World Journal of Surgery最新文献

{"title":"Turning the World Health Organization Emergency Medical Team Experiences Into Actionable Standards as Climate Disasters, Mass Casualty Incidents and Conflict Outpace Our Systems of Response.","authors":"Barclay T Stewart","doi":"10.1002/wjs.70594","DOIUrl":"https://doi.org/10.1002/wjs.70594","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070161","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":"Short-Term Clinical Outcomes and Complication Timing in Patients With Postoperative Delirium After Major Emergency Abdominal Surgery: A Prospective Cohort Study.","authors":"Astrid Warmbier Jensen, Julie Jensen, Lasse Rehné Jensen, Michael E Benros, Dunja Kokotovic, Jakob Burcharth","doi":"10.1002/wjs.70585","DOIUrl":"https://doi.org/10.1002/wjs.70585","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is linked to increased morbidity, mortality, and prolonged hospitalization; however, its short-term consequences after major emergency abdominal surgery remain insufficiently studied.</p><p><strong>Methods: </strong>This prospective cohort study included 752 patients undergoing major emergency abdominal surgery at Copenhagen University Hospital, Herlev, from 2021 to 2022. Delirium was identified via systematic screening and record review. The primary outcome was Comprehensive Complication Index (CCI). Secondary outcomes included Intensive Care Unit (ICU) admission, length of stay, discharge destination, and 30-day mortality. Multivariable logistic regression identified risk factors. The timing of complications relative to delirium onset was examined.</p><p><strong>Results: </strong>Delirium occurred in 175 (23%) patients and was associated with higher CCI (median 44 vs. 9) and longer stay (13 vs. 6 days), more ICU admissions (36% vs. 13%), and higher 30-day mortality (22% vs. 8%) (all p < 0.001). Delirium was associated with more frequent discharge to long-term care. Risk factors for delirium included higher age, higher degree of frailty, intraperitoneal contamination, and damage control surgery. The incidence rate of complications was significantly lower than in the pre-delirium period (IRR = 0.49, 95% CI: 0.39-0.60, p < 0.001), with the highest rate observed on the day of delirium onset (0.72 events per patient-day at risk).</p><p><strong>Conclusions: </strong>Delirium was strongly associated with worse short-term outcomes after emergency abdominal surgery. Delirium onset coincided with the highest complication rate, underscoring the systemic physiological stress associated with delirium. These findings support the importance of early detection of delirium and possible prevention strategies.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064955","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 Leaky Pipe: Closing the Surgical Data-Learning Loop in Low- and Middle-Income Countries.","authors":"Ebrahim Faizullabhoy, Thomas Bocian, Fatema Hirani, Kristen Grotheer, Ziad Sifri","doi":"10.1002/wjs.70593","DOIUrl":"https://doi.org/10.1002/wjs.70593","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064930","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 Outcomes of Patients With Pancreatic Neuroendocrine Neoplasms in the Context of Different Body Composition Phenotypes.","authors":"Fabiola A Bechtiger, Mariah Herbrich, Hazem K A A Hassan, Jörg Kaiser, Thomas Hank, Magdalena Lewosinska, Deniz Uluk, Osman Öcal, Nicole D Hildebrand, Steven Wm Olde Damink, Franck Billmann, Zoltan Czigany, Mohammed Al-Saeedi","doi":"10.1002/wjs.70537","DOIUrl":"https://doi.org/10.1002/wjs.70537","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic neuroendocrine neoplasms (pNEN) are rare and heterogeneous tumors with increasing incidence. While surgical resection remains the only curative treatment, perioperative outcomes are influenced by patient-related risk factors. Recent research highlights body composition (BC) as a prognostic marker in oncological and transplantation surgery that reflects the tumor-host interplay. This study describes the association between preoperative assessment of BC phenotypes and major complications following surgery for pNEN.</p><p><strong>Methods: </strong>All 623 consecutive patients who underwent surgery for pNEN at the University Hospital Heidelberg between 2010 and 2023 were retrospectively screened for inclusion. BC was assessed using preoperative CT scans at the L3 level with a deep learning-based tool (Mosamatic). Parameters included skeletal muscle index (SMI), muscle radiation attenuation (SM-RA), visceral and subcutaneous fat, and derived definitions of sarcopenia, myosteatosis, sarcopenic obesity, and visceral obesity. Postoperative (major) complications were classified according to Clavien-Dindo (CD ≥ 3) and the Comprehensive Complication Index (CCI). Logistic regression was used to identify predictors of 90-day morbidity.</p><p><strong>Results: </strong>A total of 481 patients with suitable CT-scans were included. Mean age was 58 years and 53.8% were male. Obesity was present in 24.3%, sarcopenia in 60.5%, myosteatosis in 50.3%, sarcopenic obesity in 4%, and visceral obesity in 61.1%. Obesity (postoperative pancreatic fistula B/C 33% vs. 19.9%, p = 0.014), visceral obesity (CCI 23.6 vs. 16.4, p = 0.001) and myosteatosis (stay 12 vs. 10 days, p = 0.037) were associated with significantly higher complication rates, longer hospital stays, or increased CCI. In multivariate analysis, ASA ≥ 3, overweight and prolonged surgery remained independent predictors of major complications.</p><p><strong>Conclusion: </strong>This study describes the role of BC in patients undergoing surgery for pNEN showing that impaired BC is highly prevalent in pNEN patients. Obesity-related phenotypes and myosteatosis show a potentially negative impact on perioperative outcomes, underscoring the relevance of BC assessment in preoperative risk stratification and surgical decision-making.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040731","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 Evolution of Terrorism-Related Injuries in the Sahel: Perspective From Local Surgical Teams.","authors":"S Yves G Sanou, Touré Moustapha, Abdoulaye Sanou, Yves Aziz R Nacanabo, Hannah B Wild","doi":"10.1002/wjs.70581","DOIUrl":"https://doi.org/10.1002/wjs.70581","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040707","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":"Factors Predicting the Need for Intravenous Calcium Infusion in Patients With Advanced Primary Hyperparathyroidism Undergoing Parathyroidectomy.","authors":"Prachi Krishnatrey, Anjali Mishra, Prateek Kumar Mehrotra, Sabaretnam Mayilvagnan, Gyan Chand, Gaurav Agarwal","doi":"10.1002/wjs.70586","DOIUrl":"https://doi.org/10.1002/wjs.70586","url":null,"abstract":"<p><strong>Background: </strong>A substantial proportion of patients with primary hyperparathyroidism (PHPT) presenting with advanced skeletal manifestations develop \"hungry bone syndrome\" following parathyroidectomy (PTx). This study aimed to identify predictors of the need for intravenous (IV) calcium (Ca) infusion in the postoperative period.</p><p><strong>Methods: </strong>This retrospective study (January 2000-December 2024) included 554 symptomatic PHPT patients undergoing PTx. Patients were divided into two groups: Group 1 (n = 96), who required IV Ca infusion, and Group 2 (n = 458), who did not. Clinical, biochemical, and operative parameters were compared.</p><p><strong>Results: </strong>Overall, 17% of patients required IV Ca infusion. On univariate analysis, Group 1 patients were significantly young (p < 0.001) and had a higher incidence of bed-ridden status (p = 0.001), bony symptoms (p < 0.001), skeletal fractures (p < 0.001), and osteoporosis (p = 0.025). Serum parathyroid hormone (PTH; p = 0.001) and alkaline phosphatase levels (p < 0.001) were significantly higher, whereas bone mineral density at the spine (p = 0.001), hip (p < 0.001), and distal radius (p = 0.001) was significantly lower. Bilateral neck exploration (BNE; p = 0.047) as well as resected gland size (p < 0.001) and weight (p = 0.007) were higher in Group 1. On multivariable analysis, age (p = 0.006), bony symptoms (p = 0.016), PTH (p = 0.041), BNE (p = 0.014), and parathyroid weight (p = 0.005) remained significant predictors.</p><p><strong>Conclusions: </strong>Young age, bony symptoms, BNE, and higher PTH levels and gland weight are significant predictors of the need for IV Ca after PTx in advanced PHPT. However, most patients can be effectively managed with oral Ca and vitamin D supplementation.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064885","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 Modified Frailty Index Predicts Failure-to-Rescue Mortality After Pancreatoduodenectomy: A Comparison of the 11-Item and 5-Item Versions.","authors":"Matteo De Pastena, Salvatore Paiella, Simone Veneroni, Gabriella Lionetto, Valeria Casule, Martina Derobertis, Fabio Casciani, Antonio Pea, Nicola Gentilini, Elisa Venturini, Roberto Salvia, Giuseppe Malleo","doi":"10.1002/wjs.70542","DOIUrl":"https://doi.org/10.1002/wjs.70542","url":null,"abstract":"<p><strong>Background: </strong>Frailty may influence outcomes after pancreatoduodenectomy (PD). We compared the prognostic performance of the 11-item modified Frailty Index (mFI-11) and the simplified 5-item version (mFI-5) and explored their link with post-pancreatectomy mortality (PPM).</p><p><strong>Methods: </strong>We retrospectively analyzed 1926 adults undergoing PD for periampullary lesions (2015-2023). Frailty was classified as non-frail, mildly frail, or severely frail. Co-primary outcomes were major complications, defined as Clavien-Dindo grade ≥ III, and 90-day mortality. Separate adjusted logistic models were fitted for each index; Firth regression was used for mortality sensitivity analyses. Discrimination was assessed by AUC and compared using DeLong tests. Deaths were independently adjudicated as PPM1, PPM2, or PPM3.</p><p><strong>Results: </strong>Major complications occurred in 350 patients (18.2%), and 90-day mortality was 52 (2.7%). Both indices showed a stepwise increase in event rates across frailty strata. In adjusted models, severe frailty was independently associated with mortality (mFI-11: OR 4.1, 95% CI 1.6-10.3, p < 0.001; mFI-5: OR 2.8, 95% CI 1.4-5.6, p = 0.015 by Firth regression). Discrimination was modest and comparable between indices for major complications (AUC 0.629 vs. 0.630; DeLong p = 0.68) and good and comparable for mortality (AUC 0.761 vs. 0.757; DeLong p = 0.48). Severe frailty was independently associated with PPM2 deaths for both indices but not with PPM1 or PPM3, although the latter subgroups were underpowered.</p><p><strong>Conclusion: </strong>The mFI-5 performs similarly to the mFI-11 after PD and is preferable for routine use due to its simplicity. Frailty is more strongly linked to mortality, especially pancreas-specific failure-to-rescue trajectories, than to major morbidity alone.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031554","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 the Editor: Gastroesophageal Reflux Disease After Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass: An 8-Year Prospective Cohort Study.","authors":"Yunyi Xin, Xiaojia Shi","doi":"10.1002/wjs.70583","DOIUrl":"https://doi.org/10.1002/wjs.70583","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026133","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 Factors for Malignancy of Thyroid Nodules in Children and Adolescents.","authors":"Makram Tbini, Houssem Eddine Kamel, Sarra Idriss, Rihab Laamouri, Ines Riahi, Mamia Ben Salah","doi":"10.1002/wjs.70584","DOIUrl":"https://doi.org/10.1002/wjs.70584","url":null,"abstract":"<p><p>Nodular thyroid disease is a common condition. However, thyroid nodules are rare in children and adolescents compared with the adult population. Moreover, the risk of thyroid cancer associated with these nodules is significantly higher in pediatric population than in adults (20% vs. 5%), thus underlining the crucial importance of early diagnosis and prompt, appropriate management. Several risk factors have been studied and described, particularly in adults. The aim of our work was to identify factors predictive of malignancy of thyroid nodules in children and adolescents.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026158","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":"Predictors of Surgical Outcome in Thoracic Outlet Syndrome: Analysis of One Thousand Operated Cases Over 18 Years.","authors":"Bawan Bakr Wahab, Ako Nooralddin Abdalla, Mohammed Yassin Rasul, Aram Baram","doi":"10.1002/wjs.70565","DOIUrl":"https://doi.org/10.1002/wjs.70565","url":null,"abstract":"<p><strong>Background: </strong>Thoracic outlet syndrome (TOS) comprises a heterogeneous group of neurovascular compression disorders with variable clinical presentation and complex diagnostic pathways. Despite widespread use of surgical decompression, robust long-term outcome data from large standardized cohorts remain limited.</p><p><strong>Methods: </strong>This retrospective cohort study included 1000 consecutive patients who underwent surgical decompression for neurogenic, venous, arterial, or mixed TOS between January 2007 and December 2024 at a tertiary cardiothoracic and vascular surgery center. All procedures were performed by a single surgeon using a standardized supraclavicular approach with first rib resection and scalenectomy. Diagnosis was based on clinical evaluation supported by imaging and neurophysiological studies. Outcomes were analyzed according to TOS subtype. Primary outcomes included functional improvement measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score, symptom resolution, recurrence, and venous patency. Secondary outcomes included operative characteristics and perioperative complications.</p><p><strong>Results: </strong>The mean participant age was 37.9 years, with the majority being female (70%). Neurogenic TOS accounted for 55% of cases. Significant differences were observed between TOS subtypes in terms of clinical presentation, symptom duration, and outcomes (p < 0.05). Mean DASH score improved from 52.8 preoperatively to 11.98 postoperatively (mean ΔDASH: 40.8). At 48 months, 81.7% of patients achieved full functional recovery. Recurrence and chronic pain occurred in 18.3% of patients, with higher rates in neurogenic and post-traumatic cases. Primary Venous patency was maintained in all patients with vascular TOS. Minor postoperative complications were infrequent and managed conservatively, with no major intraoperative neurovascular injuries.</p><p><strong>Conclusions: </strong>Supraclavicular thoracic outlet decompression provides safe, reproducible, and durable functional improvement across all TOS subtypes. Subtype-specific differences highlight the importance of early diagnosis and tailored surgical management. These findings support the role of specialized high-volume centers in optimizing outcomes for this complex condition.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012568","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}