Surgery最新文献

{"title":"Limited impact of sentinel lymph node biopsy in older women with cT2N0 hormone-positive human epidermal growth factor receptor 2-negative breast cancer.","authors":"Mariam T Khan, G Paul Wright, Jessica Thompson","doi":"10.1016/j.surg.2026.110626","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110626","url":null,"abstract":"<p><strong>Background: </strong>Consensus guidelines support selective omission of sentinel lymph node biopsy for axillary staging in older women with early stage, biologically favorable breast cancer; however, applicability to clinical T2 disease remains unclear. We evaluated the impact of sentinel lymph node biopsy on adjuvant treatment decisions in women ≥65 years with cT2N0 hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer.</p><p><strong>Methods: </strong>A single-institution retrospective review included consecutive patients treated from 2019 to 2023. Clinicopathologic features, adjuvant therapy decisions, and outcomes were analyzed.</p><p><strong>Results: </strong>Among 113 patients, 35 (31%) had pN1 disease, and 2 (1.8%) had pN2-3 disease. Final pathologic tumor size was pT1 in 25 patients (22.1%), 2.1-3.0 cm in 48 (42.5%), 3.1-4.0 cm in 27 (23.9%), and >4.0 cm in 13 (11.5%). Nodal positivity was lower among patients with pT1 compared with pT2 tumors (8% vs 31%, P = .035) but did not differ across pT2 subgroups (P = .864). Twelve patients (10.6%) received chemotherapy, with nodal status determining treatment in only 2 cases. Regional nodal irradiation was administered to 15 of 37 patients with pathologically node-positive disease and omitted in the remainder. At the median follow-up of 3.1 years, 9 patients (8%) experienced recurrence; all pathologically node-positive patients with recurrence (n = 4) demonstrated endocrine therapy noncompliance.</p><p><strong>Conclusion: </strong>In women ≥65 years with cT2N0 hormone receptor-positive/human epidermal growth factor receptor-negative breast cancer, sentinel lymph node biopsy infrequently influenced adjuvant management. Chemotherapy was guided by genomic assays, and most patients with pathologically node-positive disease did not receive regional nodal irradiation, supporting a selective, individualized approach to axillary staging.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110626"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081921","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":"Chronic steroid use is not associated with increased short-term morbidity after distal pancreatectomy: A propensity-matched analysis.","authors":"Sangrag Ganguli, Jason Z Gao, Mohammed F Almeflehi, Amir Ebadinejad, Hassan Aziz","doi":"10.1016/j.surg.2026.110606","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110606","url":null,"abstract":"<p><strong>Background: </strong>A national study analyzing the association between chronic steroid use and outcomes after pancreatic resection is lacking. This study aimed to evaluate the association between chronic glucocorticoid use and outcomes after distal pancreatectomy using a national database.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing distal pancreatectomy was performed using the National Surgical Quality Improvement Program database (2018-2024). In addition, we used propensity score matching to compare patients on chronic steroids with those who were not. The outcomes measured included 30-day complications and mortality, need for readmission, prolonged hospital stay, and pancreatic fistula.</p><p><strong>Results: </strong>Of the 6,876 patients who underwent distal pancreatectomy, 623 were on chronic steroids. After propensity score matching, 438 patients in the steroid group and 876 patients in the nonsteroid group were compared. There were no significant differences in pancreatic fistula (23.7% vs 21.7%; P = .3), major complications (31.7% vs 30.1%; P = .1), minor complications (42.2% vs 41.6%; P = .6), mortality (3.4% vs 3.2%; P = .6), readmission (15.8% vs 14.7%; P = .3), or prolonged length of stay (11.4% vs 10.5%; P = .5). On multivariate analysis, chronic steroid use was not independently associated with any adverse outcomes.</p><p><strong>Conclusion: </strong>Chronic glucocorticoid use was not associated with increased short-term morbidity, pancreatic fistula, or mortality following distal pancreatectomy. These findings suggest that chronic steroid dependence should not be considered a contraindication to distal pancreatectomy, although the results should be interpreted with caution, given the inability to assess dose-response relationships and the potential for residual confounding.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110606"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064330","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":"Platelet receptor shedding: An in vitro study in shock-related platelet functional impairment.","authors":"Lawrence N Diebel, David M Liberati, Vanessa Anunobi","doi":"10.1016/j.surg.2026.110608","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110608","url":null,"abstract":"<p><strong>Background: </strong>Early platelet dysfunction is a key component of trauma-induced coagulopathy. Studies have suggested that excess catecholamine following shock conditions may be implicated through proteolytic shedding of key platelet surface receptors. This study investigates the impact of epinephrine exposure on platelet receptor shedding and its subsequent effects on platelet activation, aggregation, and adhesion in an in vitro model.</p><p><strong>Methods: </strong>Whole blood samples were exposed to increasing concentrations of epinephrine for 5 and 30 minutes. Enzyme-linked immunosorbent assay was then used to quantify levels of key platelet receptors. Platelet activation was assessed via flow cytometry using platelet activation complex-1 staining. Platelet aggregation to collagen-coated microfluidic channels and platelet adhesion to human umbilical vein endothelial cell-coated microfluidic channels were measured by fluorescence. Matrix metalloproteinase and a disintegrin and metalloproteinase 17 activities were measured using fluorometric assays.</p><p><strong>Results: </strong>Epinephrine exposure significantly increased shedding of all measured platelet surface receptors in a dose- and time-dependent manner versus control (no epinephrine). These changes were accompanied by significant increases in matrix metalloproteinase and a disintegrin and metalloproteinase 17 activity. Platelet activation, adhesion, and aggregation were also significantly decreased with epinephrine exposure compared with control, especially at higher epinephrine concentrations and with longer exposure times.</p><p><strong>Conclusion: </strong>Epinephrine exposure was shown to increase platelet receptor shedding in a time- and concentration-dependent manner. This correlated with an increase in metalloproteinase activity, suggesting a possible mechanistic link. Increased platelet receptor shedding was also associated with impaired platelet adherence and aggregation in microfluidic devices. These findings support the role of catecholamine excess in early platelet dysfunction following shock and present possible therapeutic targets for future studies.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110608"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040885","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":"Who is difficult for transoral robotic thyroidectomy? A prospective analysis of 76 lobectomies.","authors":"Man Hon Tang, Moon Young Oh, Young Jun Chai","doi":"10.1016/j.surg.2026.110602","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110602","url":null,"abstract":"<p><strong>Background: </strong>Transoral robotic thyroidectomy can be technically demanding, particularly during the early learning phase. This study aimed to identify preoperative factors associated with increased surgeon's subjective difficulty in transoral robotic thyroidectomy lobectomy.</p><p><strong>Methods: </strong>This prospective observational study included consecutive 3-port transoral robotic thyroidectomy lobectomy cases performed between January and September 2025 by a single endocrine surgeon. The procedure was divided into 4 key steps, each graded on a 1-3 subjective difficulty scale. An overall difficulty score (range, 4-12) was calculated by summing step scores, and cases were classified as standard (4-5) or difficult (≥6). Patient anthropometric, clinicopathologic, operative, and postoperative variables were compared between groups.</p><p><strong>Results: </strong>A total of 76 transoral robotic thyroidectomy lobectomies (38 right-sided and 38 left-sided) were analyzed; 62 patients (81.6%) were female. Overall, 27 cases (35.5%) were classified as difficult. Difficult cases had longer operative time than standard cases (91.8 vs 71.7 minutes, P < .001), representing a 28.0% increase. Compared with the standard group, the difficult group had a higher proportion of male patients (37.0% vs 8.2%, P = .004), higher body mass index (25.7 vs 23.8 kg/m², P = .038), and deeper tracheal depth (24.4 vs 22.1 mm, P = .002). Clinicopathologic factors were not significantly associated with overall difficulty.</p><p><strong>Conclusion: </strong>Male sex, higher body mass index, and greater tracheal depth were associated with increased technical difficulty in transoral robotic thyroidectomy lobectomy. These factors may help inform preoperative case selection and operative planning in appropriately selected transoral robotic thyroidectomy candidates; however, further validation is needed before direct applicability to surgeons in the early learning phase can be assumed.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110602"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115192","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":"Surgical liver debulking and bland embolization for controlling liver metastases in patients with neuroendocrine tumors: A comparative effectiveness analysis.","authors":"Patricia G Lu, Joseph Tobias, Daniel Appelbaum, Nicholas Feinberg, Kelvin Memeh, Abdul Khan, Divya Kumari, Mikin Patel, Osman Ahmed, J Michael Millis, Chih-Yi Andy Liao, Xavier M Keutgen","doi":"10.1016/j.surg.2026.110594","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110594","url":null,"abstract":"<p><strong>Background: </strong>Surgical liver debulking and bland embolization (transarterial embolization) are commonly used to control progression of neuroendocrine tumor liver metastases. We sought to determine what sequence of surgical debulking and transarterial embolization provided longer disease control.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study to create a comparative effectiveness analysis model of surgical debulking and transarterial embolization. Inverse probability of treatment weighting was estimated from primary tumor site, Ki-67, liver tumor volume, and extrahepatic metastases to balance treatment groups. Weighted Kaplan-Meier analyses were used to estimate median progression-free survival.</p><p><strong>Results: </strong>Among 78 patients with neuroendocrine tumor liver metastases (34 small bowel, 29 pancreas, and 15 other), 24 (31%) underwent surgical debulking only, 23 (30%) surgery followed by transarterial embolization, 26 (33%) transarterial embolization only, and 5 (6%) transarterial embolization followed by surgery. Compared with patients who underwent surgery, transarterial embolization-only patients were more likely to have Ki-67 >20% (26.9% vs 9.6%, P = .03) and greater liver tumor burden (median tumor volume, 231 mL versus 150 mL, P = .04). After inverse probability of treatment weighting, covariate balance improved substantially. Weighted median progression-free survival was 13 months for surgery only or surgery first (95% confidence interval, 12-19) versus 9 months for embolization only or embolization first (95% confidence interval, 5-30, P = .003). Serotonin levels decreased significantly after surgery (1,170 to 434 ng/mL, P = .027) but not after embolization (1,873-1,445 ng/mL, P = .31).</p><p><strong>Conclusion: </strong>Neuroendocrine tumor liver metastases patients who were treated with surgical liver debulking first had longer progression-free survival. Surgery should be considered first line in appropriately selected patients, with transarterial embolization reserved for recurrent or unresectable disease.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110594"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075596","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":"Impact of delay in surgery after diagnosis of pancreatic neuroendocrine tumors: Should you rush to operate?","authors":"Anne Worth, Rasa Zarnegar, Thomas J Fahey, Brendan M Finnerty","doi":"10.1016/j.surg.2026.110597","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110597","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines for the management of pancreatic neuroendocrine tumors consider observation of localized pancreatic neuroendocrine tumors <1 cm, but it remains unclear if larger tumors have a propensity to spread. We aimed to assess the safety of delayed surgery on larger tumors and determine candidacy of a clinically relevant subgroup for nonoperative management.</p><p><strong>Methods: </strong>Resected M0, T1 (<2 cm), T2 (2-4 cm), and T3 (>4 cm) pancreatic neuroendocrine tumors from the Surveillance, Epidemiology, and End Results program from 2010 to 2022 were included. The interval from diagnosis to surgery and disease-specific survival were analyzed. National Cancer Database patients were then reviewed to assess the effect of surgical delay on incidence of pathologic upstaging and overall survival.</p><p><strong>Results: </strong>Overall, 4,898 and 9,072 patients from the Surveillance, Epidemiology, and End Results program and the National Cancer Database were included, respectively. Multivariable analysis demonstrated no impact of 3- to 6-month or 6- to 12-month delay to surgery on disease-specific survival (P = .44, .74) or overall survival (P = .51, .39). Subgroup analysis of T2, G1 nonfunctional tumors (Surveillance, Epidemiology, and End Results, n = 988; National Cancer Database, n = 1,645) demonstrated no difference in disease-specific survival (P = .28, .23), overall survival (P = .97, .77), or odds of upstaging (P = .41, .09) with delay to surgery. T2 subgroup patients undergoing nonoperative management (National Cancer Database, n = 350) demonstrated decreased overall survival when compared with surgical treatment on multivariate analysis (hazard ratio, 2.32; 95% confidence interval, 1.55-3.48; P < .01).</p><p><strong>Conclusion: </strong>Delayed surgery is safe for localized pancreatic neuroendocrine tumors without evidence of metastasis, and necessary time should be taken after diagnosis to optimize modifiable risk factors that impact survival. Expanding nonoperative management to patients with tumors >2 cm should be approached cautiously due to the association of nonoperative management with worse overall survival.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110597"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115205","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":"Human versus artificial intelligence decision-making for radioactive iodine use in differentiated thyroid cancer-A proof of concept.","authors":"Marina E Robson Chase, Jacob Hubbuch, Colleen A McMullen, Daniel Davenport, Omar El Kawkgi, Nora Habib, Alexandria Willis, Rachel Zalla, Danielle S Walsh, Oliver J Fackelmayer, Cortney Y Lee, William B Inabnet","doi":"10.1016/j.surg.2026.110590","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110590","url":null,"abstract":"<p><strong>Background: </strong>The decision to administer postoperative radioactive iodine therapy in differentiated thyroid cancer is evolving. Given the growing utility of large language models in medical decision-making, we hypothesize that artificial intelligence models can inform recommendations regarding postoperative radioactive iodine therapy.</p><p><strong>Methods: </strong>After institutional review board approval, demographic, operative, and pathologic details from 100 adult patients with differentiated thyroid cancer who underwent total thyroidectomy were retrospectively extracted. A comprehensive literature review was conducted to model an appropriate radioactive iodine consensus-informed estimate for each American Thyroid Association risk category. Four artificial intelligence platforms were queried for recommendations on the utility of postoperative radioactive iodine for each patient. The physician prescribed radioactive iodine treatment (human recommendation) and results of the artificial intelligence queries (artificial intelligence recommendation) were compared with the estimated radioactive iodine rates using binomial exact tests.</p><p><strong>Results: </strong>Of the 100 patients reviewed, the median age was 48 years, and 81% were female. The 2015 American Thyroid Association risk stratification resulted in 59 low-, 25 intermediate-, and 16 high-risk patients. Physicians and Google Gemini recommended radioactive iodine in 24% and 19% of low-risk patients, respectively, which was statistically greater than the consensus-informed estimate of 10%. In intermediate-risk patients, both physicians (92%) and Doximity GPT (76%) exceeded the radioactive iodine consensus-informed estimate of 50%. In high-risk patients, Open Evidence recommended radioactive iodine at a significantly lower rate (69%) than all comparators.</p><p><strong>Conclusion: </strong>Large language models that are not specifically trained for differentiated thyroid cancer management demonstrate variability in recommending radioactive iodine therapy. However, these platforms may complement human recommendations for radioactive iodine administration, with promise toward aligning radioactive iodine use with consensus guidelines.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110590"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064383","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":"Lactate-associated pyruvate kinase muscle isoform 2 nuclear enrichment and ferroptotic stress responses in lung cancer.","authors":"Lixiu Li, Aihong Zhong, Mingxiang Huang, Yujun Lin, Wenxin Chen, Zhijie Ni, Shuxing Chen, Feng He, Renjie Huang","doi":"10.1016/j.surg.2026.110567","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110567","url":null,"abstract":"<p><strong>Background: </strong>Ferroptosis is an iron-dependent form of regulated cell death with therapeutic potential in cancer. However, metabolic alterations within the tumor microenvironment may influence the sensitivity of lung cancer cells to ferroptotic stress. This study investigated the association between lactate exposure, pyruvate kinase muscle isoform 2 signaling, and cellular responses to RSL3-induced ferroptotic stress.</p><p><strong>Methods: </strong>Human H1299 lung cancer cells were treated with lactate (20 mmol/L; 24 hours), RSL3 (2 μmol/L), and the pyruvate kinase muscle isoform 2-targeting compound shikonin (1 μmol/L). Pyruvate kinase muscle isoform 2 expression and subcellular localization were assessed by immunofluorescence, and pyruvate kinase muscle isoform 2 immunoreactivity was evaluated by immunohistochemistry. Patient-derived lung cancer organoids were used to assess 3-dimensional growth. Wound-healing and Transwell assays were performed to evaluate wound closure and Transwell cell counts, respectively. SLC7A11 and glutathione peroxidase 4 protein levels were examined by Western blotting.</p><p><strong>Results: </strong>Under RSL3-induced ferroptotic stress, lactate treatment was associated with increased pyruvate kinase muscle isoform 2 nuclear enrichment and immunoreactivity, whereas shikonin partially attenuated these changes. Lactate partially alleviated RSL3-induced growth inhibition in patient-derived lung cancer organoids and increased wound closure and Transwell cell counts relative to RSL3 treatment alone. These lactate-associated phenotypic changes were partially attenuated by shikonin. RSL3 reduced SLC7A11 and glutathione peroxidase 4 protein levels, whereas lactate cotreatment increased the levels of both proteins. Shikonin attenuated the lactate-associated increase in glutathione peroxidase 4, while its effect on SLC7A11 was less pronounced.</p><p><strong>Conclusion: </strong>Lactate treatment was associated with increased pyruvate kinase muscle isoform 2 nuclear enrichment, higher SLC7A11 and glutathione peroxidase 4 protein levels, and partial attenuation of RSL3-induced growth inhibition. These findings suggest that lactate-associated pyruvate kinase muscle isoform 2 signaling may contribute to reduced sensitivity to ferroptotic stress in lung cancer. Further genetic and mechanistic studies are required to establish the causal role of pyruvate kinase muscle isoform 2 and determine whether nuclear pyruvate kinase muscle isoform 2 directly regulates SLC7A11 and glutathione peroxidase 4 expression.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110567"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184253","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":"How frequently does parathyroidectomy and adjuvant treatment lead to clinically meaningful changes in bone mineral density? A multi-institutional study.","authors":"Nicholas Druar, Caitlin B Finn, Benjamin Ay Cher, Vivek R Sant, Patricia Lu, Megan Applewhite, Dana Anderson, Naim M Maalouf, Jorge E Mosquera, David Schneider, Alexander Chiu, Kristin Long, Louise Davies, Rebecca S Sippel, Courtney Balentine","doi":"10.1016/j.surg.2026.110589","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110589","url":null,"abstract":"<p><strong>Background: </strong>The US Food and Drug Administration adopted percentage change in total hip bone mineral density as a validated surrogate end point to support clinical trials for osteoporosis. We evaluated the impact of parathyroidectomy for primary hyperparathyroidism on bone density using this new standard, with or without bisphosphonate therapy.</p><p><strong>Methods: </strong>We included 490 adults who underwent curative parathyroidectomy at 3 institutions and had bone mineral density testing within 3 years before and after surgery. We calculated the proportion achieving ≥3.18% improvement in total hip bone mineral density, with subgroup analyses by bisphosphonate use before and after surgery.</p><p><strong>Results: </strong>Mean age was 66.9 years, and mean preoperative calcium was 10.7 mg/dL. Overall, 45.2% (95% credible interval, 40.8%-50%) achieved meaningful bone mineral density improvement within 3 years. Among patients not on bisphosphonates preoperatively, rates were similar whether bisphosphonates were never used (43.3%), started within 1 year (53.6%), or beyond 1 year after surgery (48.5%). For patients on bisphosphonates preoperatively, improvement occurred in 37.9% if discontinued postoperatively, 36.1% if restarted within 1 year, and 46.8% if restarted after 1 year.</p><p><strong>Conclusion: </strong>Parathyroidectomy alone results in clinically meaningful bone mineral density improvement in 45.2% of patients. The additive benefit and optimal timing of bisphosphonates remain uncertain, underscoring the need for better adjuvant strategies, with respect to bone health, to enhance skeletal recovery after surgery.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110589"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031321","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":"Deep learning using wearable single-lead electrocardiograms for early detection of post-thyroidectomy hypocalcemia.","authors":"Seungho Lee, Seoi Jeong, Hyunjin Joo, Yoon Kong, Ja Kyung Lee, Woochul Kim, Hyeong Won Yu, Su-Jin Kim, Young Jun Chai, June Young Choi, Hyoun-Joong Kong, Kyu Eun Lee","doi":"10.1016/j.surg.2026.110599","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110599","url":null,"abstract":"<p><strong>Background: </strong>Timely recognition of post-thyroidectomy hypocalcemia remains challenging. We evaluated whether deep learning models using wearable single-lead electrocardiograms detect biochemical early warning hypocalcemia, defined as albumin-corrected calcium <8.5 mg/dL, compared with a heart rate-corrected QT interval benchmark.</p><p><strong>Methods: </strong>In a prospective cohort (N = 51), at baseline and postoperative day 1, postoperative day 2, 2-3 weeks, and 2-3 months, we obtained synchronized laboratory measurements and four 30-second wearable single-lead electrocardiogram recordings within 60 minutes and recorded symptom severity. Data were split at the patient level (no overlap) into internal and external cohorts for training, validation, and testing. We evaluated DenseNet, EfficientNet, ResNet, ResNeXt, and RegNet architectures. The primary end point was the area under the receiver operating characteristic curve for corrected calcium <8.5 mg/dL. Corrected QT interval from contemporaneous 12-lead electrocardiograms served as the non-deep learning benchmark.</p><p><strong>Results: </strong>We analyzed 490 electrocardiogram images from 38 patients (internal: 31; external: 7). DenseNet achieved area under the receiver operating characteristic curves of 0.878 (internal) and 0.870 (external) for corrected calcium <8.5 mg/dL, whereas postoperative day 1 12-lead corrected QT interval showed limited discrimination (area under the receiver operating characteristic curve, 0.526). In the full cohort (N = 51), the prevalence of biochemical early warning hypocalcemia was 60.8% (postoperative day 1), 58.8% (postoperative day 2), 17.6% (2-3 weeks), and 29.4% (2-3 months); the prevalence of biochemically significant hypocalcemia with low parathyroid hormone was 27.5%, 27.5%, 2.0%, and 0%, respectively.</p><p><strong>Conclusion: </strong>A wearable single-lead electrocardiogram-based deep learning model demonstrated strong discriminative performance for biochemical hypocalcemia after thyroidectomy. Compared with corrected QT interval-based assessment, the model achieved superior performance. Larger multi-institutional validation is warranted before clinical deployment.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110599"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115027","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}