Journal of Gastrointestinal Surgery最新文献

{"title":"First clinical report of the international single-port robotic rectal cancer registry","authors":"John H. Marks , Hye Jin Kim , Gyu-Seog Choi , Luis Andres Idrovo , Suraj Chetty , Thais Reif De Paula , Deborah Keller","doi":"10.1016/j.gassur.2024.101929","DOIUrl":"10.1016/j.gassur.2024.101929","url":null,"abstract":"<div><h3>Background</h3><div>Rectal cancer surgery remains a significant technical challenge. The development and implementation of a new technology offer hope for more accurate and precise surgery. To evaluate whether single-port robotic (SPr) technology helps achieve this goal, an international SPr registry was established. This study reported short-term clinical and oncologic outcomes from an international SPr registry for rectal cancer.</div></div><div><h3>Methods</h3><div>A review of a prospective international registry of SPr technology approved for colorectal surgery with an investigational design exemption was conducted. Patients with rectal adenocarcinoma who had resection for curative intent using the SPr platform between November 2018 and September 2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncologic, and clinical outcome variables. The main outcome measure was the quality of the total mesorectal excision (TME) specimen. The secondary outcome measures were intraoperative conversion and 30-day postoperative morbidity and mortality.</div></div><div><h3>Results</h3><div>A total of 113 SPr procedures for rectal cancer were performed at 2 centers by 4 colorectal surgeons. Of note, 9 local excisions were excluded, leaving 104 cases analyzed. The cohort consisted of 53 men (50.96%), had a mean age of 60.00 years (SD, 11.29), and had a body mass index of 25.80 kg/m<sup>2</sup> (SD, 6.18). The most common T stage was 3 (55 [52.8%]), followed by 2 (19 [18.26%]). More than 60% of patients had preoperative neoadjuvant chemoradiation. The mean tumor distance from the anorectal ring was 2.90 cm (SD, 2.62), and the mean tumor size was 4.52 cm (SD, 1.82). The procedures performed included transanal abdominal transanal/transanal TME (52 [46%]), low anterior resection (49 [43.3%]), and abdominoperineal resection (3 [2.7%]). The mean operating time was 168.0 min (SD, 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.30 cm (SD, 1.31). The TME specimens were complete in 101 cases (97.1%) and near complete in 3 cases (2.9%). The R1 rate was 3.8%, with 3 positive distal margins and 1 positive circumferential margin. Postoperatively, there were 15 total complications, of which 4 were major complications and 11 were minor complications. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.</div></div><div><h3>Conclusion</h3><div>This early international experience with the SPr procedure showed that it is a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates observed with other techniques and platforms used in rectal cancer surgery were not demonstrated. An international registry was used to better understand the opportunities and limitations of SPr technology in rectal cancer surgery as the tec","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101929"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824230","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 incidence and temporal trend of appendicitis in children: An analysis from the Global Burden of Disease Study 2021","authors":"Ran He ,&nbsp;Jianxiong Lai ,&nbsp;Ou Jiang ,&nbsp;Jian Li","doi":"10.1016/j.gassur.2024.101935","DOIUrl":"10.1016/j.gassur.2024.101935","url":null,"abstract":"<div><h3>Background</h3><div>Challenges persist in the management of appendicitis in children, but its incidence and temporal trends have been reported in only a few developed countries. This study aimed to comprehensively investigate the incidence and temporal trends of appendicitis in children at the global, regional, and national levels, providing evidence for implementing and scaling up intervention services to reduce adverse health outcomes.</div></div><div><h3>Methods</h3><div>This study downloaded incidence data on appendicitis in children from the Global Burden of Disease 2021. Data on number and rate of appendicitis in children were analyzed at the global, sex, age, sociodemographic, regional, and national levels. The percentage changes and average annual percentage changes were calculated. The association between the sociodemographic index (SDI) and incidence of appendicitis in children was also determined by Pearson correlation analysis.</div></div><div><h3>Results</h3><div>In 2021, the newly diagnosed appendicitis in children was estimated to be 2,193,020, accounting for 12.93% of all cases of appendicitis in the general population. The corresponding incidence rate was estimated to be 109 per 100,000. From 1990 to 2021, the incidence of appendicitis in children increased by 0.3% annually. The incidence varied widely across regions and countries, whereas there was a significant positive association between the incidence rates (R = 0.6620, <em>P</em> &lt;.001) and its percentage changes (R = 0.2234, <em>P</em> =.0013) of appendicitis in children and the SDI.</div></div><div><h3>Conclusion</h3><div>Appendicitis will continue to be a major public health challenge in children worldwide, especially in transitioning countries and regions. A comprehensive description of the incidence and its changing patterns, increasing awareness, and rational resource allocation are needed to reduce the burden of pediatric appendicitis.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101935"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864557","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":"Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?","authors":"Sami Alahmadi ,&nbsp;David L. Berger ,&nbsp;Christy E. Cauley ,&nbsp;Robert N. Goldstone ,&nbsp;William V. Kastrinakis ,&nbsp;Marc Rubin ,&nbsp;Hiroko Kunitake ,&nbsp;Rocco Ricciardi ,&nbsp;Grace C. Lee","doi":"10.1016/j.gassur.2024.101899","DOIUrl":"10.1016/j.gassur.2024.101899","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.</div></div><div><h3>Results</h3><div>Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (<em>P</em> &gt;.05) or rates of incomplete donuts (<em>P</em> =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; <em>P</em> =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; <em>P</em> =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; <em>P</em> =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; <em>P</em> =.94).</div></div><div><h3>Conclusion</h3><div>EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101899"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750972","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":"An isolated pancreatic myeloid sarcoma","authors":"Long He ,&nbsp;Hongzhen Wei ,&nbsp;Tao Yin","doi":"10.1016/j.gassur.2024.101923","DOIUrl":"10.1016/j.gassur.2024.101923","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101923"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807280","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":"Efficacy evaluation of postoperative adjuvant TACE in preventing HCC recurrence within Milan criteria: A multi-center propensity score matching analysis based on pathological indicators.","authors":"Kun He, Yongqiang Xiao, Shuju Tu, Yourao Li, Zhao Wu, Liping Liu, Wei Shen, Shiyun Bao, Yongzhu He","doi":"10.1016/j.gassur.2025.101978","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101978","url":null,"abstract":"<p><strong>Objective: </strong>Malignant biological behaviors such as microvascular invasion (MVI), satellite nodule formation and poor differentiation can appear in the postoperative pathology of early hepatocellular carcinoma (HCC), which often indicates that it has entered the stage of malignant evolution earlier. This study aimed to evaluate tumor recurrence in HCC patients meeting the Milan criteria who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE) based on postoperative pathological indices.</p><p><strong>Methods: </strong>A retrospective study was conducted on 790 HCC patients within the Milan criteria who underwent hepatectomy across four medical centers, comprising 366 patients treated with PA-TACE and 424 patients without PA-TACE. To reduce selection bias, propensity score matching (PSM) at a 1:1 ratio was applied, achieving balanced clinical characteristics between the two groups.</p><p><strong>Results: </strong>Patients receiving PA-TACE did not experience more severe adverse events or toxicity-related deaths. After PSM of each subgroup, it was found that patients with MVI (Median time: 37 months vs 17 months, p = 0.010), satellite nodules (Median time: NA vs 14 months, p = 0.018), and Edmondson-Steiner grade III-IV (Median time: NA vs 13 months, p = 0.004) who received PA-TACE had higher recurrence-free survival (RFS). However, patients who were MVI-negative, satellite nodule-negative, and Edmondson-Steiner grade I-II did not benefit from PA-TACE in terms of RFS (All p > 0.05). Patients who received PA-TACE were more likely to undergo liver transplantation, re-hepatectomy, and local ablation after tumor recurrence, whereas patients who did not receive PA-TACE were more likely to receive TACE, chemoradiotherapy, and immunotargeted therapy after tumor recurrence (All p < 0.05).</p><p><strong>Conclusion: </strong>Postoperative pathological indicators can guide the selection of PA-TACE for patients with HCC within the Milan criteria. Patients with MVI, satellite nodules, and Edmondson-Steiner grade III-IV are more suitable for receiving PA-TACE to improve RFS. PA-TACE may alter the recurrence pattern of tumors, rendering them more localized.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101978"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122999","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":"Endoluminal approaches for colorectal neoplasia in inflammatory bowel disease: a viable alternative for colectomy?","authors":"Ali Alipouriani,&nbsp;Stefan D. Holubar,&nbsp;Kamil Erozkan,&nbsp;Lukas Schabl,&nbsp;Joshua Sommovilla,&nbsp;Michael Valente,&nbsp;Scott R. Steele,&nbsp;Emre Gorgun","doi":"10.1016/j.gassur.2024.101876","DOIUrl":"10.1016/j.gassur.2024.101876","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) is an alternative to colectomy. The endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ESD combined with EMR. These endoscopic approaches may allow organ preservation in patients with IBD. This study aimed to evaluate the outcomes of endoscopic resection, including EMR, ESD, and ESD combined with EMR, for the treatment of colorectal dysplasia in patients with IBD.</div></div><div><h3>Methods</h3><div>This was a retrospective review of patients with IBD who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 and 2023. Patients were identified via a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes, including recurrence of dysplasia.</div></div><div><h3>Results</h3><div>A total of 50 patients with IBD who underwent endoscopic resection were included in the study, with 38 ESD cases, 11 ESD combined with EMR cases, and 1 EMR case. The median age was 62 years, (IQR, 54–68), and 34 patients (68%) were male. The median body mass index was 27.6 kg/m² (IQR, 24.8–31.7). The underlying diagnoses were ulcerative colitis in 33 patients (66%) and Crohn’s disease in 17 patients (33%). The median disease duration was 27.5 years (IQR, 8–30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 polyps (18%) in each area. The median procedure time was 47.5 min (IQR, 31.2–73.7). En bloc resection was performed in 34 patients (68%), and piecemeal resection was performed in 16 patients (32%). On pathology, the median lesion size was 23.5 mm (IQR, 20.2–40.0). High-grade dysplasia was found in 7 patients (14%), whereas low-grade dysplasia was found in 15 patients (30%). During a median follow-up period of 3 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD combined with EMR groups.</div></div><div><h3>Conclusion</h3><div>Endoscopic resection, including EMR, ESD, and ESD combined with EMR, is an effective treatment of visible dysplastic lesions and is a safe alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were observed after endoscopic resection.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101876"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621983","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":"Effects of gut microbiota and metabolites on pancreatitis: a 2-sample Mendelian randomization study","authors":"Zhirong Zhao ,&nbsp;Li Han ,&nbsp;Baobaonai Tuerxunbieke ,&nbsp;Lan Ming ,&nbsp;Jiamin Ji ,&nbsp;Yuan Chen ,&nbsp;Ran Sun ,&nbsp;Weiliang Tian ,&nbsp;Fan Yang ,&nbsp;Qian Huang","doi":"10.1016/j.gassur.2024.101885","DOIUrl":"10.1016/j.gassur.2024.101885","url":null,"abstract":"<div><h3>Background</h3><div>Acute pancreatitis (AP) and chronic pancreatitis (CP) have high incidences and poor prognoses. The early screening of at-risk populations still awaits further study. The limitation was mainly based on observational studies, with limited sample size and the presence of confounding factors. This study used a 2-sample Mendelian randomization (MR) analysis based on publicly available data from genome-wide association studies to reveal the causal effect of gut microbiota and metabolites on pancreatitis.</div></div><div><h3>Methods</h3><div>This study collected summary statistics on gut microbiota, metabolites, AP, and CP. A 2-sample MR analysis was performed using MR-Egger, inverse variance-weighted, MR Pleiotropy RESidual Sum and Outlier, maximum likelihood, and weighted median.</div></div><div><h3>Results</h3><div>The 2-sample MR showed that only <em>Eubacterium coprostanoligenes</em> was an independent protective factor for AP among all gut microbiota, and the other microbiota were not significant for pancreatitis. Unsaturated fatty acids in metabolites are protective factors for both AP (odds ratio [OR], 0.730; 95% CI, 0.593–0.899; <em>P</em> = .003) and CP (OR, 0.660; 95% CI, 0.457–0.916; <em>P</em> = .013). Furthermore, carnitine was a protective factor CP, and glucose was an independent risk factor for CP.</div></div><div><h3>Conclusion</h3><div>This study provides potential evidence of the causal role of gut microbiota and metabolites on pancreatitis, which may be conducive for designing microbiome and metabolite interventions on AP or CP in the future.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101885"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644075","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":"Long-term follow-up of sacrococcygeal pilonidal sinus disease after previous abscess drainage: a retrospective cohort study","authors":"Jochem de Kort ,&nbsp;Anne Akke Pronk ,&nbsp;Menno R. Vriens ,&nbsp;Niels Smakman ,&nbsp;Edgar J.B. Furnee","doi":"10.1016/j.gassur.2024.101892","DOIUrl":"10.1016/j.gassur.2024.101892","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101892"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687262","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":"Postoperative skeletal muscle loss as a prognostic indicator of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis","authors":"Chenyang Zhan ,&nbsp;Jun Bu ,&nbsp;Sheng Li ,&nbsp;Xiujin Huang ,&nbsp;Zongjie Quan","doi":"10.1016/j.gassur.2024.101898","DOIUrl":"10.1016/j.gassur.2024.101898","url":null,"abstract":"<div><h3>Background</h3><div>A decrease in skeletal muscle mass is frequently observed during the perioperative period in patients with gastric cancer (GC) and is strongly associated with postoperative complications and poor long-term survival outcomes. Relevant research indicates that a certain proportion of patients with GC experience skeletal muscle mass loss after surgery. Therefore, a systematic review and meta-analysis was conducted to assess postoperative skeletal muscle loss as a prognostic marker for clinical outcomes in patients with GC.</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, and Embase were used to systematically screen and retrieve relevant studies according to strictly established inclusion and exclusion criteria. Further analysis of the effect of postoperative skeletal muscle loss on long-term survival metrics (including overall survival [OS], recurrence-free survival [RFS], disease-free survival [DFS], and disease-specific survival [DSS]) in patients with GC was performed.</div></div><div><h3>Results’</h3><div>From 10 studies and 11 related publications, more than 3764 patients with GC were identified. Severe postoperative skeletal muscle loss occurred in 25.7% of patients with GC and was significantly correlated with poorer OS (hazard ratio [HR], 2.27; 95% CI, 1.58–3.25; <em>P</em> &lt;.00001), RFS (HR, 2.96; 95% CI, 1.47–5.97; <em>P</em> =.002), DFS (HR, 2.41; 95% CI, 1.17–4.97; <em>P</em> =.02), and DSS (HR, 4.12; 95% CI, 2.44–6.94; <em>P</em> &lt;.00001). When postoperative skeletal muscle loss advanced to sarcopenia, patients had worse OS as well (HR, 2.22; 95% CI, 1.49–3.30; <em>P</em> &lt;.0001).</div></div><div><h3>Conclusion</h3><div>Patients who undergo radical surgery for GC often experience skeletal muscle mass loss, and significant skeletal muscle mass loss is associated with poorer survival outcomes. Identifying patients with significant skeletal muscle mass loss during follow-up and promptly providing tailored interventions, such as nutritional and exercise support, are essential.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101898"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750974","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":"Analyzing the interaction between time to surgery and tumor burden score in hepatocellular carcinoma","authors":"Miho Akabane ,&nbsp;Jun Kawashima ,&nbsp;Selamawit Woldesenbet ,&nbsp;Abdullah Altaf ,&nbsp;François Cauchy ,&nbsp;Federico Aucejo ,&nbsp;Irinel Popescu ,&nbsp;Minoru Kitago ,&nbsp;Guillaume Martel ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;George A. Poultsides ,&nbsp;Yuki Imaoka ,&nbsp;Andrea Ruzzenente ,&nbsp;Itaru Endo ,&nbsp;Ana Gleisner ,&nbsp;Hugo P. Marques ,&nbsp;Vincent Lam ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2024.101903","DOIUrl":"10.1016/j.gassur.2024.101903","url":null,"abstract":"<div><h3>Background</h3><div>The effect of “time to surgery (TTS)” on outcomes for curative-intent hepatectomy of hepatocellular carcinoma (HCC) remains debated. The interaction between tumor burden score (TBS) and TTS remains unclear. We sought to evaluate the effects of TBS and TTS on long-term HCC outcomes.</div></div><div><h3>Methods</h3><div>Patients with HCC who underwent curative-intent hepatectomy (2000–2022) were analyzed from a multi-institutional database and categorized by TTS (≤60 or &gt;60 days). Overall survival (OS) and cancer-specific survival were assessed.</div></div><div><h3>Results</h3><div>Among 910 patients, median TTS estimates were 22 days in the short TTS group (n = 485) and 120 days in the long TTS group (n = 425). Patients with long TTS were older and were more likely to have American Society of Anesthesiologists class &gt;2, diabetes mellitus, and cirrhosis. There was no difference in median TBS among patients who had short versus long TTS (4.61 vs 5.00, respectively). In addition, there was no difference in 5-year OS (70.0% vs 63.1%, respectively; <em>P</em> =.05). On multivariate analysis TBS (hazard ratio [HR], 1.07; 95% CI, 1.03–1.11; <em>P</em> &lt;.001), log alpha-fetoprotein (HR, 1.08; 95% CI, 1.01–1.14; <em>P</em> =.02), and albumin-bilirubin score (HR, 2.52; 95% CI, 1.66–3.82; <em>P</em> &lt;.001) were associated with OS. In contrast, TTS was not associated with OS (HR, 1.18; 95% CI, 0.78–1.77; <em>P</em> =.43). Interaction analysis demonstrated that TBS was asssociated with OS among patients with short TTS (HR, 1.12; 95% CI, 1.07–1.17; <em>P</em> &lt;.001), but not among patients with long TTS (HR, 0.98; 95% CI, 0.91–1.05; <em>P</em> =.56). Among patients with low TBS (≤5), higher mortality was observed with long TTS versus short TTS (5-year OS: 82.4% vs 63.0%, respectively; <em>P</em> =.001); however, TTS was not associated with OS among patients with high TBS (5-year OS: 57.9% vs 63.3%, respectively; <em>P</em> =.92). Multivariate analysis demonstrated that long TTS was a risk factor for OS among patients with low TBS (HR, 3.12; 95% CI, 1.60–6.01; <em>P</em> &lt;.001), but not among individuals with high TBS (HR, 0.57; 95% CI, 0.30–1.07; <em>P</em> =.08). Similar trends were observed relative to cancer-specific survival.</div></div><div><h3>Conclusion</h3><div>TTS needs to be considered in light of patient and tumor-specific factors. Expediting TTS may be particularly important among patients with HCC and a low TBS.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101903"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755024","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}