Surgery最新文献

{"title":"Surgery or chemotherapy first? Unveiling the best approach for colorectal cancer with resectable liver metastasis","authors":"Seijong Kim MD ,&nbsp;Jung Kyong Shin MD, PhD ,&nbsp;Yoonah Park MD, PhD ,&nbsp;Gyu-Seong Choi MD ,&nbsp;Jung Wook Huh MD, PhD ,&nbsp;Hee Cheol Kim MD, PhD ,&nbsp;Jin Seok Heo MD, PhD ,&nbsp;Seong Hyeon Yun MD, PhD ,&nbsp;Woo Yong Lee MD, PhD ,&nbsp;Seung Tae Kim MD, PhD ,&nbsp;Jeeyun Lee MD, PhD ,&nbsp;Young Suk Park MD, PhD ,&nbsp;Ho Yeong Lim MD, PhD ,&nbsp;Yong Beom Cho MD, PhD","doi":"10.1016/j.surg.2025.109446","DOIUrl":"10.1016/j.surg.2025.109446","url":null,"abstract":"<div><h3>Background</h3><div>Although neoadjuvant chemotherapy is foundational in treating stage IV colorectal cancer, its effectiveness for patients with resectable colorectal cancer liver metastasis is still under debate. This study evaluates the oncologic outcomes of operation-first compared with chemotherapy-first strategies in patients with initially resectable synchronous colorectal cancer liver metastasis, including the effects of targeted therapy and the survival outcomes after recurrence based on treatment strategy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 336 patients with resectable synchronous colorectal cancer liver metastasis who underwent complete radical resection and perioperative chemotherapy between 2007 and 2022. Patients were divided into operation-first (<em>n</em> = 244) and chemotherapy-first (<em>n</em> = 92) groups. The primary end points were disease-free survival and overall survival. We also explored the impact of targeted therapy and outcomes after recurrence.</div></div><div><h3>Results</h3><div>The operation-first group achieved significantly better disease-free survival and overall survival than the chemotherapy-first group. Targeted therapy was linked with lower disease-free survival and progression-free survival. Patients experiencing oligorecurrence who received local therapy had greater overall survival than those who underwent chemotherapy alone or those with polyrecurrence treated with local therapy plus chemotherapy or chemotherapy alone.</div></div><div><h3>Conclusion</h3><div>The operation-first strategy led to improved disease-free and overall survival in comparison with neoadjuvant chemotherapy for patients with resectable synchronous colorectal cancer liver metastasis. Local treatment of oligorecurrence improved oncologic outcomes, whereas perioperative targeted therapies were associated with poorer survival outcomes. These findings indicate the potential advantages of an operation-first approach; however, prospective randomized trials are necessary to verify these findings and to refine patient selection criteria.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109446"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190315","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 dynamic risk stratification for postoperative pancreatic fistula using serum pancreatic amylase on the day after pancreatoduodenectomy","authors":"Tomotaka Kato MD, PhD ,&nbsp;Yoshiki Murase MD, PhD ,&nbsp;Yasutaka Baba MD, PhD ,&nbsp;Kenichiro Takase MD, PhD ,&nbsp;Yuichiro Watanabe MD ,&nbsp;Katsuya Okada MD, PhD ,&nbsp;Masayasu Aikawa MD, PhD ,&nbsp;Kojun Okamoto MD, PhD ,&nbsp;Isamu Koyama MD, PhD","doi":"10.1016/j.surg.2025.109454","DOIUrl":"10.1016/j.surg.2025.109454","url":null,"abstract":"<div><h3>Background</h3><div>An appropriate combination of various biomarkers, including serum pancreatic amylase, drain amylase, and C-reactive protein levels, is pivotal for assessing the dynamic changes in patient status after pancreatoduodenectomy. This study aimed to establish a dynamic risk stratification for clinically relevant postoperative pancreatic fistula using clinically applicable parameters on postoperative days 1 to 3.</div></div><div><h3>Methods</h3><div>Data from 234 patients who underwent pancreatoduodenectomy were analyzed. Multivariate analyses were conducted using biomarkers available on postoperative days 1 to 3.</div></div><div><h3>Results</h3><div>Clinically relevant postoperative pancreatic fistula, grade C postoperative pancreatic fistula, and postpancreatectomy hemorrhage were observed in 56 (24%), 12 (5%), and 24 (10%) patients, respectively. Although the prognostic value of drain amylase and C-reactive protein improved over time, serum pancreatic amylase levels on postoperative days 1 and 2 were equally predictive of clinically relevant postoperative pancreatic fistula. Patients with high levels of serum pancreatic amylase had significantly high fistula risk scores. Multivariate analysis revealed that serum pancreatic amylase ≥75 U/L and drain amylase ≥2,000 U/L on postoperative day 1 were independent risk factors (odds ratio: 18.0 and 3.45, respectively). Adding C-reactive protein on postoperative day 2 to the stratification on postoperative day 1 improved the diagnostic accuracy (odds ratio: 3.19). Finally, risk assessment on postoperative day 3, using serum pancreatic amylase ≥75 U/L on postoperative day 1, drain amylase ≥5,000 U/L on postoperative day 3, and C-reactive protein ≥22 mg/L on postoperative day 3, identified 75% of patients at highest risk for clinically relevant postoperative pancreatic fistula (odds ratio: 19.7, 5.41, and 5.01, respectively), with an accuracy of 87%.</div></div><div><h3>Conclusions</h3><div>Dynamic risk stratification using serum pancreatic amylase on postoperative day 1 gradually increased the accuracy of identifying high-risk patients from postoperative days 1 to 3. Using suitable biomarkers, including those at each perioperative stage, can facilitate the early identification of high-risk patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109454"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190239","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 regarding: \"Oncological outcomes of palliative minimally invasive distal pancreatectomy for unexpected metastatic pancreatic ductal adenocarcinoma: A single-center experience\".","authors":"Baohua Zheng, Chunhong Xiao","doi":"10.1016/j.surg.2025.109434","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109434","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109434"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217002","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 systematic review of lymphovenous anastomosis to treat nontraumatic chylous anasarca","authors":"Antoine Mathivet MD ,&nbsp;Martin M. Bertrand MD, PhD ,&nbsp;Isabelle Quere MD, PhD ,&nbsp;Jean-Christophe Gris MD, PhD ,&nbsp;Julien Ghelfi MD, PhD ,&nbsp;Bob V. Occean PhD ,&nbsp;Julien Frandon MD, PhD","doi":"10.1016/j.surg.2025.109463","DOIUrl":"10.1016/j.surg.2025.109463","url":null,"abstract":"<div><h3>Background</h3><div>Anomalies in chyle flow, obstructive, functional or malformative, are responsible for leakage of chyle into the peritoneal, pericardial, or pleural spaces. Although rare, chronic chylous effusions can have disastrous consequences. Current treatments do not provide permanent and satisfactory solutions. Lymphovenous anastomosis can be a suitable treatment in this context; however, it needs to be fully evaluated regarding its efficacy, indications, and means of achievements. The objective of the study is to assess the efficacy of lymphovenous anastomosis to treat nontraumatic chylous anasarca.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was made using PubMed, ScienceDirect, and the Cochrane library from databases creation to August 2024 to analyze all patients reported to have undergone lymphovenous anastomosis for nontraumatic chylous leakage. Quality assessment of studies was performed with Joanna Briggs Institute Manual for Evidence Synthesis assessment tools and Methodological Index for Non-Randomized Studies. Results were presented in table summaries.</div></div><div><h3>Results</h3><div>In total, 14 studies matching inclusion criteria (human subjects, articles in English or French, whose main subject was chylous effusion management) were identified (9 case reports, 5 case series), representing 48 patients treated via lymphovenous anastomosis. The indications reported were mostly thoracic duct obstruction or malformation. Lymphovenous anastomosis was at least partially successful in 35 patients (74%), the condition was completely resolved in 27 patients (57%). Only a few complications were reported.</div></div><div><h3>Conclusion</h3><div>Lymphovenous anastomosis could be a suitable treatment for nontraumatic chylous effusions but requires further evaluation via prospective cohort studies with more patients to define indications and methods and evaluate long-term outcomes for better management.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109463"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190240","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 \"Navigating the learning curve of robotic pancreatoduodenectomy: Competency, proficiency, and mastery in a first-generation robotic surgeon with established open pancreatic expertise\".","authors":"Qi Xu, Yuwan Gao","doi":"10.1016/j.surg.2025.109464","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109464","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109464"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217001","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 parathyroidectomy on depression symptoms in patients with primary hyperparathyroidism: A systematic review and meta-analysis","authors":"Juan José Ruiz-Manzanera PhD ,&nbsp;Beatriz Febrero PhD ,&nbsp;José A. López-López PhD ,&nbsp;Manuel J. Albaladejo-Sánchez MD ,&nbsp;M. Isabel Jiménez-Mascuñán MD ,&nbsp;Miriam Abellán PhD ,&nbsp;José M. Rodríguez PhD","doi":"10.1016/j.surg.2025.109461","DOIUrl":"10.1016/j.surg.2025.109461","url":null,"abstract":"<div><h3>Background</h3><div>The presentation of primary hyperparathyroidism has evolved in recent years. At the moment, most patients are diagnosed incidentally through routine tests. However, these patients may present depressive symptoms and mood disturbances that may affect their quality of life. The objective of this study was to analyze published articles that evaluate depressive symptoms in patients with primary hyperparathyroidism and the changes produced in the short, mid, and long term after parathyroidectomy.</div></div><div><h3>Methods</h3><div>A systematic review of the literature on published articles that evaluated the role of parathyroidectomy on symptoms related to depression in primary hyperparathyroidism was carried out. A search was conducted in PubMed, Cochrane Library, and SciELO databases using terms specifically related to depression. All relevant literature published from the year 2000 to the present was included. The selection of studies was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses strategy. A meta-analysis was performed with studies that used the 2 most common depression-specific questionnaires.</div></div><div><h3>Results</h3><div>In total, 26 studies conducted in 11 different countries were included. A total population of 2,365 patients with hyperparathyroidism was collected and a total of 12 measurement instruments, specific and general, for depressive symptoms were used. The meta-analysis revealed a significant short-term (up to 3 months postoperatively) improvement in depression scores after surgery (effect estimate = 0.57; 95% confidence interval [CI], 0.33–0.81), though with notable heterogeneity among studies. Mid-term assessments (between 3 and 12 months postoperatively) did not show consistent evidence of improvement (effect estimate = 0.68; 95% CI, −0.32 to 1.69). However, long-term analysis (beyond 12 months postoperatively) demonstrated a significant and consistent reduction in depression scores (effect estimate = 0.46; 95% CI, 0.21–0.71) across studies.</div></div><div><h3>Conclusion</h3><div>Patients with primary hyperparathyroidism often present with depressive symptoms at diagnosis. Following parathyroidectomy, a significant improvement in these symptoms is observed. The meta-analysis confirms marked reductions in depression scores shortly after surgery, with these benefits sustained over the long term. Overall, the surgery provides lasting mental health benefits.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109461"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184363","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":"Appendiceal neuroendocrine tumors in children and adolescents: The European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) diagnostic and therapeutic recommendations","authors":"Calogero Virgone MD, PhD ,&nbsp;Jelena Roganovic MD, PhD ,&nbsp;Guido Rindi MD, PhD ,&nbsp;Michaela Kuhlen MD ,&nbsp;Jan Jamsek MD ,&nbsp;Paraskevi Panagopoulou MD ,&nbsp;Viera Bajciova MD ,&nbsp;Tal Ben-Ami MD ,&nbsp;Martine F. Raphael MD ,&nbsp;Guido Seitz MD ,&nbsp;Patrizia Dall’Igna MD ,&nbsp;Sheila C.E.J. Terwisscha van Scheltinga MD, PhD ,&nbsp;Miranda P. Dierselhuis MD, PhD ,&nbsp;Ramon R. Gorter MD, PhD ,&nbsp;Said Bachiri MD, PhD ,&nbsp;Ulrich-Frank Pape MD, PhD ,&nbsp;Florent Guérin MD, PhD ,&nbsp;Ines B. Brecht MD ,&nbsp;Brice Fresneau MD, PhD ,&nbsp;Daniel Orbach MD ,&nbsp;Antje Redlich MD","doi":"10.1016/j.surg.2025.109451","DOIUrl":"10.1016/j.surg.2025.109451","url":null,"abstract":"<div><div>Neuroendocrine tumors of the appendix, formerly known as carcinoid tumors, represent a rare entity. They are slow-growing tumors, characterized by an indolent clinical course. In pediatric patients, the 5-year overall survival is estimated to be 100% and the event-free survival slightly less than 100%, with only one reported case of local relapse to date. Nevertheless, a proportion of these patients still undergo a second surgery, mostly represented by right hemicolectomy with mesenteric lymphadenectomy, in consideration of the presence of certain risk factors (size &gt;1.5 or 2 cm; tumors of the appendiceal base with or without suspicious residuals, mesoappendiceal invasion, lymphovascular invasion, serosal breach). This approach represents an overtreatment of patients with a benign clinical course regardless of the presence of risk factors and/or whether a second surgery is performed. National recommendations for diagnosis, treatment, and follow-up of neuroendocrine tumors of the appendix in pediatric age are available in France, Italy, and Germany, but international consensus is lacking. This review presents the internationally harmonized recommendations for the diagnosis and treatment of neuroendocrine tumors of the appendix in children and adolescents, established by the European Cooperative Study Group for Pediatric Rare Tumors group.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109451"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184362","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: \"Association of mental health assessment with postoperative outcomes following major surgery in older individuals\".","authors":"Mujtaba Khalil, Timothy M Pawlik","doi":"10.1016/j.surg.2025.109466","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109466","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109466"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200040","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":"Semisupervised home-based prehabilitation in patients undergoing pancreaticoduodenectomy: Impact on postoperative outcomes","authors":"Bikash Nepal MS ,&nbsp;Rajesh Gupta MS, MCh ,&nbsp;Thakur Deen Yadav MS ,&nbsp;Nancy Sahni PhD ,&nbsp;Sandeep Negi MPT ,&nbsp;Chhewang Dorje MPT ,&nbsp;Pankaj Gupta MD ,&nbsp;Vishal Sharma MD, DM ,&nbsp;Harjeet Singh MS, MCh","doi":"10.1016/j.surg.2025.109455","DOIUrl":"10.1016/j.surg.2025.109455","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation is a relatively newer concept of utilizing the preoperative period for patient optimization to enhance the patient's physiological reserve. We planned a study to see the impact of a structured, multidimensional prehabilitative intervention on postoperative outcomes in patients undergoing pancreaticoduodenectomy.</div></div><div><h3>Methodology</h3><div>All consecutive patients planned for pancreaticoduodenectomy from January 2023 to June 2024 were assessed for enrollment. At least 2 weeks of semisupervised home-based prehabilitative intervention was done that included physical exercises, nutritional optimization, smoking cessation, and comorbidity optimization. Postoperative outcomes were recorded that included postoperative pancreatic fistula (POPF), complications grade, delayed gastric emptying, postoperative hospital stay, readmission rate, and mortality. Postoperative outcomes were compared with a historical control group of 81 patients.</div></div><div><h3>Results</h3><div>Of the 85 patients who were assessed for inclusion, 58 patients completed the prehabilitation program and underwent pancreaticoduodenectomy and were finally analyzed. The median age of the study group was 58 (interquartile range 45, 63.2), and 29 (50%) were male. Prehabilitation intervention resulted in improved weight control (median 56.5 kg [interquartile range 51.2, 67] vs 55 kg [ 49.2, 67.5], <em>P</em> &lt; .001), increase in breath hold time (median 32 [interquartile range 28, 35] vs 28 [24, 33.5] seconds, <em>P</em> &lt; .001), higher prognostic nutritional index (median 45.5 [interquartile range 39.5, 49.6] vs 47.8 [42.4, 50.8], <em>P</em> = .003), and increased gait speed (median 0.66 [interquartile range 0.58, 0.75] vs 0.54 [0.50, 0.66] m/s, <em>P</em> = .001). Clinically relevant postoperative pancreatic fistula (18 [22.2%] vs 11 [19%], <em>P</em> = .64) and major complications were similar between the prehabilitation and control groups (17 [29.3%] vs 24 [29.6%], <em>P</em> = .96). The mortality in the control group was higher compared with that in the prehabilitation group (6.3% vs 1.7%).</div></div><div><h3>Conclusion</h3><div>Semisupervised home-based prehabilitation is effective in improving physiological parameters and functional capacity in pancreaticoduodenectomy. However, establishing the definite role of prehabilitation in pancreaticoduodenectomy to improve postoperative outcomes needs a large randomized study.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109455"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184364","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":"Minimally invasive surgery could be attempted with preoperatively predictable difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy: A large multicenter study","authors":"Hanbo Pan MD ,&nbsp;Hang Chen MD ,&nbsp;Weicheng Kong MD ,&nbsp;Zhen Ge MD ,&nbsp;Jiaqi Zhang MD ,&nbsp;Yu Tian MD ,&nbsp;Junwei Ning MD ,&nbsp;Ningyuan Zou MD ,&nbsp;Zhiyuan Bao MD ,&nbsp;Qiyang Qiu MD ,&nbsp;Difan Zhang MD ,&nbsp;Guomo Ruan MD ,&nbsp;Zhichao Pang MD ,&nbsp;Liang Fang MD ,&nbsp;Zongxiang Duan MD ,&nbsp;Weiqiu Jin MD ,&nbsp;Zhongjie Chen MD ,&nbsp;Min Zheng MD ,&nbsp;Chengwei Zhou MD ,&nbsp;Hui Wang MD ,&nbsp;Qingquan Luo MD, FACS, FRCS","doi":"10.1016/j.surg.2025.109458","DOIUrl":"10.1016/j.surg.2025.109458","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant immunochemotherapy has revolutionized the treatment of non–small cell lung cancer. However, it presents significant surgical challenges, leading to controversy over the feasibility and safety of minimally invasive surgery. This study aims to assess the adequacy of minimally invasive surgery and preoperatively predict its difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy.</div></div><div><h3>Methods</h3><div>Initial stage IIA-IIIB (excluding stage T4N2) non–small cell lung cancer patients with neoadjuvant immunochemotherapy undergoing minimally invasive surgery or open thoracotomy at 12 institutions between 2019 and 2024 were retrospectively reviewed. Difficult minimally invasive surgery was defined by conversion to thoracotomy. Propensity score matching was applied to balance baseline characteristics.</div></div><div><h3>Results</h3><div>Of the 571 cases included, propensity score matching led to 240 patients per group. Minimally invasive surgery decreased intraoperative bleeding, shortened postoperative chest tube duration and hospitalization, ameliorated postoperative pain, and reduced postoperative complications compared to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate of 15.8%, and notably, converted minimally invasive surgery achieved similar perioperative outcomes to open thoracotomy. Accumulated surgeons' experiences reduced minimally invasive surgery conversion rates and shortened surgical durations. Additionally, logistic regression identified squamous cell carcinoma, advanced preinduction N stage, preoperative tumor size &gt;5 cm, advanced preoperative stage, and extended resection as independent risk factors for conversion. A nomogram was further established with good performance (area under curve value = 0.804) and clinical utility to predict conversion probability preoperatively. Finally, minimally invasive surgery and open thoracotomy achieved comparable event-free survival and overall survival profiles.</div></div><div><h3>Conclusions</h3><div>Minimally invasive surgery achieved improved perioperative outcomes and similar oncologic efficacies to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate, which would not compromise perioperative outcomes compared with open thoracotomy and could be effectively forecasted by a prediction model.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109458"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184365","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}