Journal of Gastrointestinal Surgery最新文献_第6页

Early vs delayed oral feeding after esophagectomy for esophageal cancer: a systematic review and meta-analysis of randomized controlled trials assessing safety, clinical recovery, and quality of life outcomes 食管癌食管切除术后早期与延迟口服喂养：一项评估安全性、临床恢复和生活质量的随机对照试验的系统回顾和荟萃分析

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-12 DOI: 10.1016/j.gassur.2026.102322

Nirmal Paudel , Anurag Jha , Amina Basharat , Muhammad Huzaifa Khalil , Ramsha Ali , Shaista Qadir , Syed Hassan Akhlaq , Muhammad Anas , Muhammad Abbas , Awais Ayub , Muhammad Nabeel Saddique , Nukhbat Ullah Awan

Background

Esophagectomy traditionally involves delayed oral feeding (DOF) due to anastomotic leakage concerns. Enhanced Recovery After Surgery protocols favor early feeding, but its safety remains controversial. This study compared early oral feeding (EOF) and DOF after esophagectomy.

Methods

PubMed, Embase, and Scopus were systematically searched from inception of the study to October 2025 for randomized controlled trials comparing EOF (0–3 days) and DOF (≥5 days) after esophagectomy. The primary outcomes were anastomotic leakage and pneumonia. The secondary outcomes included complications, hospital outcomes, gastrointestinal (GI) recovery, and quality of life (QOL). Effect sizes were calculated as mean differences (MDs) or standardized MDs (SMDs) for continuous variables and risk ratios (RRs) for dichotomous variables, with 95% CIs, using Review Manager (version 5.4; Cochrane Collaboration).

Results

A total of 13 trials involving 1468 patients were included in the study. Early feeding showed no increase in anastomotic leakage (RR, 0.89 [95% CI, 0.55–1.45]; I² = 0%), with consistent safety across anastomotic locations and surgical approaches. Early feeding significantly reduced pneumonia (RR, 0.66 [95% CI, 0.47–0.92]; P =.01) and accelerated GI recovery: time to first bowel movement (MD, −0.50 days [95% CI, −0.55 to −0.46]; P <.00001) and first flatus (MD, −0.61 days [95% CI, −0.95 to −0.26]; P =.0006). Hospital stay was reduced by 1.89 days (95% CI, −3.06 to −0.72; P =.002) with lower medical expenses (SMD, −1.19 [95% CI, −2.07 to −0.30]; P =.009). QOL improved: global health status (MD, 9.08 [95% CI, 3.88–14.29]; P =.0006), dysphagia (MD, −6.15 [95% CI, −9.97 to −2.34]; P =.002), pain (MD, −3.60 [95% CI, −5.32 to −1.89]; P <.00001), and swallowing difficulties (MD, −1.39 [95% CI, −1.53 to −1.26]; P <.00001).

Conclusion

EOF after esophagectomy seems safe and effective, reducing complications while accelerating recovery. However, further high-quality multicenter trials are needed to validate these findings.

背景：传统的食管切除术由于担心吻合口漏而延迟口服喂养。手术后增强恢复（ERAS）方案支持早期喂养，但其安全性仍存在争议。我们比较了食管切除术后早期和延迟口服喂养。方法：我们系统地检索PubMed、Embase和Scopus到2025年10月的随机对照试验，比较食管切除术后早期（50 -3天）和延迟（≥5天）口服喂养。主要结局为吻合口漏和肺炎。次要结局包括并发症、医院结局、胃肠道恢复和生活质量。使用Review Manager5.4计算连续变量的效应量为平均差异（MD）或标准化平均差异（SMD），二分类变量的风险比（RR）为95%置信区间。结果：纳入13项试验，共1468例患者。早期喂养没有增加吻合口漏（RR:0.89, 95% CI:0.55 ~ 1.45, I²=0%），在不同的吻合口位置和手术入路具有一致的安全性。早期喂养可显著减少肺炎（RR:0.66, 95% CI:0.47 ~ 0.92, p=0.01），加速胃肠道恢复：至第一次排便时间（MD:-0.50天，95% CI: -0.55 ~ 0.46）。结论：食管切除术后早期口服喂养安全有效，可减少并发症，加速恢复。然而，需要进一步的高质量多中心试验来验证这些发现。

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引用次数: 0

The association of preoperative nutritional status and physical fitness with postoperative outcomes in esophageal cancer: results from the PReoperative intervention to Improve Outcomes in esophageal cancer patients after Resection study 食管癌术前营养状况和身体健康与术后预后的关系：来自PRIOR研究的结果

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-12 DOI: 10.1016/j.gassur.2026.102327

Elja A.E. Reijneveld , Jaap J. Dronkers , Iris B. Mekenkamp , Joran J. Kauw , Ewout A. Kouwenhoven , Jan Willem Haveman , Edwin J. van Adrichem , Miranda J. Velthuis , Sandra Beijer , Jelle P. Ruurda , Cindy Veenhof , On behalf of the PRIOR study group

Purpose

This study aimed to investigate whether preoperative nutritional status and physical fitness after prehabilitation are associated with surgical outcomes, functional capacity, fatigue, and quality of life after esophagectomy.

Methods

This multicenter, observational cohort study included patients with esophageal cancer who underwent curative treatment and multimodal prehabilitation as part of standard care. Preoperative assessments included body mass index (BMI), risk of malnutrition, exercise capacity, handgrip strength (HGS), upper leg muscle function, physical activity level, and fatigue, after finishing prehabilitation. Differences in preoperative parameters between patients with and without postoperative overall or pulmonary complications were analyzed using independent samples t-tests. Associations between preoperative parameters and length of hospital stay, postoperative functional capacity, fatigue, and quality of life were examined using multivariable linear regression models.

Results

A total of 168 patients were included in the study, with a mean age of 65.9 ± 8.6 years and 78.0% of the patients being male. A higher preoperative BMI was associated with more overall complications (P =.029). Better preoperative exercise capacity and upper leg muscle function were associated with less pulmonary complications (P <.045) and better postoperative functional capacity (P <.032). Less preoperative fatigue was associated with better postoperative functional capacity, quality of life, and less fatigue (P ≤.001). Risk of malnutrition, HGS, and physical activity level were not significantly associated with postoperative outcomes.

Conclusion

BMI, exercise capacity, upper leg muscle function, and fatigue seem to be important factors in the preoperative assessment before esophagectomy in terms of postoperative complications, postoperative functional capacity, fatigue, and quality of life. During prehabilitation, specific attention is needed for patients with a high BMI, low fitness level, and high fatigue.

目的：探讨食管癌患者术前营养状况和康复后的身体健康状况是否与食管癌术后预后、功能能力、疲劳和生活质量相关。方法：这项多中心、观察性队列研究纳入了接受根治性治疗和作为标准治疗一部分的多模式康复治疗的食管癌患者。术前评估包括身体质量指数（BMI）、营养不良风险、运动能力、握力、上肢肌肉功能、体力活动水平和完成康复后的疲劳程度。采用独立t检验分析有和无术后整体或肺部并发症患者术前参数的差异。使用多变量线性回归模型检查与住院时间、术后功能能力、疲劳和生活质量的关系。结果：纳入患者168例，平均年龄65.9±8.6岁；78.0%的男性。术前BMI越高，总并发症越多（p= 0.029）。结论：BMI、运动能力、上肢肌肉功能和疲劳似乎是食管切除术前术前评估的重要因素，无论是在术后并发症、术后功能能力、疲劳和生活质量方面。因此，在(p)康复过程中，需要特别注意高BMI、低健康水平和高疲劳的患者。

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引用次数: 0

Invited commentary on “Restoring bowel continuity after extended left colectomy: a comparative study of the retroileal window and Deloyers techniques” 特邀评论“延长左结肠切除术后恢复肠道连续性：回肠后窗和Deloyers技术的比较研究”

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-08 DOI: 10.1016/j.gassur.2025.102309

Vitaliy Poylin

引用次数: 0

Overuse of subtotal cholecystectomy: surgeon practice patterns and outcomes in a large healthcare system 过度使用胆囊次全切除术：大型医疗保健系统的外科医生实践模式和结果。

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-08 DOI: 10.1016/j.gassur.2026.102325

Ramsey Michael Dallal , Samantha Ekanayake , Alec C. Beekley , Sultan Mahmoud Abdelhamid , Radi F. Zaki , Noah Streitfeld , Charles J. Yeo

Background

Subtotal cholecystectomy (SC) is a possible bailout procedure to prevent bile duct injuries (BDIs) when a critical view of safety cannot be obtained during cholecystectomy (CC).

Methods

This retrospective study analyzed 17,299 CCs performed by 111 surgeons across 12 hospitals within 1 large healthcare system using multilevel propensity-weighted logistic regression to model the risk of SC and reinterventions, accounting for patient-, surgeon-, and hospital-level factors.

Results

Among 157 SC cases, 94 (60%) were performed by just 8 surgeons, who collectively accounted for only 13% of all CCs. In addition, 136 cases (87%) of SC were concentrated in 3 hospitals, accounting for 31% of all CCs. Surgeons with increasing experience performing SC were significantly more likely to perform the procedure (odds ratio [OR], 1.13; P =.004). Conversely, the more CCs a surgeon performed, the lower the likelihood of performing an SC (OR, 0.998; P <.001). Fellowship training and years of experience were not significant independent predictors. The 30-day disease-specific reintervention rate after SC was 22.3%. There was no detectable increase in reinterventions among surgeons or hospitals who had never or rarely performed SC. In addition, 6 major BDIs requiring reconstruction were identified after CC (BDI rate of 0.03%). Surgeon-level variability, not hospital-level variability, explained the residual clustering of SC use, accounting for 16% of the adjusted residual.

Conclusion

SC use was primarily surgeon driven, even after accounting for patient factors that were independently associated with SC. These findings challenge SC’s role as a universal bailout and call for curbing its discretionary overuse.

背景：当在胆囊切除术（CC）中不能获得安全的关键观点时，胆囊次全切除术（SC）是一种可能预防胆管损伤（BDI）的救助手术。方法：我们回顾性分析了一个大型医疗保健系统内12家医院111名外科医生进行的17,299例（cc）手术，采用多层次倾向加权logistic回归模型，考虑患者、外科医生和医院层面的因素，对SC和再干预的风险进行建模。结果：157例SC病例中，60%由8名外科医生完成，合计仅占全部胆囊切除术的13%。136例（87%）SC集中在3家医院，占所有CC的31%。经验丰富的外科医生更有可能实施SC手术（OR 1.13, p = 0.004）。相反，外科医生行CC越多，行SC的可能性越低（OR 0.998, p < 0.001）。研究金培训和经验年数不是显著的独立预测因子。SC后30天疾病特异性再干预率为22.3%。在从未或很少行过SC的外科医生或医院中，再干预的发生率没有明显增加。CC后发现了6个需要重建的主要胆管损伤（BDI率为0.03%）。外科医生水平的可变性，而不是医院水平的可变性，解释了SC使用的残差聚类，占调整残差的16%。结论：SC的使用主要是由外科医生驱动的，即使在考虑了与SC独立相关的患者因素之后。这些发现挑战了SC作为普遍救助的作用，并呼吁限制其酌情过度使用。

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引用次数: 0

Invited commentary on “Contemporary emergency management and 1-year outcomes of colonic diverticulitis: a population-based cohort study” 特邀评论：当代急诊管理和结肠憩室炎的1年预后：一项基于人群的队列研究。

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.gassur.2026.102323

Sean J. Langenfeld

引用次数: 0

Robotic-assisted decompression of the celiac trunk via the common hepatic artery approach for median arcuate ligament syndrome 经肝总动脉入路腹腔干机器人辅助减压治疗正中弓状韧带综合征。

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-06 DOI: 10.1016/j.gassur.2026.102321

Michela Orsi, Lorenza Beomonte Zobel, Giuseppe S. Sica

引用次数: 0

Transcriptomics Uncovers the Advantages of Magnetic Compression Technique in Gastrointestinal Anastomosis Repair and Regeneration. 转录组学揭示磁压缩技术在胃肠道吻合口修复和再生中的优势。

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-05 DOI: 10.1016/j.gassur.2025.102314

Long Liu, Shuqin Xu, Chentao Li, Jiaru Xu, Linbiao Xiang, Yuning Shao, Miaomiao Zhang, Dinghui Dong, Shuang Bai, Xuemin Liu, Xiaopeng Yan, Yi Lyu

Background: Magnetic compression technique (MCT) is a novel surgical operation leveraging the 'non-contact' magnetic forces to address challenging clinical issues. The underlying mechanisms of different healing efficacy in gastroenteric anastomosis are still not clarified between MCT and traditional suturing techniques.

Methods: A total of twenty male Sprague-Dawley (SD) rats, weighing 200-240g, were randomly and equally divided into traditional suturing (Con) and MCT group. The anastomosis construction time, survival rates, and postoperative complications were compared. Specimens were collected, and RNA sequencing was conducted at two weeks postoperatively, Meanwhile, the burst pressure and histological characteristics were compared between two groups.

Results: The anastomosis time of MCT group (6.20 ± 1.51min) was significantly shorter than Con group (15.7 ± 2.43min; P < 0.001). Compared to Con group (80%), the survival rate was significantly higher in the MCT group (100%). No postoperative complications were observed in MCT group. The burst pressure and histological characteristics suggested the MCT group harbored more durable, smoother and fatter surface, complete mucosal migration, less inflammation infiltration, and continuous submucosal layers. The transcriptomics indicated that biological characteristic of MCT group was mainly enriched in energy metabolism, especially for lipid metabolism. The evaluated expression of Nfil3 and Pdk4 could serve as key metabolic molecules regulating anastomotic healing.

Conclusion: The MCT presented significant advantages in multiple dimensions, including simple, safety, low postoperative complications. A novel insight was provided that MCT facilitated energy metabolism and further promoted anastomotic healing.

背景：磁压缩技术（MCT）是一种新型的外科手术，利用“非接触”磁力来解决具有挑战性的临床问题。MCT与传统缝合技术在胃肠吻合术中愈合效果差异的潜在机制尚不清楚。方法：选取雄性SD大鼠20只，体重200 ~ 240g，随机平均分为传统缝合组（Con）和MCT组（MCT）。比较两组吻合时间、生存率及术后并发症。术后2周采集标本，进行RNA测序，同时比较两组破裂压力及组织学特征。结果：MCT组吻合时间（6.20±1.51min）明显短于Con组（15.7±2.43min, P < 0.001）。与Con组（80%）相比，MCT组（100%）的生存率显著高于Con组（80%）。MCT组无术后并发症。破裂压力和组织学特征提示MCT组粘膜表面更持久、光滑、厚实，粘膜迁移完全，炎症浸润较少，粘膜下层连续。转录组学分析表明，MCT组的生物学特性主要集中在能量代谢方面，尤其是脂质代谢方面。Nfil3和Pdk4的表达可能是调控吻合口愈合的关键代谢分子。结论：MCT具有简单、安全、术后并发症少等多方面的显著优势。MCT促进了能量代谢，进一步促进了吻合口愈合。

{"title":"Transcriptomics Uncovers the Advantages of Magnetic Compression Technique in Gastrointestinal Anastomosis Repair and Regeneration.","authors":"Long Liu, Shuqin Xu, Chentao Li, Jiaru Xu, Linbiao Xiang, Yuning Shao, Miaomiao Zhang, Dinghui Dong, Shuang Bai, Xuemin Liu, Xiaopeng Yan, Yi Lyu","doi":"10.1016/j.gassur.2025.102314","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.102314","url":null,"abstract":"<p><strong>Background: </strong>Magnetic compression technique (MCT) is a novel surgical operation leveraging the 'non-contact' magnetic forces to address challenging clinical issues. The underlying mechanisms of different healing efficacy in gastroenteric anastomosis are still not clarified between MCT and traditional suturing techniques.</p><p><strong>Methods: </strong>A total of twenty male Sprague-Dawley (SD) rats, weighing 200-240g, were randomly and equally divided into traditional suturing (Con) and MCT group. The anastomosis construction time, survival rates, and postoperative complications were compared. Specimens were collected, and RNA sequencing was conducted at two weeks postoperatively, Meanwhile, the burst pressure and histological characteristics were compared between two groups.</p><p><strong>Results: </strong>The anastomosis time of MCT group (6.20 ± 1.51min) was significantly shorter than Con group (15.7 ± 2.43min; P < 0.001). Compared to Con group (80%), the survival rate was significantly higher in the MCT group (100%). No postoperative complications were observed in MCT group. The burst pressure and histological characteristics suggested the MCT group harbored more durable, smoother and fatter surface, complete mucosal migration, less inflammation infiltration, and continuous submucosal layers. The transcriptomics indicated that biological characteristic of MCT group was mainly enriched in energy metabolism, especially for lipid metabolism. The evaluated expression of Nfil3 and Pdk4 could serve as key metabolic molecules regulating anastomotic healing.</p><p><strong>Conclusion: </strong>The MCT presented significant advantages in multiple dimensions, including simple, safety, low postoperative complications. A novel insight was provided that MCT facilitated energy metabolism and further promoted anastomotic healing.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102314"},"PeriodicalIF":2.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917527","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}

引用次数: 0

Exercise interventions for health-related quality of life, fatigue, depression, and anxiety in colorectal cancer survivors: a systematic review and network meta-analysis 运动干预对结直肠癌幸存者健康相关生活质量、疲劳、抑郁和焦虑的影响：系统综述和网络荟萃分析

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-03 DOI: 10.1016/j.gassur.2026.102320

Hu Tang , Lin Zhang , Yangliang Ren , Yuxiang Wu , Xiang Zhang , Yi Dai , Jian Chen

Background

Colorectal cancer survivors frequently experience persistent fatigue, psychological distress, and reduced health-related quality of life (HRQoL) after treatment. Exercise is increasingly recognized as an effective nonpharmacologic intervention, but the comparative efficacy of different modalities remains uncertain. This study aimed to evaluate and rank the effects of exercise interventions on HRQoL, fatigue, depression, and anxiety in colorectal cancer survivors through a systematic review and network meta-analysis.

Methods

Five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar) were searched from inception to October 30, 2025. Eligible randomized controlled trials included adult colorectal cancer survivors receiving structured exercise interventions—such as aerobic exercise (AE), resistance training (RT), combined AE plus RT (AE + RT), yoga, qigong, tai chi, or multicomponent programs—compared with usual care or alternative exercise modalities. Primary outcomes were HRQoL, fatigue, depression, and anxiety assessed after the intervention. Standardized mean differences (SMDs) and 95% CIs were pooled using random-effects models, and comparative rankings were estimated using the surface under the cumulative ranking curve (SUCRA).

Results

A total of 22 trials (n = 1676) met the inclusion criteria. Overall, exercise significantly improved HRQoL (SMD, 0.48; 95% CI, 0.28–0.67) and reduced fatigue (SMD, −0.44; 95% CI, −0.70 to −0.19), depression (SMD, −0.29; 95% CI, −0.48 to −0.10), and anxiety (SMD, −0.29; 95% CI, −0.42 to −0.15). Subgroup analyses indicated greater effects with supervised or tele-supervised, moderate-intensity programs (3–5.9 metabolic equivalents of task) in 30- to 60-min sessions, 3 to 4 times weekly for 9 to 23 weeks. Network meta-analysis ranked RT highest for improving HRQoL (SUCRA, 91.8%), and AE + RT most effective for reducing fatigue, depression, and anxiety (SUCRA, 81.7%–82.4%).

Conclusion

Exercise significantly enhances HRQoL and psychological well-being in colorectal cancer survivors, with optimal benefits observed from moderate-intensity, supervised, or tele-supervised programs. AE + RT seems the most effective for symptom relief, whereas RT provides the greatest gains in global quality of life.

背景：结直肠癌幸存者在治疗后经常经历持续疲劳、心理困扰和健康相关生活质量（HRQoL）下降。运动越来越被认为是一种有效的非药物干预，但不同方式的比较效果仍然不确定。本研究旨在通过系统回顾和网络荟萃分析，评估和排名运动干预对结直肠癌幸存者HRQoL、疲劳、抑郁和焦虑的影响。方法：检索5个数据库（PubMed、Embase、Cochrane CENTRAL、Web of Science和谷歌Scholar），检索时间从建库到2025年10月30日。符合条件的随机对照试验包括接受结构化运动干预的成年结直肠癌幸存者，如有氧运动（AE）、阻力训练（RT）、有氧加阻力联合训练（AE+RT）、瑜伽、气功、太极或多组分项目，与常规护理或替代运动方式进行比较。干预后评估的主要结局是HRQoL、疲劳、抑郁和焦虑。采用随机效应模型合并标准化平均差异（SMDs）和95%置信区间（ci），并通过累积排名曲线（SUCRA）下的曲面估计比较排名。结果：22项试验（n = 1676）符合纳入标准。总的来说，运动显著改善了HRQoL (SMD = 0.48, 95% CI 0.28-0.67)，减少了疲劳（SMD = -0.44, 95% CI -0.70至-0.19）、抑郁（SMD = -0.29, 95% CI -0.48至-0.10）和焦虑（SMD = -0.29, 95% CI -0.42至-0.15）。亚组分析表明，有监督或远程监督的项目效果更好，中等强度（3-5.9 METs），每次30-60分钟，每周三到四次，持续9-23周。网络荟萃分析显示，RT在改善HRQoL方面效果最好（SUCRA = 91.8%）， AE+RT在减轻疲劳、抑郁和焦虑方面效果最好（SUCRA = 81.7%-82.4%）。结论：运动可显著提高结直肠癌幸存者的HRQoL和心理健康，中等强度、监督或远程监督的运动效果最佳。AE+RT似乎对症状缓解最有效，而RT在总体生活质量方面提供了最大的收益。

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引用次数: 0

Invited commentary on “Body mass index and survival after surgery for gastric adenocarcinoma – a population-based nationwide cohort study in Finland” revisiting the obesity paradox in gastric cancer surgery 特邀评论“体重指数与胃腺癌术后生存率——芬兰一项以人群为基础的全国性队列研究”重新审视胃癌手术中的肥胖悖论。

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2026-01-02 DOI: 10.1016/j.gassur.2025.102310

Mio Kitano, Alexander A. Parikh

引用次数: 0

Defining a new 6-factor Charlson Comorbidity Index utilizing data points available in the American College of Surgeons National Surgical Quality Improvement Program for patients undergoing pancreatoduodenectomy 利用ACS-NSQIP数据点定义胰十二指肠切除术患者新的6因素Charlson合并症指数

IF 2.4 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-12-30 DOI: 10.1016/j.gassur.2025.102319

John Christopher Polanco-Santana , João P.G. Kasakewitch , Kaique Filardi , Scott C. Fligor , Manuel Castillo-Angeles , Tara S. Kent

Background

The Charlson Comorbidity Index (CCI) is widely used in surgical research to summarize patients’ baseline comorbidities. However, large surgical databases, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), lack key CCI components, limiting its applicability. Developing a modified CCI (mCCI) using available ACS-NSQIP variables could improve baseline risk stratification for patients undergoing pancreatoduodenectomy (PD). This study aimed to define such an mCCI and evaluate its performance compared with that of the conventional CCI.

Methods

This was a 2-phase retrospective study that included patients who underwent PD. In the derivation phase, our institutional ACS-NSQIP database (2015–2021) was used to construct the mCCI, with scores reweighted to the observed 14-point maximum. The Spearman rank correlation was used to evaluate the relationship between CCI and mCCI. The nationwide ACS-NSQIP database (2022) was used for external validation. Unadjusted logistic regression models were constructed to predict discharge disposition and postoperative complications. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC)/receiver operating characteristic curve analysis with AUCs compared with the DeLong test.

Results

A total of 333 institutional and 4867 national patients who underwent PD were included. In the derivation cohort, the mCCI was strongly correlated with the CCI (r = 0.85; P <.001). For discharge disposition, both indices yielded an AUC of 0.74. For postoperative complications, AUCs were 0.50 for CCI and 0.55 for mCCI. Similar trends were observed in external validation. No significant differences were found in the discriminatory capacities between the models.

Conclusion

mCCI is a reasonable alternative to account for baseline comorbidities in patients undergoing PD using the ACS-NSQIP database. Further studies should refine weighting schemes across diverse populations to optimize mCCI performance.

背景：Charlson合并症指数（CCI）在外科研究中被广泛用于总结患者的基线合并症。然而，大型外科数据库如ACS-NSQIP缺乏关键的CCI组件，限制了其适用性。使用ACS-NSQIP可用变量开发改良的CCI （mCCI）可以改善胰十二指肠切除术（PD）患者的基线风险分层。我们的目标是定义这样一个mCCI，并评估其性能与传统的CCI比较。方法：两期回顾性研究，纳入PD患者。在推导阶段，使用我们的机构ACS-NSQIP数据库（2015-2021）构建mCCI，并将得分重新加权为观测到的14分最大值。采用Spearman等级相关评价CCI与mCCI之间的关系。外部验证采用全国ACS-NSQIP数据库（2022）。建立未调整logistic回归模型预测出院处置和术后并发症。模型判别采用AUC/ROC分析，AUC比较采用DeLong检验。结果：共纳入333名机构和4867名全国PD患者。在衍生队列中，mCCI与CCI呈强相关（r=0.85）。结论：使用ACS-NSQIP数据库，mCCI是考虑PD患者基线合并症的合理选择。进一步的研究应该改进不同人群的加权方案，以优化mCCI性能。

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引用次数: 0