Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Surgical trend including minimally invasive surgeries for ulcerative colitis in the COSUC study: the largest multicenter cohort study in Japan.","authors":"Koya Hida, Yoshiki Okita, Yusuke Fujii, Toru Miyake, Yoshiaki Kuriu, Yu Hidaka, Tomohiro Arita, Kiyotaka Kawaguchi, Shingo Ochi, Yusuke Fujita, Kazutaka Obama, Takeshi Naitoh","doi":"10.1007/s00464-025-11758-6","DOIUrl":"10.1007/s00464-025-11758-6","url":null,"abstract":"<p><strong>Background: </strong>The number of patients with ulcerative colitis (UC) is increasing rapidly in Asia. No large study has evaluated the clinical outcomes of hand-sewn ileal pouch-anal anastomosis (IPAA). This study aimed to create a large database of the surgical outcomes of UC, present the trends of surgical procedures, and evaluate the impact of minimally invasive procedures on UC.</p><p><strong>Methods: </strong>Data of patients first treated from 2005 to 2019 were collected; two-staged surgery data were extracted, and minimally invasive surgery (MIS) and open surgery (OS) outcomes were compared using propensity-score matching.</p><p><strong>Results: </strong>The data of 1558 cases were selected as the main analysis set. The number of surgical cases of UC has been increasing, with increasing proportion of MIS cases (2005: 43%, 2019: 84%). The median age of the patients increased in these 15 years (39.5-56 years old). Of 873 patients who underwent two-staged surgery, after 3:1 matching, 408 MIS and 176 OS cases were compared. Hand-sewn anastomoses were performed in 293 MIS (72.0%) and 142 OS-IPAA (80.7%) cases. The proportion of early complications (≥ Grade 3) did not vary between the two groups. Intraoperative blood loss was lower and blood transfusions were less frequent in the MIS group.</p><p><strong>Conclusions: </strong>The proportion of MIS for UC has rapidly increased over the past 15 years. The total number of MIS and OS complications did not vary significantly between the groups. The short-term advantages of MIS include reduced blood loss and less necessity for blood transfusions.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3911-3920"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048900","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":"Effectiveness of anterior gastropexy with mesh reinforcement in reducing the recurrence of giant hiatal hernia.","authors":"Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Masato Hoshino, Masami Yuda, Keita Takahashi, Yuki Sakashita, Hideyuki Takeuchi, Nobuo Omura, Fumiaki Yano, Ken Eto","doi":"10.1007/s00464-025-11721-5","DOIUrl":"10.1007/s00464-025-11721-5","url":null,"abstract":"<p><strong>Background: </strong>The number of patients with giant hiatal hernias requiring surgery is increasing. However, there have been some concerns regarding the possible high recurrence rates. Additional gastropexy has been suggested to reduce recurrence rates. This study aimed to examine whether additional gastropexy is effective in patients with giant hiatal hernias.</p><p><strong>Methods: </strong>We enrolled 77 patients with giant hiatal hernias who underwent laparoscopic hiatal hernia repair between June 2011 and December 2022. The patients were divided into two groups according to the presence or absence of gastropexy, the surgical outcomes and recurrence of hiatal hernia between the groups were compared.</p><p><strong>Results: </strong>The gastropexy group included 52 patients (68%). Although the operating time was longer in the gastropexy than in the non- gastropexy group (P < 0.01), there were no differences in the pre- and post- operative complications between the two groups. Surgery with gastropexy significantly improved symptoms, such as heartburn, reflux, chest pain, and vomiting, as well as the pathology of hiatal hernia, cardiac loosening, and esophagitis. The rates of recurrence of hiatal hernia and esophagitis were significantly lower in the gastropexy than in the non- gastropexy group (P < 0.01 and P = 0.04, respectively).</p><p><strong>Conclusions: </strong>Laparoscopic anterior gastropexy is safe and effective for preventing the recurrence of giant hiatal hernias.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3484-3491"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052298","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":"The SAGES MASTERS Program: top 10 seminal articles for Heller myotomy and treatment of achalasia.","authors":"Ankit D Patel, Ruchir Puri, Peter Nau, Alice Race, Lauren McCormack, Andrew Brown, Leena Khaitan, Jon C Gould","doi":"10.1007/s00464-025-11779-1","DOIUrl":"10.1007/s00464-025-11779-1","url":null,"abstract":"<p><strong>Background: </strong>The Foregut Surgery Pathway of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program focuses on four anchoring procedures, which include laparoscopic Nissen fundoplication, laparoscopic paraesophageal hernia repair, laparoscopic Heller myotomy, and revisional foregut surgery. In this manuscript, we present and discuss the top 10 seminal articles related to a Heller myotomy and treatment of achalasia. Heller myotomy represents \"mastery\" level for foregut operations.</p><p><strong>Methods: </strong>The literature was systematically searched to identify the most cited and pertinent articles on achalasia and Heller Myotomy. Members of the SAGES Foregut committee reviewed these articles and using a Delphi method elected the seminal articles deemed most pertinent to a Heller Myotomy. These articles were reviewed in detail by committee members and are presented here.</p><p><strong>Results: </strong>These top 10 seminal articles on Heller myotomy focus on diagnosis, therapeutic options, outcomes, adverse effects, and their management. A summary of each paper is presented, including expert appraisal and commentary.</p><p><strong>Conclusions: </strong>The top 10 articles presented here emphasize Heller myotomy as a core foregut operation. These articles highlight this operation an effective therapeutic option for achalasia that provides relief of dysphagia with decreased risk of post-operative gastroesophageal reflux.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3447-3455"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054844","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":"Comparison of short- and long-term outcomes for robotic versus laparoscopic gastrectomy in elderly patients with gastric cancer: a multicenter cohort study.","authors":"Ze-Ning Huang, Wen-Wu Qiu, Tai-Yuan Li, Li Zhang, Jun-Jun She, Bao-Qing Jia, Xin-Gan Qin, Shuang-Yi Ren, Hong-Liang Yao, Dong-Ning Liu, Han Liang, Fei-Yu Shi, Peng Li, Bo-Pei Li, Xin-Sheng Zhang, Kui-Jie Liu, Chao-Hui Zheng, Chang-Ming Huang, Jian-Xian Lin, Ping Li","doi":"10.1007/s00464-025-11756-8","DOIUrl":"10.1007/s00464-025-11756-8","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence from large-scale multicenter studies regarding the short- and long-term efficacy of robotic gastrectomy (RG) in elderly patients diagnosed with gastric cancer (GC). As such, this retrospective investigation compared short-term outcomes and long-term oncological prognoses of RG versus (vs.) laparoscopic gastrectomy (LG) in a representative sample of this population.</p><p><strong>Methods: </strong>Data from 1393 patients ≥ 65 years of age diagnosed with GC, who underwent radical gastrectomy at 8 large tertiary hospitals in China between August 2016 and June 2019, were analyzed. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to reduce confounding bias.</p><p><strong>Results: </strong>After IPTW and PSM adjustments, baseline characteristics between the RG and LG groups were comparable (standardized mean difference < 0.10). After IPTW adjustment, mean blood loss in the RG group was significantly less than that in the LG group (89.36 vs. 103.39 mL; p = 0.046) as was mean length of hospital stay (9.62 vs. 10.47 days; p = 0.017). There were no statistical differences in postoperative complications between the RG and LG groups (p > 0.05), nor in 3y-DFS (IPTW-adjusted: 74.5% vs. 74.6%, p = 0.957; PSM-adjusted: 76.8% vs. 79.3%, p = 0.323) or 3y-OS (IPTW-adjusted: 75.9% vs. 77.0%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). Similarly, there were no significant differences in postoperative recurrence rates between the RG and LG groups (IPTW-adjusted: 21.1% vs. 20.5%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235).</p><p><strong>Conclusion: </strong>RG yielded superior short-term outcomes compared with LG in elderly patients diagnosed with GC, while achieving comparable long-term outcomes and demonstrating safety and effectiveness.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3860-3872"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995453","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":"Efficacy evaluation and prognostic prediction of endoscopic ultrasound for neoadjuvant immunotherapy in esophageal cancer.","authors":"Qiao-Na Liu, Yu-Fan Chen, Guang-Yu Luo, Xu Zhang","doi":"10.1007/s00464-025-11728-y","DOIUrl":"10.1007/s00464-025-11728-y","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neoadjuvant immunotherapy combined with chemotherapy or chemoradiotherapy has emerged as a promising approach in the treatment of esophageal cancer. However, there is a lack of comprehensive understanding regarding the clinical factors that can predict patient response to this therapy. The aim of this study was to develop a predictive model for assessing the efficacy of neoadjuvant immunotherapy in patients undergoing surgical treatment.</p><p><strong>Methods: </strong>This study retrospectively enrolled 220 consecutive patients with preoperative immunotherapy combined chemotherapy or chemoradiotherapy. A logistic regression was used to evaluate the association between pathologic complete response (pCR) and endoscopic ultrasound parameters, constructing a predictive model for treatment response. Additional, overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and Cox regression analyses were introduced to explore the associations between EUS factors after neoadjuvant immunotherapy.</p><p><strong>Results: </strong>Logistic regression analysis identified that the significant predictors of pCR were treatment regimen, negative biopsy findings, RECIST assessment, endoscopic ultrasound responder, and downstaging in uN. A predictive model including above five variables was generated, and area under the curve was 0.840(95%CI 0.78-0.89), this nomogram was also adequately validated internally. In the cox regression analyses, EUS responder was found to be a significant predictor of overall survival with a hazard ratio (HR) of 0.38(95%CI 0.15-0.98), whereas only pCR status was a significant predictor of PFS (HR 0.80; 95%CI 0.01-0.60).</p><p><strong>Conclusions: </strong>EUS responder can serve as a valuable predictor of the efficacy of adjuvant immunotherapy combined with chemotherapy or chemoradiotherapy, as well as of survival outcomes.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3624-3639"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019773","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":"Monitoring early discharge after laparoscopic colon surgery: an interventional study.","authors":"L van Outersterp, S H H Laurijs, Y El Amraoui, A E Peeters, E E G Verdaasdonk","doi":"10.1007/s00464-025-11716-2","DOIUrl":"10.1007/s00464-025-11716-2","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic colorectal surgery combined with Enhanced Recovery after Surgery (ERAS) has improved patient outcomes by promoting faster recovery, reducing pain, and lowering the risk of complications. However, increasing demand on hospital capacity for clinical admissions and the shortage of healthcare professionals remains challenging. Home monitoring after surgical procedures and early discharge offers a potential solution. This study aims to assess the feasibility, safety and patient satisfaction with early discharge following elective colorectal surgery using continuous monitoring of vital signs and questionnaires.</p><p><strong>Methods: </strong>A prospective, single-centre, interventional study. Patients who meet the discharge criteria could leave on day one or two after surgery, monitored at home with sensors for vital signs and health questionnaires.</p><p><strong>Results: </strong>Of 51 patients, 30 (58.8%) were discharged early. The results show successful early discharge in 80% (24 out of 30 patients) with a readmission rate of 20% of which 13.3% due to problems with the monitoring system. None of these readmissions were due to deviations in vital sign measurement at home. The patient satisfaction was high ranging between 6 and 7 (out of 7).</p><p><strong>Conclusion: </strong>Early discharge with continue monitoring is feasible for a selected group of colorectal surgery patients. No patients were readmitted because of serious complications. Further research should focus on expending the sample size and investigating the impact of early discharge without continuous monitoring.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3654-3661"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033155","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":"Concurrent pathological scar: independent risk factor for esophageal stricture after endoscopic submucosal dissection.","authors":"Yue-Yi Zhang, Zhi-Yu Yan, Qing-Wei Jiang, Yun-Lu Feng, Ying-Yun Yang, Sheng-Yu Zhang, Dong-Sheng Wu, Tao Guo, Xi Wu, Qiang Wang, Ai-Ming Yang","doi":"10.1007/s00464-025-11762-w","DOIUrl":"10.1007/s00464-025-11762-w","url":null,"abstract":"<p><strong>Background and aims: </strong>Esophageal stricture is a common complication after esophageal endoscopic submucosal dissection (ESD). Pathological scars may predict stricture development, but clinical studies exploring their relationship are limited. This study aimed to investigate the link between concurrent pathological scarring and post-ESD esophageal stricture and develop a predictive risk model.</p><p><strong>Methods: </strong>This retrospective single-center study included patients who underwent ESD for superficial esophageal lesions (SELs) over the past decade. Data on demographics, endoscopy, pathology, and concurrent scarring were collected. Multivariate logistic regression identified risk factors, followed by validation using subgroup analysis and propensity score matching. A nomogram was developed and internally validated.</p><p><strong>Results: </strong>Of 255 patients, 28 (11.0%) developed esophageal stricture. Multivariate logistic regression identified concurrent pathological scarring as an independent risk factor for stricture development (OR 96.520 [10.641-875.536], p < 0.001). Additional risk factors included lesions in the upper esophagus, lesions longer than 4 cm, circumferential involvement over 50%, infiltration depth beyond the epithelium, and muscular layer injury during the procedure. A predictive model incorporating these factors was developed, demonstrating high discriminative ability (AUC 0.943 [0.902-0.984]) with an optimal cutoff of 135.6, sensitivity of 82.4%, and specificity of 94.3%. The calibration curve showed good accuracy.</p><p><strong>Conclusions: </strong>Concurrent pathological scarring is an independent risk factor for post-ESD esophageal stricture.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3848-3859"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039838","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":"What matters in laparoscopic hepatectomy for lesions located in posterosuperior segments? Initial experiences and analysis of risk factors for postoperative complications: a retrospective cohort study.","authors":"Patrick Téoule, Niccolo Dunker, Vanessa Gölz, Erik Rasbach, Christoph Reissfelder, Emrullah Birgin, Nuh N Rahbari","doi":"10.1007/s00464-025-11674-9","DOIUrl":"10.1007/s00464-025-11674-9","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic liver resection (LLR) for lesions in the posterosuperior segments (PSS) is challenging. Identifying and minimizing risk factors for postoperative morbidity and mortality is crucial. This retrospective cohort study shares initial experiences with LLR of the PSS (VII, VIII, IVa) and wants to identify risk factors for clinically relevant postoperative complications (Clavien-Dindo grade ≥ III) in these patients.</p><p><strong>Methods: </strong>We reviewed our prospective database for all patients who underwent LLR with at least one lesion in the PSS (April 2018-October 2022). Uni- and multivariate analyses were carried out using binary logistic regression analysis.</p><p><strong>Results: </strong>110 patients underwent LLR of the PSS. Median age was 67 years (IQR 59-76); 62% were male (n = 68), with a median BMI of 26 (IQR 23-30). The most frequent indications for LLR were primary liver cancer (37%) and colorectal liver metastasis (36%). Median operating time was 211 min (IQR 135-281) with a median blood loss of 460 mL (IQR 240-1200). Postoperative length of stay was 6 days (IQR 4-8). Clinically relevant postoperative complications were present in 20 patients (18%) with a 90-day mortality rate of 5% (n = 6). Multivariate analyses identified ASA ≥ III (OR 3.23 [95%CI 1.03-10.09]; p = 0.043), diabetes (OR 4.31 [95%CI 1.20-15.49]; p = 0.025), and intraoperative transfusion of packed red blood cells (PRBC) (OR 4.80 [95%CI 1.01-22.86]; p = 0.049) as risk factors for Clavien-Dindo grade ≥ III complications.</p><p><strong>Conclusion: </strong>ASA ≥ III status, diabetes, and intraoperative PRBC transfusion are associated with an increased risk of Clavien-Dindo grade ≥ III complications in patients undergoing LLR in PSS. Preoperative optimization should include diabetes management, screening for anemia with appropriate supplementation, and comprehensive risk counseling for ASA ≥ III patients. Additionally, minimizing intraoperative PRBC transfusion should remain a key perioperative goal.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3691-3701"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015737","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}

{"title":"Clinical outcomes and cost-effectiveness analysis of robotic and endoscopic cooperative surgery for treating gastric submucosal tumors: a longitudinal nested cohort study.","authors":"Lei Ma, Ruihan Liu, Chenhao Hu, Lei Zhang, Penghong Qu, Junjun She","doi":"10.1007/s00464-025-11775-5","DOIUrl":"10.1007/s00464-025-11775-5","url":null,"abstract":"<p><strong>Background: </strong>Robotic and endoscopic cooperative surgery (RECS) is an emerging and promising therapeutic approach for treating gastric submucosal tumors (GSMTs). However, the efficacy of RECS has not been well established, and its high medical costs significantly limit its application.</p><p><strong>Methods: </strong>This nested cohort study examined patients with GSMTs managed with different surgical techniques. A total of 314 consecutive patients were enrolled in this study, including 61 patients treated with RECS, 196 patients treated laparoscopically, and 57 patients treated with open surgery. To mitigate confounding bias, 1:1:1 propensity score matching (PSM) was utilized. The perioperative outcomes, postoperative gastrointestinal symptoms, long-term outcomes, and cost-effectiveness among the three groups were compared.</p><p><strong>Results: </strong>After PSM, 51 patients were included in each group. Compared with the laparoscopic and open surgical groups, the RECS group presented significantly lower intraoperative bleeding volumes, times to first flatus, times to liquid intake, and postoperative hospital stay. The severity of gastrointestinal symptoms in the RECS group was notably better than that in the laparoscopic and open groups 3, 6, and 12 months postsurgery. Regarding long-term outcomes, there were no differences in overall or relapse-free survival among the three groups. The total hospitalization cost was significantly greater in the RECS group, primarily due to surgical cost differences. The incremental cost-effectiveness ratios per quality-adjusted life year for the RECS group relative to the laparoscopic and open groups were 18,244 and 56,914 Chinese yuan (CNY), respectively. Analysis of the cost-effectiveness acceptability curves indicated that across all willingness-to-pay thresholds, the probability that RECS was cost-effective exceeded 90%.</p><p><strong>Conclusions: </strong>RECS is a safe and effective method for treating GSMTs, offering faster postoperative recovery and fewer gastrointestinal symptoms than laparoscopic and open surgeries. Despite the increased costs associated with the introduction of RECS technology, it remains a cost-effective option.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3959-3969"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052286","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}

{"title":"Automated machine learning model for predicting anastomotic strictures after esophageal cancer surgery: a retrospective cohort study.","authors":"Junxi Hu, Qingwen Liu, Wenbo He, Jun Wu, Dong Zhang, Chao Sun, Shichun Lu, Xiaolin Wang, Yusheng Shu","doi":"10.1007/s00464-025-11759-5","DOIUrl":"10.1007/s00464-025-11759-5","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic strictures (AS) frequently occurs in patients following esophageal cancer surgery, significantly affecting their long-term quality of life. This study aims to develop a machine learning model to predict high-risk AS, enabling early intervention and precise management.</p><p><strong>Methods: </strong>A total of 1549 patients underwent radical esophageal cancer surgery and were split into a training set (1084) and a validation set (465). Adaptive Synthetic Sampling (ADASYN) handled class imbalance, while Boruta and Least Absolute Shrinkage and Selection Operator (LASSO) with cross-validation refined key features. High-correlation features (r > 0.8) were assessed using variance inflation factors (VIFs) and clinical relevance. Machine learning models were trained and evaluated using area under curve (AUC), accuracy, sensitivity, specificity, calibration curves, and decision curve analysis (DCA). Shapley Additive exPlanations (SHAP) analysis improved model interpretability.</p><p><strong>Results: </strong>Seven critical variables were finalized, including anastomotic leakage (AL), neoadjuvant therapy (NCRT), suture method (SM), endoscopic assistance (EA), white blood cell count (WBC), albumin (Alb), and Suture site (SS). The Gradient Boosting Machine (GBM) model achieved the highest AUC, with 0.886 in the training set and 0.872 in the validation set. Shapley Additive Explanations (SHAP) analysis indicated that AL, SM, and NCRT were the most significant variables for model predictions.</p><p><strong>Conclusion: </strong>The GBM machine learning model constructed in this study can effectively identify high-risk patients for AS following esophageal cancer surgery, offering strong support for earlier postoperative detection and precise clinical management.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3737-3748"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047249","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}