World Journal of Surgery最新文献

{"title":"Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonist on Outcomes Following Major Surgery.","authors":"Zayed Rashid, Selamawit Woldesenbet, Mujtaba Khalil, Abdullah Altaf, Jun Kawashima, Khalid Mumtaz, Timothy M Pawlik","doi":"10.1002/wjs.12484","DOIUrl":"https://doi.org/10.1002/wjs.12484","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly being used for the management of diabetes mellitus and obesity. We sought to define the impact of preoperative GLP-1RA use on outcomes following major surgical procedures.</p><p><strong>Methods: </strong>Patients who underwent a major surgical procedure between 2013 and 2021 were identified using the IBM MarketScan database. Patients who took GLP-1RA within a year before surgery were categorized as \"exposed.\" After propensity score matching (PSM), multivariable regression analysis was used to define the association of GLP-1RA exposure with postoperative complications.</p><p><strong>Results: </strong>Among 138,980 patients (coronary artery bypass graft: n = 39,516, 28.4%; pneumonectomy: n = 4,881, 3.5%; abdominal aortic aneurysm repair: 4,459, 3.3%; pancreatectomy: n = 15,873, 11.4%; and colectomy: n = 74,251, 53.4%), most individuals were male (n = 80,871, 58.2%) with a median age of 58 (IQR 53-61) years. 2944 (2.2%) individuals had GLP-1RA exposure before surgery. Overall incidence of complications was 36.5% (n = 50,724); complications included sepsis (n = 6,385, 4.6%), surgical site infections (n = 7,431, 5.3%), thromboembolism (n = 3,609, 2.6%), pneumonia (n = 4,783, 3.4%), renal (n = 9,017, 6.5%), or cardiopulmonary failure (n = 26,661, 19.2%). On unmatched analysis, patients on GLP-1RA had a higher risk of complications (no GLP-1RA: 36.3% vs. GLP-1RA: 44.5% p < 0.001); however, after PSM to account for measured confounders, GLP-1RA exposure was not associated with the odds of surgical complications (OR 0.99 95% CI 0.91-1.08; p > 0.05). Among patients using GLP-1RA during the 2 weeks before surgery (n = 522, 17.7%), there was no association of GLP-1RA with risk of complications (nonrecent GLP-1RA: 44.7% vs. recent GLP-1RA: 44.1%; p = 0.992).</p><p><strong>Conclusions: </strong>GLP-1RA use was not associated with an increased risk of complications following major surgical procedures.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955978","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 and Role of Lymphadenectomy in Hypervascular Intrahepatic Cholangiocarcinoma Based on CT-Vascularity.","authors":"Xuefeng Li, Tomoaki Yoh, Kotaro Shimada, Yutaro Hori, Yukinori Koyama, Satoshi Ogiso, Takamichi Ishii, Hiroyoshi Isoda, Yuji Nakamoto, Etsuro Hatano","doi":"10.1002/wjs.12476","DOIUrl":"10.1002/wjs.12476","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the outcomes and role of lymphadenectomy in hypervascular intrahepatic cholangiocarcinoma (ICC) quantified using the arterial phase of contrast-enhanced computed tomography (CT).</p><p><strong>Methods: </strong>Consecutive patients with mass-forming (MF) or predominantly MF type ICC who underwent surgical resection from 2000 to 2019 were retrospectively analyzed. Using the image of the late arterial phase, CT-vascularity was calculated by dividing the CT value of the tumor (Hounsfield units) with that of the liver parenchyma. According to the CT-vascularity, patients were divided into hypervascular (CT-vascularity > 1) and non-hypervascular (CT-vascularity ≤ 1) groups. Clinicopathologic features and survival outcomes were compared between the two groups. Further, the prognostic impact of lymphadenectomy was assessed in the hypervascular group.</p><p><strong>Results: </strong>Of the 135 patients with MF-ICC, the hypervascular group, and non-hypervascular group comprised 47 (34.8%) and 88 patients (65.2%), respectively. The hypervascular group displayed clinical features typically associated with hepatocellular carcinoma (HCC) (i.e., viral hepatitis or history of HCC) and less aggressive tumor characteristics such as lower proportions of regional lymph node metastasis. The overall survival (OS) and recurrence-free survival (RFS) of the hypervascular group were significantly better than those of the non-hypervascular group (all, p < 0.001), and these results were retained after adjusting for known prognostic factors. Further, implementation of lymphadenectomy was not associated with benefit for OS and RFS in the hypervascular group (p = 0.819, p = 0.912).</p><p><strong>Conclusion: </strong>Hypervascular ICC itself represents a favorable prognosis, and there is a possibility of omitting lymphadenectomy in this subgroup.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955979","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":"Long-term outcomes of active surveillance for low-risk papillary thyroid carcinoma: Progression patterns and tumor calcification.","authors":"Iwao Sugitani, Ryuta Nagaoka, Marie Saitou, Masaomi Sen, Hiroko Kazusaka, Mami Matsui, Takeshi Abe, Ryo Ito, Kazuhisa Toda","doi":"10.1002/wjs.12417","DOIUrl":"10.1002/wjs.12417","url":null,"abstract":"<p><strong>Introduction: </strong>Active surveillance (AS) for low-risk papillary thyroid carcinoma (PTC) is acknowledged as a valid management strategy. While older age is identified as a favorable factor for progression, long-term evidence is scarce and lifelong monitoring has been deemed essential. This study investigated progression patterns and tumor calcification under long-term AS and explored the possibility of ending follow-up.</p><p><strong>Materials and methods: </strong>A total of 650 patients with low-risk PTC who chose AS were enrolled. Progression was defined as either tumor enlargement (≥3 mm from initiation) or development of clinically apparent lymph node metastasis.</p><p><strong>Results: </strong>The median observation period was 8 years; 45.2% were under surveillance for ≥10 years. Overall, 80 patients (12.3%) exhibited progression. Median age and observation period at the time of progression were 55 and 4 years, respectively. Only 2 patients showed progression after 15 years of follow-up and 5 patients showed progression after reaching 80 years old. Among 71 patients experiencing tumor enlargement, surgery was performed immediately in 32 patients. The remaining 39 patients continued surveillance, but only 5 demonstrated ongoing enlargement thereafter. Of 40 surgeries due to progression, 36 were conducted within the first 10 years. The degree of calcification correlated with age and observation periods. No progression occurred after the development of rim calcification.</p><p><strong>Conclusions: </strong>Progression during AS was extremely rare in older patients with long-term surveillance and in tumors with rim calcification. It may be feasible to consider ending scheduled surveillance visits for these patients. Instances of progression halting after enlargement are not uncommon.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"159-169"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733225","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":"Association of commission on cancer accreditation with receipt of guideline-concordant care and survival among patients with colon cancer.","authors":"Kelley Chan, Bryan E Palis, Joseph H Cotler, Lauren M Janczewski, Ronald J Weigel, David J Bentrem, Clifford Y Ko","doi":"10.1002/wjs.12391","DOIUrl":"10.1002/wjs.12391","url":null,"abstract":"<p><strong>Background: </strong>Guideline-concordant care (GCC) is associated with improved survival for patients with cancer; however, variations in receipt of GCC remain a concern. The objective of this study was to evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of GCC and survival among patients with colon cancer.</p><p><strong>Methods: </strong>This retrospective observational study identified patients diagnosed with stage I-IV colon cancer from 2018 to 2020 from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program Database. Guideline concordance was defined as receipt of stage-appropriate lymphadenectomy or chemotherapy. Multivariable logistic regression models investigated associations with receipt of GCC. Cox proportional hazards regression models assessed 3-year cancer-specific mortality risk.</p><p><strong>Results: </strong>Of 222,583 patients with colon cancer, 146,629 (91.2%) of eligible patients received guideline-concordant lymphadenectomy and 70,586 (81.9%) of the eligible patients received guideline-concordant chemotherapy. Treatment at CoC-accredited hospitals was the strongest modifiable predictor for receipt of guideline-concordant lymphadenectomy (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.75-1.88) and chemotherapy (OR 2.14; 95% CI 2.06-2.23). Among patients treated at CoC-accredited hospitals, risk adjusted mortality was decreased for patients with stage I-II disease (hazard ratio [HR] 0.94; 95% CI 0.80-0.99), stage III disease (HR 0.93; 95% CI 0.88-0.98), and stage IV disease (HR 0.88; 95% CI 0.84-0.92).</p><p><strong>Conclusions: </strong>For patients with colon cancer, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk. Benchmarking data may serve as a valuable accountability tool for quality assessment to improve cancer treatment and outcomes.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"34-45"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605839","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":"Overall satisfaction following laparoscopic fundoplication for patients with atypical extraesophageal symptoms: A comparative cohort study.","authors":"Jamie Hua, Tanya Irvine, Sarah K Thompson, Tim Bright, David I Watson","doi":"10.1002/wjs.12415","DOIUrl":"10.1002/wjs.12415","url":null,"abstract":"<p><strong>Background: </strong>Some patients with gastroesophageal reflux (GERD) experience extraesophageal symptoms, which are considered due to laryngopharyngeal reflux (LPR). Most studies evaluating fundoplication for LPR report outcomes from individuals who also have typical esophageal GERD symptoms. Information is limited for patients with LPR but no GERD symptoms. To determine whether LPR patients benefit from fundoplication outcomes were determined for individuals with LPR ± GERD and also those without LPR.</p><p><strong>Methods: </strong>Patients undergoing fundoplication from 1997 to 2015 were identified and divided into three symptom groups: LPR only, LPR and GERD, and GERD only. Heartburn, dysphagia, and satisfaction were assessed using 0-10 analog scores and compared at short (1-2 years) and later (5 years) follow-up.</p><p><strong>Results: </strong>2204 patients underwent fundoplication. 24 patients had LPR only, 130 patients had LPR and GERD, and matched to 1319 patients with GERD only. At 1-2 years follow-up, the LPR only group had lower satisfaction scores than those with GERD symptoms (± concurrent LPR) (7.00 ± 3.49 vs. 8.41 ± 2.42, p = 0.019, and mean ± s.d.). At 1-2 years, 68.1% of the LPR only group had a good outcome (satisfaction score: 7-10) versus 84.6% with LPR and GERD and 84.1% with GERD only.</p><p><strong>Conclusion: </strong>At 1-2 years follow-up, patients with LPR only were less satisfied following fundoplication compared with patients with typical GERD (±LPR). However, some patients with LPR only did benefit and might be considered for surgery if appropriately counseled. Outcomes were similar for patients with LPR and typical GERD and those with only typical symptoms.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"66-73"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733227","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 introduction of surgical telementoring systems in rural hospitals.","authors":"Takuya Tokunaga, Masato Yoshikawa, Mitsuo Shimada","doi":"10.1002/wjs.12418","DOIUrl":"10.1002/wjs.12418","url":null,"abstract":"<p><p>The shortage of surgeons in rural hospitals is a serious problem in Japan. In this study, we investigated the potential contribution of surgical telementoring systems to improving surgical skills and resolving the shortage of surgeons in rural hospitals. The conference room at Tokushima University was connected to the operating room at Miyoshi Hospital, a rural hospital approximately 75 km away, via a virtual private network. Telementoring was conducted for surgeries performed at Miyoshi Hospital from Tokushima University using ADMENIC ANNOTATOR (Carina Corporation). A questionnaire using the NASA Task Load Index was completed by two surgeons who received remote instruction. The surgeries when using the surgical telementoring system had significantly better \"mental\", \"performance\", and \"frustration\" scores compared with those performed without using the system. In a questionnaire about the surgical telementoring system, both surgeons did not notice a communication delay and indicated that annotation and voice instruction was easier to understand than voice only. In addition, fifty fifth-year medical students completed a questionnaire. After experiencing the surgical telementoring system, the number of students who responded favorably to working in a rural hospital increased from 22 (44%) to 31 (62%) (p < 0.01). Surprisingly, 10 of the 27 students who were not interested in becoming a surgeon indicated that they were now interested in becoming a surgeon (p < 0.01). This study suggests that the introduction of a surgical telementoring system in rural hospitals may help improve the skills of rural surgeons and contribute to eliminating the maldistribution and shortage of surgeons in the future.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"84-88"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751816","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: \"Open or laparoscopic appendectomy in pregnancy?\"","authors":"Edward M Clarke, David A Watters","doi":"10.1002/wjs.12438","DOIUrl":"10.1002/wjs.12438","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"82-83"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781131","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 cumulative risk and severity of postoperative complications in patients with frailty undergoing major emergency abdominal surgery-A prospective cohort study.","authors":"Christian Snitkjær, Thomas K Jensen, Dunja Kokotovic, Jakob Burcharth","doi":"10.1002/wjs.12407","DOIUrl":"10.1002/wjs.12407","url":null,"abstract":"<p><strong>Background: </strong>Major emergency abdominal surgery (MEAS) has high morbidity and mortality rates. With an aging and frail population, understanding the impact of frailty on postoperative complications is crucial.</p><p><strong>Methods: </strong>This prospective cohort study was conducted at a major university hospital in Denmark from October 1, 2020, to January 1, 2024. A total of 733 patients undergoing MEAS were assessed for frailty using the clinical frailty scale (CFS) at admission and grouped into low (CFS 1-3), moderate (CFS 4-6), and high (CFS 7-9) frailty categories. Postoperative complications were classified by the Clavien-Dindo score and comprehensive complication index (CCI) until discharge.</p><p><strong>Results: </strong>Patients with CFS one to three had 140 complications per 100 patients, CFS four to six had 267 complications per 100 patients, and CFS seven to nine had 297 complications per 100 patients (p < 0.001). Increased frailty was associated with higher severity of complications (Clavien-Dindo score). Median CCI scores were 8.7 (CFS 1-3), 29.6 (CFS 4-6), and 38.2 (CFS 7-9) (p < 0.001). The cumulative risk of complications was higher in patients with CFS four to six and seven to nine.</p><p><strong>Conclusion: </strong>Higher frailty scores correlate with an increased number and severity of complications as well as a greater overall burden of postoperative complications. The clinical frailty scale is effective for preoperative identification of high-risk patients.</p><p><strong>Trial registration: </strong>The study was approved by the Capital Region of Denmark (P-2020-1166 and R-21038079) and the Danish Data Protection Agency (P-2021-431).</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"55-65"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755736","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":"Prognostic significance of socioeconomic deprivation in patients undergoing emergency laparotomy: A retrospective cohort study. A Letter to the Editor.","authors":"Amir Farah","doi":"10.1002/wjs.12414","DOIUrl":"10.1002/wjs.12414","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"298-299"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693448","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 structured simulation-based mastery learning curriculum in chest tube insertion results in superior skills compared to traditional training programs.","authors":"Leander De Mol, Isabelle Van Herzeele, Patrick Van de Voorde, Hanne Vanommeslaeghe, Lars Konge, Liesbeth Desender, Wouter Willaert","doi":"10.1002/wjs.12439","DOIUrl":"10.1002/wjs.12439","url":null,"abstract":"<p><strong>Background: </strong>Chest tube insertions (CTI) have a high complication rate, warranting a dedicated Simulation-Based Mastery Learning (SBML) curriculum to acquire technical skills. This randomized controlled trial compares residents' skills in CTI after completing a SBML curriculum with those enrolled in a traditional residency program.</p><p><strong>Methods: </strong>Junior residents were baseline tested on cognitive and technical skills (Thiel bodies) before randomization into an intervention and control group. The former deliberately trained CTI on a porcine rib model until passing a predefined pass/fail score and were then summatively tested on Thiel bodies. The latter had no additional training opportunities and was evaluated 3 months later.</p><p><strong>Results: </strong>Seventeen residents were recruited and randomized. Following the per-protocol principle, a significant interaction effect for Group × Procedure (F(1,14) = 6.2, p = 0.026) was observed. Between baseline and summative assessment, both the control group (28.0 ± 8.2 vs. 43.6 ± 8.1, p < 0.001) and the intervention group (33.2 ± 7.7 vs. 57.6 ± 5.7, p < 0.001) significantly increased their scores. The intervention group outperformed the control group at summative assessment (43.6 ± 8.1 vs. 57.6 ± 5.7, p < 0.001). All participants in the intervention group and one resident in the control group achieved the pass/fail score.</p><p><strong>Conclusion: </strong>This SBML curriculum enabled quicker and superior skill acquisition. Skills trained on a porcine model are transferred to the highly realistic Thiel bodies and reach expert level, potentially increasing resident skill in clinical practice.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"89-97"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772924","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}