International journal of surgery最新文献

Background: A comprehensive evaluation of the causes of death in Asian patients with esophageal cancer (ECA) is lacking.

Methods: This population-based cohort study used data from the Korean National Health Insurance Service database. A total of 5406 patients who underwent surgical resection for ECA between 2010 and 2017 were included and matched at a ratio of 1:3 with 16 218 controls from the general population. Causes of death were identified from national mortality data and compared according to the time after surgery and treatment modalities. Cause-specific hazard ratios (csHRs) were calculated using Cox proportional hazards models with landmark analyses performed 1, 3, and 5 years after surgery.

Results: ECA accounted for 83% of deaths within 5 years of surgery, declining to 32% beyond 5 years. Compared with controls, patients with ECA had persistently higher risks of all causes of death (csHR, 2.42; 95% confidence intervals [CI], 2.19-2.68 beyond 5 years). Deaths from other cancers increased steadily, comprising 25.3% of deaths beyond 5 years, with the greatest risks observed in patients who received surgery and chemotherapy. Risk of cardiovascular death was overall lower than in controls but increased gradually among patients treated with surgery and radiotherapy. Risk of respiratory death increased over time, particularly in patients who received surgery, chemotherapy, and radiotherapy, with a csHR of 3.47 (95% CI, 1.77-6.80) beyond 5 years.

Conclusions: Comprehensive survivorship care is essential for ECA patients. Priorities include intensive recurrence surveillance, tailored screening for second primary malignancies, and cardiopulmonary monitoring to improve long-term survival.

Background: The International Neuroblastoma Surgical Report Form (INSRF) was developed to standardize intraoperative assessment and documentation in patients with neuroblastoma (NB). This study aimed to identify independent risk factors and develop a model to predict postoperative complications using INSRF and clinical data.

Methods: A single-center analysis was conducted using prospectively collected data from NB patients undergoing resection between 2021 and 2024. Intraoperative variables and complications were recorded via the INSRF. Postoperative complications were graded using the Clavien-Dindo classification and the Comprehensive Complication Index (CCI).

Results: Among the 205 children who underwent tumor resection, 87 (42.4%) experienced intraoperative complications and 136 (66.3%) developed postoperative complications. Renal ischemia (20.5%), intraoperative hypertension (18.5%), and vascular injury (13.2%) were the most common intraoperative events observed. Vascular injury was significantly associated with tumor encasement of the major vessels (P<0.001, AUC = 0.834), whereas renal ischemia was independently predicted by superior mesenteric artery (SMA) encasement (P = 0.01) and renal invasion (P = 0.049). Postoperative complications included hepatic dysfunction (48.8%), lymphatic leakage (20.0%), diarrhea (19.0%), renal atrophy (18.1%), and infections (13.7%). Independent predictors of severe complications (Clavien-Dindo grade ≥ IIIa or CCI>32) included renal vein and inferior vena cava (IVC) encasement, hepatic and diaphragmatic invasion, and major vascular injury. Furthermore, pancreatic fistulas, lymphatic leakage, diarrhea, and postoperative infection are associated with extended postoperative hospitalization.

Conclusion: Using prospectively collected INSRF data, we identified tumor vascular encasement and organ invasion as key independent risk factors for surgical complications in NB. These findings underscore the importance of standardized preoperative risk assessments and tailored surgical strategies to improve perioperative safety. Integrating complication profiling into surgical planning may facilitate early intervention, reduce morbidity, and enhance patient recovery. Future efforts will focus on refining INSRF-based predictive models to optimize outcomes and guide precision surgical care in pediatric NB.

Background: The clinical adoption of digital surgical guides and the determination of safe surgical margins for precise mandibular ameloblastoma resection remain inadequately explored.This study aims to evaluate the precision of digital surgical guide technology in the resection of mandibular ameloblastoma and, based on the histological status of resection margins, to investigate the minimum acceptable safe bone margin distance that ensures radical tumor removal.

Materials and methods: This study analyzed 23 patients with ameloblastoma who underwent digitally guided segmental mandibulectomy at the Department of Oral and Maxillofacial Surgery between May 2023 and September 2025. All cases underwent three-dimensional virtual surgical planning based on preoperative imaging boundaries to predefine the osteotomy margins. Data collected included gender, age, clinical and radiographic features, surgical approach, histopathological type, histopathological status of the bone margins, and the minimum vertical distance from the tumor border to the osteotomy margin.The patients were divided into two cohorts according to the predefined target resection margins established during virtual planning: Cohort 1 had a target margin of 5-10 mm, aimed to evaluate the geometric discrepancy between the preoperatively planned and postoperatively measured surgical margins, along with their corresponding histopathological status; Cohort 2 had a uniformly preset target margin of 6 mm, intended to assess the histological status of the actual resection margins achieved at this distance.

Results: Cohort 1: The mean deviation between the planned and postoperatively measured surgical margin distances was 1.05 mm in 10 patients, with no statistically significant difference (P > 0.05). Histopathological examination confirmed negative margins in all cases. Cohort 2: A total of 26 bone margins were generated from 13 patients. After excluding one case where the posterior margin was unassessable due to condylar resection, 25 margins were ultimately assessed. Histopathological examination revealed one case of conventional ameloblastoma with a positive anterior margin, resulting in a positive margin rate of 4.0% (1/25).

Conclusion: Digital surgical guidance achieves millimeter-level precision in resecting mandibular ameloblastomas. Even with a planned 6-mm bone margin, a 4.0% positive margin risk remains; however, this distance can be considered a practical minimum benchmark for balancing oncological radicality and functional preservation.