World Journal of Surgery最新文献

{"title":"Children's Surgery: The Missing Link in the Global Child Survival Agenda.","authors":"Ayesha De Costa, Lee Wallis","doi":"10.1002/wjs.70617","DOIUrl":"https://doi.org/10.1002/wjs.70617","url":null,"abstract":"<p><p>Global child health is at an inflection point. Under-five mortality has fallen substantially over recent decades, yet progress is slowing and preventable deaths and disability remain concentrated in low- and middle-income countries. As mortality from vaccine-preventable diseases and other infections declines, birth defects and other surgically treatable conditions account for an increasing share of the residual burden. For many children, access to timely, safe and affordable surgical, anesthesia and perioperative care is the difference between survival, disability and death. Yet these services remain insufficiently embedded in child health policy, service delivery and universal health coverage. Children's surgery should therefore be understood not as a peripheral specialty, but as an essential component of integrated services to improve child health outcomes. Congenital anomalies make this case clear. Outcomes for surgically treatable conditions differ starkly by setting, reflecting inequities in early recognition, safe referral, anesthesia, operative and postoperative care, infection prevention, and follow-up. The same services are also required for injuries, burns, surgical infections, complications of sickle cell disease and acute abdominal emergencies. Strengthening them would extend well beyond specialist surgery; it would build the capacity of health systems to respond to some of the most time-sensitive and disabling conditions affecting children. Recent World Health Assembly resolutions on operative care, universal health coverage and newborn screening provide a clear mandate for action. The next phase of the global child survival agenda must recognize children's surgical care as an essential service to be planned, adequately financed and routinely monitored. Integrating surgical, anesthesia, perioperative and rehabilitation care into child health programmes is critical to avert preventable deaths, reduce lifelong disability, protect families from catastrophic costs and ensure that children everywhere have the opportunity not only to survive but also to thrive.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228922","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":"Optimal Resources for Children's Surgery 2: Tiered Recommendations for Minimum Essential Children's Surgical Procedures Across Health System Levels.","authors":"Arpita Biswangree, Emmanuel A Ameh, Kokila Lakhoo, Mohamed Shalaby, Sarah Beth Cairo","doi":"10.1002/wjs.70630","DOIUrl":"https://doi.org/10.1002/wjs.70630","url":null,"abstract":"<p><strong>Background: </strong>In 2015 the World Health Assembly (WHO), based on recommendations by the Lancet Commission on Global Surgery, passed resolution (68:15) on strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage. However, children's surgery was not adequately represented and in response, the Global Initiative for Children's Surgery (GICS) published the Optimal Resources for Children's Surgical Care (OReCS) in 2019 providing insight into procedures which should be performed at different facility types. OReCS 2 addresses a gap in both policy and published literature to further define surgical conditions and procedural capabilities by hospital level.</p><p><strong>Methods: </strong>We performed a review of the literature to identify procedures routinely performed in a variety of settings. We then used an iterative Delphi like approach to identify specialty-specific procedures and nursing skills by hospital level. Participation was open to all members of GICS with representation from 21 working groups and more than 50 low-middle income countries (LMICs) and high-income countries (HICs). Data on essential procedures were collected for twelve specialty groups. Modifications of the recommendations provided by the working groups were made by the executive board based on firsthand knowledge of capabilities at lower-level facilities where subspecialists have less experience. Final recommendations were made based on greater than 75% agreement by respondents and review of the executive board of GICS.</p><p><strong>Results: </strong>Procedures performed at health centers were limited to those not requiring anesthesia or sedation and were largely identified to help triage and stabilize patients for transfer to higher level care. Similarly, first level hospital procedures focused on stabilization and transfer to referral level hospitals for most specialties. Alternatively, specialties such as ophthalmology and dental surgery have identified definitive procedures for lower-level facilities. Procedures performed at the National Children's Hospital level include those requiring specialty providers and equipment such as transplantation, repair of congenital heart disease, and reconstructive surgery for complex trauma, congenital anomalies, and burns.</p><p><strong>Conclusions: </strong>This updated version of OReCS provides specific examples of procedural capabilities for twelve subspecialties at the health center, first, second, third, and referral level hospitals in LMICs. Whereas the list is not meant to be all inclusive, it provides a framework within which to define the minimum essential material resources, equipment, and personnel by hospital level.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228886","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":"Optimal Resources for Children's Surgery 2: Essential Human Resources for Optimal Children's Surgery.","authors":"Nathan Ezie Kengo, Sarah B Cairo, Emmanuel A Ameh, Mohamed Sameh Shalaby, Kokila Lakhoo","doi":"10.1002/wjs.70631","DOIUrl":"https://doi.org/10.1002/wjs.70631","url":null,"abstract":"<p><strong>Background: </strong>Following its inaugural meeting at the Royal College of Surgeons of England, London, United Kingdom, in 2016, the Global Initiative for Children's Surgery (GICS) published the Optimal Resources for Children's Surgery 1 (OReCS) consensus document detailing the facilities and resources required at each level of care. In addition to physical resources needed to provide care for children, the Lancet Commission on Global Surgery (LCoGS) identified the density of surgical providers as a marker of sufficient workforce in capacity. To meet the needs of patients, OReCS 2 details the varying types of providers needed at each level of care to meet the minimum expected capacity to care for children with surgical needs.</p><p><strong>Methods: </strong>We performed a review of the literature and reviewed LCoGS recommendations that applied solutions in low resource settings. We then used an iterative Delphi-like approach to determine the types of providers needed for each of 13 sub-specialties in children's surgical care at the different hospital levels. Participation was open to all GICS V conference attendees that were held from 24 to 26 February 2024 in Manila Philippines. This represents 441 participants from 50 countries (79% low to middle income countries). Final recommendations were made based on a greater than 75% agreement by respondents and reviewed by the 20 GICS board of directors.</p><p><strong>Results: </strong>In the current literature, there is considerable variability in the provider types described for each facility level with an emphasis on the use of non-physician health workers such as clinical officers, nurse anesthetists, and community health workers to improve access. Using the modified Delphi from GICS V, it is recommended to have a generalist medical practitioner, followed by non-physician surgical providers at the health center level. First level hospitals should have generalist medical practitioner, non-physician surgical provider, and generalist medical practitioner with pediatric-specific training. At the referring hospital level, which includes 2nd level hospital, third level hospital, and children's hospital, recommendations are generalist medical practitioner (GMP), non-physician surgical providers (NPSP), pediatric general and specialty surgeons, and some medical specialists such as cardiologist, gastroenterologist, and others, for maximum care coverage.</p><p><strong>Conclusions: </strong>To improve access to high-quality care and perform the procedures considered essential, different types of providers are needed at different facility levels. Ranging from community health workers to surgical subspecialists to nurses with expertise in pediatric intensive care units to physiotherapists. OReCS 2 provides detailed examples of the optimal human resources and workforce needed at each facility level.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231245","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":"Early and Late Outcomes Following Cardiac Surgery in Patients With Immune-Mediated Inflammatory Diseases.","authors":"Kentaro Amano, Yoshiyuki Takami, Kiyotoshi Akita, Kazuki Matsuhashi, Wakana Niwa, Kazuma Okamoto, Naonori Kawamoto, Tomonobu Abe","doi":"10.1002/wjs.70619","DOIUrl":"https://doi.org/10.1002/wjs.70619","url":null,"abstract":"<p><strong>Background: </strong>Immune-mediated inflammatory diseases (IMIDs) are associated with increased cardiovascular risk, but surgical outcomes in the modern era of immunosuppressive therapy remain unclear. We evaluated early and late outcomes after cardiac and thoracic aortic surgery in patients with IMIDs, focusing on the impact of glucocorticoids and disease-modifying antirheumatic drugs (DMARDs).</p><p><strong>Methods: </strong>A total of 140 patients with IMIDs who underwent cardiac or thoracic aortic surgery between 2008 and 2025 were retrospectively analyzed. The primary endpoints were in-hospital mortality and long-term overall survival.</p><p><strong>Results: </strong>Median age was 70 [61-76] years, and 62% were women. Rheumatoid arthritis was the most common IMID (36%). Prednisolone and DMARDs were used in 68% and 33% of patients, respectively. Procedures included valve (43%), ischemic (26%), and thoracic aortic surgery (23%). In-hospital mortality was 4.3%. During a median follow-up of 5.9 years (93% completeness), overall survival was 91% at 1 year, 87% at 3 years, 78% at 5 years, and 62% at 10 years, respectively. Outcomes did not differ by a surgical category or IMID subtype. Glucocorticoid use was independently associated with worse late survival (HR, 2.91; 95% CI, 1.01-8.41; p = 0.048), whereas DMARD use showed a trend toward improved survival (HR 0.46; 95% CI, 0.19-1.09; p = 0.08). Notably, a dose-dependent relationship was observed, with high-dose prednisolone (≥ 5 mg/day) showing significantly worse survival compared with low-dose (< 5 mg/day) or no glucocorticoid use (p = 0.004). Diabetes mellitus and preoperative anemia were also independent predictors of late mortality.</p><p><strong>Conclusions: </strong>Cardiac surgery in patients with IMIDs provides acceptable early outcomes but suboptimal long-term survival. Glucocorticoid use was associated with worse late survival, with a dose-dependent relationship, whereas DMARD use showed a nonsignificant trend toward better survival, underscoring the importance of optimized immunosuppressive management.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225009","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":"Optimal Resources for Children's Surgery 2: Tiered Quality Improvement Recommendations for Children's Surgical Care Across Health System Levels.","authors":"Sabrina Sedano, Emmanuel A Ameh, Kokila Lakhoo, Mohamed Shalaby, Sarah B Cairo","doi":"10.1002/wjs.70611","DOIUrl":"https://doi.org/10.1002/wjs.70611","url":null,"abstract":"<p><strong>Background: </strong>The previously published Optimal Resources for Children's Surgical Care (OReCS) addressed disparities in access to high-quality children's surgery in low- and middle-income countries (LMICs) with an emphasis on physical and human resources. Data from high-income countries (HICs) show a clear advantage in outcomes when there is an investment in quality improvement (QI) programs. In-hospital adverse events, many of which are avoidable through implementation of quality improvement programs, contribute disproportionately to morbidity in LMICs. The objective of this document is to make recommendations for quality improvement programming at the hospital level.</p><p><strong>Methods: </strong>We performed a systematic review of the literature to identify quality improvement programming appropriate for a variety of healthcare settings. We then used an iterative Delphi like approach to rank specific quality improvement programs by hospital level according to the DCP3 and WHO classification systems. Participation was open to all members of the Global Initiative for Children's Surgery (GICS) with representation from 21 working groups and 50 LMICs and HICs. Final recommendations were made based on greater than 75% agreement by respondents and review by the GICS executive board.</p><p><strong>Results: </strong>After three rounds of an iterative Delphi like approach, it is recommended that facilities of all levels, participate in a minimum of local data collection and review and establish an antibiotic stewardship program. Recommendations increased by the complexity of work done at each hospital level with the addition of surgical safety checklists, and protocols for multiple domains including the operating room, radiology, and transfusion medicine at first level hospitals. Surgical quality improvement committees and routine mortality and serious event review processes should be implemented at second level hospitals and above. At the National Children's Hospital level, program recommendations mirror those of most HICs, including continuous data collection and monitoring, multidisciplinary review boards, morbidity and mortality conferences and more.</p><p><strong>Conclusion: </strong>Quality improvement is defined in the literature as a systematic, data driven approach to improve outcomes and safety of healthcare delivery. Despite significant barriers in data collection, we recommend a minimum level of quality improvement programming and standardization of care for facilities of various levels.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224991","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":"Interobserver Variability in Intraoperative Classification of Acute Appendicitis and Postoperative Antibiotic Management.","authors":"Miranda Elisabeth Krusmynta Ocklind, Kathrine Holte, Niels Henrik Bruun, Rasmus Virenfeldt Flak","doi":"10.1002/wjs.70643","DOIUrl":"https://doi.org/10.1002/wjs.70643","url":null,"abstract":"<p><strong>Background: </strong>During laparoscopy for suspected acute appendicitis (AA), surgeons classify the appendix as normal, phlegmonous, gangrenous, or perforated, with or without abscess. The surgeon's assessment directly influences postoperative antibiotic treatment and length of hospitalization. There is currently no objective gold standard for this classification. This study aimed to evaluate interobserver variability in the laparoscopic classification of AA.</p><p><strong>Methods: </strong>Surgeons and surgical trainees viewed video recordings of laparoscopies from 30 patients suspected of AA. Each participant anonymously classified the appendices according to the diagnostic categories and indicated whether they would prescribe postoperative antibiotics. Inter-rater reliability was assessed using Fleiss' κ for dichotomous outcomes, and percent agreement for multivariable outcomes.</p><p><strong>Results: </strong>The study included 89 surgeons and trainees from seven Danish hospitals with varying experience levels. Interobserver agreement was moderate for distinguishing a normal appendix from appendicitis (κ = 0.72, 95% CI 0.61-0.84) and for identifying complex appendicitis (κ = 0.66, 95% CI 0.52-0.80). Agreement regarding postoperative antibiotics was high: 96% for phlegmonous, 81% for gangrenous, and 99.7% for perforated appendicitis.</p><p><strong>Conclusions: </strong>This study demonstrates moderate to high interobserver agreement among surgeons in the classification of AA and decisions regarding postoperative antibiotics. However, a larger sample size combined with a dichotomous classification (simple vs. complex) may be required to detect potential differences between demographic groups.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220928","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":"Thyroid Nodule Colloid Is Associated With a Pro-Inflammatory Response in THP-1-Derived Macrophages: An Exploratory In Vitro Study.","authors":"Mohit Kumar Rai, Spandana Jagannath, Mayilvaganan Sabaretnam, Gyan Chand, Anjali Mishra, Durga Prasanna Misra, Vikas Agarwal, Gaurav Agarwal","doi":"10.1002/wjs.70635","DOIUrl":"https://doi.org/10.1002/wjs.70635","url":null,"abstract":"<p><strong>Background: </strong>Benign thyroid nodules are common, but the contribution of the intranodular microenvironment to local inflammation remains incompletely understood. Thyroid colloid has traditionally been regarded primarily as a reservoir for thyroid hormone precursors, although it may also contain inflammatory mediators. We therefore explored the response of THP-1-derived macrophages to colloid obtained from benign thyroid nodules and compared this response with exposure to matched patient serum and healthy donor serum.</p><p><strong>Methods: </strong>Thyroid colloid and serum samples (n = 10) were collected from patients undergoing hemithyroidectomy for benign nodules. Additionally, serum samples from age- and sex-matched healthy controls (n = 10) were obtained. They were centrifuged at 1500 rpm for 10 minutes and stored at -80°C. THP-1 monocytes were differentiated into macrophages using phorbol-12-myristate-13-acetate (PMA) and exposed to thyroid colloid, matched patient serum, or healthy donor serum. Expression of M1-associated (IL12 B, IL23 A, NOS2, and CD80) and M2-associated (ARG1, CD206, CD163, CD68, and IL10) genes was quantified by quantitative real-time PCR. Cytokine secretion was determined using an enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>THP-1-derived macrophages exposed to thyroid nodule colloid showed significant upregulation of M1-associated markers, including IL12 B, IL23 A, NOS2, and CD80, compared with macrophages exposed to patient serum or healthy donor serum. Expression of several M2-associated genes, including IL10, CD163, and CD68, was reduced following colloid exposure. Colloid-exposed macrophages also showed higher secretion of IL-1β, IL-6, and IL-17, whereas IL-10 levels remained unchanged. These findings indicate a pro-inflammatory M1-associated transcriptional and secretory response to thyroid nodule colloid under the present in vitro conditions.</p><p><strong>Conclusions: </strong>Exposure to benign thyroid nodule colloid was associated with a pro-inflammatory M1-associated response in THP-1-derived macrophages in vitro. Because non-nodular thyroid colloid was not available as a biologically matched comparator, these findings cannot establish that this response is specific to nodule-derived colloid or that colloid is a causal driver of inflammation in vivo. Studies using non-nodular thyroid comparators and primary patient-derived macrophages are required to validate the specificity and biological relevance of this observation.</p><p><strong>Trial registry registration no: </strong>8638 dated January 22, 2023.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220886","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":"Night-Time Presentation as an Independent Predictor of Unnecessary Appendectomy in Children: A Prospective Cohort Study.","authors":"Mohamed Zouari, Oumaima Jarboui, Asma Issaoui, Rim Ouaghleni, Mohamed Karim Tounsi","doi":"10.1002/wjs.70640","DOIUrl":"https://doi.org/10.1002/wjs.70640","url":null,"abstract":"<p><strong>Background: </strong>Unnecessary appendectomy (UA) remains an important quality indicator in pediatric emergency surgery, reflecting persistent diagnostic uncertainty despite advances in clinical assessment and imaging. The aim of this study was to identify predictors of UA in children.</p><p><strong>Method: </strong>This investigation was designed as a prospective cohort study involving consecutive pediatric patients who underwent appendectomy for suspected acute appendicitis during January 2022 through December 2025. Unnecessary appendectomy was defined as the removal of a macroscopically and histologically normal appendix.</p><p><strong>Results: </strong>A total of 653 children were included, of whom 53 (8.1%) underwent UA. The median age was 9.5 years, and males represented 66.8% of the cohort. Univariate analysis identified several factors potentially associated with UA. After adjustment for confounding variables, four factors remained independently associated with UA. These independent predictors included night-time admission (OR 3.51; 95% CI 1.83-6.71; p < 0.001), a NLR below 5 (OR 3.12; 95% CI 1.60-6.12; p = 0.001), a CRP level below 10 mg/L (OR 2.13; 95% CI 1.12-4.06; p = 0.021), and a negative US result (OR 5.67; 95% CI 2.98-10.76; p < 0.001).</p><p><strong>Conclusion: </strong>Unnecessary appendectomy in children is influenced not only by clinical and biological variables but also by contextual factors related to the timing of presentation. Recognition of night-time admission as a high-risk context may support more cautious decision-making strategies and help reduce avoidable surgical interventions in pediatric emergency care.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220877","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":"Development and Evaluation of an Evidence-Based Operative Reporting Framework for Pediatric Surgical Oncology: A Translational Program of Research.","authors":"Abdelhafeez Abdelhafeez, Kokila Lakhoo","doi":"10.1002/wjs.70616","DOIUrl":"https://doi.org/10.1002/wjs.70616","url":null,"abstract":"<p><p>Accurate documentation of critical intraoperative oncologic findings is essential for the subsequent management of children with solid tumors. This program of research aimed to establish an evidence-informed framework for operative documentation and evaluate whether synoptic reporting improves documentation completeness compared with traditional narrative reporting. A sequential, multiphase translational program of research was undertaken. First, evidence-based surgical guidelines for Wilms tumor and rhabdomyosarcoma were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to identify surgical factors relevant to local control and subsequent treatment. These recommendations informed an international multidisciplinary Delphi consensus process to establish essential universal and tumor-specific intraoperative reporting elements and develop a standardized synoptic operative reporting template. The template was subsequently implemented across five pediatric oncology centers in a prospective before-and-after study. The primary outcome was complete documentation of six predefined critical intraoperative oncologic elements. Exploratory end-user feedback assessed usability and acceptability. The guideline development process generated evidence-based recommendations addressing key aspects of pediatric solid tumor surgery, including lymph node sampling, vascular involvement, surgical margins, tumor spillage, and residual disease. The International Delphi consensus subsequently established 15 consensus statements defining essential operative documentation, including universal and tumor-specific elements. Following implementation of synoptic reporting, complete documentation of all six predefined critical intraoperative elements increased from 3 of 73 narrative reports (4.1%) to 71 of 92 synoptic reports (77.2%), an absolute increase of 73.1 percentage points (p < 0.000001). Exploratory end-user evaluation demonstrated high perceived usability, with a mean System Usability Scale score of 81.1. This translational program establishes an evidence-informed framework for operative documentation in pediatric surgical oncology by linking evidence-based guideline development, international consensus, and implementation of a standardized synoptic reporting tool. Synoptic reporting substantially improved the completeness of documentation of critical intraoperative oncologic findings compared with narrative reporting.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220893","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":"Asymptomatic Portomesenteric Venous Thrombosis After Colorectal Cancer Surgery: Incidence, Natural History, and Implications for Management.","authors":"Chang Hwan Kim, DongJun Kim, Jin Hyung Park, Dae Hee Pyo, Jong Kyung Park, HyungJin Kim","doi":"10.1002/wjs.70633","DOIUrl":"https://doi.org/10.1002/wjs.70633","url":null,"abstract":"<p><strong>Background: </strong>Portomesenteric venous thrombosis (PMVT) after colorectal cancer (CRC) surgery is most often reported in symptomatic patients, leaving its frequency and natural history across the asymptomatic spectrum poorly defined. When encountered incidentally, it frequently prompts anticoagulation, hypercoagulability evaluation, or delays in oncologic treatment, despite limited evidence that intervention alters its course. Using a cohort with routine postoperative imaging, we characterized the incidence, anatomic distribution, risk factors, and clinical course of asymptomatic PMVT.</p><p><strong>Methods: </strong>We retrospectively studied 799 consecutive patients who underwent CRC surgery between April 2019 and June 2025. All patients underwent standardized abdominal computed tomography (CT) on postoperative day (POD) 6 as part of our institutional clinical pathway for immediate postoperative follow-up. PMVT was defined radiologically, and thrombus location was classified as peripheral intrahepatic branches or main portal/superior mesenteric vein. Management followed a risk-stratified pathway of therapeutic anticoagulation or active surveillance, with radiologic resolution assessed on follow-up CT. Given the limited number of events, multivariable analysis was considered exploratory.</p><p><strong>Results: </strong>Asymptomatic PMVT was identified in 33 patients (4.1%), none symptomatic at detection. Thrombi were predominantly confined to the distal intrahepatic branches. In exploratory multivariable analysis, age ≤ 60 years (OR 2.45, 95% CI 1.19-5.03, p = 0.015) and POD 5 WBC > 10 × 10⁹/L (OR 2.39, 95% CI 1.16-4.93, p = 0.018) were independently associated with PMVT. Twenty-one patients received anticoagulation and 12 were managed with surveillance alone. Complete radiologic resolution occurred in all 33 patients within one year, including every patient managed without anticoagulation. Furthermore, there were no cases of thrombus extension, portal hypertension, or bowel ischemia.</p><p><strong>Conclusion: </strong>When postoperative imaging is routinely performed, asymptomatic PMVT after CRC surgery is detected in approximately 4% of patients. It is typically confined to peripheral intrahepatic branches, and follows a uniformly benign self-limiting course, even in patients managed without anticoagulation. These findings argue against reflexive anticoagulation and extensive workup for short-segment, non-occlusive PMVT confined to peripheral intrahepatic branches, and support an individualized, predominantly conservative approach. We do not advocate routine postoperative CT; rather, surgeons who encounter incidental PMVT can be reassured regarding its favorable prognosis.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220923","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}