World Journal of Surgery最新文献

{"title":"Safe Surgery Starts With Safe Anesthesia: Positioning Pediatric Anesthesia as a Core Health-System Function Within Global Children's Surgical Systems.","authors":"Zipporah N Gathuya, Emma M Mutio, Eddy Mboya, Mary T Nabukenya, Hazel Mumphansha","doi":"10.1002/wjs.70610","DOIUrl":"https://doi.org/10.1002/wjs.70610","url":null,"abstract":"<p><strong>Background: </strong>Children's surgery is increasingly recognized as a global health priority, yet pediatric anesthesia remains comparatively under-recognized despite being essential for safe surgical and perioperative care.</p><p><strong>The problem: </strong>Children require specialized expertise, age-appropriate equipment, reliable monitoring, oxygen, medicines, recovery, and critical care. In many low- and middle-income countries, deficiencies across these domains limit access and contribute to preventable perioperative morbidity and mortality.</p><p><strong>The central claim: </strong>We posit that children's surgical systems cannot be strengthened without parallel investment in pediatric anesthesia systems. Pediatric anesthesia should therefore be recognized as a cross-cutting core health-system function rather than a supporting clinical specialty.</p><p><strong>Evidence synthesis: </strong>This perspective integrates the WHO Health Systems Building Blocks, the Lancet Commission on Global Surgery, National Surgical, Obstetric and Anesthesia Plans, the GICS Optimal Resources for Children's Surgery framework, and Donabedian's Structure-Process-Outcome model into an Integrated Pediatric Anesthesia Systems Framework (IPASF).</p><p><strong>Recommendations: </strong>Governments, professional societies, academic institutions, global surgery organizations, and development partners should integrate pediatric anesthesia into surgical-system planning, workforce development, financing, service delivery, quality improvement, and research.</p><p><strong>Conclusion: </strong>Safe and equitable children's surgery requires deliberate investment in the systems that enable safe anesthesia. The IPASF provides a practical framework for policy, implementation, education, research, and evaluation across the perioperative continuum.</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":"149220955","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":"Reconceptualizing Pediatric Surgery for the Adult Surgeon: A New Era of Integrated Surgical Care.","authors":"Cassandra Mbanje, Kokila Lakhoo","doi":"10.1002/wjs.70604","DOIUrl":"https://doi.org/10.1002/wjs.70604","url":null,"abstract":"<p><strong>Background: </strong>Despite major advances in global surgery, children remain insufficiently represented within surgical system strengthening efforts, particularly in low- and middle-income countries where specialist pediatric surgical capacity is limited. This article reflects on a decade of work by the Global Initiative for Children's Surgery and its academic partners, highlighting approaches to addressing unmet pediatric surgical needs and considering how these lessons can inform closer integration of children's surgical care within broader global surgery systems.</p><p><strong>Methods: </strong>We synthesized published literature on global pediatric surgical need, barriers to access, workforce limitations, surgical outcomes and health-system responses, alongside examples of initiatives developed through the Global Initiative for Children's Surgery (GICS) and its academic partners. Findings were interpreted through the three-delay framework and emerging integrated emergency, critical and operative care approaches.</p><p><strong>Results: </strong>Pediatric surgical access is constrained by delays in seeking, reaching and receiving appropriate care, compounded by shortages of specialist personnel and concentration of pediatric surgical services in urban tertiary centers. GICS-supported initiatives have addressed different points along this pathway through service standards, outreach, decentralized care, multidisciplinary training and hub-and-spoke models. Training adult surgical, anesthesia and nursing teams to provide essential pediatric care represents a pragmatic strategy where specialist pediatric surgeons are unavailable. However, improving access alone is insufficient without parallel attention to quality, resuscitation, perioperative care and recognition of deterioration.</p><p><strong>Conclusions: </strong>Pediatric surgery should not develop as a parallel system to broader global surgery efforts. Children's surgical care should be deliberately incorporated into national surgical planning and workforce development and integrated emergency, critical and operative care systems. Strengthening adult teams to safely manage essential pediatric surgical conditions offers a scalable approach to improving both access and quality in resource-constrained settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184660","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":"A Scalable Model for Global Procedural Skills Training: Introduction to SELF.","authors":"Catherine J Mohr, Megan Kern, Mitchell Corwin, Patrick Diamond, Eric O'Flynn","doi":"10.1002/wjs.70603","DOIUrl":"https://doi.org/10.1002/wjs.70603","url":null,"abstract":"<p><strong>Background: </strong>Around the world, demand for surgical care is growing rapidly as populations expand and incomes rise. Procedural skills are still largely taught through apprenticeship models that depend on the availability of experienced instructors and specialized training environments. These constraints make it difficult to scale training fast enough to meet patient needs, particularly in resource-constrained settings. The Surgical Education Learners Forum (SELF) is a global community of practice bringing together clinicians, educators, technologists, and institutions to explore a different model for skills training-one that allows clinicians to learn, practice, and evaluate procedural skills independently. This introductory article of the SELF series introduces the SELF community of practice, the 2023 SELF Symposium, the methodology used at this Symposium to converge on shared recommendations, and the series of articles that follows.</p><p><strong>Methods: </strong>In August 2023, SELF convened a global group of medical, educational, and technology leaders for a 3-day symposium in Sunnyvale, California, USA. These leaders sought to reach agreement on the fundamental components of the SELF framework through a series of ideation and convergence exercises, using a semi-anonymized, modified nominal group technique.</p><p><strong>Results: </strong>The consensus output is presented in the four subsequent articles, which address in sequence: prioritization of procedures for training development, best practices for simulator design in resource-constrained settings, self-administered skills assessment, and strategies for scaling SELF training globally.</p><p><strong>Conclusions: </strong>The SELF series of articles charts a route from the long-established maxim of \"see one, do one, teach one\" toward a scalable alternative for a world that cannot train fast enough by the old model: \"see one, teach yourself one, do one.\"</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184699","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":"Big Five Personality Traits Across the Surgical Career Spectrum: A Cross-Sectional Study of Surgically Oriented Individuals in Malaysia.","authors":"Wick Champ Lai, Retnagowri Rajandram, Sanjay Rampal Lekhraj Rampal, April Camilla Roslani","doi":"10.1002/wjs.70607","DOIUrl":"https://doi.org/10.1002/wjs.70607","url":null,"abstract":"<p><strong>Introduction: </strong>The \"surgical personality\" describes a constellation of traits considered advantageous in high-stakes operative environments. Although Western studies suggest that surgeons exhibit higher conscientiousness, openness, and extraversion, with lower neuroticism, data from Asian populations remain limited. Moreover, whether these traits are innate or shaped through surgical training is unclear.</p><p><strong>Objectives: </strong>To compare personality traits across different stages of a surgical career in Malaysia, examine sex-related differences, and explore the potential mutability of the surgical personality.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from March to August 2024 involving Malaysian surgeons, surgical trainees, junior doctors, and surgically interested medical students. Participants were recruited from public hospitals and four university-based Master of General Surgery programs. Personality was assessed using the 60-item Big Five Inventory-2 (BFI-2). Domain and facet scores were compared using ANOVA with post hoc Tukey testing. Independent t-tests assessed sex differences. Ethics approval was obtained from the Universiti Malaya Research Ethics Committee.</p><p><strong>Results: </strong>A total of 245 participants were included: 62 surgeons, 71 trainees, 53 junior doctors, and 59 medical students. Conscientiousness was the only domain differing significantly between groups (p = 0.01), with surgeons scoring higher than trainees and students. Significant facet-level differences were observed in energy level, productiveness, and responsibility, predominantly favoring surgeons. Female participants, particularly students and surgeons, demonstrated higher neuroticism scores, driven by anxiety and emotional volatility. Overall personality patterns across the groups were largely similar.</p><p><strong>Conclusion: </strong>Surgically oriented individuals in Malaysia share broadly similar personality profiles across career stages, suggesting an underlying predisposition. However, increasing conscientiousness with seniority may reflect training effects. Personality assessment may inform surgical selection, training strategies, and burnout prevention initiatives.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184630","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":"Ebola and Safe Surgery: Strengthening an Overlooked Dimension of Global Health Security.","authors":"Franck Katembo Sikakulya, Claude Kasereka Masumbuko","doi":"10.1002/wjs.70592","DOIUrl":"https://doi.org/10.1002/wjs.70592","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184638","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":"The Use of Adhesion Barriers in Abdominopelvic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Paul Van Siang Lian Mang, Hui Jun Chuen, Ka Ting Ng","doi":"10.1002/wjs.70606","DOIUrl":"https://doi.org/10.1002/wjs.70606","url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety of adhesion barriers in preventing postoperative adhesions remain uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of adhesion barriers in reducing postoperative adhesions following abdominopelvic surgery.</p><p><strong>Methods: </strong>CENTRAL, EMBASE and MEDLINE were searched from inception to January 15, 2025 for parallel-arm randomized controlled trials (RCTs) comparing adhesion barriers with controls in patients undergoing abdominopelvic surgery. Case series, case reports, reviews, animal studies, observational studies and studies involving patients with pre-existing adhesions were excluded.</p><p><strong>Results: </strong>Thirty-six RCTs involving 6729 patients were included. Adhesion barriers significantly reduced the incidence of postoperative adhesions on second-look assessment compared with controls (21 RCTs, n = 2351; OR 0.37, 95% CI 0.30-0.45, p < 0.00001; I² = 51%; certainty of evidence: moderate). Subgroup analyses demonstrated significant reductions in postoperative adhesions in both general surgery (9 studies, n = 1162; OR 0.38, 95% CI 0.27-0.53, p < 0.00001; I² = 27%) and obstetrics and gynecology (12 studies, n = 1189; OR 0.36, 95% CI 0.27-0.47, p < 0.00001; I² = 62%). Pooled analysis demonstrated no significant differences between the adhesion barrier and control groups in the incidence of anastomotic leakage (9 RCTs, n = 1541), abscess formation (6 RCTs, n = 1182), wound infection (11 RCTs, n = 1084), time between initial surgery and second surgery (10 RCTs, n = 874), intraoperative blood loss (15 RCTs, n = 5327) and adhesion severity (11 RCTs, n = 756). Adhesion barriers were associated with a modest reduction in post-operative small bowel obstruction (12 RCTs, n = 4917; OR 0.81, 95% CI 0.66 to 0.99, p = 0.04; I² = 38%), but were associated with a significantly longer duration of the index operation (18 RCTs, n = 5868; MD 18.66, 95% CI 11.25 to 26.06, p < 0.00001; I² = 99%).</p><p><strong>Conclusions: </strong>Adhesion barriers reduced adhesions at second-look assessment in a meta-analysis of pooling eight heterogeneous agent classes and procedures against an inconsistently scored surrogate outcome. Thus, evidence remains insufficient to recommend routine use or to define which patients, procedures, or risk levels warrant its use. Until adequately powered, agent-specific trials with standardized scoring and patient-centered endpoints exist, adhesion-barrier use should remain an individual clinical decision, not standard care.</p><p><strong>Prospero registration: </strong>CRD42024595564.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184640","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":"Perioperative Hospital-at-Home Program: A Scoping Review.","authors":"Chun En Chua, Shi Yun Low, Adena L Peh, Natasha Fitria, Rany H Tan, Stephanie Q Ko","doi":"10.1002/wjs.70589","DOIUrl":"https://doi.org/10.1002/wjs.70589","url":null,"abstract":"<p><strong>Background: </strong>Hospital-at-Home (HaH) is an established model of care for medical patients, particularly following rapid expansion during the COVID-19 pandemic. In contrast, perioperative HaH remains in its early stages, with limited understanding of appropriate care delivery models, staffing, feasibility, cost-effectiveness, and relevant clinical outcomes. Surgical-specific demands limit the operational transferability of HaH from nonsurgical care. This scoping review synthesizes existing evidence on perioperative HaH to clarify current practices and identify key domains for future research and implementation.</p><p><strong>Methods: </strong>A systematic search strategy was developed for MEDLINE (via PubMed) and adapted for Embase and Scopus to identify studies involving adults undergoing surgery who received HaH care. After data extraction, a narrative synthesis was conducted to map care delivery and staffing models and the domains of reported clinical outcome measures.</p><p><strong>Results: </strong>The search identified 5612 records, of which 18 studies met the inclusion criteria. The studies were published between 1991 and 2024 and originated mainly from the United Kingdom, Spain, and the United States. Care-delivery models and clinical outcome measures were heterogeneous, particularly those relating to patient safety. Orthopedic procedures were most common, followed by bariatric surgery and other general surgical specialties. Most studies evaluated postoperative HaH pathways, with only two examining preoperative models. Surgical admissions were predominantly elective, although some included emergency populations.</p><p><strong>Conclusion: </strong>Perioperative HaH shows promise as a rapidly evolving model of perioperative care, but the current evidence base is limited by small, largely noncomparative studies and a lack of standardized outcome measures. This is the first scoping review to systematically map perioperative-specific HaH models across pre- and postoperative phases and surgical specialties. Strengthening the quality of evidence is essential to inform policy, guide best practices, and support the safe and scalable adoption of perioperative HaH programs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148960","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":"Global Disparity Within the Management of Traumatic Abdominal Vascular Injuries: Analysis of a Global Dataset.","authors":"J Amoako, M F Bath, K Kohler, E Caceres, G Aryee, L Hobbs, T G Weiser, Z Perkins, T C Hardcastle, T Bashford","doi":"10.1002/wjs.70596","DOIUrl":"https://doi.org/10.1002/wjs.70596","url":null,"abstract":"<p><strong>Background: </strong>Vascular injuries are common to trauma and carry a high risk to limb and life. Integrating specialist vascular care into existing trauma systems is essential; however, global data on this topic remains limited. This study describes global patterns of abdominal vascular trauma, through secondary analysis of the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study dataset, examining system- and patient-level differences across resource settings.</p><p><strong>Methods: </strong>Patients of any age with blunt or penetrating trauma who underwent an abdominal vascular procedure during trauma laparotomy were included. Patient characteristics, injury patterns, peri-operative factors, and outcomes were recorded. Data were summarized using descriptive statistics and differences across Human Development Index (HDI) tertiles were analyzed with the Kruskal-Wallis or χ² tests, where appropriate.</p><p><strong>Results: </strong>A total of 178 patients from 82 hospitals across 33 countries were included, representing one in 10 patients (178 of 1769) of the original dataset. A higher proportion of patients had vascular procedures in the upper HDI tertile (64 of 492, 13.0%), compared to middle (82 of 714, 11.5%) and lower (32 of 563, 5.7%) HDI tertiles. The median time from injury to operation was 5.0 hours (IQR 2.0-9.0). Among patients who were hypotensive on presentation, time from arrival to operation was significantly longer in the lower HDI tertile (p = 0.033). The most common regions of vascular injury were the inferior vena cava (37 patients, 20.8%) and iliac vein (30 patients, 16.9%). Thirty day post-operative mortality was 17.4% (31 of 178 patients), with only around half of the patients (94 of 178, 52.8%) discharged to their usual place of residence.</p><p><strong>Conclusions: </strong>As trauma systems become integrated into national healthcare services, prioritizing vascular care is crucial. There remains considerable variation in the provision of vascular services in trauma globally, yet given the time-critical nature of vascular injuries, it is essential to ensure effective, integrated care pathways.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137789","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":"Defining the Role of Staging Laparoscopy in the Management of the Gallbladder Cancers: A Single Institution Experience.","authors":"Niket Shah, Shraddha Patkar, Gurudutt P Varty, Kaival Gundavda, Mahesh Goel","doi":"10.1002/wjs.70608","DOIUrl":"https://doi.org/10.1002/wjs.70608","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in imaging and extensive staging work-up, occult metastases may still be encountered at laparotomy in patients with apparently resectable gallbladder cancer (GBC), resulting in nontherapeutic surgery. This study evaluates the incremental yield of staging laparoscopy (SL) in detecting radiologically occult metastases in resectable GBC and its role in routine staging.</p><p><strong>Methods: </strong>A prospectively maintained database of patients operated for GBC at a high volume institution was analyzed to calculate the diagnostic yield of SL and the percentage of missed metastases by modern imaging analysis but subsequently diagnosed on SL. In the univariate and multivariate logistic regression, the following binary variables were evaluated to identify predictors of metastasis on SL: (i) NACT (neoadjuvant chemotherapy) receipt: yes versus no; (ii) serum carbohydrate antigen 19-9 (CA19-9) level: > 1000 u/mL versus ≤ 1000 U/mL; (iii) ¹⁸fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG PET/CT) scan result: equivocal versus negative (positive results were excluded from this analysis as they would not have proceeded to SL without additional workup); (iv) clinical stage: locally advanced versus early; (v) incidental GBC: yes versus no; (vi) tumor grade: moderate/poorly differentiated versus well differentiated.</p><p><strong>Results: </strong>The SL was incorporated into the diagnostic and management pathway of 330 GBC patients. SL was performed (i) as a staging prior to a planned radical cholecystectomy (n = 210, 63.6%) and (ii) prior to initiating systemic therapy (n = 120, 36.4%). The diagnostic yield of SL for detection of metastases over cross-sectional imaging was 11.5% (n = 38). Reasons for inoperability on laparotomy were metastatic 16b1 lymph node (LN) (n = 19, 50%), locally unresectable disease (n = 15, 39.5%), peritoneal metastasis (n = 2, 5.3%), and liver metastasis (n = 2, 5.3%). The reason for locally unresectable disease was right hepatic artery encasement at the porta hepatis. Regression analysis showed that the significant predictors for metastatic disease on SL were equivocal uptake on ¹⁸FDG PET/CT scan (p = < 0.001) and prior NACT (p = 0.026).</p><p><strong>Conclusion: </strong>SL provides an incremental detection of radiologically occult metastasis in up to 11.5% patients. The study underscores the benefit of SL and suggests that it should be incorporated in the management of all GBC patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138502","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":"Comparison of Patient Satisfaction Using the BREAST-Q Questionnaire in Patients Undergoing Breast-Conserving Surgery and Implant-Based Breast Reconstruction.","authors":"Gudrat Alibalayev, Baran Mollavelioglu, Mahmut Müslümanoglu, Mustafa Tükenmez","doi":"10.1002/wjs.70538","DOIUrl":"https://doi.org/10.1002/wjs.70538","url":null,"abstract":"<p><strong>Objective: </strong>As breast cancer impacts patients' physical and mental well-being, treatment modalities are expected to enhance both survival rates and overall quality of life. With increasing cosmetic expectations, surgical techniques have been developed to enhance patient satisfaction while ensuring appropriate oncological principles. One such technique is mastectomy combined with implant reconstruction. Evidence-based data comparing patient satisfaction among surgical methods contribute to managing preoperative patient expectations and determining the type of surgery. This study aimed to compare the satisfaction levels of patients undergoing subcutaneous mastectomy with implant reconstruction and those receiving breast-conserving surgery using the BREAST-Q scale.</p><p><strong>Materials and methods: </strong>Two hundred female patients over the age of 18 who underwent either breast-conserving surgery or subcutaneous mastectomy with implant reconstruction for breast cancer, without concurrent oncoplastic procedures, were included. Patients who experienced implant loss for any reason were excluded. Postoperative patient satisfaction was evaluated using the BREAST-Q scale.</p><p><strong>Results: </strong>A total of 200 patients were included, with 115 undergoing breast-conserving surgery and 85 undergoing subcutaneous mastectomy with implant reconstruction. The mastectomy and implant group had a significantly higher proportion of patients under 50 years old (p = 0.001) and ideal body mass index (p = 0.024) compared to the breast-conserving surgery group. While nearly all patients in the breast-conserving surgery group (98%) received radiotherapy, approximately half of the mastectomy group received radiotherapy (p < 0.001). Breast-conserving surgery patients had significantly higher BREAST-Q scores in psychosocial well-being (p < 0.001), sexual well-being (p = 0.002), and satisfaction with breast appearance (p < 0.001) compared to the mastectomy and implant groups. No demographic or clinical factors affected breast satisfaction in the breast-conserving group, whereas smoking, radiotherapy, and chronic disease negatively impacted breast satisfaction in the mastectomy and implant groups.</p><p><strong>Conclusions: </strong>Breast satisfaction subscale scores on the BREAST-Q were significantly higher in patients undergoing breast-conserving surgery compared with those undergoing subcutaneous mastectomy with implant reconstruction. Radiotherapy, smoking, and chronic disease history were associated with reduced satisfaction with breast appearance in the mastectomy and implant groups, whereas satisfaction levels in the breast-conserving surgery group were not influenced by any clinical or demographic factors.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138452","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}