American Surgeon最新文献

{"title":"Beyond Morphology: Understanding Tumor Budding, Lymphovascular Invasion, and Perineural Invasion in Colorectal Cancer.","authors":"Weiran Kong, Chenglu Lu, Xinyao Liu, Linlin Zhang, Yan Li, Chuantao Yuan, Shuai Chen","doi":"10.1177/00031348261491334","DOIUrl":"https://doi.org/10.1177/00031348261491334","url":null,"abstract":"<p><p>The American Joint Committee on Cancer (AJCC) TNM staging system, grounded in morphologic assessment of tumor invasion depth, remains the cornerstone of surgical decision-making and prognostication for colorectal cancer (CRC). However, marked prognostic heterogeneity among patients at identical T stages represents a longstanding clinical challenge that cannot be fully accounted for by conventional morphologic evaluation alone. Epithelial-mesenchymal transition (EMT), the core biological process driving tumor cell invasion and metastasis, may provide a unifying biologic framework to interpret this stage-specific variability. From a surgical perspective, this review summarizes the established clinical and prognostic significance of routinely reported pathologic features-tumor budding, lymphovascular invasion (LVI), and perineural invasion (PNI)-and explores how EMT biology may explain their underlying biological basis. We outline how EMT activation may underpin the aggressive behavior associated with these histologic findings, and how it may account for prognostic heterogeneity in stage II disease. Finally, we outline emerging investigational applications of EMT biology, including biomarker testing, biologically informed margin assessment, and integrated staging systems, and discuss their potential future role in surgical practice.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261491334"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size Under Scrutiny: Preoperative Imaging Size of Mesenteric Deposits Does Not Predict Oncological Outcomes in Small Intestinal Neuroendocrine Tumors.","authors":"Adam Goldstein, Haggi Mazeh, Pavel Kushnir, Naheel Mahajna, Yaara Gutman, Yehonatan Bar Moshe, Amram Kupietzky, Orit Twito, Ilan Edri, Shimrit Eliyahu, Mordechai Shimonov, Shachar Laks","doi":"10.1177/00031348261495997","DOIUrl":"https://doi.org/10.1177/00031348261495997","url":null,"abstract":"<p><p>BackgroundSmall intestinal neuroendocrine tumors (SiNETs) are rare tumors with propensity to cause bulky fibrotic mesenteric masses by hematogenous and lymphatic invasion. They exhibit variable oncological behavior and reliable prognostic markers remain elusive. The 8^th edition American Joint Commission on Cancer introduced mesenteric mass ≥2 cm to improve prognostication. The clinical utility in prognostication remains unknown. We reviewed outcomes of resected SiNETs to determine if computed tomography (CT) size is associated with oncological outcomes.MethodsRetrospective review of resected SiNET patients at two tertiary centers with evaluable preoperative CT scans. Measured the largest diameter of the mesenteric mass and the cutoff of 2 cm used to correlate with oncological outcomes.ResultsSeventy-three patients operated for SiNET with preoperative CT were included. The largest mesenteric mass was <2 cm in 28 and ≥2 cm in 45 patients. Cohorts were similar in demographic and clinical characteristics. Median follow-up was 47 months. Overall survival (OS) and progression free survival (PFS) were similar. No significant differences in estimated mean OS (136 vs 139 months, <i>P</i> = 0.981) or median PFS (90 vs 71 months, <i>P</i> = 0.126) for the <2 cm and >2 cm cohorts, respectively. Univariable analysis failed to show an association between mesenteric size as a continuous variable, and at the ≥2 cmcutoff. Age, cardiac comorbidities, and palliative intent surgery were the only factors that correlated with survival.DiscussionMesenteric mass size on preoperative CT was not correlated with oncological outcomes and by itself showed little utility in preoperative decision-making.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495997"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Diagnostic Challenges in Patients Being Evaluated for Resection of Pancreatic Serous Cystadenomas.","authors":"Dimitrios Moris, Vasalya Panchumarthi, Matthew Luckman, Piyush Gupta, Brian Nguyen, David Walls, Shekhar Gogna, Thomas Fishbein, Pejman Radkani, Emily Winslow","doi":"10.1177/00031348261496002","DOIUrl":"https://doi.org/10.1177/00031348261496002","url":null,"abstract":"<p><p>Serous cystadenomas (SCAs) are benign pancreatic cystic neoplasms for which surveillance can be safely discontinued once the diagnosis is established with confidence. However, distinguishing SCAs from premalignant or malignant pancreatic cystic lesions remains challenging despite advances in cross-sectional imaging and endoscopic ultrasound (EUS), resulting in unnecessary pancreatic resection. We performed a retrospective review of all pancreatic resections performed at a single tertiary referral center between January 2010 and December 2022 to identify patients with a final pathological diagnosis of SCA. Demographic, radiographic, operative, and postoperative outcomes were analyzed. Among 556 pancreatic resections, 20 patients (4%) had pathologically confirmed SCAs. The median age was 62 years, 55% were women, and the median cyst size was 3.0 cm. Surgery was performed because malignancy could not be excluded in 40% of patients, concern for a mucinous cystic neoplasm in 35%, and interval cyst growth in 25%. Sixteen patients (80%) underwent preoperative EUS with fine-needle aspiration, but cytology was frequently nondiagnostic and neither confirmed SCA nor reliably excluded a mucinous lesion. Seven patients underwent pancreaticoduodenectomy and 13 underwent distal pancreatectomy. Postoperative morbidity occurred in 50% of patients, including clinically relevant postoperative pancreatic fistula in 30%, with no disease-specific mortality. These findings demonstrate that pancreatic resection for SCAs is driven primarily by persistent diagnostic uncertainty rather than symptoms or malignant potential. Despite contemporary imaging and EUS, confidently differentiating SCAs from premalignant or malignant pancreatic cystic neoplasms remains difficult. Improved diagnostic strategies, including molecular testing and enhanced risk stratification, may reduce unnecessary pancreatic resection while preserving oncologic safety.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496002"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: \"Utilization of Cardiopulmonary Bypass in Trauma Patients: A Multi-Institutional Study of the American Association for the Surgery of Trauma\".","authors":"Annabella M Hochschild, Ioannis Dimarakis","doi":"10.1177/00031348261496612","DOIUrl":"https://doi.org/10.1177/00031348261496612","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496612"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interval-Based Estimation of Colorectal Neoplastic Polyp Growth and Its Value in Polyp Screening: A Retrospective Cohort Study.","authors":"Xiaochun Zhang, Chao Jin","doi":"10.1177/00031348261494470","DOIUrl":"https://doi.org/10.1177/00031348261494470","url":null,"abstract":"<p><p>BackgroundCurrent post-polypectomy surveillance guidelines rely primarily on baseline polyp pathology, lacking integration of metabolic factors and quantitative growth estimation for individualized interval stratification. This study sought to translate cancer growth modeling concepts into clinically actionable insights for surgical practice.MethodsThis retrospective cohort study enrolled 795 patients who underwent polypectomy and at least one follow-up colonoscopy. Independent prognostic factors were identified and a nomogram was constructed using Cox proportional hazards regression and LASSO Cox regression with 10-fold cross-validation. Interval-based polyp progression was quantified via multivariable linear regression (ordinary least squares, robust regression, and log-transformed models). Model performance was evaluated by receiver operating characteristic (ROC), calibration and decision curve analyses with internal validation.ResultsOver a median follow-up of 13 months, the crude recurrence rate was 80.8%. Abnormal HDL-C, baseline polyp count, and baseline polyp volume were independently associated with shorter time to recurrence in the multivariable Cox model. The model showed moderate and consistent discrimination, with good calibration and positive net benefit across moderate-to-high-risk thresholds. In exploratory progression analyses, baseline polyp count and surveillance interval were robustly positively associated with recurrent polyp number and maximum diameter across all model specifications, while associations of abnormal HDL-C were inconsistent and not significant for diameter outcomes in log-transformed models.ConclusionsIntegrating metabolic biomarkers with endoscopic data may modestly improve recurrence risk stratification, though this added value is limited by inconsistent associations and potential confounding. Prospective studies with adjustment for medication use and metabolic syndrome components are needed for validation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261494470"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Stoma Creation in Patients With Peritoneal Carcinomatosis and Mechanical Intestinal Obstruction: A Single-Center Experience.","authors":"Başar Can Turgut, Sefa Ergun, Sadiye Akbas, Ergin Erginoz, Yasemin Pekmezci, Osman Simsek, Gurhan Celik, Salih Pekmezci","doi":"10.1177/00031348261495996","DOIUrl":"https://doi.org/10.1177/00031348261495996","url":null,"abstract":"<p><p>IntroductionMalignant bowel obstruction secondary to peritoneal carcinomatosis (PC) is a challenging end-stage complication in which operative palliation must balance symptom relief against perioperative burden and limited survival. This study evaluated palliative stoma creation not only as an outcome-based intervention, but as a practical decision-making strategy integrating patient selection, hospitalization burden, and individualized operative planning in anatomically hostile abdomens.MethodsWe retrospectively reviewed 46 patients with PC who developed mechanical intestinal obstruction refractory to conservative management between 2016 and 2025 at a tertiary academic referral center. Demographic characteristics, tumor origin, peritoneal carcinomatosis index (PCI), operative strategy, stoma type, incision location, postoperative outcomes, complications, and survival were analyzed. Hospitalization burden was descriptively assessed as the proportion of median remaining survival spent during the index admission.ResultsThe study included 24 (52.2%) female and 22 (47.8%) male patients with a mean age of 61.5 ± 14.4 years (range 29-91). The mean PCI score was 14.9 ± 4.3; 67.4% of the cases underwent loop ileostomy; and the mean operative time was 95 minutes. Mean time to oral intake was 2.7 days, and median length of hospitalization was 11 days. The overall complication rate was 23.9%, and 30-day mortality was 13.0%. Median survival was 60 days, making the index hospitalization approximately 18.3% of median remaining survival. No significant correlation was observed between PC index and duration of hospitalization (r = 0.071, <i>P</i> = .658) or survival (r = ‒0.242, <i>P</i> = .128), although these negative findings should be interpreted cautiously given the limited sample size.ConclusionPalliative stoma creation provides rapid symptom relief in selected patients with PC and mechanical intestinal obstruction. Its value should be judged less by survival extension than by whether the procedure can restore oral intake, allow discharge, and preserve meaningful time outside the hospital. Individualized surgical planning may facilitate safe palliation when standard stoma construction is limited by hostile abdominal conditions.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495996"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Preoperative Liquid Diets on Bariatric Surgery Outcomes.","authors":"Shivani Desai, Androw Abdelnour, Braelyn Webb, Ellaree Estes, Dawn Blackhurst, John Scott","doi":"10.1177/00031348261495987","DOIUrl":"https://doi.org/10.1177/00031348261495987","url":null,"abstract":"<p><p>BackgroundEffects of preoperative weight loss on bariatric surgery outcomes have been previously studied, but the true association remains unclear. We aim to determine whether duration of a standardized preoperative liquid diet has significant effects on postoperative outcomes.MethodsA retrospective analysis was conducted on 576 patients categorized by preoperative diet duration (2-week vs 4-week). Differences in characteristics were assessed using Pearson Chi-square test for categorical variables and Student's t-test for independent groups for continuous data. Least squares multivariable linear regression modeling was used to assess predictors of total body weight loss percentage (TBWL%) at 1 year with TBWL% at 30 days and 1 year as primary endpoints.ResultsFive-hundred and seventy-six patients were analyzed, with 516 undergoing initial bariatric surgery. Ninety-three patients were enrolled in the 2-week liquid diet; 419 patients were enrolled in the 4-week diet. Patients in the 4-week group lost significantly more weight during the preoperative phase (<i>P</i> < 0.001). There was no difference between 2-week and 4-week diets on TBWL% at 30 days or 1 year. Five-hundred and twelve patients had follow-up at 1 year with age (<i>P</i> = 0.001) and race (<i>P</i> < 0.001) of the only significant predictors of TBWL% at 1 year.ConclusionIn this retrospective, non-randomized cohort, extending the preoperative liquid diet from 2 to 4 weeks did not result in improved postoperative weight loss at 30 days or 1 year. Age and race were the only significant predictors of TBWL% at 1 year in our cohort, underscoring the importance of patient-level biologic and social determinants.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495987"},"PeriodicalIF":1.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurologic Presentations of Pediatric Intussusception Lead to Diagnostic Delay and Increased Need for Surgery.","authors":"Yılmaz Seçilmiş, Seda Gümüştekin Bilgin, Ahmet Burak Doğan","doi":"10.1177/00031348261448893","DOIUrl":"10.1177/00031348261448893","url":null,"abstract":"<p><p>BackgroundNeurological presentations of pediatric intussusception lead to delayed diagnosis, higher rates of surgical intervention, and worse outcomes compared with classic presentations. These atypical manifestations, including lethargy, altered mental status, and rarely movement disorders, may predominate and redirect evaluation toward primary neurological etiologies, delaying recognition of this reversible surgical emergency.Case PresentationA previously healthy 2-year-old boy presented with clustered orofacial dyskinesias and irregular upper-extremity jerks without exposure to dopamine-receptor antagonists. He was initially misdiagnosed with tardive dyskinesia and treated with biperiden without improvement. Neurologic examination and brain magnetic resonance imaging were normal. During observation, he developed bilious vomiting. Abdominal imaging revealed ileocolic intussusception. Pneumatic reduction was unsuccessful, and surgical exploration demonstrated an invaginated Meckel diverticulum with ischemic bowel requiring resection. Abnormal movements resolved completely following surgery.MethodsWe conducted a systematic case-based review of published pediatric cases of intussusception presenting with neurological manifestations.ResultsNeurological symptoms-most commonly lethargy and altered mental status-frequently dominated the initial presentation and contributed to significant diagnostic delay (median 12 hours vs 5 hours in classic presentations, <i>P</i> < 0.001). Critically, patients with neurological presentations required surgical intervention in 60% of cases compared with 18% of classic presentations (<i>P</i> < 0.001), with approximately one-quarter of surgical patients requiring bowel resection, reflecting more advanced disease at diagnosis.ConclusionIntussusception should be considered in infants and young children with unexplained acute neurological symptoms, particularly when initial neurologic evaluation is unrevealing. Early abdominal imaging may prevent diagnostic delay in this reversible surgical emergency.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2635-2641"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Significance of Surgeons Possessing a Thorough Understanding of Esophageal Function Tests?","authors":"Fernando A M Herbella, Rafael C Katayama, Francisco Schlottmann, Marco G Patti","doi":"10.1177/00031348261443349","DOIUrl":"10.1177/00031348261443349","url":null,"abstract":"<p><p>Esophageal function tests (esophageal manometry and 24-hour pH monitoring) are essential to diagnose benign esophageal disorders such as gastroesophageal reflux disease and achalasia. Unfortunately, these tests are rarely taught during medical school or surgical training, so that surgeons who treat these diseases must rely on the interpretation and conclusions made by other physicians, mostly gastroenterologists, just reading the report without looking at the tracings themselves. Potentially, this approach may lead to poor outcomes or even malpractice.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2609-2612"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Tumor Markers for Intraoperative Specimen Radiography Does Not Decrease the Rate of Margin Positivity in Breast Conservation Surgery (BCS).","authors":"Rachna Prasad, Micah Brainerd, Camila Ortega, Joseph N Gabra, Caroline Mangira, Adina Brett-Morris, Christopher Mamone, Andrew Fenton, Mary Murray","doi":"10.1177/00031348261448903","DOIUrl":"10.1177/00031348261448903","url":null,"abstract":"<p><p>IntroductionMargin status after lumpectomy is crucial in determining risk of local recurrence. Current guidelines recommend \"no ink on tumor\" as adequate negative margins for invasive breast carcinoma. Still, up to 20% of patients may have positive margins and need re-excision. This study explored the use of a commercially available tumor marking system during specimen radiography and its effect on re-excision rates in breast conservation surgery.MethodsWith IRRB approval, a review was conducted of a prospectively collected cohort of 105 study patients and a retrospectively collected cohort of 92 control patients with invasive breast carcinoma undergoing breast conservation surgery. In the study group, lumpectomy specimens were labeled with clips from a commercial tumor marking system, followed by two-view radiography to assess the need for shave margins. The surgeon interpreted the radiograph, and, at their discretion, excised additional margins. A control group was managed by the same surgeons without the tumor marking system. Categorical variables were compared using Chi-Squared or Fisher's exact tests and continuous variables were compared using t-tests or Wilcoxon Rank Sum tests depending on their distribution.ResultsA total of 197 patients were divided into a study group (n = 105) and a control group (n = 92). The types of margin excision rates differed significantly between groups (<i>P</i> ≤ 0.0105). In the study group, the rates of selective and complete margin excisions were 39% and 7%, respectively, while 53% had no margins excised, as determined using the tumor marking system. In the control group, rates of selective and complete margin excisions were 42% and 21%, respectively, and 37% had no margins excised. Final pathology showed positive margins in 24% (study) vs 21% (control), with no significant difference between the groups (<i>P</i> ≤ 0.0810).ConclusionsThe tumor marking system did not decrease the rate of margin positivity compared to the control group. However, the study group demonstrated a significant decrease in the number of patients requiring selective or complete margin excision.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2539-2545"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}