"Early peripheral vascular intervention for treating patients with claudication: A decision analysis using national administrative claims data.","authors":"Chen Dun, Jesse A Columbo, Caitlin W Hicks, Harold P Lehmann","doi":"10.1016/j.surg.2025.109589","DOIUrl":"10.1016/j.surg.2025.109589","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Claudication, a symptom commonly associated with peripheral artery disease, affects approximately 30-40% of adults in the United States. A decision analysis is needed to integrate data, information, and knowledge from multiple sources about the stages of a patient's journey in this condition to assess the optimal treatment approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We designed a decision model including patient perspective and outcomes of claudication, peripheral vascular intervention, open surgical bypass, chronic limb-threatening ischemia, and amputation. Time horizon was 2 years and tradeoffs were expressed as \"cost-effectiveness,\" with \"cost\" taken as number of procedures, and \"effectiveness,\" the amount of time in claudication and/or recovery. The treatment alternatives were peripheral vascular intervention within 6 months of initial diagnosis of claudication (early peripheral vascular intervention) or peripheral vascular intervention &gt;6 months after claudication diagnosis (to allow for guideline-directed conservative therapy first). Probabilities were derived from 100% Medicare fee-for-service claims data between January 2017 and December 2021. A Markov model was designed and populated for the 2 scenarios. The main outcomes included the estimated number of peripheral vascular interventions, estimated number of open bypass procedures, and total time in claudication. Using Monte Carlo Simulation, 1,000,000 patients were run through the model for the 2-year time horizon. Sensitivity analysis using propensity score matching was conducted to control for baseline differences between groups, matching patients on age, sex, race, and comorbidities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A cohort comprising 445,305 patients newly diagnosed with claudication was identified, exhibiting a mean age of 76.2 years. Among these patients, 12,102 (2.7%) underwent early peripheral vascular intervention, whereas 433,203 (97.3%) had no early peripheral vascular intervention. The simulation demonstrated that patients who underwent an early peripheral vascular intervention experienced an estimated average of 3.6 peripheral vascular interventions over the 2 years, whereas those who did not undergo early peripheral vascular intervention averaged 0.3 PVIs over 2 years. Moreover, patients who underwent early peripheral vascular intervention were projected to undergo an average of 1.7 open bypass procedures subsequent to the initial diagnosis of claudication, whereas those who did not receive early peripheral vascular intervention were expected to undergo 0.8 open bypass procedures. The duration of time spent in a state of claudication was observed to be 190 days for patients who underwent early peripheral vascular intervention, in contrast to 360 days for those who did not receive early peripheral vascular intervention. After controlling for baseline characteristics such as age, sex, race, and comorbidities, the results remained consistent in t","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109589"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812341","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":"Differences in histopathologic features and diagnostic performance of ^99mTc-methoxy-isobutyl-isonitrol single photon emission tomography-CT and ¹⁸F-fluorocholine positron emission tomography-CT in primary hyperparathyroidism.","authors":"Irene Osorio-Silla, Diego Meneses González, Hernán Darío Quiceno Arias, Paula Pastor Peinado, Jersy Jair Cárdenas Salas, María Miguélez González, Carlos Augusto Pestana Soares, Luisa Fernanda Martínez Ruiz, Laura Cristina Landaeta Kancev, Luis Martínez Dhier, Manuel Escanciano, María Luisa Sánchez de Molina, Amalia Paniagua Ruíz, Pedro Villarejo Campos","doi":"10.1016/j.surg.2025.109595","DOIUrl":"10.1016/j.surg.2025.109595","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism is a common endocrine disorder. Accurate preoperative localization is crucial for the success of minimally invasive parathyroidectomy. Although ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography remains the gold standard imaging technique, its diagnostic performance can be limited in certain clinical scenarios. In recent years, ¹⁸F-fluorocholine positron emission tomography-computed tomography has emerged as a promising alternative, especially in cases where first-line imaging results are inconclusive or negative. However, the mechanisms contributing to its superior diagnostic performance remain incompletely understood. The study aims to assess the diagnostic accuracy of ¹⁸F-fluorocholine positron emission tomography-computed tomography in patients with negative or discordant ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography results and to evaluate the biochemical and histopathologic characteristics of hyperfunctioning glands detected by each imaging modalities.</p><p><strong>Methods: </strong>A retrospective study was performed of 245 primary hyperparathyroidism patients who underwent parathyroid surgery between January 2021 and April 2024. Imaging findings were correlated with biochemical data, histopathology, and surgical outcomes. Semiquantitative positron emission tomography parameters were analyzed and statistical comparisons were made regarding gland size, weight, cellular composition, and growth patterns.</p><p><strong>Results: </strong>¹⁸F-Fluorocholine positron emission tomography-computed tomography presented a sensitivity of 93.1% and a diagnostic accuracy of 78.8%. This imaging modality identified smaller glands and was more frequently associated with chief-cell predominance. ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography demonstrated a sensitivity of 70.4% and an accuracy of 60.7%, with higher radiotracer uptake observed in oxyphilic and oncocytic adenomas. The maximum standardized uptake value correlated with parathyroid hormone levels and gland size but not with cellular composition or growth pattern.</p><p><strong>Conclusion: </strong>¹⁸F-fluorocholine positron emission tomography-computed tomography demonstrates high diagnostic performance in lesion localization, particularly in patients with negative or inconclusive first-line imaging. These findings suggest that radiotracer uptake may be influenced by biochemical and morphologic features, although further studies are warranted to clarify these mechanisms.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109595"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812340","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":"Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy.","authors":"Domenico Tamburrino, Giovanni Guarneri, Lorenzo Provinciali, Giuseppe Vanella, Matteo Tacelli, Livia Archibugi, Marcella Negri, Marco Ripa, Gabriele Capurso, Paolo Giorgio Arcidiacono, Antonella Castagna, Nicolò Pecorelli, Stefano Crippa, Stefano Partelli, Massimo Falconi","doi":"10.1016/j.surg.2025.109594","DOIUrl":"10.1016/j.surg.2025.109594","url":null,"abstract":"<p><strong>Background: </strong>Bile colonization after biliary drainage is associated with a greater rate of morbidity and mortality after pancreaticoduodenectomy. The increased use of antibiotics has led to a greater rate of bile colonization by multidrug-resistant microorganisms. This study aimed to analyze the correlation between multidrug-resistant microorganisms and the rate of postoperative complications.</p><p><strong>Methods: </strong>Data from patients who underwent pancreaticoduodenectomy between 2016 and 2022 were retrospectively analyzed, and biliary culture data were revised and collected. Microorganisms were defined as sensitive to antibiotics or multidrug-resistant according to the literature.</p><p><strong>Results: </strong>Overall, 460 patients with intraoperative biliary cultures were included in the study group. Multidrug-resistant microorganisms were isolated from 102 (22%) patients. The presence of multidrug resistance at biliary culture was an independent risk factor for clinically relevant postoperative pancreatic fistula (odds ratio, 2.590; 95% confidence interval, 1.49-4.48, P = .001) and infectious complications (odds ratio, 3.232; 95% confidence interval, 1.99-5.25, P < .001). The isolation of multidrug-resistant microorganisms also increased the final burden of complications. In patients with clinically relevant postoperative pancreatic fistula, the presence of multidrug-resistant microorganisms resulted in a median comprehensive complication index of 47.10 [interquartile range, 36.2-66.6] versus 39.53 [interquartile range, 29.6-54.2], P = .034. Among the different microorganisms, Escherichia coli multidrug resistance and Klebsiella pneumoniae multidrug resistance were significantly associated with pancreatic surgery-specific complications.</p><p><strong>Conclusion: </strong>Multidrug-resistance bile colonization is an independent risk factor for complications after pancreaticoduodenectomy, including clinically relevant postoperative pancreatic fistula. In case of the onset of pancreatic surgery-specific complications, the presence of these microorganisms increases the burden of complications.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109594"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804901","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":"Short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder carcinoma: A systematic review and meta-analysis with meta-regression.","authors":"Shahin Hajibandeh, Shahab Hajibandeh, Syed Soulat Raza, David C Bartlett, Nikolaos Chatzizacharias, Bobby V M Dasari, Keith J Roberts, Ravi Marudanayagam, Robert P Sutcliffe","doi":"10.1016/j.surg.2025.109593","DOIUrl":"10.1016/j.surg.2025.109593","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma or gallbladder cancer were included, and their risk of bias were assessed. Effect sizes were determined for clinically relevant postoperative pancreatic fistula, clinically relevant posthepatectomy liver failure, bile leak, Clavien-Dindo classification III or greater complications, mortality, and 1- to 5-year survival using random-effects modeling followed by meta-regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-three retrospective studies (789 patients) conducted between 2007 and 2025 were included. Hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma was associated with clinically relevant postoperative pancreatic fistula: 52.1% (95% confidence interval, 38.8%-65.4%), CR-posthepatectomy liver failure: 31.5% (95% confidence interval, 14.5-48.4%), bile leak: 17.6% (95% confidence interval, 13.3-22.0%), Clavien-Dindo grade III or greater: 59.4% (95% confidence interval, 47.3-71.6%), mortality: 2.8% (95% confidence interval, 0.9-4.6%), and 1-year: 61.8% (95% confidence interval, 49.6-73.9%), 3-year: 30.2% (95% confidence interval, 23.5-36.9%) and 5-year survival: 23.7% (95% confidence interval, 17.3-30.2%). hepatopancreatoduodenectomy for gallbladder cancer was associated with clinically relevant postoperative pancreatic fistula: 48.7% (95% confidence interval, 19.9-77.5%), clinically relevant posthepatectomy liver failure: 15.7% (95% confidence interval, 0.2-31.2%), bile leak: 9.4% (95% confidence interval, 4.0-14.9%), Clavien-Dindo classification III or greater: 45.7% (95% confidence interval, 22.6-68.9%), mortality: 6.7% (95% confidence interval, 1.8-11.6%), and 1-year: 65.0% (95% confidence interval, 44.8-85.1%), 3-year: 19.9% (95% confidence interval, 10.8-29.0%), and 5-year survival: 14.0% (95% confidence interval, 5.2-22.9%). Portal vein resection was associated with clinically relevant postoperative pancreatic fistula (P = .003), clinically relevant posthepatectomy liver failure (P &lt; .001), and Clavien-Dindo grade III or greater (P &lt; .001) in extrahepatic cholangiocarcinoma, and clinically relevant postoperative pancreatic fistula (P &lt; .001) and clinically relevant posthepatectomy liver failure (P &lt; .001) in gallbladder cancer. Arterial resection was associated with clinically relevant posthepatectomy liver failure (P &lt; .001), and Clavien-Dindo classification III or greater (P &lt; .001) in extrahepatic cholangiocarcinoma. Portal vein embolization predicted posthepatectomy liver failure in both extrahepatic cholangiocarcinoma (P &lt; .001) and gallbladder cancer (P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Hepatopancreatoduodenectomy f","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109593"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812342","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":"Comparison of outcomes between robotic and laparoscopic right hemicolectomy for colon cancer in patients with diabetes: Results from the US Nationwide Inpatient Sample.","authors":"Chih-Jung Chen, Hsin-Yuan Hung","doi":"10.1016/j.surg.2025.109597","DOIUrl":"10.1016/j.surg.2025.109597","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus is a prevalent comorbid condition with colon cancer and may significantly impact surgical outcomes. This study aims to compare the postoperative outcomes between robotic-assisted right hemicolectomy and laparoscopic right hemicolectomy for right-side colon cancer in patients with co-existing diabetes mellitus.</p><p><strong>Methods: </strong>Data from Nationwide Inpatient Sample were analyzed retrospectively. Adult patients ≥20 years with diabetes mellitus who underwent either robotic-assisted right hemicolectomy or laparoscopic right hemicolectomy were included. Outcomes included in-hospital mortality, length of stay, total hospital costs, nonroutine discharge, major complications, and rates of conversion to open surgery. Univariate and multivariable logistic regression analyses were used to compare the outcomes between robotic-assisted right hemicolectomy and laparoscopic right hemicolectomy.</p><p><strong>Results: </strong>A total of 8,273 patients were included, with 1,119 undergoing robotic-assisted right hemicolectomy and 7,154 undergoing laparoscopic right hemicolectomy. Robotic-assisted right hemicolectomy was associated with shorter length of stay (adjusted beta, -0.86; 95% confidence interval, -0.89 to -0.83, P < .001), a lower risk of major complications (adjusted odds ratio, 0.80; 95% confidence interval, 0.67-0.96, P = .016), but greater total hospital costs (adjusted beta, 30.64; 95% confidence interval, 30.00-30.66, P < .001) compared with laparoscopic right hemicolectomy.</p><p><strong>Conclusion: </strong>Robotic-assisted right hemicolectomy offers significant advantages over laparoscopic right hemicolectomy for diabetic patients undergoing right hemicolectomy for colon cancer, including shorter hospital stays and lower rates of major complications. Despite greater total hospital costs, the improved short-term outcomes suggest that robotic-assisted right hemicolectomy is a safer and more effective surgical option for this patient population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109597"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812339","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.2025.109753","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109753","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109753"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207640","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 risks of inflammation and metabolism in distinct phenotypes of bicuspid aortic valve–associated aortopathy and aortic dissection: A population-based cohort study","authors":"Haoyu Gao MD ,&nbsp;Bangjie Xun MD ,&nbsp;Xiang Liu MD ,&nbsp;Zhenghua Xiao MD ,&nbsp;Bin Shao PhD ,&nbsp;Jun Shi MD ,&nbsp;Yingqiang Guo MD","doi":"10.1016/j.surg.2025.109727","DOIUrl":"10.1016/j.surg.2025.109727","url":null,"abstract":"<div><h3>Background</h3><div>Bicuspid aortic valve is frequently associated with progressive dilation of the ascending aorta and aortic root, predisposing patients to life-threatening complications such as aortic dissection. The roles of systemic inflammation and glucose-lipid metabolism in bicuspid aortic valve–associated aortopathy remain poorly defined.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 1,678 bicuspid aortic valve patients diagnosed between 2008 and 2024. Imaging, echocardiographic, and peripheral blood biochemical data were collected. Principal components analysis was used to generate composite metabolic and inflammatory scores. Random forest, LASSO regression, and SHAP (SHapley Additive exPlanations) methods were used for feature selection. Logistic and Cox regression models, along with restricted cubic spline analysis and Kaplan-Meier curves, were applied to evaluate risk factors for aortic dilation and Stanford type A aortic dissection.</div></div><div><h3>Results</h3><div>Ascending aortic dilation (≥40 mm) was present in 66.98% of patients, and aortic root dilation in 19.79%. Both metabolic and inflammatory scores were significantly associated with ascending aortic diameter, but only the metabolic score remained independently associated with root diameter after adjustment. Triglyceride-glucose and monocyte-to-lymphocyte ratio were identified as the key metabolic and inflammatory markers. Triglyceride-glucose was independently associated with ascending aortic dilation (odds ratio = 2.15, <em>P</em> &lt; .001), but not with Stanford type A aortic dissection. Monocyte-to-lymphocyte ratio was independently associated with both ascending aortic dilation (odds ratio = 3.17, <em>P</em> = .001) and Stanford type A aortic dissection (hazard ratio = 8.87, <em>P</em> &lt; .01). A monocyte-to-lymphocyte ratio threshold of 0.38 stratified Stanford type A aortic dissection risk (log-rank <em>P</em> = .003). For aortic root dilation, neither the monocyte-to-lymphocyte ratio nor the triglyceride-glucose index showed significant independent associations overall. Subgroup analysis revealed that the triglyceride-glucose index was significantly associated with increased root diameter only in patients with aortic root diameter &lt;40 mm.</div></div><div><h3>Conclusions</h3><div>Systemic metabolic and inflammatory states are key contributors to ascending aortic dilation, but not to aortic root dilation, in patients with bicuspid aortic valve. Monocyte-to-lymphocyte ratio is a robust predictor of Stanford type A aortic dissection, offering a potential biomarker for early risk stratification and surgical decision making. These findings support the presence of phenotype-specific mechanisms in bicuspid aortic valve–associated aortopathy and underscore the distinct roles of inflammation and metabolism in different aortopathy phenotypes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109727"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207685","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}