World Journal of Surgery最新文献

{"title":"Building Capacity in Perioperative Quality Improvement in Low- and Middle- Income Countries: Experiences From Mombasa, Lusaka and Hawassa.","authors":"Anoosha Moturu, Sehar Salim Virani, Taylor Jaraczewski, Belay Melesse, Tien Vo, Clifford Y Ko, Francis Pikiti, Hazel Sonkwe, Bright Moyo, Kelly McQueen, Girma Tefera, Xane Peters, Daniel Ojuka, Haytham Kaafarani, Robert Parker, Chris Dodgion, Deborah Rusy, Syed Nabeel Zafar","doi":"10.1002/wjs.70126","DOIUrl":"https://doi.org/10.1002/wjs.70126","url":null,"abstract":"<p><strong>Background: </strong>Perioperative morbidity and mortality remain disproportionately high in low- and middle-income countries (LMICs). Quality improvement (QI) has shown effectiveness in improving health outcomes and patient safety across healthcare systems globally and is often a mandatory part of training in high income countries. However, QI education in LMICs remains decentralized and limited in scope. Aiming to address this gap, we designed and delivered perioperative QI education in three LMIC settings. This study aims to summarize methodology and experiences across the three settings and outline the factors leading to success and challenges experienced to inform future QI education efforts in LMICs.</p><p><strong>Methods: </strong>We designed and implemented a perioperative QI curriculum that included online didactic content, course assessments, and a two to three day in-person course featuring both didactic and QI project development training. Descriptive statistics were reported for course features and participant pre- and post-course survey results. Qualitative course feedback from participants and administrators is summarized in a narrative format.</p><p><strong>Results: </strong>Five courses were conducted, training a total of 90 participants. Of those who completed pre-course surveys, most participants were nurses (35.5%) or residents (43.6%), and the majority (71.1%) had no prior experience with QI. Self-assessed comfort significantly improved across several domains, including understanding QI concepts, developing aim statements, and designing projects. Qualitatively, participants enjoyed the course's interactive format and recommended future offerings be longer, more frequent, and include expanded content on data analysis and project implementation. Course administrators recommend involving local partners throughout course development, forming structured plans to sustain QI initiatives started as part of the course, and ensuring any pre-course materials use context-specific examples.</p><p><strong>Conclusion: </strong>Implementation of a perioperative QI curriculum across three LMIC settings was feasible and associated with significant improvements in participant-reported comfort with core QI skills and knowledge. Success was driven by the inclusion of local faculty, interactive project development, and adaptation of course content to local context. Future efforts should focus on building local QI mentorship capacity, integrating QI education into residency training, and developing contextually appropriate resources to support scalable, sustainable QI training in LMICs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon Performed Vacuum Assisted Breast Biopsy/Excision Is a Viable Paradigm for the Management of Benign and B3 Lesions-An Australian Multicenter Experience.","authors":"Deepali Poels, Daniel de Viana, Tirsa Van Wyngaard, Ian Bennett, Michael Law","doi":"10.1002/wjs.70132","DOIUrl":"https://doi.org/10.1002/wjs.70132","url":null,"abstract":"<p><strong>Background: </strong>Open excisional biopsy is currently the mainstay of management of a variety of benign and indeterminant (B3) breast lesions in Australasia. Vacuum assisted biopsy (VAB) and vacuum assisted excision (VAE) are being increasingly adopted into the management algorithm of such breast lesions internationally and are beginning to gain interest in Australasia. This study aims to review the experience and outcomes of a series of surgeon-performed ultrasound (US) guided VAB/VAEs undertaken by specialist breast surgeons in Australasian including its application and clinical deployment.</p><p><strong>Methods: </strong>An Australian multicenter trial of US-guided surgeon-performed VAB and VAE of benign or indeterminant breast lesions was conducted by three experienced breast surgeons from major breast services. The study involved prospectively collected data on 462 US-guided VAB/VAEs in 397 patients, in both outpatient and day case settings from 2015 to 2024. Malignant lesions proven on previous biopsies were excluded.</p><p><strong>Results: </strong>A total of 462 surgeon-performed US-guided vacuum-assisted procedures were undertaken in 397 patients. 137 procedures (29%) were performed as diagnostic VABs and 325 (71%) were undertaken as VAEs. Successful complete excision was achieved in 308 (95%) of cases where the intent of the procedure was complete excision, defined as absence of any lesion seen on US following the procedure and on subsequent interval US examination. Duration of follow-up ranged from 6 months to 9 years. The average size of lesions was 20 mm in the diagnostic VAB group and 11 mm in the VAE excision group. The average time for either procedure was approximately 15 min. No infection was reported and hematomas requiring surgical evacuation were < 1%.</p><p><strong>Conclusion: </strong>VAB/VAE are minimally invasive techniques well suited for management of variety of benign and B3 breast lesions. US guided VAB/VAE interventions are reliable, safe, and quick to perform in both day procedure or outpatient settings and can be readily learned by breast surgeons, especially those who already possess experience in breast interventional US. We have demonstrated its utility and viable deployment in contemporary Australian breast surgical practice and would advocate for its adoption in the Australasian surgical management algorithm, especially for small B3 lesions.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learner and Teacher Entrustability Concordance in Endocrine Surgery Entrustable Professional Activities.","authors":"Polina Zmijewski, Julia Adriana Kasmirski, Sanjana Balachandra, Chandler McLeod, Ramsha Akhund, Ashba Allahwasaya, Taylor Lafrinere, Jessica M Fazendin, Sally E Carty, Paul H Graham, David T Hughes, Melanie Lyden, Barbra S Miller, Brendan M Finnerty, Linwah Yip, Brenessa Lindeman","doi":"10.1002/wjs.70124","DOIUrl":"https://doi.org/10.1002/wjs.70124","url":null,"abstract":"<p><strong>Introduction: </strong>The American Association of Endocrine Surgeons (AAES) drafted Entrustable Professional Activities (EPAs) for Endocrine Surgery (ES) to assess general surgery residents and ES fellows in core topics. Here, we examine learner and teacher concordance of entrustability ratings.</p><p><strong>Methods: </strong>Fourteen EPAs were defined (10 \"core\"-6 with pre-, intra-, and post-operative phases, four single-phase-and four elective EPAs). Ten institutions collected three-item micro-assessments (MAs) of learner EPA performance using a web-based platform, where entrustment was assessed on observable behaviors using a five-point scale. Learner provided self-assessment ratings, while teachers separately assigned ratings for the same activities. Spearman rank correlation tests were applied to compare learner-teacher ratings for EPAs.</p><p><strong>Results: </strong>MAs (n = 698) were submitted between 7/2022-9/2023. Programs submitted between 3 and 468 MAs. Among 3-phase core EPAs, the intraoperative phase was most assessed (n = 496), followed by pre- and post-operative phases (n = 108 and 55, respectively). Thirty-nine single-phase EPAs were submitted. Learner self-assessment and teacher ratings were equivalent for 32% of pre-operative EPAs, 53% of intra-operative EPAs, 29% of post-operative EPAs, and 64% of single phase of care EPAs. Spearman rank correlation between teacher and learner ratings for all phases of care combined was 0.66. Correlation was highest for the intra-operative phase (0.73), followed by single-phase (0.65), pre-operative phase (0.27), and post-operative phase (0.20). Rating concordance did not differ when high and low scores were examined independently. Learners were more prone to underestimate performance than to overestimate it when ratings were discordant.</p><p><strong>Conclusions: </strong>Learners' self-assessment and teacher ratings of endocrine surgery EPAs are strongly concordant with operative technical skills. However, learners often underestimate their performance of pre- and post-operative care compared to faculty ratings when using EPAs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological Outcomes of Locally Recurrent Rectal Cancer Treated With Curative Intent: A Single Center Retrospective Cohort Study.","authors":"F E C Vande Kerckhove, A G J Aalbers, H C Groen, P Snaebjornsson, B van Triest, G L Beets, Brechtje A Grotenhuis","doi":"10.1002/wjs.70135","DOIUrl":"https://doi.org/10.1002/wjs.70135","url":null,"abstract":"<p><strong>Background: </strong>Treatment paradigms for patients with locally recurrent rectal cancer (LRRC) have shifted from palliative approaches to multimodal curative-intent treatment in selected patients. This retrospective cohort study evaluates survival outcomes following curative-intent treatment in patients with LRRC.</p><p><strong>Methods: </strong>All consecutive patients with LRRC undergoing curative-intent treatment at a tertiary referral center between 2014 and 2024 were retrospectively analyzed (n = 147). Overall survival (OS), local re-recurrence-free survival (LRFS), metastasis-free survival (MFS), and prognostic factors were analyzed using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>147 patients underwent neoadjuvant treatment with curative intent at baseline. After response assessment, 117/147 (80%) patients continued curative therapy, which consisted of 109/117 (93%) patients undergoing surgery and a highly selected group of 8/117 (7%) patients monitored with a watch-and-wait strategy. For the remaining 30/147 patients (20%), treatment intent changed from curative to palliative. Median OS was 54 months with a 5-year OS of 47%. For patients treated with an overall curative intent (n = 117), median OS was 63 months with a 5-year OS of 58%. Clear resection margins, achieved in 76% of surgical cases, was a prognostic factor for OS and LRFS: 5-year OS was 66% for R0-resections and 33% for R1-resections (p < 0.001), and 3-year RFS was 69% for R0-resections and 50% for R1-resections (p < 0.001). Among the watch-and-wait group, 5/8 patients remained alive and disease-free (median follow-up 14 months (IQR 9-16)).</p><p><strong>Conclusions: </strong>This single-center retrospective cohort study demonstrates reasonably good oncological outcomes following curative-intent LRRC treatment. Further investigation of watch-and-wait strategies in highly selected patients is warranted.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery Protocols in Gastrectomy for Gastric Cancer: Evaluating the Impact of Frailty.","authors":"Leonardo Solaini, Federica Filippini, Annalisa Coppola, Marco Realis Luc, Marco Milone, Laura Fortuna, Paolo Morgagni, Valentina Zucchini, Fabio Cianchi, Giovanni Domenico De Palma, Elio Treppiedi, Stefano de Pascale, Simone Giacopuzzi, Giorgio Ercolani","doi":"10.1002/wjs.70118","DOIUrl":"https://doi.org/10.1002/wjs.70118","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is a known risk factor for adverse postoperative outcomes after gastrectomy for gastric cancer. However, its impact within standardized enhanced recovery protocols (ERPs) has not been fully elucidated. This study aimed to evaluate the association of frailty with postoperative outcomes and protocol adherence in patients undergoing gastrectomy managed under ERP across six Italian centers.</p><p><strong>Methods: </strong>This retrospective multicenter study included 957 patients undergoing gastrectomy within an ERP between 2018 and 2024. Frailty was assessed using the 5-item modified frailty index (5MFI), classifying patients as frail (5MFI ≥ 2) or nonfrail (5MFI < 2). Postoperative outcomes and compliance with individual ERP components were compared between frail and nonfrail patients. Entropy balancing was applied to adjust for confounders including surgical approach, procedure type, lymphadenectomy, and neoadjuvant therapy.</p><p><strong>Results: </strong>Among ERP patients, 291 (30.4%) were frail. Frail patients were older (median 75 vs. 67 years; p < 0.001) and had higher comorbidity scores. Compliance to ERP items was significantly lower in the frail group for urinary catheter removal within 48 h (64.3% vs. 73.1%, p = 0.024) and avoidance of central venous catheters (36.7% vs. 45.0%, p = 0.043). Overall complication rates (36.8% vs. 32.0%, p = 0.212) and 90-day mortality (2.7% vs. 1.0%, p = 0.146) did not differ significantly between groups. However, frail patients experienced higher rates of pulmonary complications (13.0% vs. 6.2%, p = 0.008) and ICU admissions (15.8% vs. 9.3%, p = 0.029). Length of hospital stay and readmission rates were similar between groups.</p><p><strong>Conclusions: </strong>Frailty remains a significant factor associated with specific postoperative complications and ICU admissions despite standardized ERP management. Although overall adherence to ERP items was largely comparable, frail patients showed lower compliance with selected preoperative components, suggesting the need for targeted strategies to support full protocol implementation in this vulnerable population.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Tall Cell Variant Histology Predicts Poorer Disease-Free Survival in Papillary Thyroid Carcinoma: A Propensity-Matched Cohort Study.","authors":"Namrata Maskara, Spandana Jagannath, Sabaretnam Mayilvaganan","doi":"10.1002/wjs.70127","DOIUrl":"https://doi.org/10.1002/wjs.70127","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardizing Tissue Preservation in Breast-Conserving Surgery: Ultrasound Guidance Reduces Resection Volumes by 40% Compared to Palpation.","authors":"Jean Christian Nzengue, Vidmi Taolam Martin","doi":"10.1002/wjs.70136","DOIUrl":"https://doi.org/10.1002/wjs.70136","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound guidance (US) may optimize breast-conserving surgery (BCS) by standardizing resection precision, but comparative quantitative data remain limited. This study evaluates whether US improves margin control and tissue preservation versus palpation-guided BCS using a calculated resection ratio (CRR).</p><p><strong>Methods: </strong>Retrospective analysis of 114 patients with BCS (37 palpation-guided; 77 US-guided [34 palpable and 43 nonpalpable]).</p><p><strong>Primary endpoints: </strong>positive margin rates, re-excision rates, and CRR. Statistical analysis included Mann-Whitney U tests (CRR) and multivariate logistic regression.</p><p><strong>Results: </strong>US guidance reduced positive margins by 76% (2.2% vs. 9.0% and p < 0.0001) and re-excisions by 81% (2.6% vs. 14.0%). Resection efficiency improved by 40% (median CRR 1.8 vs. 3.0 and p < 0.001), with nonpalpable tumors achieving the lowest CRR (1.6). For a representative 2 cm tumor, US guidance reduced total resection volumes by 78% (17.6 vs. 81.4 cm³) and healthy tissue excision by 81% (14.6 vs. 78.4 cm³) compared to palpation-guided surgery. Multivariate analysis showed nonsignificant trends for the US (OR 0.375 and p = 0.416), though clinical benefits were consistent across subgroups. However, CRR correlated with cosmetic outcomes (91% vs. 78% \"Excellent/Good\"), suggesting dual oncologic-esthetic benefits.</p><p><strong>Conclusions: </strong>US-guided BCS standardizes tissue preservation, reducing resection volumes by 40% while maintaining oncologic safety. CRR emerges as a replicable metric for surgical quality. Despite nonsignificant multivariate results, the magnitude of improvement supports US adoption where expertise exists.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes and Quality of Life Assessment in Breast Surgery Using BREAST-Q: A Multi-Center Prospective Study.","authors":"Megan Roy Pickard, Sarkis Meterissian","doi":"10.1002/wjs.70131","DOIUrl":"https://doi.org/10.1002/wjs.70131","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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: A 48-Hour Symptom Threshold Predicts Perforated Appendicitis: Development of a Clinical Risk Model.","authors":"Pratik Bhattacharya, Shaadman Umran, Constantine Ezeme, Giordano Perin","doi":"10.1002/wjs.70137","DOIUrl":"https://doi.org/10.1002/wjs.70137","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Prehospital Trauma Quality Improvement: Database-Driven Opportunities for Timely Access\".","authors":"Wilhelm Hansen","doi":"10.1002/wjs.70133","DOIUrl":"https://doi.org/10.1002/wjs.70133","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}