International Journal of Surgery (London, England)最新文献

{"title":"Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis","authors":"Kang Xue, Xing Huang, Pengcheng Zhao, Yi Zhang, Bole Tian","doi":"10.1097/js9.0000000000000742","DOIUrl":"https://doi.org/10.1097/js9.0000000000000742","url":null,"abstract":"Background: Pancreatic cancer frequently involves the surrounding major arteries, preventing surgeons from making a radical excision. Neoadjuvant therapy (NAT) can lessen the size of local tumors and eliminate potential micrommetastases. However, systematic and evidence-based recommendations for the treatment of arterial resection (AR) after NAT in pancreatic cancer are scarce. Method: A computerized search of the Medline, Embase, Cochrane Library databases, and Clinicaltrials was performed to identify studies reporting the outcomes of patients who underwent pancreatectomy with AR and NAT for pancreatic cancer. Studies that reported perioperative and/or long-term results after pancreatectomy with AR and NAT were eligible for inclusion. The quality of the evidence was assessed with Newcastle–Ottawa Quality Assessment Form of bias tool. Data were pooled and analyzed by Stata 14.0 software. Result: Nine studies with an overall sample size of 215 met our eligibility criteria and were included in the meta-analysis. All studies were retrospective studies, and the methodological quality was moderate. The pooled morbidity and mortality rates were 51% (95% CI: 41–61%; I²= 0.0%) and 2% (95% CI: 0–0.08; I²=33.3%), respectively. Meta-analysis showed that the overall R0 resection rate was 79% (CI: 70–86%, I²=15.5%). Comparative data on R0 rates of patients who underwent pancreatectomy with and without NAT showed a significant difference in favor of the former group with moderate statistical heterogeneity (Relative risk=1.21; 95% CI: 0.776–1.915; I²=48.0%). The median 1-, 2-, 3-, and 5-year survival rates of patients who had AR were 92.3% (range: 72.7–100%), 64.8% (range: 25–78.8%), 51.6% (range: 16.7–63.6%), and 14% (range: 0–41.1%), respectively. Data on median progression-free survival ranged from 5.25 to 36.3 months, and the median overall survival ranged from 17 to 44.9 months. Conclusions: Pancreatectomy with major AR following NAT has the potential to enhance the survival rate of patients with unresectable pancreatic cancer involving the arteries by achieving R0 resection, despite a significant risk of postoperative complications. However, to validate the feasibility and effectiveness of this procedure, prospective controlled studies are necessary to address limitations arising from small sample sizes and potential biases inherent in retrospective studies.","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"50 1","pages":"4309 - 4321"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139337925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The percentage of unnecessary mastectomy due to false size prediction using preoperative ultrasonography and MRI in breast cancer patients who underwent neoadjuvant chemotherapy: a prospective cohort study","authors":"Yireh Han, Jigwang Jung, Jang-il Kim, C. Lim, Hong-Kyu Kim, Han-Byoel Lee, H. Moon, W. Han","doi":"10.1097/JS9.0000000000000754","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000754","url":null,"abstract":"Background: Imaging-estimated tumour extent after neoadjuvant chemotherapy tends to be discordant with the pathological extent. The authors aimed to prospectively determine the proportion of decisions regarding total mastectomy for potential breast-conserving surgery candidates owing to false size prediction with imaging in neoadjuvant chemotherapy and non-neoadjuvant chemotherapy patients. Materials and methods: The authors prospectively enroled clinical stage II or III breast cancer patients who are scheduled for total mastectomy between 2018 and 2021. This study was conducted at Seoul National University Hospital at South Korea. Before surgery, each surgeon recorded the hypothetical maximum tumour size at which the surgeon would have been able to attempt breast-conserving surgery if the patient had actually less than the size of the tumour at that location in the breast. After surgery, the hypothetical maximum tumour size was compared with the final pathologic total extent of the tumour, including invasive and in situ cancers. Results: Among the 360 enroled patients, 130 underwent neoadjuvant chemotherapy, and 230 did not undergo neoadjuvant chemotherapy. Of the total of each group, 47.7% in the neoadjuvant chemotherapy group and 21.3% in the non-neoadjuvant chemotherapy group had a smaller pathologic tumour extent than the pre-recorded hypothetical maximum tumour size (P<0.001). Further analyses were conducted for the neoadjuvant chemotherapy group. The proportions of total mastectomy with false size prediction were higher in HER2-positive (63.3%) and triple-negative (57.6%) patients compared with ER-positive/HER2-negative (25.0%) patients (P<0.001). Both magnetic resonance imaging-pathology and ultrasonography-pathology size discrepancies were significantly associated with false decisions for total mastectomy (both P<0.001). Without magnetic resonance imaging, the false decision may be reduced by 21.5%. Conclusion: A total of 47.7% of patients who received total mastectomy after neoadjuvant chemotherapy were breast-conserving surgery eligible, which was significantly higher than that of non-neoadjuvant chemotherapy patients. Magnetic resonance imaging contributed the most to false size predictions.","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"19 1","pages":"3993 - 3999"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139338102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of systemic inflammatory markers and tertiary lymphoid structure with pathological complete response in gastric cancer patients receiving preoperative treatment: a retrospective cohort study","authors":"Yingying Wu, Junjie Zhao, Zhaoming Wang, Dan Liu, Chenyu Tian, Botian Ye, Yihong Sun, Haojie Li, Xuefei Wang","doi":"10.1097/js9.0000000000000741","DOIUrl":"https://doi.org/10.1097/js9.0000000000000741","url":null,"abstract":"Background: Assessment of systemic and local immune responses is crucial in determining the efficacy of cancer interventions. The identification of specific factors that correlate with pathological complete response (pCR) is essential for optimizing treatment decisions. Methods: In this retrospective study, a total of 521 patients diagnosed with gastric adenocarcinoma who underwent curative gastrectomy following preoperative treatment were reviewed. Of these patients, 463 did not achieve pCR (non-pCR) and 58 achieved pCR. Clinicopathological factors were evaluated to identify predictors for pCR using a logistic regression model. Additionally, a smaller cohort (n=76) was derived using propensity score matching to investigate local immune response, specifically the features of tertiary lymphoid structure (TLS) using H&E staining, immunohistochemistry, and multiplex immunofluorescence. Results: The multivariate regression analysis demonstrated a significant association between low systemic inflammatory status and pCR, as evidenced by reduced levels of the combined systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) (SII+NLR) (odds ratio: 3.33, 95% CI: 1.79–6.17, P<0.001). In the smaller cohort analysis, distinct TLS characteristics were correlated with the presence of pCR. Specifically, a higher density of TLS and a lower proportion of PD1+ cells and CD8+ cells within TLS in the tumor bed were strongly associated with pCR. Conclusion: Both systemic and local immune profile were associated with pCR. A low level of SII+NLR served as an independent predictor of pCR, while distinct TLS features were associated with the presence of pCR. Focusing on the immune profile was crucial for optimal management of gastric cancer patients receiving preoperative treatment.","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"13 1","pages":"4151 - 4161"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139337994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel skin grafting modality: prefabricated large sheet of postage-stamp autografts and allografts to repair extensive burn wounds; a prospective matched-control study","authors":"Chuan’an Shen, Bohan Zhang, Xinzhu Liu, Jian-hua Cai, Tian-jie Sun, Dongjie Li, Huping Deng, H. Yuan","doi":"10.1097/JS9.0000000000000724","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000724","url":null,"abstract":"Background: The excessively long operative time has been the greatest barrier to the success of transplanting postage-stamp auto- and allografts directly and piece-by-piece onto extensive burn wounds. To solve this challenge, the authors present a novel grafting modality, that is, the prefabricated-large-sheet grafting that moves the labor-intensive and time-consuming process of grafts-positioning before grafting and thereby markedly shortens the operative time. Methods: Twenty-one operations using the novel modality were performed on 11 patients with extensive deep burns. The grafting time using the novel modality was recorded and compared with that of the conventional piece-by-piece grafting. Eventually, the take rates of the two modalities were compared. Results: All patients were healed and discharged. The average grafting time per unit area (100 cm2) of prefabricated-large-sheet grafting and piece-by-piece grafting were (0.41±0.09) min and (7.46±1.07) min, respectively, and the difference is statistically significant(P<0.001). The average take rate of the prefabricated sheets was (85.43±6.14)% and that of the piece-by-piece transplanted grafts was (87.29±5.23)% and there is no significant difference(P>0.05). Conclusions: The prefabricated-large-sheet grafting significantly reduces the intraoperative grafting time while ensures uniformity of the skin grafts and secures good outcomes, thereby making the intermingled transplantation of postage-stamp auto- and allografts, which has been an excellent modality per se but limited to repair small residual wounds, now feasible to repair extensive deep burn wounds. It is worth wider understanding and application in the treatment of extensive deep burns.","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"19 1","pages":"3967 - 3973"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139340409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different therapeutic regimens in the treatment of metastatic prostate cancer","authors":"Shuai Huang, Sheng Huang, Jiangang Pan, Zhuoyuan Lin, Yubo Tang, Qingde Wa","doi":"10.1097/JS9.0000000000000685","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000685","url":null,"abstract":"","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"19 1","pages":"4361 - 4362"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139340302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on ‘Minimally invasive surgery versus laparotomy of non-metastatic pT4a colorectal cancer: a propensity score analysis’","authors":"Xiao-Lin Zhao, Xue-Lei Li, Zhi-Peng Liu, Xian-Yu Yin, Zhi-Yu Chen, Hui Zhang","doi":"10.1097/JS9.0000000000000739","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000739","url":null,"abstract":"With great interest","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"2021 1","pages":"4387 - 4388"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139340540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on ‘Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial’","authors":"Zhichao Chen, Jianfeng Wei","doi":"10.1097/JS9.0000000000000744","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000744","url":null,"abstract":"It was with great interest that we read the article published in the International Journal of Surgery in 2022. The authors observed the effectiveness of local anesthetic injection (LAI), abdominal local anesthesia injection (IPLA), and transabdominal plane block (TAPB), and no local anesthetic controls on post-operative pain, and compared the analgesic ef fi cacy of these methods [1] . The results showed that intraoperative local anesthesia can effectively control postoperative pain, especially TAPB can better manage postoperative pain. Many aspects of this study are well done. The authors conducted a double-blind, randomized controlled study. They had 160 patients who underwent laparoscopic cholecystectomy for cholecystitis and used statistical analysis to rule out confounding factors that might in fl uence postoperative pain, such as age, gender, previous operations, body mass index and number of trocars. In addition, they openly discussed the limitations of their study. All of these are advantages of research design. We can learn from their examples. However, we believe that there are several important questions in this study that are not well addressed. The authors","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"137 1","pages":"4385 - 4386"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139340582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA grants approval to the RSV vaccine (nirsevimab-alip) for all infants: a leap forward for shielding the smallest","authors":"Abubakar Nazir, Rida Fatima, Awais Nazir","doi":"10.1097/js9.0000000000000698","DOIUrl":"https://doi.org/10.1097/js9.0000000000000698","url":null,"abstract":"","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"44 1","pages":"3745 - 3746"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on ‘The experience of neoadjuvant chemotherapy versus upfront surgery in resectable pancreatic cancer. A cross sectional study’ – a correspondence","authors":"Xue-Lei Li, Zhi-Peng Liu, Hai-Su Dai, Xian-Yu Yin, Zhi-Yu Chen","doi":"10.1097/JS9.0000000000000680","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000680","url":null,"abstract":"With great interest, we read the article by Su et al . [1] . This article is a single-center cross-sectional study involving an analysis of the prognosis of neoadjuvant chemotherapy versus upfront surgical treatment for resectable pancreatic ductal adenocarcinoma. The authors collected clinical data of patients with stage I and stage II pancreatic ductal adenocarcinoma who received treatment from a tertiary hospital from 2013 to 2020, and a total of 159 patients were eligible after exclusion, including 46 patients (29%) in the neoadjuvant chemotherapy (NAC) group and 113 patients (71%) in the upfront resection (UR) group. They found that NAC is superior to UR in resectable pancreatic cancer with better survival. This is a great fi nding; however, after carefully reading the article, we would like to raise the following questions regarding some details","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"87 1","pages":"4347 - 4348"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on ‘Comparison of pharmacologic therapies alone versus operative techniques in combination with pharmacologic therapies for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial’","authors":"Dongyao Xu, Youbao Huang, Wei Wang","doi":"10.1097/JS9.0000000000000676","DOIUrl":"https://doi.org/10.1097/JS9.0000000000000676","url":null,"abstract":"Recently, we read the article by Kim et al . [1] with immense interest. The authors conducted a meaningful assessment of the quality of evidence concerning operative analgesic techniques for patients undergoing laparoscopic cholecystectomy (LC) with postoperative pain. The topic is particularly intriguing as it explores how these techniques can effectively reduce post-operative pain resulting from LC. Their fi ndings revealed that not only pain at rest ( P < 0.001) but also pain on cough ( P = 0.001) scores were higher in the pharmacologic analgesia (P) group compared with those in the operative analgesic treatments with pharmacologic analgesia (OP) group. Additionally, the authors observed that the sleep quality scores at 24 h postoperatively were lower in the P group compared with the OP group (67 ± 15 vs. 56 ± 18; P = 0.017). This randomized controlled trial provided signi fi cant evidence of the treatment techniques for patients undergoing LC. Although the study is inspiring and thought-provoking, we have the following comments:","PeriodicalId":297147,"journal":{"name":"International Journal of Surgery (London, England)","volume":"39 1","pages":"4351 - 4352"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}