World Journal of Surgery最新文献

{"title":"Association of obesity and thyroidectomy-specific perioperative outcomes.","authors":"Kelvin Memeh, Sara Abou Azar, Oluwasegun Afolaranmi, Tanaz M Vaghaiwalla","doi":"10.1002/wjs.12437","DOIUrl":"10.1002/wjs.12437","url":null,"abstract":"<p><strong>Background: </strong>There is limited large-scale data on the effect of obesity on thyroidectomy-specific outcomes. To fill this gap in the literature, this study evaluates the association between obesity and thyroidectomy-specific outcomes using a large real-world surgical outcomes dataset.</p><p><strong>Materials and methods: </strong>The 2016-2019 American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy dataset (ACS NSQIP) was queried. Using an inverse probability weighted (IPW) model, the impact of BMI on the primary (postoperative voice hoarseness, neck hematoma, and hypocalcemia.) and secondary outcomes (operative time and postoperative length of stay) were estimated. BMI was evaluated as per the WHO obesity categories. Sensitivity analysis was performed.</p><p><strong>Results: </strong>24,370 patients were evaluated with an average BMI of 30.6, a mean age of 51.8 years, 77.5% were female, and 7.9 % were Hispanic. In univariate analysis, patients with BMI >30 had a higher risk of postoperative voice hoarseness (6.7 vs. 5.8% and p = 0.005) and neck hematoma (2.1 vs. 1.7% and p = 0.014) and a lower risk in hypocalcemia rates (3.6% vs. 4.6 % and p < 0.001). In the fully adjusted multivariable IPW models, BMI >30 was associated with a higher rate of postoperative voice hoarseness (RR 1.12 and p = 0.031) and neck hematoma (RR 1.25 and p = 0.024) but a lower rate of hypocalcemia (RR 0.81 and p = 0.001). Also, patients with BMI >30 had longer OR time (adjusted difference: 6.33 min and p < 0.001) and length of stay (adjusted difference: 1.36 h and p = 0.002).</p><p><strong>Conclusion: </strong>In this national cohort of patients undergoing thyroidectomy, obesity was associated with a decreased rate of hypocalcemia but an increased rate of postoperative voice hoarseness and neck hematoma.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"179-186"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802397","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":"Invited commentary: \"Risk of neuropsychiatric disorders in primary hyperparathyroidism: Parathyroidectomy versus nonoperative management\".","authors":"Christine J O'Neill","doi":"10.1002/wjs.12318","DOIUrl":"10.1002/wjs.12318","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"115-116"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector spinae plane block versus quadratus lumborum block for abdominal surgery: A systematic review and meta-analysis.","authors":"Yifan Qin, Xiaofeng Zhou, Mengmeng Wu, Huiyu She, Jin Wu","doi":"10.1002/wjs.12428","DOIUrl":"10.1002/wjs.12428","url":null,"abstract":"<p><strong>Background: </strong>The erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are two novel interfascial plane block techniques with possible analgesic effects for both incisional and visceral pain. However, the results of the intercomparison of the two techniques for analgesia after abdominal surgery remain controversial.</p><p><strong>Methods: </strong>A systematic literature search was performed on five databases for randomized controlled trials comparing the analgesic efficacy of ESPB and QLB in abdominal surgery. The primary outcome was the 24 h postoperative intravenous IV morphine-equivalent consumption. A meta-analysis was performed using a random-effects model, with subgroup analyses based on the types of surgery and approaches of QLB.</p><p><strong>Results: </strong>The 24 h postoperative IV morphine-equivalent consumption was lower in patients receiving ESPB than in those receiving QLB (MD -2.307 mg; 95% CI ‒4.577 to -0.038; p = 0.046; and I² = 96.5%), though the reduction did not reach clinically meaningful difference. Static and dynamic pain at different postoperative time points, the time to first rescue analgesia, and the incidence of PONV showed no significant difference between the two groups. However, the QLB group demonstrated a significantly prolonged time in performing the block compared to the ESPB group (MD -2.985 min; 95% CI -4.608 to -1.363; p < 0.001; and I² = 97.5%).</p><p><strong>Conclusions: </strong>Based on the available evidence from a systematic search of databases, the single-shot ESPB exhibits similar analgesic effects as QLB in abdominal surgery. The incidence of PONV was similar between the two techniques, with no block-related complications identified though QLB might be a more technically challenging approach than ESPB.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"204-218"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693416","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":"Impact of postoperative infectious complications on long-term prognosis after esophagectomy.","authors":"Suguru Maruyama, Katsutoshi Shoda, Yoshihiko Kawaguchi, Yudai Higuchi, Takaomi Ozawa, Takashi Nakayama, Ryo Saito, Wataru Izumo, Koichi Takiguchi, Kensuke Shiraishi, Shinji Furuya, Yuki Nakata, Hidetake Amemiya, Hiromichi Kawaida, Daisuke Ichikawa","doi":"10.1002/wjs.12421","DOIUrl":"10.1002/wjs.12421","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications have been reported to be a risk factor for worse oncologic outcomes in patients with esophageal cancer. However, the impact of postoperative complications on prognosis after esophagectomy remains controversial. We aimed to investigate the factors that influence the prognosis of postoperative complications in patients who underwent oncological esophagectomy, focusing on chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>In total, 254 consecutive patients who underwent esophagectomy for esophageal cancer between 2009 and 2021 were eligible. We examined the association between postoperative complications and long-term outcomes.</p><p><strong>Results: </strong>Focusing on infectious complications (IC: a combination of postoperative pneumonia and anastomotic leakage), overall survival (OS) and relapse-free survival (RFS) rates were significantly worse in patients with IC than those without (p < 0.01, and <0.01, respectively), whereas the presence of other complications demonstrated no survival impact. No clinicopathological variables have changed the influence of IC on long-term outcomes. Meanwhile, patients with postoperative pneumonia exhibited significantly lower OS and RFS rates compared to those without in non-COPD group, however, the presence of postoperative pneumonia demonstrated no prognostic impact in COPD group. Also, interaction analysis revealed that the effect of postoperative pneumonia on poor RFS differed based on the presence of COPD (p for interaction = 0.09).</p><p><strong>Conclusions: </strong>IC influenced the long-term outcomes in patients with esophageal cancer, however no clinicopathological variables have changed the effect of the presence of IC on prognosis. Meanwhile, the effect of postoperative pneumonia on poor survival differed based on the presence of COPD.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"253-261"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772513","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":"Longitudinal assessment of disparities in pancreatic cancer care: A retrospective analysis of the National Cancer Database.","authors":"Mahip Grewal, Victor J Kroon, Sarah R Kaslow, Anthony M Sorrentino, Megan D Winner, John D Allendorf, Paresh C Shah, Diane M Simeone, Theodore H Welling, Russell S Berman, Steven M Cohen, Christopher L Wolfgang, Greg D Sacks, Ammar A Javed","doi":"10.1002/wjs.12431","DOIUrl":"10.1002/wjs.12431","url":null,"abstract":"<p><strong>Background: </strong>The existence of sociodemographic disparities in pancreatic cancer has been well-studied but how these disparities have changed over time is unclear. The purpose of this study was to longitudinally assess patient management in the context of sociodemographic factors to identify persisting disparities in pancreatic cancer care.</p><p><strong>Methods: </strong>Using the National Cancer Database, patients diagnosed with pancreatic ductal adenocarcinoma from 2010 to 2017 were identified. The primary outcomes were surgical resection and/or receipt of chemotherapy. Outcome measures included changes in associations between sociodemographic factors (i.e., sex, age, race, comorbidity index, SES, and insurance type) and treatment-related factors (i.e., clinical stage at diagnosis, surgical resection, and receipt of chemotherapy). For each year, associations were assessed via univariate and multivariate analyses.</p><p><strong>Results: </strong>Of 75,801 studied patients, the majority were female (51%), White (83%), and had government insurance (65%). Older age (range of OR 2010-2017 [range-OR]:0.19-0.29), Black race (range-OR: 0.61-0.78), lower SES (range-OR: 0.52-0.94), and uninsured status (range-OR: 0.46-0.71) were associated with lower odds of surgical resection (all p < 0.005), with minimal fluctuations over the study period. Older age (range-OR: 0.11-0.84), lower SES (range-OR: 0.41-0.63), and uninsured status (range-OR: 0.38-0.61) were associated with largely stable lower odds of receiving chemotherapy (all p < 0.005).</p><p><strong>Conclusions: </strong>Throughout the study period, age, SES, and insurance type were associated with stable lower odds for both surgery and chemotherapy. Black patients exhibited stable lower odds of resection underscoring the continued importance of mitigating racial disparities in surgery. Investigation of mechanisms driving sociodemographic disparities are needed to promote equitable care.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"262-269"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802400","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":"Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis.","authors":"Wenjun Meng, Ping Yao, Yuan Dan","doi":"10.1002/wjs.12347","DOIUrl":"10.1002/wjs.12347","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"283-284"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296800","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":"Author's reply: Is routine histopathological analysis of hemorrhoidectomy specimens necessary? A systematic review and meta-analysis.","authors":"Velia Men, James Jin, Andrew Hill","doi":"10.1002/wjs.12393","DOIUrl":"10.1002/wjs.12393","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"289-290"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565015","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":"Invited commentary: Lymph node yield independently predicts local recurrence in papillary thyroid cancer.","authors":"Fausto F Palazzo","doi":"10.1002/wjs.12396","DOIUrl":"10.1002/wjs.12396","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"138-139"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation of antibiotics and antifungal strategy to preoperative biliary drainage to improve postoperative outcomes after pancreatic head resection.","authors":"Fabio Giannone, Charles Lagarrigue, Oronzo Ligurgo, Lina Jazaerli, Paul Michel Mertes, Olivier Collange, Patrick Pessaux","doi":"10.1002/wjs.12446","DOIUrl":"10.1002/wjs.12446","url":null,"abstract":"<p><strong>Background: </strong>Biliary contamination significantly correlates with major comorbidities during pancreatic head resection. Recently, a piperacillin-tazobactam prophylaxis demonstrated a lower rate of infectious complications (IC) and postoperative pancreatic fistula (POPF) in this population. However, bacterial contamination is rare in patients without a preoperative biliary drainage (PBD) and probably could not benefit from this antibiotic. Furthermore, little is known about the role of biliary fungal contamination.</p><p><strong>Method: </strong>All retrospective cases undergoing pancreatic head resection with intraoperative biliary sample were included. Postoperative outcomes of patients with a piperacillin-tazobactam-based treatment were compared to cases in which a narrow-spectrum antibiotic was administrated, stratified according to the use of a PBD. The same analysis was repeated for antifungal treatment administration.</p><p><strong>Results: </strong>Among the 205 cases included, PBD was necessary in 127 patients (62%). Broad-spectrum treatment was associated with fewer overall and clinically relevant POPF (p = 0.001 and p = 0.004), overall morbidity (p = 0.044), and overall IC (p = 0.018), but only in the PBD group. Similarly, antifungal treatment was significantly associated with some specific IC only in the PBD group. At multivariable analysis, antifungal therapy in the whole cohort (p = 0.029) and the use of a piperacillin-tazobactam (p = 0.007) treatment in patients with a PBD were independently associated with a reduced risk of a clinically relevant POPF.</p><p><strong>Conclusions: </strong>A broad-spectrum antibiotic therapy reduces overall morbidity after pancreatic head resection, but only in cases with a history of PBD. Furthermore, the use of an antifungal prophylaxis or therapy should be further investigated in these patients because it may reduce the risk of some IC.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"270-282"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-radical gastrectomy long-term survival and etiologies of mortalities in older adult patients greater than 80 years of age with gastric cancer.","authors":"Ryota Matsui, Souya Nunobe, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Masaru Hayami, Manabu Ohashi, Takeshi Sano","doi":"10.1002/wjs.12405","DOIUrl":"10.1002/wjs.12405","url":null,"abstract":"<p><strong>Background: </strong>Patients aged >80-years-old with gastric cancer are commonly excluded from clinical trials, and no consensus exists regarding surgical indications and outcomes in older patients. In this study, we analyzed the post-gastrectomy long-term survival and etiologies of mortality in older patients with gastric cancer.</p><p><strong>Methods: </strong>Patients aged >80-years-old with pathological stages I-III primary gastric cancer who undergone radical gastrectomies, between May 2006 and March 2017, were included in the study. Eligible patients were categorized into 3 age cohorts: <85-, 85-90-, and >90-years-old. The primary outcome was the overall survival. The etiologies of mortalities were compared. Survival curves were compared using the log-rank test. Prognostic factors were identified by multivariate analysis, using the Cox proportional hazards regression model.</p><p><strong>Results: </strong>The median follow-up duration was 59 months. Of the 353 patients, 269 (76.2%), 71 (20.1%), and 13 (3.7%) were categorized into the <85-, 85-90-, >90-years-old age cohorts, respectively. Older patients had a poorer overall survival (p = 0.003) and statistically significant difference in the other-cause survival (p < 0.001). The multivariate analysis revealed that age was not an independent prognostic factor for overall or cancer-specific survival. However, an age >90-years-old was an independent prognostic factor for the other-cause survival.</p><p><strong>Conclusions: </strong>In patients aged >80-years-old with gastric cancer who had undergone gastrectomies, mortalities from other diseases increased with age; while mortalities from gastric cancer did not. An age of ≥90-years-old was an independent prognostic factor for mortalities from other diseases.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"230-240"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689026","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}