Surgery最新文献

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109793","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109793","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109793"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201421","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":"Development and validation of a predictive score of 30-day mortality following proctectomy for rectal cancer: A National Cancer Database analysis","authors":"Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Nir Horesh MD ,&nbsp;Zoe Garoufalia MD ,&nbsp;Rachel Gefen MD ,&nbsp;Peige Zhou MD ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109718","DOIUrl":"10.1016/j.surg.2025.109718","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate predictors of 30-day mortality after rectal cancer surgery and develop a predictive score using significant independent predictors.</div></div><div><h3>Methods</h3><div>A retrospective case-control analysis of the National Cancer Database (2010–2017) was conducted. Patients with stage I-III rectal adenocarcinoma who underwent proctectomy were included. Patients who died within 30 days of surgery were compared to patients alive at 30 days after surgery for patient, disease, and treatment characteristics. Binary logistic regression was used to develop a predictive model; independent predictors of 30-day mortality were incorporated into a predictive risk score and validated using another cohort from the National Cancer Database (2018–2019).</div></div><div><h3>Results</h3><div>53,651 patients with rectal cancer (60.9% male) were included. Thirty-day mortality was 1.1%. Independent predictors of 30-day mortality were increased age (odds ratio: 1.07, 95% confidence interval: 1.05–1.08), male sex (2.19, 1.61–2.98), Black race (2.16, 1.44–3.25), Charlson score ≥3 (1.86, 1.05–3.3), tumor-node-metastasis stage III (1.66, 1.12–2.46), neoadjuvant systemic treatment (0.523, 0.296–0.925), prolonged hospitalization (1.02, 1.01–1.03), and conversion to open surgery (1.59, 1.13–2.23). A predictive score entailing 3 risk groups was developed. There was a linear trend of increased 30-day mortality across the three groups (0.8% to 1.9% to 4.5%; <em>P</em> &lt; .001). Score specificity in the development and validation datasets was 99.6% and 99.5% and accuracy was 98.7% and 98.8%, respectively.</div></div><div><h3>Conclusions</h3><div>Independent predictors of increased 30-day mortality were incorporated into a risk score with a specificity and accuracy of more than 98%. The score may be used to improve outcomes of high-risk patients by implementing additional strategies to reduce the risk of short-term mortality.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109718"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109745","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109745","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109745"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109743","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109743","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109743"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201429","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":"Targeted RNA sequencing of thyroid tumors from individuals with PTEN hamartoma tumor syndrome reveals a unique transcriptome with a predominantly RAS-like expression profile.","authors":"Gilman Plitt, Takae Mitzukami, Lamis Yehia, Laura Rabinowitz, Christopher C Griffith, Gustavo Romero-Velez, Allan Siperstein, Charis Eng","doi":"10.1016/j.surg.2025.109697","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109697","url":null,"abstract":"<p><strong>Background: </strong>Differentiated thyroid cancer is typically caused by a single oncogenic driver alteration. In PTEN hamartoma tumor syndrome, a pathogenic germline PTEN alteration results in a predisposition to thyroid cancer and adenomatous thyroid nodules. This provides a unique model to study thyroid carcinogenesis in the setting of a baseline \"hit\" to the PI3K/AKT/mTOR pathway, implicated in RAS-like thyroid tumors.</p><p><strong>Methods: </strong>RNA sequencing and differential expression analysis were performed on thyroid cancers, adenomatous nodules, and background thyroid tissue in patients with PTEN hamartoma tumor syndrome. BRAF^V600E-RAS scores were calculated and compared across histologic subtypes. RNA sequencing data were then integrated with previously published paired exome sequencing data.</p><p><strong>Results: </strong>RNA sequencing was performed on 26 cancers, 27 adenomatous nodules, and 15 background thyroid samples from 20 patients with PTEN hamartoma tumor syndrome. This demonstrated 3 expression clusters: papillary architecture tumors, follicular architecture tumors, and background thyroid tissue. The majority (17, 65.4%) of cancers were RAS-like. Follicular architecture cancers were primarily RAS-like (BRAF^V600E-RAS score +0.67) and frequently associated with biallelic PTEN alterations. Papillary architecture cancers were BRAF-like (BRAF^V600E-RAS score -0.77), often in absence of biallelic PTEN alterations. Adenomatous nodules had indistinguishable expression profiles from follicular architecture cancers.</p><p><strong>Conclusions: </strong>PTEN hamartoma tumor syndrome-associated thyroid tumors most frequently have RAS-like expression profiles. This appears to be caused by baseline dysregulation of the PI3K/AKT/mTOR pathway, with predisposition to biallelic PTEN inactivation promoting follicular adenomatous growth and subsequent malignant transformation to follicular architecture cancers. Better understanding malignant potential and tumor progression in PTEN hamartoma tumor syndrome thyroid tissue is essential for optimizing diagnosis, enhanced surveillance, and treatment in this population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109697"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201391","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":"Expenses and expectations for endocrine surgeries: A national analysis of price transparency and cost of care.","authors":"Anthony T Saxton, Alberto J Monreal, Sabran Masoud, Hadiza S Kazaure, Michael T Stang, Marcelo Cerulo, Randall P Scheri","doi":"10.1016/j.surg.2025.109692","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109692","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services price transparency rule aims to facilitate cost-conscious consumer decision making. However, factors mediating transparency and real-world prices for endocrine surgeries are not well described.</p><p><strong>Methods: </strong>Data were obtained from Turquoise Health and Centers for Medicare and Medicaid Services reports. The American Association of Endocrine Surgeons \"Find A Surgeon\" tool identified endocrine surgeons. Chi-square, Kruskal-Wallis, and Wilcoxon rank-sum tests evaluated associations with price disclosure. Multivariable linear regression models assessed the marginal effects of factors on reimbursements.</p><p><strong>Results: </strong>There were 439 American Association of Endocrine Surgeons-affiliated surgeons identified from 307 unique practice locations, of which 254 (82.7%) disclosed endocrine surgery prices. Locations with an American Association of Endocrine Surgeons-affiliated surgeon that disclosed prices were more likely to be teaching hospitals, nonprofit, large size (200+ beds), with a higher share of Medicare patients, greater patient complexity, higher Medicare star rating, and in markets with more endocrine surgery competition (all P < .05). Factors associated with higher prices included commercial insurance or self-pay, nonprofit health system, larger bed size, and in markets with nearby American Association of Endocrine Surgeons-affiliated surgeons. Lower prices were seen for low Centers for Medicare and Medicaid Services star rating, urban locations, in moderately competitive health care markets, and with 21-80 nearby facilities disclosing endocrine surgery prices. Hospitals with an American Association of Endocrine Surgeons-affiliated surgeon had higher hospitalization and lower procedure prices.</p><p><strong>Conclusion: </strong>Facilities with an American Association of Endocrine Surgeons-affiliated surgeon demonstrated excellent price disclosure for endocrine surgeries. Hospital characteristics such as size, ownership, quality, geographic location, and market factors influenced final reimbursements. Further studies are needed to investigate the alignment of reimbursement with quality of care to translate price transparency into increased value for patients.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109692"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201455","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":"Long-term phonation status after recurrent laryngeal nerve reconstruction.","authors":"Akihide Matsunaga, Akira Miyauchi, Shiori Adachi, Shiori Kawano, Masashi Yamamoto, Takahiro Sasaki, Makoto Fujishima, Hiroo Masuoka, Takuya Higashiyama, Minoru Kihara, Naoyoshi Onoda, Yasuhiro Ito, Akihiro Miya","doi":"10.1016/j.surg.2025.109695","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109695","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing recurrent laryngeal nerve resection and reconstruction usually recover phonatory function within a year. However, their long-term outcomes remain unclear. This study assessed phonatory function over more than 10 years.</p><p><strong>Methods: </strong>Data of a cohort of 212 patients (165 female, 47 male) who underwent recurrent laryngeal nerve reconstruction between February 2005 and August 2022 were retrospectively analyzed. Maximum phonation time and mean flow rate were measured preoperatively and, periodically, postoperatively. The Voice Handicap Index-10 questionnaire was administered at patients' final visits. Postoperative periods were divided into period I (>6 months-2 years), period II (>2-10 years), and period III (>10 years).</p><p><strong>Results: </strong>Preoperatively, 100 patients (47.2%) had vocal cord paralysis. For both sexes, patients with preoperative vocal cord paralysis had significantly longer maximum phonation times and smaller mean flow rates in period I than they had preoperatively; these values further improved in period II, with improvements maintained in period III. Patients without vocal cord paralysis showed recovery in voice after recurrent laryngeal nerve reconstruction; however, in both sexes, their maximum phonation times and mean flow rates in period I did not reach preoperative levels. Maximum phonation time and mean flow rate improved in period II in both sexes, with these improvements being maintained in period III. The Voice Handicap Index-10 score improved over time in all patients except female patients without preoperative vocal cord paralysis, whose best score was obtained in period I.</p><p><strong>Conclusions: </strong>In patients who required recurrent laryngeal nerve resection, reconstructive surgery restored phonatory function early. Further modest improvement was observed over 10 years, persisting beyond 10 years.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109695"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109805","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109805","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109805"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201451","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":"Setting yourself up for reoperative surgical success: Lessons learned from a 10-year experience with selective venous sampling for reoperative parathyroidectomy.","authors":"Eileen R Smith, Elizabeth Cooper, Jason Pinchot, Rebecca S Sippel","doi":"10.1016/j.surg.2025.109708","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109708","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative localization is critical in preparing for reoperative parathyroidectomy. Given the limitations of noninvasive imaging modalities, we examined how parathyroid selective venous sampling aided in identification of hyperactive parathyroid tissue and facilitated operative cure in challenging parathyroidectomy cases.</p><p><strong>Methods: </strong>We performed a retrospective review of patients who underwent selective venous sampling prior to reoperative parathyroidectomy between 2014 and 2024. Operative reports, imaging studies, and selective venous sampling results were analyzed to evaluate the utility of venous sampling for reoperative parathyroidectomy.</p><p><strong>Results: </strong>83 patients underwent selective venous sampling prior to reoperative parathyroidectomy. Before undergoing selective venous sampling, all patients underwent a neck ultrasonography and a 4-dimensional computed tomography, and 49% (n = 41) also underwent Tc-99m sestamibi scan. Imaging was negative or inconclusive in all patients. Selective venous sampling results showed lateralization to one side of the neck in 77% (n = 64), clear mediastinal location facilitating thoracic approach in 6% (n = 5), inferior location without lateralization in 11% (n = 9), multigland disease in 2% (n = 2), and equivocal results in 4% (n = 3). After reviewing the selective venous sampling results, potential targets were identified on noninvasive imaging in 62% (n = 51) of cases. Overall, 92% (n = 76) proceeded with further surgical exploration based on the selective venous sampling. At the time of reoperative surgery, an abnormal parathyroid gland concordant with selective venous sampling localization was found in 81% (n = 62) of patients.</p><p><strong>Conclusions: </strong>Selective venous sampling can be a useful adjunct in reoperative parathyroidectomy when less invasive imaging modalities are inconclusive. Selective venous sampling requires significant expertise to do well and interpretation is nuanced and should be done in the context of additional imaging and a thorough understanding of patients' prior operations.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109708"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182252","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":"Surgery for normocalcemic hyperparathyroidism is safe and effective.","authors":"C Corbin Frye, Zhixing Song, Sanjana Balachandra, Niranjna Swaminathan, Andrea Gillis, Jessica Fazendin, Brenessa Lindeman, Herbert Chen","doi":"10.1016/j.surg.2025.109707","DOIUrl":"10.1016/j.surg.2025.109707","url":null,"abstract":"<p><strong>Background: </strong>The ideal management of normocalcemic primary hyperparathyroidism is controversial and is not discussed in recent guidelines as a result of limited published data. To help fill this knowledge gap, we aimed to report the outcomes of a large case series of patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database was conducted to identify patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy from 2000 to 2023. A small subset of patients participated in a prospective quality of life pilot study.</p><p><strong>Results: </strong>In 554 patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy, 89% had clinical manifestations and 58% were caused by multigland disease. Intraoperative parathyroid hormone decrease >50% was achieved in 99% and normal parathyroid hormone levels at 6 months were achieved in 81% of patients. Serious complications were rare. Younger patients had greater rates of transient postoperative hypocalcemia (P < .01). Patients undergoing bilateral exploration were more likely to be Black (P < .01). In participating patients (n = 18), median overall quality of life improved significantly from 29 (interquartile range, 18) preoperatively to 2 (interquartile range, 18) at 2 weeks' postoperatively (P < .001). Each of the individual quality of life subsections including the pain, activities of daily living, occupation, mobility, leisure, general health, and mental function domains all improved significantly after parathyroidectomy (P < .05).</p><p><strong>Conclusion: </strong>We have herein reported the largest institutional case series of patients with normocalcemic primary hyperparathyroidism undergoing parathyroidectomy. Surgery for normocalcemic primary hyperparathyroidism was safe, effective, and, in a prospective pilot study, was associated with significant improvements in quality of life at 2 weeks postoperatively. These findings further support that parathyroidectomy may play an important role in the management of normocalcemic primary hyperparathyroidism.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109707"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}