World Journal of Surgery最新文献

{"title":"Beyond Frailty in Pancreatic Surgery: Toward a Pancreas-Specific Surgical Vulnerability Framework.","authors":"Tiziana Marchese, Valentina Valle, Annalisa Comandatore, Gregorio Di Franco, Marcello G Spampinato, Benedetto Ielpo, Luca Morelli","doi":"10.1002/wjs.70595","DOIUrl":"https://doi.org/10.1002/wjs.70595","url":null,"abstract":"<p><strong>Background: </strong>Frailty is an important determinant of postoperative outcomes after pancreatic surgery. However, available assessment instruments are heterogeneous and may inadequately capture the interaction between patient vulnerability, nutritional status, body composition, and procedure-specific risk. This systematic review evaluated frailty assessment tools in pancreatic surgery and proposed a conceptual pancreas-specific framework for surgical vulnerability assessment.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched for studies published between January 2016 and April 2026 evaluating frailty in adult patients undergoing pancreatic resection. Findings were primarily synthesized narratively because of substantial methodological heterogeneity. An exploratory subgroup meta-analysis was restricted to studies using the Modified Frailty Index that reported adjusted effect estimates for major morbidity or short-term mortality.</p><p><strong>Results: </strong>Twenty studies involving more than 150,000 patients were included. The Modified Frailty Index was the most frequently used instrument, followed by the Hospital Frailty Risk Score. Frailty was generally associated with increased postoperative morbidity, major complications, mortality, prolonged hospitalization, non-home discharge, and functional decline, although the extent of confounding control varied across studies. Several associations persisted in adjusted analyses, whereas other findings were supported only by unadjusted comparisons. In an exploratory subgroup meta-analysis restricted to adjusted estimates from Modified Frailty Index studies, greater mFI-defined frailty burden was associated with major morbidity (pooled OR 1.60, 95% CI 1.27-2.01; I<sup>2</sup> = 53%) and short-term mortality (pooled OR 1.31, 95% CI 1.16-1.48; I<sup>2</sup> = 0%), although these findings remain hypothesis-generating because of substantial methodological heterogeneity. However, most tools primarily reflect comorbidity burden and incompletely capture nutritional status, sarcopenia, obesity, and pancreas-specific operative risk. Current evidence suggests that surgical vulnerability in pancreatic resection results from the interaction between patient-related, nutritional-, body-composition, and procedure-related factors rather than frailty alone.</p><p><strong>Conclusions: </strong>Frailty is clinically relevant to postoperative risk assessment in pancreatic surgery and should be incorporated into preoperative evaluation. Existing tools, however, inadequately capture the multidimensional nature of surgical vulnerability. We therefore propose the PANFRAIL framework, a conceptual, hypothesis-generating model integrating frailty, nutritional status, body composition, procedure-related complexity, and pancreas-specific risk to guide future development of pancreatic ","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128468","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":"Establishing a Routine Teleconsultation Follow-Up Clinic in a Tertiary Care Hospital of a Low-Middle-Income Country: An Operational Blueprint and Implementation Experience.","authors":"Sarrah Idrees, Firoz Ahmed, S K Mishra","doi":"10.1002/wjs.70601","DOIUrl":"https://doi.org/10.1002/wjs.70601","url":null,"abstract":"<p><p>Literature on teleconsultation is rich in outcome data, and only a smaller body of work has described the operational setup of specific teleconsultation services, mainly from the COVID-era. However, publications on a routine, non-pandemic, low-cost, and asynchronous departmental teleconsultation model built on a widely available messaging application remain scarce. No structured replicable blueprint exists for establishing such a model for follow-up clinics at the departmental level in a government tertiary care hospital. We describe a step-by-step operational framework implemented in the Department of Endocrine and Breast Surgery since May 2025, which has now served 587 teleconsultations (post-thyroidectomy, post-parathyroidectomy, breast carcinoma, and pheochromocytoma) over 13 months. The model requires no dedicated funding, no institutional IT infrastructure, and no proprietary telemedicine platform. It uses a dedicated departmental smartphone, WhatsApp, a structured asynchronous review schedule, and a documentation proforma aligned with India's Digital Personal Data Protection (DPDP) Act, 2023, and the Ministry of Health and Family Welfare (MoHFW) Telemedicine Practice Guidelines, 2020. WhatsApp was selected over e-Sanjeevani for its asynchronous capability, universal patient accessibility, and zero registration burden. The average clinician time per teleconsultation is 5-10 minutes; the entire daily review session is completed within 30 minutes. The underlying principles are specialty-agnostic and potentially adaptable to cardiology, neurology, hematology, and oncology, though each specialty would require its own eligibility criteria and escalation thresholds.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115729","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 Training-of-Trainers Approach to Scaling Surgical Antibiotic Stewardship Knowledge and Practices in Rwanda: A Quality Improvement Study.","authors":"Maia R Nofal, Alype Rwamatwara, Roda Uwayesu, Desire Gacumu, Lambert Christophe Safari, Pierrine Nyirangeri, Stella Matutina Isingizwe, Tite Ikuzwe, Diane Senga, Assefa Tesfaye, Elise Presser, Natnael Gebeyehu, Thomas G Weiser, Abebe Bekele, Tihitena Negussie Mammo","doi":"10.1002/wjs.70605","DOIUrl":"https://doi.org/10.1002/wjs.70605","url":null,"abstract":"<p><p>Changes in prolonged postoperative antibiotic prescribing practices (> 24 hours of antibiotics for prophylaxis) in relation to initial workshop and TOT-led training cascade. Proportion of patients receiving prolonged postoperative antibiotic prophylaxis.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115750","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":"Outcomes of Long-Term Absorbable Mesh Use for Ventral Hernia Repair in Immunosuppressed Patients.","authors":"Gaëtan-Romain Joliat, Benoit Romain, Guillaume Passot","doi":"10.1002/wjs.70609","DOIUrl":"https://doi.org/10.1002/wjs.70609","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressed patients are more at risk of perioperative infections. In case of ventral hernia repair, the use of a long-term absorbable mesh could potentially decrease the infectious risk in these patients. This study aimed to assess the short- and mid-term outcomes of ventral hernia repair with long-term absorbable mesh in immunosuppressed and non-immunosuppressed patients compared with permanent mesh in non-immunosuppressed patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in two tertiary centers in France. Consecutive patients who underwent ventral hernia repair with a long-term absorbable (poly-4-hydroxybutyrate, P4HB) mesh between 2017 and 2024 were included. Immunosuppression was defined as a decreased immunity level caused by a disease or medication. Outcomes of these patients were compared to non-immunosuppressed patients who underwent ventral hernia repair with P4HB mesh and with synthetic mesh.</p><p><strong>Results: </strong>A total of 465 patients were included: 27 in the immunosuppressed group with P4HB mesh, 232 non-immunosuppressed patients with P4HB mesh, and 206 non-immunosuppressed patients with synthetic mesh. Among patients with P4HB mesh, no differences in postoperative outcomes were found between the immunosuppressed and non-immunosuppressed groups (mean follow-up: 15 months, 95% CI 12-17). When comparing immunosuppressed patients with P4HB to non-immunosuppressed patients with synthetic mesh, the morbidity rate was higher in immunosuppressed patients (12/27 = 44% vs. 38/206 = 18%, p = 0.002), while surgical site infection, mesh infection, or recurrence rates were similar (mean follow-up: 19 months, 95% CI 16-23). Immunosuppression was not found as a predictor of surgical site infection (OR 5.0, 95% CI 0.7-10.0, p = 0.091).</p><p><strong>Conclusions: </strong>Immunosuppressed patients with P4HB mesh had similar short- and mid-term infectious complications to non-immunosuppressed patients. Long-term recurrence rates remain to be evaluated.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115771","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":"Bolus-Only Versus Bolus-Plus-Infusion Tranexamic Acid for Trauma: A Propensity Score-Matched Study.","authors":"Soon Ki Min, Kang Kook Choi, Byungchul Yu, Gil Jae Lee, Min A Lee, Seunghwan Lee, Sebeom Jeon, Myungjin Jang","doi":"10.1002/wjs.70587","DOIUrl":"https://doi.org/10.1002/wjs.70587","url":null,"abstract":"<p><strong>Background: </strong>The CRASH-2 regimen for tranexamic acid (TXA) consists of a 1-g intravenous bolus followed by a 1-g infusion over 8 hours. The maintenance infusion may be challenging to administer during the early phase of trauma resuscitation. We compared mortality outcomes between patients receiving a 1-g TXA bolus alone and those receiving a bolus-plus-infusion regimen.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult trauma patients (≥ 19 years) who presented directly to the trauma bay at a regional trauma center between July 2018 and December 2023. Patients who received TXA within 3 hours of injury were included in the inter-regimen analysis and categorized into either a 1-g bolus-only group or a 1-g bolus plus 1-g infusion group. Clinical outcomes were compared using multivariable logistic regression. To minimize selection bias and baseline imbalances, 1:1 propensity score matching was performed, followed by McNemar testing and conditional logistic regression analyses in the matched cohort.</p><p><strong>Results: </strong>Among 5204 eligible patients, 1787 received TXA. The primary inter-regimen cohort included 1408 patients treated within 3 hours of injury: 409 received bolus-only TXA and 999 received bolus-plus-infusion TXA. Propensity score matching yielded 335 pairs. After matching, mortality did not differ significantly between the groups: in-hospital mortality 14.0% versus 17.3% (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 0.84-1.97; p = 0.240), 24-h mortality 4.5% versus 5.1% (aOR, 1.13; 95% CI, 0.57-2.27; p = 0.724), and 28-day mortality 9.3% versus 11.9% (aOR, 1.36; 95% CI, 0.81-2.28; p = 0.243).</p><p><strong>Conclusions: </strong>In this single-center retrospective cohort study, a 1-g TXA bolus alone was associated with mortality outcomes comparable to those of the conventional bolus-plus-infusion regimen among patients treated within 3 hours of injury. Prospective studies are warranted to validate these findings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115745","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":"From Effectiveness to Long-Term Impact. Sustainability of a Frugal Managed Surgical Consultation Network in Low-Income Settings: Evidence From Malawi.","authors":"Jakub Gajewski, Kaja Czwojda, Chiara Pittalis, Ruairi Brugha, Jonathan Waluza, Patrick Noah, Eric Borgstein","doi":"10.1002/wjs.70602","DOIUrl":"https://doi.org/10.1002/wjs.70602","url":null,"abstract":"<p><strong>Background: </strong>Digital technology holds transformative potential to address barriers to safe and timely surgical expertise and surgery in low-resource settings, where shortages of specialists, fragmented referral systems, and limited infrastructure remain significant challenges. In 2018, Malawi launched a managed surgical clinical network (MCN) in the Southern region, utilizing a structured mobile technology platform to link non-specialist district clinicians with tertiary-level surgeons. Following the conclusion of donor funding in 2022, the MCN has continued to operate under full local stewardship. This study assesses the functionality and potential scalability of the network 1 year after this transition.</p><p><strong>Methods: </strong>A prospective study was conducted of all district-to-central hospital MCN consultations between January and December 2023. Anonymized data were extracted from digital transcripts and analyzed descriptively and inferentially, including case characteristics, timing, clinician participation, and consultation outcomes.</p><p><strong>Results: </strong>Over the 12 months, 994 cases were submitted by 158 district clinicians across 17 hospitals (mean 3 cases/day). Pediatric patients accounted for 47% of consultations. The most frequent presentations were acute abdomens (25%), trauma (22%), and congenital abnormalities (21%). Nearly 70% of cases included supporting images. Among the 811 consultations that required a response, 92% received specialist input, and 69% of the responses were provided within 1 h. Most cases (69%) resulted in a recommended referral, whereas 8% were managed locally with remote specialist guidance. Other outcomes included referral at a later stage (9%), forwarding to consultants outside of the MCN (3%), and an unknown conclusion (3%). In 183 cases, a referral notification was submitted without requiring a response. The MCN also supported professional learning and triggered social service mobilization in cases of suspected violence.</p><p><strong>Conclusion: </strong>The Malawi Surgical MCN has evolved into a sustainable, locally owned platform supporting real-time decision-making, capacity building, and coordination of surgical care across district and central hospitals. Its continuation, after donor funding ended, demonstrates the feasibility of affordable, digitally enabled clinical networks in resource-constrained environments. The MCN is a potentially scalable model that could be used to strengthen surgical systems and reduce inequities in access to specialist care across sub-Saharan Africa and other similar contexts.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115804","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":"Direct-to-Implant Versus Two-Stage Tissue Expander/Implant Reconstruction: A Decade of Institutional Experience From China.","authors":"Cong Su, Shu Wang, Shanshan He, Weiqing Zhao, Jian Yin","doi":"10.1002/wjs.70598","DOIUrl":"https://doi.org/10.1002/wjs.70598","url":null,"abstract":"<p><strong>Background: </strong>The choice between direct-to-implant (DTI) and two-stage tissue expander/implant (TE/I) breast reconstruction remains debated. This study aimed to compare complication profiles between these techniques and evaluate the modifying effect of postoperative radiotherapy in a large Asian cohort.</p><p><strong>Methods: </strong>A retrospective single-center analysis was performed on patients who underwent immediate prosthetic breast reconstruction from 2014 to 2023. Patients were grouped by DTI or TE/I. Propensity score full matching was used to balance baseline covariates. Subgroup analysis by postoperative radiotherapy status was conducted.</p><p><strong>Results: </strong>569 female patients (600 breasts) were included. 437 patients (465 breasts) underwent DTI and 132 patients (135 breasts) underwent TE/I breast reconstruction. After full matching on the propensity score, the TE group had significantly higher risks of any complication (p = 0.002), reconstructive failure (p < 0.001), implant or expander removal (p < 0.001), and exposure of implant or expander (p < 0.001) compared with the DTI group. In the subgroup analysis, TE/I had higher risks of failure, removal, and exposure in the non-radiotherapy subgroup, whereas in the radiotherapy subgroup most complications showed no intergroup differences, and TE/I had a significantly lower risk of flap necrosis (p = 0.002).</p><p><strong>Conclusions: </strong>TE group had higher complication rates than DTI group, but postoperative radiotherapy significantly modifies the risk profile. In irradiated patients, TE may offer a protective effect against flap necrosis. These findings provide evidence-based guidance for individualized surgical decision-making in Asian populations.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115761","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":"Predictive Value of Follow-Up CT in Conservatively Managed Traumatic Brain Injury.","authors":"Hatem Marie, Dana Abdullatif Alkandari, Maximilian Peter Forssten, Yousef AlHussaini, Retaj Mohammad, Mohamed Lafi, Dhanisha Trivedi, Shahin Mohseni","doi":"10.1002/wjs.70588","DOIUrl":"https://doi.org/10.1002/wjs.70588","url":null,"abstract":"<p><p>Progression of intracranial hematoma on routine follow-up CT in conservative managed traumatic brain injury patients rarely leads to operative intervention. Initial Marshall score is. more predictive than progression of intracranial hematoma on routine follow-up CT for the need of surgical intervention (AUC 0.88 vs. 057, p=0.016).</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115732","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":"Socioeconomic Vulnerability as a Predictor of Burn Severity: Development of a Multidimensional Risk Model.","authors":"Laura Ordoñez-Arenas, Sergio Alzate-Ricaurte, Valeria Tobon, María Astudillo, Natalia Forero, Juan C Puyana, María F Escobar, Fernando Rodriguez-Holguín, Alberto García","doi":"10.1002/wjs.70599","DOIUrl":"https://doi.org/10.1002/wjs.70599","url":null,"abstract":"<p><strong>Background: </strong>Burn severity assessment traditionally relies on clinical and injury-related factors. However, the influence of social determinants of health on burn outcomes remains poorly understood. We aimed to develop a multidimensional prediction model of burn severity, defined as intensive care unit (ICU) admission, incorporating both clinical and social factors.</p><p><strong>Methods: </strong>A retrospective cohort study of burn patients aged ≥ 15 years admitted to a specialized burn center in Cali-Colombia between January 2023 and December 2024. Sociodemographic, clinical, and injury-related variables were collected from institutional records. The primary outcome was ICU admission. Variables associated with ICU admission were evaluated using multivariable logistic regression, and model performance was assessed through discrimination and calibration metrics.</p><p><strong>Results: </strong>A total of 160 patients were included, of whom 68 (42.5%) required ICU admission. Median age was 40 years (IQR 30.5-51.5), and 77.5% were male. In the multivariable model, greater total body surface area burned (OR 1.11, 95% CI 1.06-1.15; p < 0.001), higher heart rate on admission (OR 1.03, 95% CI 1.00-1.05; p = 0.030), and subsidized health insurance status (OR 3.50, 95% CI 1.38-8.87; p = 0.008) were independently associated with ICU admission. In the Colombian healthcare system, subsidized insurance primarily covers low-income and socioeconomically vulnerable populations. The model demonstrated excellent discrimination (AUC 0.892) and good calibration (Brier score 0.128).</p><p><strong>Conclusions: </strong>ICU admission following burn injury is influenced by a combination of injury severity, physiological response, and social vulnerability. Incorporating social determinants of health into burn severity assessment may improve early risk stratification and provide a more comprehensive framework for predicting critical care needs, particularly in resource-limited settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115779","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":"Per Protocol Analysis and Long-Term Outcomes of Laparoscopic Radical Resection for Gallbladder Cancer Compared With Open Method.","authors":"Tae Ho Hong, Kwang Yeol Paik, Yoon Kyung Woo, Jae Hyun Han, Jung Woo Lee, Jong Woo Lee, Dong Do You","doi":"10.1002/wjs.70535","DOIUrl":"10.1002/wjs.70535","url":null,"abstract":"<p><strong>Background: </strong>Although laparoscopic radical resection for gallbladder (GB) cancer has been attempted, only a limited number of studies have evaluated its outcomes using a per-protocol analytical approach.</p><p><strong>Methods: </strong>Between January 2010 and December 2019, 213 patients underwent surgery for gallbladder (GB) cancer at three institutions, of whom 203 consecutive patients with T2 or T3 disease were retrospectively analyzed. Protocol-adherent radical resection (per-protocol) was defined as wedge liver resection or IVb/V bisegmentectomy with the procurement of at least four lymph nodes. Propensity score matching was performed to compare the laparoscopic and open approaches.</p><p><strong>Results: </strong>Protocol-adherent radical resection was achieved in 14 of 76 patients (18.4%) in the laparoscopic group and in 76 of 127 patients (59.8%) in the open surgery group. The primary unmet criterion for radical resection was an insufficient lymph node yield (60/76, 78.9%) in the laparoscopic group. After 1:1 propensity score matching (54 pairs), the 5-year overall survival (OS) rate did not differ between the laparoscopic and open approaches (46.1% vs. 49.9%; hazard ratio 0.90, 95% confidence interval 0.55-1.47; p = 0.668), whereas the disparity in oncological adequacy persisted (protocol-adherent radical resection 20.4% vs. 70.4%). Among patients who achieved protocol-adherent radical resection (N = 90), the exploratory comparison of 5-year OS between the laparoscopic (N = 14) and open (N = 76) groups showed no significant difference (61.5% vs. 53.3%; p = 0.288). Multivariate analysis in patients with protocol-adherent radical resection identified N stage and elevated CA 19-9 levels as independent prognostic factors for OS.</p><p><strong>Conclusions: </strong>Regardless of whether a laparoscopic or open approach is used, radical surgery-including appropriate hepatic resection with the retrieval of at least four lymph nodes-is essential for improving long-term prognosis in patients with GB cancer. N stage and elevated CA 19-9 levels were independently associated with overall survival.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3065-3073"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809009","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}