Surgery最新文献

{"title":"Efficacy and safety of subserosal versus submucosal carbon nanoparticle-guided laparoscopic radical gastrectomy (DANCE-04): A randomized clinical trial.","authors":"Song Liu, Peng Song, Qiongyuan Hu, Feng Sun, Xiaofeng Lu, Meng Wang, Haijian Zhao, Wenxian Guan","doi":"10.1016/j.surg.2025.109398","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109398","url":null,"abstract":"<p><strong>Background: </strong>To compare the efficacy in lymph node dissection, perioperative safety, and cost of subserosal and submucosal administration of carbon nanoparticles in laparoscopic radical gastrectomy for gastric cancer.</p><p><strong>Methods: </strong>This was a randomized clinical trial. Patients with potentially resectable gastric cancer (cT1-4a, cNany, cM0) were randomized into subserosal or submucosal groups. Laparoscopic D2 lymphadenectomy was performed for each patient.</p><p><strong>Results: </strong>Between September 2023 and August 2024, 49 patients were enrolled in the subserosal group and 50 patients were enrolled in the submucosal group. The number of retrieved lymph nodes in the subserosal group was significantly greater than that in the submucosal group (36.6 ± 1.4 vs 32.2 ± 1.4, P = .02). The number of retrieved metastatic lymph nodes in the subserosal group was also significantly greater than that in the submucosal group (3.1 ± 0.6 vs 1.5 ± 0.5, P = .04). The duration of surgery in the subserosal group was shorter than that in the submucosal group (150.9 ± 3.0 minutes vs 194.7 ± 6.2 minutes, P < .001). The tracing-related cost in the subserosal group was lower than that in the submucosal group (1,824.8 ± 110.9 vs 2,395.5 ± 112.5 [in Chinese currency], P < .001), whereas the tracing-excluded cost was similar between groups. Diagnostic values, including sensitivity, specificity, positive predictive value, and negative predictive value for metastatic stations or lymph nodes, of the subserosal approach were superior to those of the submucosal approach.</p><p><strong>Conclusion: </strong>Subserosal is superior to submucosal administration of carbon nanoparticles in lymph node dissection with comparable perioperative safety and decreased tracing-related cost in laparoscopic radical gastrectomy for gastric cancer.</p><p><strong>Trial registration: </strong>ISRCTN11247387 (https://doi.org/10.1186/ISRCTN11247387).</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109398"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111915","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":"Military–civilian partnerships","authors":"Robel T. Beyene MD,&nbsp;Bradley M. Dennis MD,&nbsp;Joshua P. Smith DO","doi":"10.1016/j.surg.2025.109312","DOIUrl":"10.1016/j.surg.2025.109312","url":null,"abstract":"<div><div>Battlefield medicine has advanced trauma care knowledge throughout history and continues to do so now. However, as war has become less common and civilian trauma continues to occur, civilian trauma centers have become essential in maintaining competency in casualty care. Military–civilian partnerships, such as the US Army Military Civilian Trauma Team Training program and the Strategic Medical Asset Readiness Training program, allow military medical personnel to practice complex trauma care in high-volume trauma centers. Civilian centers benefit from both the deployed experience of the military personnel and extra skilled personnel contributing to their practice without the salary costs. Although both sides have potential drawbacks, these partnerships represent one strategy to meet the military's goal of decreasing battlefield mortality.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109312"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor on \"Prognostic relevance of lymph node metastasis in pancreaticoduodenectomy for distal cholangiocarcinoma: Rational extent and number-based nodal classification for regional lymphadenectomy\".","authors":"Weiqiao Niu, Yan Zhang, Jianwu Wu","doi":"10.1016/j.surg.2025.109341","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109341","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109341"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080421","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":"Risk assessment of lymph node metastasis in early gastric cancer patients with vagus nerve–preserving gastrectomy: A multiple centers potential analysis in China","authors":"Xinyu Wang MD ,&nbsp;Xiangyu Wang MD ,&nbsp;Qi You MD ,&nbsp;Kun Yang MD ,&nbsp;Zhiqiang Liu MD ,&nbsp;Zuli Yang MD ,&nbsp;Tong Zhou MD ,&nbsp;Yong Li MD ,&nbsp;Yi Zeng MD ,&nbsp;Haitao Hu MD ,&nbsp;RuPeng Zhang MD ,&nbsp;Han Liang MD ,&nbsp;Tao Zhang MD ,&nbsp;Yantao Tian MD ,&nbsp;Zaisheng Ye MD ,&nbsp;Bin Ke MD ,&nbsp;Jingyu Deng MD","doi":"10.1016/j.surg.2025.109411","DOIUrl":"10.1016/j.surg.2025.109411","url":null,"abstract":"<div><h3>Background</h3><div>Vagus nerve–preserving gastrectomy is gaining popularity for early gastric cancer treatment. This study assesses vagus nerve–preserving gastrectomy's perioperative safety and impact on postoperative quality of life, and explores vagus nerve–associated lymph node metastasis to create a risk model for enhanced therapy.</div></div><div><h3>Methods</h3><div>Clinicopathologic data from 1,210 early gastric cancer patients across 11 Chinese centers were analyzed, and the data of 800 patients with follow-up information and 48 patients who underwent vagus nerve–preserving gastrectomy for validation were collected. Propensity score matching was applied to the analysis of perioperative safety and quality of life in vagus nerve–preserving gastrectomy patients. A 6-point risk assessment model was devised and validated to evaluate the risk of vagus nerve–associated lymph node metastasis after vagus nerve–preserving gastrectomy in early gastric cancer patients.</div></div><div><h3>Results</h3><div>Vagus nerve–preserving gastrectomy patients had shorter postoperative stays, quicker drainage cessation, and fewer incidences of diarrhea, acid reflux, and postoperative gallstones. Additionally, key independent risk factors for vagus nerve–associated lymph node metastasis included tumor size, differentiation type, invasion depth, and lymphatic vessel invasion. Using these factors, a 6-point risk assessment model was established. The values of the area under the receiver operating characteristic curve for the model were 0.796, 0.806, 0.808, and 0.829 in the training cohort, internal validation cohort, external validation cohort, and vagus nerve–preserving gastrectomy cohort, respectively. The model effectively differentiated between high- and low-risk groups in terms of postoperative survival.</div></div><div><h3>Conclusions</h3><div>Vagus nerve–preserving gastrectomy can improve the patients' postoperative quality of life and ensure safety in the perioperative period. The vagus nerve–associated lymph node metastasis risk assessment model is a crucial tool in guiding the selection of optimal surgical procedures and treatment strategies for early gastric cancer patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109411"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941172","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":"Clustering of burns with other types of injury in patients younger than 10 years of age","authors":"Gabrielle Kang-Auger MD, MSc(c) ,&nbsp;Daniel E. Borsuk MD, MBA, FRCSC, FACS ,&nbsp;Andrée-Anne Roy MD, MSc, FRCSC ,&nbsp;Aimina Ayoub MSc ,&nbsp;Nathalie Auger MD, MSc, FRCPC ,&nbsp;Gabriel Côté-Corriveau MD, MSc, FRCPC","doi":"10.1016/j.surg.2025.109409","DOIUrl":"10.1016/j.surg.2025.109409","url":null,"abstract":"<div><h3>Background</h3><div>Childhood burns may cluster with other trauma, but the relationship between burns and other injuries is poorly understood. The objective of this study was to determine the association between burns and other types of injury hospitalization in children younger than age 10 years.</div></div><div><h3>Methods</h3><div>We carried out a multicenter cohort study of 4,262 patients aged younger than 10 years with burns who were matched with 40,518 controls in Quebec, Canada. The main exposure measure was a burn requiring hospital treatment. The main outcome was hospitalization for other types of injury anytime between birth and age 10 years. We used Cox regression models adjusted for patient characteristics to assess the association (hazard ratio; 95% confidence interval) between burns and risk of other injury hospitalization.</div></div><div><h3>Results</h3><div>Patients with burns had a greater rate of hospitalization for other types of injury than controls (7.6 vs 5.1 per 1,000 person-years), equivalent to 1.46 times greater risk (95% confidence interval, 1.29–1.65). Compared with controls, patients with burns were 1.61 times more likely to have an injury hospitalization between age 0 and &lt;5 years (95% confidence interval, 1.39–1.88) and 1.25 times more likely between age 5 and &lt;10 years (95% confidence interval, 1.02–1.52). Patients with burns were 4.74 times more likely to have been hospitalized for a maltreatment injury before their burn (95% confidence interval, 2.68–8.38).</div></div><div><h3>Conclusion</h3><div>Children with burns are at high risk of hospitalization for other injuries before age 10 years. A better understanding of how pediatric injuries cluster with burns may help prevent child trauma.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109409"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor on: \"Prognostic relevance of lymph node metastasis in pancreaticoduodenectomy for distal cholangiocarcinoma: Rational extent and number-based nodal classification for regional lymphadenectomy\".","authors":"Yuki Hirose, Jun Sakata, Tatsuya Nomura, Kabuto Takano, Kazuyasu Takizawa, Kohei Miura, Hirosuke Ishikawa, Koji Toge, Takuya Ando, Shun Abe, Yusuke Kawachi, Hiroshi Ichikawa, Yoshifumi Shimada, Toshifumi Wakai","doi":"10.1016/j.surg.2025.109400","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109400","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109400"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080424","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":"Retrospective analysis of surgical pancreatic necrosectomy outcomes in patients with and without obesity","authors":"Roberto J. Valera MD ,&nbsp;Mir Shanaz Hossain MD ,&nbsp;Ronit Patnaik MD ,&nbsp;Cesar Valdivieso MD ,&nbsp;Lisandro Montorfano MD ,&nbsp;Albert Parlade MD ,&nbsp;Toms Augustin MD ,&nbsp;R. Matthew Walsh MD ,&nbsp;Conrad H. Simpfendorfer MD ,&nbsp;Mayank Roy MD","doi":"10.1016/j.surg.2025.109410","DOIUrl":"10.1016/j.surg.2025.109410","url":null,"abstract":"<div><h3>Background</h3><div>Acute necrotizing pancreatitis is associated with high morbidity and mortality. This study aims to compare surgical necrosectomy outcomes in acute necrotizing pancreatitis between patients with and without obesity.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed for all patients who underwent surgical necrosectomy via a minimally invasive approach or an open approach over a 10-year period at a large US healthcare system. Patients were divided into 2 groups: those with obesity (body mass index ≥30 kg/m²) and those without obesity (body mass index &lt;30 kg/m²). The primary end point was the incidence of early complications or postoperative death within 30 and 90 days. The secondary end point was the incidence of long-term complications.</div></div><div><h3>Results</h3><div>In total, 80 patients were included with 36 (45%) with obesity, and 44 (55%) without obesity. A total of 52 patients (65%) had an open approach and 28 (35%) had an minimally invasive approach. The average age was 54.79 ± 15.25 years, and the median follow-up time was 83.5 days (interquartile range, 40.25–149.75 days). The median body mass index of the patient group with obesity was 34.55 kg/m² (interquartile range, 31.55–40.61), and that for the patient group without obesity was 25.97 kg/m² (interquartile range, 23.22–28.35 kg/m²) (<em>P</em> ≤ .0001). Days from admission to surgical intervention was longer in obese patients but it was not statistically significant (44.50 [interquartile range, 12–88] vs 27 [interquartile range, 15–42.5], <em>P</em> = .831). 30 and 90-day complication rates and mortality were similar between the groups.</div></div><div><h3>Conclusion</h3><div>Operative outcomes of pancreatic necrosectomy in patients with obesity appears to be comparable with patients without obesity. Surgical pancreatic necrosectomy can be performed safely, effectively, and in a similar time frame regardless of the presence of obesity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109410"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941151","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":"SHapley Additive exPlanations (SHAP)-based, multivariate machine-learning techniques with external validation: Construction of a preoperative interpretable predictive model for intestinal resection of incarcerated inguinal hernia","authors":"Zheqi Zhou MD ,&nbsp;Cong Tong MD ,&nbsp;Yiliang Li MD ,&nbsp;Aikebaier Aili PhD ,&nbsp;Maimaitiaili Maimaitiming MD ,&nbsp;Tao Hong MD ,&nbsp;Mirezati Maimaiti MD ,&nbsp;Yusujiang Tusuntuoheti MD ,&nbsp;Kelimu Abudureyimu MD ,&nbsp;Likun Yan MD","doi":"10.1016/j.surg.2025.109406","DOIUrl":"10.1016/j.surg.2025.109406","url":null,"abstract":"<div><h3>Background</h3><div>Currently, there are a lack of effective tools for preoperative risk assessment of intestinal resection in patients with inguinal incarcerated hernia. The purpose of this study is to investigate the variable characteristics associated with intestinal resection and develop an interpretable preoperative prediction model, aiming to assist clinicians in preoperative risk for intestinal resection in patients with inguinal incarcerated hernia.</div></div><div><h3>Methods</h3><div>The data from 2 medical institutions were retrospectively collected, and they were grouped according to whether intestinal resection was performed intraoperatively and the pathologic results. Lasso and multifactor logistic regression screened variables, and 10 machine-learning algorithms built and validated the model, with evaluation using the confusion matrix and SHapley Additive exPlanations value.</div></div><div><h3>Results</h3><div>Lasso regression and multifactorial logistic regression analyses showed that peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein were the key characteristic variables. The area under curve of models constructed by 10 algorithms in the external validation set were all above 0.8, and the k-nearest neighbor algorithm had the most comprehensive model performance. The constructed model exhibits good predictive performance on the external validation set.</div></div><div><h3>Conclusion</h3><div>Accurate preoperative prediction of intraoperative intestinal ischemia in patients with incarcerated inguinal hernia is crucial. This study identified peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein as characteristic variables for predicting intraoperative intestinal ischemia in these patients. The constructed prediction model can assist clinicians in more accurately assessing intestinal viability during surgery, offering valuable insights for evaluating intestinal resection risk.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109406"},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937435","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":"OptLung: An online predictive model for optimizing therapeutic strategies for second primary lung cancer in cancer survivors","authors":"Tingting Tang MD ,&nbsp;Guang Li MD ,&nbsp;Junwen Pei MD ,&nbsp;Hangyan Du MD ,&nbsp;Fei Ding MD ,&nbsp;Jianjun Wang MD ,&nbsp;Guangliang Duan MD","doi":"10.1016/j.surg.2025.109376","DOIUrl":"10.1016/j.surg.2025.109376","url":null,"abstract":"<div><h3>Background</h3><div>Advances in cancer detection and treatment have significantly improved survival rates and led to an increasing prevalence of the second primary lung malignancy among cancer survivors. The prognosis and optimal treatment strategies of second primary lung malignancy differ substantially from those of first primary lung cancers. Existing prognostic models primarily focus on the first primary lung cancers and offer limited guidance for personalized treatment strategies to patients with second primary lung malignancy.</div></div><div><h3>Methods</h3><div>We identified patients with second primary lung malignancy who met the inclusion criteria in the Surveillance, Epidemiology, and End Results database. Machine learning models, including classification trees, K-nearest neighbors, gradient boosting machine, neural network, and random forest, were developed to predict 1- to 5-year overall survival and cancer-specific survival. The dataset was split into training and testing sets (8:2 ratio), and the model performance was evaluated using area under the curve, accuracy, sensitivity, specificity, precision, F1 scores, and Brier scores. By comparing survival outcomes between the concordant group (patients whose treatments aligned with model recommendations) and the discordant group (patients whose treatments did not), the ability of models to recommend optimal therapeutic strategy was validated.</div></div><div><h3>Results</h3><div>Among 32,370 patients with second primary lung malignancy from the Surveillance, Epidemiology, and End Results database, factors associated with worse prognosis included older age, male sex, White race, unmarried status, nonadenocarcinoma histology, advanced T and N stages, and advanced American Joint Committee on Cancer stage. Conversely, smaller tumor size, surgical intervention, chemotherapy, and radiotherapy were associated with improved prognosis. The gradient boosting machine model exhibited superior predictive performance for overall survival and cancer-specific survival and achieved area under the curve values exceeding 0.84 across all time points. Therapeutic recommendations from models proved effective because the concordant group demonstrated significantly better overall survival and cancer-specific survival than the discordant group. To enhance the clinical applicability of treatment recommendations by machine-learning models, an interactive web-based tool, OptLung (<span><span>https://hznuduan.shinyapps.io/OptLung/</span><svg><path></path></svg></span>), was developed.</div></div><div><h3>Conclusion</h3><div>This study used machine-learning models to accurately predict the survival curve of patients with second primary lung malignancy. These models built a user-friendly web-based platform where clinicians can obtain the optimal therapeutic strategy for patients with second primary lung malignancy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109376"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor on \"Differential MYC and PROM1 mRNA isoform expression in breast invasive carcinoma as biomarkers for subtyping and prognosis\".","authors":"Chang Liu, Shidi Yuan, Zhichun Liu","doi":"10.1016/j.surg.2025.109401","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109401","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109401"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062272","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}