World Journal of Surgery最新文献

{"title":"Does Mammography Density Change the Response to Neoadjuvant Chemotherapy and Predict a Pathological Complete Response Rate?","authors":"Upander Kumar, Anand Kumar Mishra, Kul Ranjan Singh, Anit Parihar, Nancy Raja, Mithun Raam, Ashwinee Rahalkar, Pooja Ramakant","doi":"10.1002/wjs.12502","DOIUrl":"https://doi.org/10.1002/wjs.12502","url":null,"abstract":"<p><strong>Background: </strong>Pathological complete response (PCR) is the surrogate marker of the outcome of a breast cancer patient. Breast cancer (BC) patients have variable responses to neoadjuvant chemotherapy (NACT). The effect of chemotherapy on mammographic density (MD) is unclear in the literature. Also, MD and PCR correlation is not extensively studied. The aim of the present study is to find MD's potential as a PCR predictor in a resource-constrained setting.</p><p><strong>Methods: </strong>The study included all patients of BC-related surgery from January 2018 to June 2021 with follow-up till June 2023. MD was classified by the American College of Radiology (ACR) (classes A-D) based on breast composition. The chi-square test and logistic regression analysis were used to calculate p-values.</p><p><strong>Results: </strong>Out of 557 patients, 554 were female with a mean age 46.8 years (premenopausal 54.5%). ACR grades of MD A, B, C, and D were 18.1% (n = 101), 56% (n = 312), 21.5% (n = 120), and 4.3% (n = 24), respectively. The odds of having PCR with MD B, C, and D were 0.51, 0.04, and 0.03, respectively, with respect to MD A. There was a significant inverse association of PCR and Ki-67 with MD on multivariate analysis. HER2 positive, TNBC, Ki 67 > 15%, and grade 3 had significantly high PCR.</p><p><strong>Conclusion: </strong>MD had an inverse correlation with PCR and Ki-67. Low MD, HER2 positive, TNBC, high Ki-67 subtypes, and grade 3 were good predictors for PCR.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484153","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":"Detection Rate and Concordance of 4D-MDCT, US, and Tc99m MIBI Imaging in the Detection of Ectopic and Intrathyroidal Parathyroid Adenomas.","authors":"Trevor Abts, Thinh Vu, Nancy D Perrier, Yunyi Wang, Jing Ning, J Matthew Debnam","doi":"10.1002/wjs.12512","DOIUrl":"https://doi.org/10.1002/wjs.12512","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism is often caused by parathyroid adenomas (PAs), which can be ectopic (EPAs) or intrathyroidal (ITPAs). Accurate localization is crucial for effective surgical intervention. This study aimed to determine the detection rate of four-dimensional multidetector computed tomography (4D-MDCT), ultrasonography (US), and technetium 99 m sestamibi scintigraphy (MIBI) in detecting EPAs and ITPAs. Additionally, we explored the role of ultrasound-guided fine-needle aspiration (US-FNA) and evaluated correlations between parathyroid hormone (PTH) levels, adenoma size, and detection performance.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of 28 patients with 29 EPAs and 27 patients with 27 ITPAs who underwent 4D-MDCT, US (including cine Doppler US and US-FNA), and/or MIBI at our institution. Data were collected on demographics, laboratory values, imaging findings, and intraoperative findings. The detection rate was calculated for each imaging modality and their combination. Logistic regression models were used to assess the relationship between PTH level, adenoma size, and detection performance.</p><p><strong>Results: </strong>The detection rate of EPAs was 96% for 4D-MDCT, 97% for MIBI, and 46% for US. The detection rate of ITPAs was 96% for US, 65% for 4D-MDCT, and 58% for MIBI. Combined multimodality imaging with results concordant between two or more modalities achieved an overall detection rate of 87%. For ITPAs, smaller PA size was associated with significantly worse MIBI detection performance (p < 0.05). The PTH level was not associated with detection performance.</p><p><strong>Conclusions: </strong>Our study highlights the superior detection rate of 4D-MDCT and MIBI for EPAs and US for ITPAs. Combining imaging modalities enhances the diagnostic detection rate.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484148","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: Vacuum-Assisted Closure Significantly Reduces Surgical Postoperative Complications Compared With Primary Abdominal Closure in Patients With Secondary Peritonitis: A Comparative Retrospective Study.","authors":"Pooya Rajabaleyan, Ask Vang, Sören Möller, Sardar Khalaf, Anna Gosvig Ladegaard, Niels Qvist, Mark Bremholm Ellebæk","doi":"10.1002/wjs.12518","DOIUrl":"https://doi.org/10.1002/wjs.12518","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473033","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":"Antrum Resection Versus Preservation Following Laparoscopic Sleeve Gastrectomy in the Treatment of Obesity: A Meta-Analysis of Randomized Controlled Trials and Systematic Review.","authors":"Jinlong Luo, Furui Zhong, Hua Yang, Lie Yang","doi":"10.1002/wjs.12500","DOIUrl":"https://doi.org/10.1002/wjs.12500","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic sleeve gastrectomy (LSG) has been proven to be an effective surgical method for managing morbid obesity. However, the extent of the antral excision remains controversial. In this meta-analysis, we evaluated the safety and efficacy of LSG with antral resection (AR) and antral preservation (AP).</p><p><strong>Materials and methods: </strong>The PubMed, Embase, Cochrane Library, and Google Scholar databases were systematically searched for randomized clinical trials (RCTs) from their inception dates to March 2024. The main outcomes were the percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and BMI at 3, 6, 12, and 24 months postsurgery.</p><p><strong>Results: </strong>Fourteen RCTs comprising 1222 patients were included in the study. The %EWL was significantly lower in the AP group at 6 (mean difference [MD]: -5.65 and p = 0.003), 12 (MD: -5.08 and p < 0.00001), and 24 (MD: -5.23 and p = 0.0004) months. The %TWL was significantly lower in the AP group at 3 (MD: -4.63 and p = 0.02), 6 (MD: -3.98 and p < 0.0001), and 12 (MD: -4.63 and p < 0.00001) months. BMI was lower in the AR group at 3 (MD: 1.81 and p = 0.007) and 6 (MD: 2.39 and p = 0.002) months. No significant difference was found in surgical time and de novo gastroesophageal reflux disease; however, the AP group demonstrated significantly longer hospital stays and a lower rate of late vomiting.</p><p><strong>Conclusion: </strong>LSG with AR yields better weight loss than LSG with AP but may lead to a higher rate of late vomiting.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469207","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 T2 Translational Science Modified Delphi Study: The Ethical Triage and Treatment of Entrapped and Mangled Extremities in Resource-Scarce Environments.","authors":"Eric S Weinstein, Zachary Gilbert, James Gosney, Brielle Weinstein, Hannah B Wild, Joseph Cuthbertson, Melissa Leming, Rachel Semmons, Dónal O'Mathúna, Carl Montan, Richard Gosselin, Frederick Skip Burkle","doi":"10.1002/wjs.12486","DOIUrl":"https://doi.org/10.1002/wjs.12486","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of ethical triage and treatment guidelines for the entrapped and mangled extremity (E&ME) in resource-scarce environments (RSE): mass casualty incidents, low- to middle-income countries, complex humanitarian emergencies including conflict, and prolonged transport times (RSE). The aim of this study is to use a modified Delphi (mD) approach to produce statements to develop treatment guidelines of the E&ME in RSE.</p><p><strong>Method: </strong>Experts rated their agreement with each statement on a 7-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤ 1. Statements attaining consensus after the first round moved to the final report. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for the opportunity to reconsider their rating for that round. Statements attaining consensus after the second round moved to the final report. This process was repeated in the third round. Statements attaining consensus were moved to the final report. The remaining statements did not attain consensus.</p><p><strong>Results: </strong>Seventy-seven experts participated in the first, 75 in the second, and 74 in the third round. Twenty-three statements attained consensus. Twenty-one statements did not attain consensus.</p><p><strong>Conclusion: </strong>A modified Delphi technique was used to establish consensus regarding the numerous complex factors influencing treatment of the E&ME in RSEs. Twenty-three statements attained consensus and can be incorporated into guidelines to advance the ethical treatment of the E&ME in RSEs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469203","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":"Modified APPEND Score for the Diagnosis of Acute Appendicitis in a New Zealand Pasifika Population.","authors":"Renato Pitesa, Andrew G Hill, Andrew D MacCormick","doi":"10.1002/wjs.12510","DOIUrl":"https://doi.org/10.1002/wjs.12510","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing acute appendicitis often requires biochemical and imaging support which may not be feasible in low- and middle-income countries (LMICs). The APPEND score, developed in New Zealand, includes C-reactive protein (CRP) which in resource-limited settings, may be hindered by slow processing times. This study aims to evaluate a modified APPEND score (mAPPEND), excluding CRP for diagnosing appendicitis in a New Zealand Pasifika cohort.</p><p><strong>Methods: </strong>This secondary analysis utilized data from two cohorts (2011 and 2017) from Middlemore Hospital, Auckland. Patients aged ≥ 15 years with right iliac fossa pain for < 7 days were included, excluding those with prior appendicectomy or generalized peritonitis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and diagnostic performance was assessed using receiver operating characteristic curve analysis, comparing the area under the curve (AUC) for both scores.</p><p><strong>Results: </strong>Among 143 Pasifika patients, the AUC for the APPEND and mAPPEND scores were comparable (0.84 vs. 0.85 respectively, p = 0.41). The mAPPEND score demonstrated high diagnostic accuracy with scores between 1 and 2 showing high sensitivity (100% and 97%) and NPV (90% and 92%), scores 4-5 showing high specificity (94% and 100%, respectively) and PPV (90% and 100%, respectively), and a score of 3 being the most efficient with a sensitivity of 82% and specificity of 71%.</p><p><strong>Conclusion: </strong>The mAPPEND score maintains high diagnostic accuracy for appendicitis in a New Zealand Pasifika population. This modified score is a simple and viable tool in settings where CRP testing is unfeasible, supporting its use in Pacific Island countries.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450233","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":"Shouldice Versus TAPP for Inguinal Hernia Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Caio Mendonça Magalhães, Eric Pasqualotto, William Silva Barbosa, Sergio Mazzola Poli de Figueiredo","doi":"10.1002/wjs.12514","DOIUrl":"https://doi.org/10.1002/wjs.12514","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal hernia (IH) repair is one of the most common surgical procedures worldwide. Among the various techniques available, the Shouldice (SHD) technique is mainly used for nonmesh open repair whereas, the transabdominal preperitoneal (TAPP) approach is a commonly performed minimally invasive method. Despite its widespread use, a direct comparison between the two techniques is lacking. Therefore, this study aims to evaluate the short and long-term outcomes of SHD and TAPP for elective IH repair.</p><p><strong>Methods: </strong>We searched the PubMed, Embase, and Cochrane Library on April 16. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary endpoints, respectively. Heterogeneity was assessed with I² statistics.</p><p><strong>Results: </strong>Thirteen RCTs comprising 2214 patients were included. Of these, 1089 patients (49%) underwent SHD repair and 1125 (51%) patients underwent TAPP repair. The mean BMI was reported in four studies ranging from 23 to 25.7 kg/m². Data regarding hernia sizes were not available. Compared with TAPP, SHD significantly reduced seroma (RR 0.20; 95% CI 0.04-0.90; p = 0.04; and I² = 0%) and increased chronic pain (RR 2.13; 95% CI 1.31-3.46; p < 0.01; and I² = 0%) and 1-day postoperative pain (MD 2.01; 95% CI 0.72-3.29; p < 0.01; and I² = 97%). However, there were no significant differences between the groups in recurrence (RR 0.94; 95% CI 0.66-1.35; p = 0.75; and I² = 12%), hematoma (RR 1.08; 95% CI 0.80-1.46; p = 0.63; and I² = 0%), urinary retention (RR 0.82; 95% CI 0.49-1.36; p = 0.43; and I² = 0%), and testicular atrophy (RR 3.28; 95% CI 0.79-13.54; p = 0.10; and I² = 0%).</p><p><strong>Conclusion: </strong>SHD repair demonstrated a lower occurrence of seromas; however, it was associated with a higher occurrence of both acute and chronic postoperative pain compared to TAPP in patients with a normal BMI. No significant differences were observed between the two techniques in terms of hernia recurrence, hematoma formation, urinary retention, or testicular atrophy rates.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450237","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":"Letter to Editor: Vacuum-Assisted Closure: Clinical Promise or Resource Challenge?","authors":"Michele Schiano di Visconte","doi":"10.1002/wjs.12496","DOIUrl":"https://doi.org/10.1002/wjs.12496","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415330","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 \"Most Interesting Journey\" to America for the International Society of Surgery in 1914.","authors":"David E Clark","doi":"10.1002/wjs.12495","DOIUrl":"https://doi.org/10.1002/wjs.12495","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383394","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":"Improving Patient Safety Culture in Conflict-Affected Zones: A Cross-Sectional Survey of North Kivu Surgical Personnel in the Democratic Republic of the Congo.","authors":"Jacques Fadhili Bake, Claude Kasereka Masumbuko, Zacharie Tsongo Kibendelwa, Georges Bushu Lubuto, Jean-Claude Mafuta Kyembwa, Esaie Kasereka Nzala, Papy Waleyirwe Kakule, Clovis Bwami Akumbi, Jean Zanga Kitutu, Tresor Basubi Wakilongo, Theophile Kubuya Hangi, Wilson Katembo Kwiraviwe, Benjamin Musemakweli, Beate Tshikudju Bahati, Steve Kisembo Bakabona, Dan Poenaru","doi":"10.1002/wjs.12497","DOIUrl":"https://doi.org/10.1002/wjs.12497","url":null,"abstract":"<p><strong>Background: </strong>Patient safety culture significantly impacts outcomes in surgery, where preventable errors can occur. This study assessed patient safety culture and its determinants in operating rooms across North Kivu, a conflict-affected province in the eastern Democratic Republic of the Congo (DRC).</p><p><strong>Methods: </strong>A descriptive multicenter cross-sectional study was conducted from July to September 2024 in five urban and six rural hospitals. The French version of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 328 operating room healthcare professionals.</p><p><strong>Results: </strong>The response rate was 78% (256 completed surveys). Urban hospitals accounted for 55.5% of respondents, who were 73.4% male and 62.5% under the age of 40. The overall composite score for patient safety culture was 63.2%. Teamwork (81.1%) and management support for patient safety (77.7%) received the highest positive responses, whereas error reporting (39.9%) and patient safety event reporting (50%) scored lower. Half (49.6%) of the respondents rated patient safety as excellent or very good. There were no significant differences in overall mean composite scores between urban and rural hospitals (p = 0.677) and between medical and paramedical staff (p = 0.694).</p><p><strong>Conclusions: </strong>The patient safety culture rating in North Kivu falls below international standards, highlighting an urgent need for improvement, particularly in error response and event reporting. Developing a tailored patient safety bundle for the region is essential to enhance overall health outcomes.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374759","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}