Annals of Gastroenterological Surgery最新文献

{"title":"Surgical Resection for Colorectal Liver Metastasis in Elderly Patients Aged ≥ 80: A Retrospective Nationwide Cohort Survey in Japan With Propensity Score Matching","authors":"Kiichi Sugimoto,&nbsp;Akio Saiura,&nbsp;Shuko Nojiri,&nbsp;Hirotoshi Kobayashi,&nbsp;Goro Honda,&nbsp;Kazushige Kawai,&nbsp;Kiyoshi Hasegawa,&nbsp;Keiichi Takahashi","doi":"10.1002/ags3.70213","DOIUrl":"https://doi.org/10.1002/ags3.70213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As the aging of the global population increases, the number of elderly patients with colorectal liver metastasis (CRLM) is expected to increase. The aim of this study was to clarify the long-term oncological outcomes and treatment of CRLM in elderly patients aged ≥ 80.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with CRLM were identified from the Japanese database of Liver Metastases Survey of Colorectal Cancer, collected from 145 centers. Two thousand four hundred nine patients with liver resection were eligible for analysis. This cohort was divided into two groups aged &lt; 80 (group Y (younger); <i>n</i> = 2194) and ≥ 80 (group E (elderly); <i>n</i> = 215). We compared the long-term outcomes after liver resection of patients with CRLM aged ≥ 80 and &lt; 80 years after adjustment using propensity score matching (PSM), and we identified the reasons for differences in these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM, group E showed a comparable recurrence-free survival to that in group Y (hazard ratio (HR): 1.20, <i>p</i> = 0.16). However, group E had significantly worse cancer-specific survival (CSS) (HR: 1.77, <i>p</i> = 0.002) and overall survival (OS) (HR: 1.80, <i>p</i> = 0.0004). Treatment for recurrence was given at a significantly lower rate in group E (80/130 (61.5%) vs. 1148/1329 (86.4%), <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Surgical resection seems to be as effective in elderly patients aged ≥ 80 as in nonelderly patients. The significantly worse CSS and OS may have resulted from a lower rate of treatment for recurrence in elderly patients aged ≥ 80. Physicians should keep this finding in mind with regard to limitations of treatments for recurrence after initial liver resection in elderly patients aged ≥ 80 with CRLM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 4","pages":"1107-1119"},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148373317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends, Demographic Characteristics and Seasonal Patterns of Rectal Prolapse Surgery in Japan: A Nationwide Claims-Based Analysis From 2014 to 2023.","authors":"Masamitsu Kido, Tomohiro Arita, Hiroki Shimizu, Jun Kiuchi, Kenji Nanishi, Katsutoshi Shoda, Hiroyuki Okimura, Atsuko Fujihara, Kengo Yoshii, Atsushi Shiozaki","doi":"10.1002/ags3.70242","DOIUrl":"10.1002/ags3.70242","url":null,"abstract":"<p><strong>Aim: </strong>This study investigated nationwide trends, demographic characteristics, and seasonal patterns of rectal prolapse surgery in Japan, using healthcare claims databases.</p><p><strong>Methods: </strong>Surgical data were extracted from the National Database of Health Insurance Claims (NDB) from 2014 to 2023. Procedures were classified by surgical approach as conventional or laparoscopic. Crude and age-adjusted rates per 100 000 person-years were calculated. Temporal trends were assessed using linear and Poisson regression. Seasonal variations (April 2019-March 2024) were evaluated using one-way analysis of variance with post hoc comparisons, and correlations with meteorological variables were examined using Pearson's correlation coefficients.</p><p><strong>Results: </strong>Over the decade, a total of 62 407 overall surgeries were performed, with an average annual rate of 4.7 per 100 000 person-years and an overall female-to-male ratio of 6.9:1. Overall surgery rates peaked at ages 85-89 in males (5.5 per 100 000 person-years) and females (59.1). While age-adjusted overall and conventional surgeries declined significantly, laparoscopic surgeries significantly increased (all <i>p</i> < 0.01). Age-adjusted overall surgery rates declined significantly in both sexes (RR = 0.960 for males, 0.983 for females, and 0.979 overall; each <i>p</i> < 0.0001), particularly among younger women aged 30-39 years (<i>p</i> < 0.0024). The mean seasonal overall surgeries exhibited distinct seasonal variation: 578.0 (SD 99.2) in spring, 440.0 (SD 85.9) in summer, 432.4 (SD 50.8) in autumn, and 544.4 (SD 71.8) in winter, and showed moderate negative correlations with temperature.</p><p><strong>Conclusion: </strong>This study provides contemporary epidemiological insights into surgical management of rectal prolapse in Japan.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1612-1622"},"PeriodicalIF":3.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Incision Laparoscopy-First Strategy in Crohn's Disease: Risk Factors for Conversion and Surgical Outcomes.","authors":"Yuki Horio, Motoi Uchino, Yusuke Tomoo, Kentaro Nagano, Kurando Kusunoki, Ryuichi Kuwahara, Kei Kimura, Kozo Kataoka, Masataka Ikeda, Hiroki Ikeuchi","doi":"10.1002/ags3.70241","DOIUrl":"10.1002/ags3.70241","url":null,"abstract":"<p><strong>Background: </strong>Single-incision laparoscopic surgery (SILS) is an evolving minimally invasive technique for Crohn's disease (CD). However, evidence regarding conversion risk, specifically in SILS, is limited. This study aimed to identify independent predictors of conversion to open surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with CD who underwent intestinal resection using an SILS-first strategy between April 2018 and October 2025. The patients were classified into conversion and non-conversion groups. Logistic regression analyses were performed to analyze risk factors for conversion to open surgery. The model's performance was evaluated using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Of 289 patients, 34 (11.8%) required conversion to open surgery. Additional ports were required in 30 (10.4%) patients; 22 of these were completed laparoscopically. Multivariate analysis identified fistula (odds ratio [OR]: 7.53, 95% confidence interval [CI]: 3.28-17.6), colon resection (OR: 4.26, 95% CI: 1.87-9.91), and smoking history (OR: 2.49, 95% CI: 1.09-5.77) as independent risk factors. The predictive model demonstrated good discrimination (area under the curve [AUC] = 0.81). Conversion was associated with a longer operative time and greater blood loss, whereas postoperative complications and length of hospital stay were similar between the groups.</p><p><strong>Conclusion: </strong>The SILS-first strategy achieved a low conversion rate, while maintaining operative safety. Risk factors for conversion were consistent with those reported in multi-port laparoscopy, supporting a flexible and staged port-escalation approach in CD.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1602-1611"},"PeriodicalIF":3.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the Efficacy of Adjuvant Chemotherapy Using Immuno-Nutritional and Inflammatory Markers in Elderly Patients With Stage III Colorectal Cancer.","authors":"Tomoya Tago, Yasuyuki Takamizawa, Takeharu Kato, Hiroshi Nagata, Konosuke Moritani, Shunsuke Tsukamoto, Yukihide Kanemitsu","doi":"10.1002/ags3.70235","DOIUrl":"10.1002/ags3.70235","url":null,"abstract":"<p><strong>Aim: </strong>Use of postoperative adjuvant chemotherapy for colorectal cancer (CRC) in elderly patients raises concerns regarding efficacy and toxicity. This study aimed to determine whether immuno-nutritional and inflammatory markers could serve as predictors of the outcomes of postoperative adjuvant chemotherapy in this population.</p><p><strong>Methods: </strong>Patients aged ≥ 70 years who were diagnosed with stage III CRC and treated at the National Cancer Center Hospital in Japan between 2000 and 2017 were retrospectively analyzed. Long-term survival outcomes were compared after propensity score matching (PSM) according to whether adjuvant chemotherapy was administered. Subgroup analyses were performed to determine the interaction of immuno-nutritional and inflammatory markers with the outcomes of postoperative adjuvant chemotherapy.</p><p><strong>Results: </strong>A total of 606 patients were included, and PSM resulted in 78 matched pairs. After PSM, there were significant improvements in recurrence-free survival (RFS) and overall survival (OS) in the group that received adjuvant chemotherapy (RFS: Hazard ratio (HR) 0.537, 95% confidence interval (CI) 0.302-0.955, <i>p</i> = 0.034; OS: HR 0.495, 95% CI 0.247-0.990, <i>p</i> = 0.047, respectively). The postoperative lymphocyte-to-monocyte ratio (LMR) significantly affected RFS and OS (interaction <i>p</i> = 0.030 and interaction <i>p</i> = 0.023, respectively), and the postoperative C-reactive protein-to-albumin ratio (CAR) significantly affected RFS (interaction <i>p</i> = 0.033).</p><p><strong>Conclusion: </strong>Postoperative LMR and postoperative CAR were associated with the outcome of adjuvant chemotherapy and may help inform its administration in elderly patients with stage III CRC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1575-1585"},"PeriodicalIF":3.2,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery.","authors":"Hiroshi Hasegawa, Hiraku Kumamaru, Momoko Ara, Yoshihiro Kakeji, Hideko Yamauchi, Masafumi Inomata, Sadako Akashi-Tanaka, Koji Ito, Shinji Itoh, Hidetoshi Eguchi, Kazumi Kawase, Yoshiaki Kinoshita, Yuki Kiyozumi, Shogo Kobayashi, Ikuko Shibasaki, Chiyoe Shirota, Hiroyuki Suzuki, Chie Takasu, Aoi Fujikawa, Saki Bessho, Kiyomi Horiuchi, Kosei Maemura, Ayako Maruo, Takuya Miura, Yuji Miyamoto, Toshiki Yajima, Ayuko Yasuda, Toshiharu Yamaguchi, Tadashi Iwanaka, Hideo Baba, Akinobu Taketomi","doi":"10.1002/ags3.70239","DOIUrl":"10.1002/ags3.70239","url":null,"abstract":"<p><strong>Background: </strong>Regional disparities in surgical resources may influence the delivery and sustainability of gastroenterological surgery, particularly in countries experiencing rapid population aging and depopulation.</p><p><strong>Methods: </strong>This nationwide cross-sectional study used data from the Japanese National Clinical Database to examine temporal trends (2013-2023) in surgical volume, surgeon supply, and annual operative volume per surgeon for colectomy, gastrectomy, and pancreaticoduodenectomy. Analyses were conducted at the prefectural level and stratified by population density and surgeon experience.</p><p><strong>Results: </strong>A total of 955 168 colectomies, 514 155 gastrectomies, and 126 008 pancreaticoduodenectomies were analyzed. Colectomy volume increased despite declining surgeon numbers in medium- and high-density areas, resulting in increased operative volume per surgeon. Gastrectomy volume decreased nationwide, whereas pancreaticoduodenectomy volume increased across all regions, accompanied by a reduction in surgeon supply and a rise in procedures per surgeon. By 2023, operative volume per surgeon was largely comparable across population density categories. Notably, surgeons with ≥ 20 years of experience were disproportionately represented in low-density areas.</p><p><strong>Conclusions: </strong>Although regional differences in population density persist, surgeon workload for major gastroenterological procedures has converged across regions in recent years. However, surgical care in low-density areas depends heavily on senior surgeons, raising concerns regarding generational transition and long-term sustainability of gastroenterological surgical services in Japan.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1646-1654"},"PeriodicalIF":3.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translational Gap in Biomarker Discovery: Tumor Surface Markers Rarely Mirror Circulating Levels.","authors":"Junko Mukohyama, Shohei F Fujita, Xinyi Fu, Shigenori Suzuki, Hiroki Hamamoto, Dai Shida, Kimihiro Yamashita, Kohei Taniguchi, Sang-Woong Lee, Akihide Yoshimi","doi":"10.1002/ags3.70240","DOIUrl":"10.1002/ags3.70240","url":null,"abstract":"<p><strong>Background: </strong>Tumor-associated cell surface proteins are frequently proposed as circulating biomarkers for colorectal cancer (CRC) based on their high tumor expression. However, many candidates identified through tissue-based analyses fail to translate into clinically useful biomarkers. We investigated the translational gap between tissue-level expression and circulating detectability in CRC, focusing on molecular subtypes defined by caudal-type homeobox 2 (CDX2) expression.</p><p><strong>Methods: </strong>Transcriptomic data from The Cancer Genome Atlas (TCGA) were analyzed to identify cell surface markers differentially expressed between CDX2-Low and CDX2-High CRCs. A clinical cohort of right-sided CRC patients was evaluated using paired tumor tissue and preoperative plasma samples. CDX2 expression was assessed by immunohistochemistry, and circulating concentrations of selected cell surface proteins were quantified using a multiplex ELISA platform.</p><p><strong>Results: </strong>Several tumor-associated cell surface markers exhibited marked CDX2-dependent differences in tissue expression. However, for most markers, circulating plasma levels did not mirror tissue-level patterns. CEACAM1 was the sole marker demonstrating concordant CDX2-dependent differences in both tumor tissue and plasma, with significantly lower levels in CDX2-Low CRCs. In contrast, CEACAM5 showed a dissociation between tissue expression and circulating levels, despite analytical validation against serum carcinoembryonic antigen (CEA).</p><p><strong>Conclusions: </strong>Our findings demonstrate that tumor overexpression of cell surface markers does not necessarily translate into detectable circulating biomarkers. This translational disconnect underscores limitations of biomarker selection strategies based solely on tissue expression and highlights the importance of integrating systemic biology into biomarker development. While some tumor-associated proteins may lack utility as circulating biomarkers, they may still represent viable therapeutic targets in CRC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1594-1601"},"PeriodicalIF":3.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MiR-146a-5p Suppresses M1 Polarization of Tumor-Associated Macrophages via IRAK1/NF-κB Signaling in Colorectal Polyps.","authors":"Peng Song, Lianhui Wu, Huabin Qiu, Lei Luo, Jianzhao Qiu, Shuping Xiao, Jincai He","doi":"10.1002/ags3.70232","DOIUrl":"10.1002/ags3.70232","url":null,"abstract":"<p><strong>Background: </strong>Tumor-associated macrophages (TAMs) play a pivotal role in shaping the inflammatory microenvironment of colorectal polyps. MiR-146a-5p has been implicated in innate immune regulation, but its function in TAM polarization and polyp pathogenesis remains unclear.</p><p><strong>Methods: </strong>Forty paired colorectal polyp and adjacent normal tissues were analyzed for miR-146a-5p, IRAK1, and macrophage markers (CD86/CD206) by qRT-PCR and immunohistochemistry. THP-1-derived macrophages were polarized to M1 or M2 phenotypes, transfected with miR-146a-5p mimic/inhibitor, si-IRAK1, or IRAK1 overexpression plasmids, and treated with polyp-conditioned medium (Polyp-CM) where indicated. Macrophage polarization was evaluated by flow cytometry, qRT-PCR, ELISA, and Western blot. Dual-luciferase reporter assays in HEK293T cells validated direct targeting of IRAK1 by miR-146a-5p. Rescue experiments assessed the functional contribution of IRAK1 and NF-κB signaling to M1 polarization.</p><p><strong>Results: </strong>MiR-146a-5p was significantly downregulated in polyp tissues, whereas IRAK1 and M1 macrophage markers (CD86, iNOS) were upregulated, with a strong negative correlation between miR-146a-5p and IRAK1. Overexpression of miR-146a-5p in macrophages suppressed M1 polarization, decreased pro-inflammatory cytokines (TNF-α, IL-6), and reduced NF-κB activation, while miR-146a-5p inhibition enhanced these responses. Dual-luciferase assays confirmed IRAK1 as a direct target of miR-146a-5p. Silencing IRAK1 or inhibiting NF-κB rescued the pro-M1 effects induced by miR-146a-5p loss. Conversely, IRAK1 overexpression promoted M1 polarization, which was attenuated by miR-146a-5p co-expression. Polyp-CM experiments corroborated these effects under tumor-mimicking inflammatory conditions.</p><p><strong>Conclusion: </strong>These findings suggest that the miR-146a-5p/IRAK1/NF-κB axis may represent a potential therapeutic target for modulating macrophage-mediated inflammatory responses in colorectal polyps.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1563-1574"},"PeriodicalIF":3.2,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphocyte-C-Reactive Protein Ratio as Promising New Marker for Predicting Surgical Site Infection in Children With Ulcerative Colitis.","authors":"Yuhki Koike, Koki Higashi, Yuki Sato, Yuka Nagano, Tadanobu Shimura, Takahito Kitajima, Kohei Matsushita, Yoshiki Okita, Yoshinaga Okugawa, Yuji Toiyama","doi":"10.1002/ags3.70236","DOIUrl":"10.1002/ags3.70236","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a major complication after ileal pouch-anal anastomosis (IPAA) in pediatric ulcerative colitis (UC), significantly impairing quality of life. The lymphocyte-to-C-reactive protein ratio (LCR), a composite marker of systemic inflammation and immune/nutritional status, has emerged as a potential predictor of postoperative outcomes. This study assessed the utility of preoperative LCR in predicting SSI in pediatric UC.</p><p><strong>Methods: </strong>We retrospectively reviewed pediatric UC patients who underwent IPAA at Mie University Hospital between 2000 and 2024. Preoperative LCR values were analyzed, and the optimal cutoff for SSI prediction was determined using receiver operating characteristic (ROC) analysis. Multivariate logistic regression was performed to identify independent risk factors. SSI was defined according to CDC criteria within 30 days postoperatively.</p><p><strong>Results: </strong>Among 57 patients, 11 (19.3%) developed SSI. The incidence was higher in three-stage procedures than in two-stage procedures (22.7% vs. 17.1%). In both groups, preoperative LCR was significantly lower in SSI-positive patients. ROC analysis demonstrated good discrimination (AUC: 0.80), with an optimal cutoff of LCR < 5000 (sensitivity: 90.9%, specificity: 71.7%). Multivariate analysis confirmed LCR < 5000 as an independent predictor of SSI (odds ratio [OR]: 6.34, 95% CI: 1.23-48.2, <i>p</i> = 0.027).</p><p><strong>Conclusion: </strong>Preoperative LCR is a simple, objective biomarker that reliably predicts SSI risk in pediatric UC patients undergoing IPAA. Incorporating LCR into preoperative risk stratification may enable personalized interventions, including nutritional optimization and tailored prophylaxis, to improve surgical outcomes.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1586-1593"},"PeriodicalIF":3.2,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 3","pages":"635-637"},"PeriodicalIF":3.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148080006","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":"Can Machine Learning Reduce Unnecessary Surgeries? A Retrospective Analysis Using Threshold Optimization to Prevent Negative Appendectomies in Adults.","authors":"Ivan Males, Marko Kumric, Zvonimir Boban, Josip Vrdoljak, Dario Pecenkovic, Matej Ivanda, Marko Grahovac, Zenon Pogorelic, Josko Bozic","doi":"10.1002/ags3.70225","DOIUrl":"10.1002/ags3.70225","url":null,"abstract":"<p><strong>Aim: </strong>To develop and validate machine learning models using routinely available clinical and laboratory data in adults with highly suspected acute appendicitis and to assess their potential to reduce negative appendectomies.</p><p><strong>Methods: </strong>A retrospective study was conducted including adult patients who underwent appendectomy for suspected acute appendicitis between January 2020 and June 2024. Histopathology was the reference standard. Logistic regression, random forest, balanced random forest, and gradient boosting models were developed. Decision thresholds were calibrated to achieve predefined sensitivity targets. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and standard diagnostic metrics. Stability was evaluated using bootstrap resampling and explainability by SHAP analysis.</p><p><strong>Results: </strong>A total of 623 patients were included, of whom 66 had a negative appendectomy. For appendicitis detection, logistic regression demonstrated the best performance with a mean AUC of 0.765. At the highest sensitivity thresholds, specificity remained low but identified a small subset of patients at minimal risk of appendicitis. For complicated appendicitis prediction, random forest performed the best with a mean AUC of 0.785. SHAP analysis identified inflammatory laboratory markers as the most influential predictors. Bootstrap analysis confirmed model stability.</p><p><strong>Conclusion: </strong>Machine learning models based on clinical and laboratory variables may provide adjunctive decision support in surgically selected adults with suspected acute appendicitis and may help identify a small subgroup in whom immediate surgery could be reconsidered at carefully selected sensitivity thresholds. Prospective external validation using a similar study design is required before clinical implementation.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":" ","pages":"1631-1645"},"PeriodicalIF":3.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}