Surgery最新文献

{"title":"The minimum number of lymph node retrieval in gastric cancer patients after neoadjuvant therapy: An international multi-institute cohort study","authors":"Zhi-Quan Zhang MD ,&nbsp;Qing Zhong PhD ,&nbsp;Yu-Qin Sun MD ,&nbsp;Yu-Bin Ma MD ,&nbsp;Fang-Hui Ding MD ,&nbsp;Dong Wu MD ,&nbsp;Meng-Qi Xue MD ,&nbsp;Jacopo Desiderio PhD ,&nbsp;Jun-Hua Yu MD ,&nbsp;Ju Wu MD ,&nbsp;Chao-Hui Zheng PhD ,&nbsp;Ping Li PhD ,&nbsp;Qi-Yue Chen PhD ,&nbsp;Chang-Ming Huang MD ,&nbsp;Jian-Wei Xie PhD","doi":"10.1016/j.surg.2025.109373","DOIUrl":"10.1016/j.surg.2025.109373","url":null,"abstract":"<div><h3>Background</h3><div>The minimum number of retrieved lymph nodes for radical gastrectomy after neoadjuvant therapy remains controversial. The objective of this study was to determine the minimum threshold for retrieved lymph nodes in patients with gastric cancer after neoadjuvant therapy to accurately evaluate staging and prognosis.</div></div><div><h3>Methods</h3><div>Multivariate models were employed to investigate the correlation between the number of retrieved lymph nodes and survival outcomes and stage migration. The hazard ratio curves for each retrieved lymph node count compared with 1 retrieved lymph node (as a reference), including overall survival and disease-specific survival, were fitted using a LOWESS smoother, and the structural break points were determined by Chow test.</div></div><div><h3>Results</h3><div>This international multicenter study analyzed the clinicopathological data of 2,490 patients with gastric cancer who underwent gastrectomy after neoadjuvant therapy. The median follow-up period for the overall population was 90.0 months, with a median of 22 retrieved lymph nodes. The study demonstrated that a greater number of retrieved lymph nodes was linked to a greater probability of detecting positive lymph nodes (odds ratio, 1.005; <em>P</em> = .030) as well as improved overall survival and disease-specific survival (overall survival: hazard ratio, 0.988; <em>P</em> &lt; .001 and disease-specific survival: hazard ratio, 0.987; <em>P</em> &lt; .001). The cutoff point analysis identified 24 as the minimum number of retrieved lymph nodes. The 5-year overall survival rate was significantly greater in the group with ≥24 retrieved lymph nodes (46.0%) compared with the group with 16–23 retrieved lymph nodes (35.3%) and the group with &lt;16 retrieved lymph nodes group (29.3%) (<em>P</em> &lt; .001). Similar trends were observed with regard to disease-specific survival. The time-dependent area under the curve analysis revealed that the group with ≥24 retrieved lymph nodes exhibited superior predictive performance for overall survival and disease-specific survival compared to the group with &lt;24 retrieved lymph nodes, on the basis of ypN staging (overall survival: time-dependent areas under the receiver operating characteristic curve_≥24, 0.71 vs time-dependent areas under the receiver operating characteristic curve_&lt;24, 0.67; disease-specific survival: time-dependent areas under the receiver operating characteristic curve_≥24, 0.72 vs time-dependent areas under the receiver operating characteristic curve_&lt;24, 0.68).</div></div><div><h3>Conclusion</h3><div>The minimum number of retrieved lymph nodes for evaluation prognosis and reducing stage migration in patients with gastric cancer who undergo radical gastrectomy after neoadjuvant therapy was 24.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109373"},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908221","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":"Contemporary epidemiologic overview of adult liver trauma management across the United States: Analysis of the American College of Surgeons Trauma Quality Improvement Program database","authors":"Omar Obaid MD ,&nbsp;Tania Torres-Ruiz MD, MS ,&nbsp;Emily Rady MD ,&nbsp;Francisco Rodriguez-Silva MD ,&nbsp;Meghan Wandtke Barber MD ,&nbsp;Robert N. Cotterman DO, FACS","doi":"10.1016/j.surg.2025.109390","DOIUrl":"10.1016/j.surg.2025.109390","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple definitive and temporizing management techniques have been devised for liver trauma, and we have shifted toward nonoperative management as endovascular capabilities have evolved. Despite management guidelines, no large-scale data on implementation exist. This study characterizes current nationwide liver trauma management.</div></div><div><h3>Methods</h3><div>This was an analysis of 2017–2020 American College of Surgeons Trauma Quality Improvement Program. Adult patients with liver trauma were included, with the exclusion of those with severe extra-abdominal injuries (Abbreviated Injury Scale &gt;3). Nonoperative management was defined as no exploratory laparotomy (ex-lap) within 6 hours. Primary outcomes were management strategies employed and failure of nonoperative management (ex-lap after 6 hours), stratified by injury mechanism, American Association for the Surgery of Trauma liver injury grade, and American College of Surgeons trauma center verification level. Secondary outcomes were mortality, survivor-only length of stay, and in-hospital complications. Interfacility transfer patients were subanalyzed.</div></div><div><h3>Results</h3><div>A total of 96,652 patients with liver trauma were identified, of which 60,199 were included [24% penetrating; 74% blunt]. In total, 60% grade I/II injuries, 21% grade III, 14% grade IV, 5% grade V, and 0.2% grade VI. Mean age 39 ± 17 years, 65% male, 58% White, ISS was 17[12–24], liver-AIS 2[2–4], and lowest systolic blood pressure within 1-hour was 84 ± 31 mm Hg. Mortality was 5%, hospital length of stay was 6 [2–13] days, and intensive care unit length of stay 3 [2–6] days. Both blunt and penetrating liver injuries of all severities were more likely to undergo operative management at higher American College of Surgeons trauma center verification levels. Of 13,672 patients who were transferred, 92% underwent nonoperative management, 1.3% angioembolization, and only 3.4% failed nonoperative management.</div></div><div><h3>Conclusion</h3><div>Liver trauma remains a major public health burden with mortality approaching 66% among severely injured patients, and current management shows significant nationwide variability. Blunt liver trauma is primarily being managed nonoperatively, and angioembolization is assuming a growing role. Very few patients who were transferred to greater levels of care required operative intervention, having implications for resource allocation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109390"},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908222","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: \"Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases\".","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1016/j.surg.2025.109384","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109384","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109384"},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015670","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":"Outcomes of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma","authors":"Kelong Shao MM ,&nbsp;Yening Du MM ,&nbsp;Liwei Xu MD ,&nbsp;Youhua Jiang MD ,&nbsp;Qixun Chen MD ,&nbsp;Jian Zeng MD ,&nbsp;Lei Cai MD ,&nbsp;Yujin Xu MD ,&nbsp;Xiaojiang Sun MD ,&nbsp;Weimin Mao MD ,&nbsp;Changchun Wang MD","doi":"10.1016/j.surg.2025.109383","DOIUrl":"10.1016/j.surg.2025.109383","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal squamous carcinoma is a prevalent cancer worldwide, particularly in China. Few studies have compared the treatment effects of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy on the long-term prognosis of patients with esophageal squamous carcinoma. This study analyzed the 3-year overall survival rate of patients with locally advanced esophageal squamous carcinoma treated with esophagectomy after neoadjuvant immunochemotherapy or neoadjuvant chemoradiotherapy.</div></div><div><h3>Methods</h3><div>A total of 309 patients with esophageal squamous carcinoma who underwent neoadjuvant chemoradiotherapy between 2010 and 2020 and 88 who underwent neoadjuvant immunochemotherapy between 2019 and 2020 at Zhejiang Cancer Hospital were included in this study. Propensity score matching with a 1:1 ratio and a caliper of 0.02 was used to balance the baseline characteristics.</div></div><div><h3>Results</h3><div>The study included 397 patients with locally advanced thoracic segmental esophageal squamous carcinoma, including 88 who received neoadjuvant immunochemotherapy and 309 who received neoadjuvant chemoradiotherapy. After propensity score matching, there were no significant differences in pathologic complete response between the 2 groups (21.3% vs 33.3%, χ² = 2.148, <em>P</em> = .143), and the neoadjuvant immunochemotherapy group demonstrated a greater 3-year overall survival rate (73.8% vs 54.8%, <em>P</em> = .003), particularly for patients with a primary stage Ⅲ diagnosis (T₃N₁M₀, T_1–3N₂M₀) or an initial suspicion of lymph node metastases. Pathologic complete response emerged as a reliable predictor of long-term outcomes in patients receiving neoadjuvant chemoradiotherapy, but not in those receiving neoadjuvant immunochemotherapy.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant immunochemotherapy was associated with improved long-term prognosis in patients with a primary stage Ⅲ diagnosis or an initial suspicion of lymph node metastases. Neoadjuvant immunochemotherapy plus surgery emerged as an effective therapeutic strategy for treating locally advanced thoracic segmental esophageal squamous carcinoma.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109383"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902140","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":"Amendment and subsumption of \"Insights and comprehensive evaluation on 'Robotic-assisted esophagectomy with total mesoesophageal excision enhances R0-resection in patients with esophageal cancer'\".","authors":"Lukas Fortmann, Jens P Hoelzen, Andreas Pascher, Mazen A Juratli","doi":"10.1016/j.surg.2025.109369","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109369","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109369"},"PeriodicalIF":3.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995464","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: \"Predictors of 1-year mortality following discharge from the surgical intensive care unit after sepsis\".","authors":"Wen Lv","doi":"10.1016/j.surg.2024.109011","DOIUrl":"10.1016/j.surg.2024.109011","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109011"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898253","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":"Can the anatomical location of pneumothorax impact lung ultrasound sensitivity?","authors":"Carlos Augusto Metidieri Menegozzo, Sérgio Henrique Bastos Damous, Edivaldo Massazo Utiyama","doi":"10.1016/j.surg.2024.109113","DOIUrl":"10.1016/j.surg.2024.109113","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109113"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972030","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: Postoperative prophylactic antibiotic therapy after pancreaticoduodenectomy in bile duct-stented patients reduces postoperative major complications.","authors":"Uday Singh Dadhwal","doi":"10.1016/j.surg.2024.108961","DOIUrl":"10.1016/j.surg.2024.108961","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"108961"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819252","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: \"Calcium phosphate deposition, tertiary hyperparathyroidism, and the long-term effect on kidney allografts\".","authors":"Weizhuo Wang, Mingwei Chen, Kai Fu","doi":"10.1016/j.surg.2024.109022","DOIUrl":"10.1016/j.surg.2024.109022","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109022"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898255","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-Comment on: Association between textbook outcome and long-term survival among patients undergoing curative-intent resection of gastric cancer.","authors":"Yin-Fang Wu, Wei-Xing Xu","doi":"10.1016/j.surg.2024.109008","DOIUrl":"10.1016/j.surg.2024.109008","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109008"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898261","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}