Pub Date : 2024-11-16DOI: 10.1016/j.jss.2024.10.014
Andrei Gurau MD, MHS, MS , Olivia Monton MD, ScM , Jonathan B. Greer MD , Fabian M. Johnston MD, MHS
<div><h3>Introduction</h3><div>Minimally invasive surgery (MIS) is increasingly used in the surgical management of gastric cancer; however, its adoption lags that of other cancers. Most randomized controlled trials comparing MIS to open gastrectomy have been conducted in Asia, with limited data from the United States. This study aimed to compare perioperative, oncologic, and survival outcomes between open, laparoscopic, and robotic gastrectomy in a large US cohort.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, we identified patients with gastric adenocarcinoma who underwent open, laparoscopic, or robotic gastrectomy between 2010 and 2020. Multivariate regression models were used to examine the association between surgical approach and various outcomes, including 30-d readmission, length of stay (LOS), surgical margin status, lymph node yield, 30- and 90-d mortality, and overall survival (OS). The interaction between surgical approach and tumor location (distal versus proximal or gastroesophageal junction [GEJ]) was also assessed.</div></div><div><h3>Results</h3><div>Of the 34,937 included patients, 64.8% underwent open gastrectomy, 25.7% underwent laparoscopic surgery, and 9.5% underwent robotic surgery. MIS was associated with lower odds of 30-d readmission (laparoscopic: odds ratio [OR] 0.78, 95% confidence interval [CI] 0.67-0.89; robotic: OR 0.75, 95% CI 0.60-0.92), positive margins (laparoscopic: OR 0.83, 95% CI 0.74-0.93; robotic: OR 0.75, 95% CI 0.62-0.90), 30-d mortality (laparoscopic: OR 0.69, 95% CI 0.55-0.85; robotic: OR 0.66, 95% CI 0.44-0.95), and 90-d mortality (laparoscopic: OR 0.74, 95% CI 0.63-0.87; robotic: OR 0.63, 95% CI 0.47-0.84), as well as improved OS (laparoscopic: hazard ratio 0.83, 95% CI 0.79-0.87; robotic: hazard ratio 0.76, 95% CI 0.69-0.83) compared to open surgery. Considering the interaction of approach with tumor location, for proximal/GEJ tumors, the associated outcome improvements with MIS were attenuated. We observe that the odds for 30-d readmission, 90-d mortality, and OS are similar to those for open operations. However, regardless of tumor location, robotic gastrectomy was associated with decreased LOS and yielded a higher lymph node count than laparoscopic or open approaches.</div></div><div><h3>Conclusions</h3><div>In this large US cohort, MIS gastrectomy was associated with improved perioperative, oncologic, and survival outcomes compared to open surgery for distal gastric cancers. However, the associated benefits of MIS were attenuated for proximal/GEJ tumors, with higher odds of readmission, mortality, and worse OS. Notably, robotic gastrectomy was associated with superior lymph node yield and LOS compared to laparoscopic and open approaches, even for proximal/GEJ tumors. These findings underscore the need for further research, especially randomized controlled trials conducted in Western populations, to definitively determine the efficacy of MIS for distal and proximal/GEJ t
导言：微创手术（MIS）越来越多地用于胃癌的外科治疗，但其应用却落后于其他癌症。大多数比较微创手术和开腹胃切除术的随机对照试验都是在亚洲进行的，来自美国的数据有限。本研究旨在比较美国大样本中开腹胃切除术、腹腔镜胃切除术和机器人胃切除术的围手术期、肿瘤学和生存结果：我们利用美国国家癌症数据库，确定了2010年至2020年间接受开腹、腹腔镜或机器人胃切除术的胃腺癌患者。我们使用多变量回归模型研究了手术方式与各种结果之间的关系，包括 30 天再入院率、住院时间（LOS）、手术边缘状态、淋巴结转移率、30 天和 90 天死亡率以及总生存率（OS）。此外，还评估了手术方法与肿瘤位置（远端与近端或胃食管交界处[GEJ]）之间的相互作用：结果：在纳入的 34,937 例患者中，64.8% 接受了开腹胃切除术，25.7% 接受了腹腔镜手术，9.5% 接受了机器人手术。MIS 与较低的 30 天再入院几率相关（腹腔镜：几率比 [OR] 0.78，95% 置信区间 [CI]0.67-0.89；机器人：几率比 [OR] 0.75，95% 置信区间 [CI]0.67-0.89）：OR为0.75，95% CI为0.60-0.92）、边缘阳性（腹腔镜：OR为0.83，95% CI为0.74-0.93；机器人：OR为0.75，95% CI为0.62-0.90）、30天死亡率（腹腔镜：OR为0.69，95% CI为0.55-0.85；机器人：OR为0.66，95% CI为0.44-0.95）和90天死亡率（腹腔镜：OR为0.69，95% CI为0.55-0.85；机器人：OR为0.66，95% CI为0.44-0.95）均较低。95）和90天死亡率（腹腔镜：OR 0.74，95% CI 0.63-0.87；机器人：OR 0.63，95% CI 0.47-0.84），与开腹手术相比，OS（腹腔镜：危险比0.83，95% CI 0.79-0.87；机器人：危险比0.76，95% CI 0.69-0.83）也有所改善。考虑到手术方式与肿瘤位置的交互作用，对于近端/GEJ肿瘤，MIS手术的相关预后改善有所减弱。我们观察到，30 天后再入院、90 天后死亡率和 OS 的几率与开放手术相似。然而，与腹腔镜或开腹手术相比，无论肿瘤位置如何，机器人胃切除术都能缩短住院时间并获得更高的淋巴结计数：结论：在这一大型美国队列中，与开腹手术相比，MIS胃切除术可改善远端胃癌的围手术期、肿瘤学和生存率。然而，对于近端/GEJ肿瘤，MIS的相关益处有所减弱，再入院几率更高、死亡率更高、OS更差。值得注意的是，与腹腔镜和开腹方法相比，机器人胃切除术的淋巴结产量和LOS都更高，即使是近端/GEJ肿瘤也是如此。这些发现强调了进一步研究的必要性，尤其是在西方人群中开展随机对照试验，以明确确定 MIS 对远端和近端/GEJ 肿瘤的疗效，并指导胃腺癌的手术决策。
{"title":"Comparing the Effectiveness of Open, Laparoscopic, and Robotic Gastrectomy in the United States: A Retrospective Analysis of Perioperative, Oncologic, and Survival Outcomes","authors":"Andrei Gurau MD, MHS, MS , Olivia Monton MD, ScM , Jonathan B. Greer MD , Fabian M. Johnston MD, MHS","doi":"10.1016/j.jss.2024.10.014","DOIUrl":"10.1016/j.jss.2024.10.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Minimally invasive surgery (MIS) is increasingly used in the surgical management of gastric cancer; however, its adoption lags that of other cancers. Most randomized controlled trials comparing MIS to open gastrectomy have been conducted in Asia, with limited data from the United States. This study aimed to compare perioperative, oncologic, and survival outcomes between open, laparoscopic, and robotic gastrectomy in a large US cohort.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, we identified patients with gastric adenocarcinoma who underwent open, laparoscopic, or robotic gastrectomy between 2010 and 2020. Multivariate regression models were used to examine the association between surgical approach and various outcomes, including 30-d readmission, length of stay (LOS), surgical margin status, lymph node yield, 30- and 90-d mortality, and overall survival (OS). The interaction between surgical approach and tumor location (distal versus proximal or gastroesophageal junction [GEJ]) was also assessed.</div></div><div><h3>Results</h3><div>Of the 34,937 included patients, 64.8% underwent open gastrectomy, 25.7% underwent laparoscopic surgery, and 9.5% underwent robotic surgery. MIS was associated with lower odds of 30-d readmission (laparoscopic: odds ratio [OR] 0.78, 95% confidence interval [CI] 0.67-0.89; robotic: OR 0.75, 95% CI 0.60-0.92), positive margins (laparoscopic: OR 0.83, 95% CI 0.74-0.93; robotic: OR 0.75, 95% CI 0.62-0.90), 30-d mortality (laparoscopic: OR 0.69, 95% CI 0.55-0.85; robotic: OR 0.66, 95% CI 0.44-0.95), and 90-d mortality (laparoscopic: OR 0.74, 95% CI 0.63-0.87; robotic: OR 0.63, 95% CI 0.47-0.84), as well as improved OS (laparoscopic: hazard ratio 0.83, 95% CI 0.79-0.87; robotic: hazard ratio 0.76, 95% CI 0.69-0.83) compared to open surgery. Considering the interaction of approach with tumor location, for proximal/GEJ tumors, the associated outcome improvements with MIS were attenuated. We observe that the odds for 30-d readmission, 90-d mortality, and OS are similar to those for open operations. However, regardless of tumor location, robotic gastrectomy was associated with decreased LOS and yielded a higher lymph node count than laparoscopic or open approaches.</div></div><div><h3>Conclusions</h3><div>In this large US cohort, MIS gastrectomy was associated with improved perioperative, oncologic, and survival outcomes compared to open surgery for distal gastric cancers. However, the associated benefits of MIS were attenuated for proximal/GEJ tumors, with higher odds of readmission, mortality, and worse OS. Notably, robotic gastrectomy was associated with superior lymph node yield and LOS compared to laparoscopic and open approaches, even for proximal/GEJ tumors. These findings underscore the need for further research, especially randomized controlled trials conducted in Western populations, to definitively determine the efficacy of MIS for distal and proximal/GEJ t","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 196-206"},"PeriodicalIF":1.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648082","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}
Pub Date : 2024-11-16DOI: 10.1016/j.jss.2024.10.021
An-Kwok Ian Wong MD, PhD , Paul E. Wischmeyer MD , Haesung Lee DO , Laura Gorenshtein DO , Trevor Sytsma BS , Sicheng Hao MS , Chuan Hong PhD , Nrupen A. Bhavsar PhD , Ricardo Henao PhD , Matt Maciejewski PhD , Michael Pencina PhD , Christopher E. Cox MD, MPH , Joseph Fernandez-Moure MD, MS , Suresh Agarwal MD , Krista Haines DO, MA
Introduction
Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences.
Methods
Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics.
Results
Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation.
Conclusions
Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed.
{"title":"Enteral and Parenteral Nutrition Timing in eICU Collaborative Research Database by Race: A Retrospective Observational Study","authors":"An-Kwok Ian Wong MD, PhD , Paul E. Wischmeyer MD , Haesung Lee DO , Laura Gorenshtein DO , Trevor Sytsma BS , Sicheng Hao MS , Chuan Hong PhD , Nrupen A. Bhavsar PhD , Ricardo Henao PhD , Matt Maciejewski PhD , Michael Pencina PhD , Christopher E. Cox MD, MPH , Joseph Fernandez-Moure MD, MS , Suresh Agarwal MD , Krista Haines DO, MA","doi":"10.1016/j.jss.2024.10.021","DOIUrl":"10.1016/j.jss.2024.10.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences.</div></div><div><h3>Methods</h3><div>Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics.</div></div><div><h3>Results</h3><div>Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation.</div></div><div><h3>Conclusions</h3><div>Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 181-189"},"PeriodicalIF":1.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648098","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}
Pub Date : 2024-11-16DOI: 10.1016/j.jss.2024.10.026
Shruthi Srinivas MD, Julia R. Coleman MD MPH, Holly Baselice MPH, Sara Scarlet MD MPH, Brett M. Tracy MD
Introduction
We sought to determine if there was a relationship between skin management and surgical site infections (SSIs) among patients undergoing a laparotomy for emergency general surgery (EGS). We hypothesize that skin closure technique is not associated with SSI.
Methods
We performed a retrospective review of adult patients (>18 y) who underwent an exploratory laparotomy for EGS conditions within 6 h of surgical consultation from 2015 to 2019. Patients whose fascia was not closed during the index operation were excluded. Patients were divided into groups: open skin (OS) and closed skin (CS). OS included negative pressure wound therapy or wet-to-dry gauze; CS included closure with staples or sutures. Our primary outcome was the rate of SSI.
Results
The cohort comprised 388 patients: 42.3% OS (n = 164) and 57.7% CS (n = 224). The OS group had greater rates of systemic inflammatory response syndrome [SIRS] (54.9% versus 27.7%, P < 0.0001), hollow viscus perforation [HVP] (71.3% versus 20.5%, P < 0.0001), and peritoneal drains (51.2% versus 17.9%, P < 0.0001). Rates of OS management increased as wound class severity increased (0% [I] versus 12.2% [II] versus 15.9% [III] versus 72% [IV], P < 0.0001). The SSI rate for the cohort was 3.6% (n = 14); there was no difference in SSI rates (2.7% versus 4.9%, P = 0.3) between the CS or OS groups. Median length of stay was longer for the OS group (10 d versus 6.5 d, P < 0.0001). Independent predictors of OS management were SIRS (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.01-2.93, P = 0.04), HVP (aOR 2.03, 95% CI 1.09-3.8, P = 0.03), and class III/IV wounds (aOR 8.65, 95% CI 4.43-16.89, P < 0.0001).
Conclusions
OS management occurs more often in patients with SIRS, HVP, and dirty wounds after EGS laparotomies. However, we found no difference in SSI between groups, suggesting that skin closure can be considered in contaminated or dirty wounds.
{"title":"Open or Closed? Management of Skin Incisions After Emergency General Surgery Laparotomies","authors":"Shruthi Srinivas MD, Julia R. Coleman MD MPH, Holly Baselice MPH, Sara Scarlet MD MPH, Brett M. Tracy MD","doi":"10.1016/j.jss.2024.10.026","DOIUrl":"10.1016/j.jss.2024.10.026","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to determine if there was a relationship between skin management and surgical site infections (SSIs) among patients undergoing a laparotomy for emergency general surgery (EGS). We hypothesize that skin closure technique is not associated with SSI.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of adult patients (>18 y) who underwent an exploratory laparotomy for EGS conditions within 6 h of surgical consultation from 2015 to 2019. Patients whose fascia was not closed during the index operation were excluded. Patients were divided into groups: open skin (OS) and closed skin (CS). OS included negative pressure wound therapy or wet-to-dry gauze; CS included closure with staples or sutures. Our primary outcome was the rate of SSI.</div></div><div><h3>Results</h3><div>The cohort comprised 388 patients: 42.3% OS (<em>n</em> = 164) and 57.7% CS (<em>n</em> = 224). The OS group had greater rates of systemic inflammatory response syndrome [SIRS] (54.9% <em>versus</em> 27.7%, <em>P</em> < 0.0001), hollow viscus perforation [HVP] (71.3% <em>versus</em> 20.5%, <em>P</em> < 0.0001), and peritoneal drains (51.2% <em>versus</em> 17.9%, <em>P</em> < 0.0001). Rates of OS management increased as wound class severity increased (0% [I] <em>versus</em> 12.2% [II] <em>versus</em> 15.9% [III] <em>versus</em> 72% [IV], <em>P</em> < 0.0001). The SSI rate for the cohort was 3.6% (<em>n</em> = 14); there was no difference in SSI rates (2.7% <em>versus</em> 4.9%, <em>P</em> = 0.3) between the CS or OS groups. Median length of stay was longer for the OS group (10 d <em>versus</em> 6.5 d, <em>P</em> < 0.0001). Independent predictors of OS management were SIRS (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.01-2.93, <em>P</em> = 0.04), HVP (aOR 2.03, 95% CI 1.09-3.8, <em>P</em> = 0.03), and class III/IV wounds (aOR 8.65, 95% CI 4.43-16.89, <em>P</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>OS management occurs more often in patients with SIRS, HVP, and dirty wounds after EGS laparotomies. However, we found no difference in SSI between groups, suggesting that skin closure can be considered in contaminated or dirty wounds.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 190-195"},"PeriodicalIF":1.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648102","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}
Pub Date : 2024-11-15DOI: 10.1016/j.jss.2024.10.009
Lauren Haskins DO, MBA , Nicole Tobin MD , Elle Reineman , Rebecca Sippel MD , David Schneider MD , Kristin Long MD, MPH , Dawn Elfenbein MD , Courtney Balentine MD , Alexander Chiu MD, MPH
Introduction
Laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) are safe, effective surgical approaches. A direct comparison of postoperative pain and narcotic use is needed.
Methods
Adults who had laparoscopic adrenalectomy at a tertiary institution from 2015 to 2021 were identified from a surgical database. Evaluated key outcomes included opioid use and patient-reported pain during the perioperative period, which were analyzed by surgical approach and compared using multivariate linear regression. Additional data on pain postdischarge, prescription refills, length of stay, and 30-d readmission were also collected.
Results
Eighty-eight (69.3%) surgeries were LTA and 39 (30.7%) were PRA. The studied patient population was 58% female and had an average age of 54 (standard deviation 13). Adrenal tumors were 75% functional and 3.4 cm on average (standard deviation 2.6). Postoperative pain scores at rest (4.4 LTA versus 4.5 PRA, P = 0.87) and activity (4.7 LTA versus 5.6 PRA, P = 0.08) did not reach statistical significance. Patients undergoing LTA used a median of 110.3 morphine milligram equivalents (interquartile range 70.1-144.5) of opioids during their hospital stay compared to 91.0 (interquartile range 59.1-133.3) for PRA (P = 0.16). Linear regression demonstrated no significant difference in postoperative opioid use between approaches (−9.3 morphine milligram equivalents [95% confidence interval −40.7 to 22.1]).
Conclusions
Our analysis found no significant advantage of PRA over LTA in terms of postoperative pain or opioid use, contrary to earlier findings by Barczyński et al., who reported lower postoperative pain with PRA. Both approaches show similar clinical outcomes, and the choice between them should be based on individual patient factors rather than differences in patient-reported pain and opioid usage.
{"title":"Equivalent Pain and Opioid Use Between Transabdominal and Retroperitoneal Adrenalectomy","authors":"Lauren Haskins DO, MBA , Nicole Tobin MD , Elle Reineman , Rebecca Sippel MD , David Schneider MD , Kristin Long MD, MPH , Dawn Elfenbein MD , Courtney Balentine MD , Alexander Chiu MD, MPH","doi":"10.1016/j.jss.2024.10.009","DOIUrl":"10.1016/j.jss.2024.10.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) are safe, effective surgical approaches. A direct comparison of postoperative pain and narcotic use is needed.</div></div><div><h3>Methods</h3><div>Adults who had laparoscopic adrenalectomy at a tertiary institution from 2015 to 2021 were identified from a surgical database. Evaluated key outcomes included opioid use and patient-reported pain during the perioperative period, which were analyzed by surgical approach and compared using multivariate linear regression. Additional data on pain postdischarge, prescription refills, length of stay, and 30-d readmission were also collected.</div></div><div><h3>Results</h3><div>Eighty-eight (69.3%) surgeries were LTA and 39 (30.7%) were PRA. The studied patient population was 58% female and had an average age of 54 (standard deviation 13). Adrenal tumors were 75% functional and 3.4 cm on average (standard deviation 2.6). Postoperative pain scores at rest (4.4 LTA <em>versus</em> 4.5 PRA, <em>P</em> = 0.87) and activity (4.7 LTA <em>versus</em> 5.6 PRA, <em>P</em> = 0.08) did not reach statistical significance. Patients undergoing LTA used a median of 110.3 morphine milligram equivalents (interquartile range 70.1-144.5) of opioids during their hospital stay compared to 91.0 (interquartile range 59.1-133.3) for PRA (<em>P</em> = 0.16). Linear regression demonstrated no significant difference in postoperative opioid use between approaches (−9.3 morphine milligram equivalents [95% confidence interval −40.7 to 22.1]).</div></div><div><h3>Conclusions</h3><div>Our analysis found no significant advantage of PRA over LTA in terms of postoperative pain or opioid use, contrary to earlier findings by Barczyński <em>et al.</em>, who reported lower postoperative pain with PRA. Both approaches show similar clinical outcomes, and the choice between them should be based on individual patient factors rather than differences in patient-reported pain and opioid usage.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 173-180"},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643796","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}
Pub Date : 2024-11-15DOI: 10.1016/j.jss.2024.10.018
Raymundo A. Muñoz MD , Andrei A. Ramos MD , Francisco J. Miranda MD , José E. De La Rosa MD , Alfonzo E. Muñoz BS , Aáron A. Ramírez MD , Eva P. Chavez MD , Guillermo Gallardo MD, FACS , Salvador Pizarro MD
Introduction
There are studies with mixed conclusions about the role cholecystectomy plays as a risk factor for proximal colorectal cancer (CRC).
Methods
We performed a multicenter retrospective cohort study where the records of patients with CRC were reviewed. Data was collected regarding affected colon subsegment (cecum, ascending, transverse, descending, sigmoid, or rectum, which were also combined into proximal or distal colon), history and time since cholecystectomy, histopathology reports (TNM classification and clinical stage), and KRAS, NRAS, and BRAF mutation analysis. Univariate and multivariate analysis adjusting for age, smoking history, body mass index, sex, and family history of cancer were performed. Logistical regression for statistical analysis was used to estimate the odds ratio for the association between cholecystectomy and tumor location.
Results
Four hundred four cases were obtained, of which 52 previously had cholecystectomy. The date of surgery was recorded in 43 patients, with a 5 y median and an interquartile range of 1.5-14 y prior to CRC diagnosis. Both crude and adjusted odds ratio (2.86 and 2.42, respectively) confirmed an associated risk for developing proximal CRC after cholecystectomy. When proximal CRC cases with previous cholecystectomy were directly compared against proximal CRC without cholecystectomy and distal CRC cases, the former had a higher distribution of prevalence for T3, T4b, N1b, M1a, and M1c. KRAS mutation also presented its highest prevalence in this group with 33%.
Conclusions
Cholecystectomy was related to the development of proximal CRC in all its subsegments, seemingly associated with higher stages at diagnosis. Close surveillance should be considered in patients who undergo cholecystectomy.
{"title":"Cholecystectomy Is a Risk Factor for Proximal Colon Cancer That May Also Relate to its Aggressiveness","authors":"Raymundo A. Muñoz MD , Andrei A. Ramos MD , Francisco J. Miranda MD , José E. De La Rosa MD , Alfonzo E. Muñoz BS , Aáron A. Ramírez MD , Eva P. Chavez MD , Guillermo Gallardo MD, FACS , Salvador Pizarro MD","doi":"10.1016/j.jss.2024.10.018","DOIUrl":"10.1016/j.jss.2024.10.018","url":null,"abstract":"<div><h3>Introduction</h3><div>There are studies with mixed conclusions about the role cholecystectomy plays as a risk factor for proximal colorectal cancer (CRC).</div></div><div><h3>Methods</h3><div>We performed a multicenter retrospective cohort study where the records of patients with CRC were reviewed. Data was collected regarding affected colon subsegment (cecum, ascending, transverse, descending, sigmoid, or rectum, which were also combined into proximal or distal colon), history and time since cholecystectomy, histopathology reports (TNM classification and clinical stage), and KRAS, NRAS, and BRAF mutation analysis. Univariate and multivariate analysis adjusting for age, smoking history, body mass index, sex, and family history of cancer were performed. Logistical regression for statistical analysis was used to estimate the odds ratio for the association between cholecystectomy and tumor location.</div></div><div><h3>Results</h3><div>Four hundred four cases were obtained, of which 52 previously had cholecystectomy. The date of surgery was recorded in 43 patients, with a 5 y median and an interquartile range of 1.5-14 y prior to CRC diagnosis. Both crude and adjusted odds ratio (2.86 and 2.42, respectively) confirmed an associated risk for developing proximal CRC after cholecystectomy. When proximal CRC cases with previous cholecystectomy were directly compared against proximal CRC without cholecystectomy and distal CRC cases, the former had a higher distribution of prevalence for T3, T4b, N1b, M1a, and M1c. KRAS mutation also presented its highest prevalence in this group with 33%.</div></div><div><h3>Conclusions</h3><div>Cholecystectomy was related to the development of proximal CRC in all its subsegments, seemingly associated with higher stages at diagnosis. Close surveillance should be considered in patients who undergo cholecystectomy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 152-161"},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638050","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}
Pub Date : 2024-11-14DOI: 10.1016/j.jss.2024.10.022
Elisa Bass, Scott Anderson, Braden C Hintze, Young Erben
{"title":"Corrigendum to \"Gender Parity Among Vascular Surgeons: Progress and Attrition\" [Journal of Surgical Research, Volume 303 (2024) P281-286].","authors":"Elisa Bass, Scott Anderson, Braden C Hintze, Young Erben","doi":"10.1016/j.jss.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.022","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639308","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}
Postoperative adhesion often develops as a natural physiological response following abdominal and pelvic surgeries. Although existing resorbable adhesion barriers have reduced the incidence of postoperative adhesion formation, their clinical efficacy requires improvement. In this study, we generated a novel cross-linked, powder-formed chondroitin sulfate (SI-449) as an effective postoperative anti-adhesion barrier. We evaluated its anti-adhesion effect in animal models of abdominal and pelvic surgeries and elucidated its mechanism of action.
Methods
Rats in the cecum-abraded adhesion and uterine horn adhesion models were treated with SI-449 and Seprafilm, and adhesion frequency and scores were evaluated. The mechanisms underlying this anti-adhesion effect were examined histopathologically using a cecum-abraded adhesion model.
Results
In the cecum-abraded adhesion model, SI-449 reduced the adhesion frequency and total adhesion score to 30% and 1.6, respectively, compared with 100% and 8.1 in the control group and 50% and 2.5 in the Seprafilm group. We observed an SI-449-like substance between the cecum and abdominal wall and no fibrin net structure connecting the invasive tissues after surgery, as observed in the control group. In the rat uterine horn adhesion model, SI-449 reduced the adhesion frequency to 40%, compared with 100% in the control.
Conclusions
SI-449 exhibits anti-adhesion activity in animal models of postoperative adhesion. The mechanism of action of SI-449 during wound healing suggests mechanical obstruction of fibrin net structure formation, which is a key step in the development of adhesions at surgical sites. SI-449 is a promising candidate for preventing postoperative adhesions in clinical practice.
{"title":"Effects of Novel Cross-Linked Chondroitin Sulfate (SI-449) as a Postoperative Anti-Adhesion Barrier","authors":"Kei Toyama PhD , Katsuya Takahashi BS , Sho Funayama MS , Keiji Yoshioka PhD","doi":"10.1016/j.jss.2024.10.016","DOIUrl":"10.1016/j.jss.2024.10.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative adhesion often develops as a natural physiological response following abdominal and pelvic surgeries. Although existing resorbable adhesion barriers have reduced the incidence of postoperative adhesion formation, their clinical efficacy requires improvement. In this study, we generated a novel cross-linked, powder-formed chondroitin sulfate (SI-449) as an effective postoperative anti-adhesion barrier. We evaluated its anti-adhesion effect in animal models of abdominal and pelvic surgeries and elucidated its mechanism of action.</div></div><div><h3>Methods</h3><div>Rats in the cecum-abraded adhesion and uterine horn adhesion models were treated with SI-449 and Seprafilm, and adhesion frequency and scores were evaluated. The mechanisms underlying this anti-adhesion effect were examined histopathologically using a cecum-abraded adhesion model.</div></div><div><h3>Results</h3><div>In the cecum-abraded adhesion model, SI-449 reduced the adhesion frequency and total adhesion score to 30% and 1.6, respectively, compared with 100% and 8.1 in the control group and 50% and 2.5 in the Seprafilm group. We observed an SI-449-like substance between the cecum and abdominal wall and no fibrin net structure connecting the invasive tissues after surgery, as observed in the control group. In the rat uterine horn adhesion model, SI-449 reduced the adhesion frequency to 40%, compared with 100% in the control.</div></div><div><h3>Conclusions</h3><div>SI-449 exhibits anti-adhesion activity in animal models of postoperative adhesion. The mechanism of action of SI-449 during wound healing suggests mechanical obstruction of fibrin net structure formation, which is a key step in the development of adhesions at surgical sites. SI-449 is a promising candidate for preventing postoperative adhesions in clinical practice.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 162-172"},"PeriodicalIF":1.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To improve patient safety and reduce burden on healthcare professionals and institutions, the individual management of surgical instruments is essential. There are two methods for individual item management: radio-frequency identification (RFID) and barcoding. However, there has been no examination of efficiency regarding reading times. Therefore, this study aimed to compare the reading times of RFID-tagged and barcode-engraved surgical instruments and evaluate the influence of operator proficiency.
Methods
The participants included 8 individuals and 41 surgical instruments from a varicose vein set. RFID tags and barcodes were attached to the surgical instruments. Five trials were conducted for each, and the reading times were measured.
Results
The reading times for RFID-tagged surgical instruments in the skilled and unskilled groups were 64.0 ± 9.0s and 79.4 ± 17.0 s, respectively, whereas those for barcode-engraved surgical instruments were 190.4 ± 28.1 s and 212.3 ± 40.3 s, respectively. Barcodes took 3.0 and 2.7 times longer to read than RFID-tagged instruments for the skilled and unskilled groups, respectively. Additionally, skilled operators using barcodes required 2.4 times more time than unskilled operators using RFID. Even nonmedical individuals were able to achieve quick and accurate readings with RFID. The estimated labor hours per person were $24,146-$42,322 for RFID and $71,078-$110,898 for barcode scanning for a year (working 8 h/d for 250 d).
Conclusions
RFID-tagged surgical instruments impose a lighter workload and financial burden than barcode-engraved surgical instruments. RFID technology may also improve patient safety due to less dependency on operator proficiency.
导言：为了提高患者安全，减轻医护人员和医疗机构的负担，对手术器械进行单独管理至关重要。单个物品管理有两种方法：射频识别（RFID）和条形码。然而，目前还没有关于读取时间效率的研究。因此，本研究旨在比较 RFID 标签和条形码刻印手术器械的读取时间，并评估操作员熟练程度的影响：参与者包括 8 个人和 41 件静脉曲张手术器械。手术器械上分别贴有 RFID 标签和条形码。结果：贴有 RFID 标签的手术器械的读取时间短于贴有条形码的手术器械的读取时间：结果：熟练组和非熟练组的 RFID 标签手术器械的读取时间分别为 64.0 ± 9.0 秒和 79.4 ± 17.0 秒，而刻有条形码的手术器械的读取时间分别为 190.4 ± 28.1 秒和 212.3 ± 40.3 秒。熟练组和非熟练组读取条形码所需的时间分别是 RFID 标签器械的 3.0 倍和 2.7 倍。此外，使用条形码的熟练操作员所需的时间是使用 RFID 的非熟练操作员的 2.4 倍。即使是非医务人员也能使用 RFID 快速准确地读取数据。一年下来，RFID 的人均工时估计为 24,146 美元至 42,322 美元，条形码扫描的人均工时估计为 71,078 美元至 110,898 美元（250 天/天，每天工作 8 小时）：RFID 标签手术器械比条形码标签手术器械的工作量和经济负担更轻。RFID 技术还可减少对操作人员熟练程度的依赖，从而提高患者安全。
{"title":"Comparison of Reading Times of RFID-Tagged and Barcode-Engraved Surgical Instruments","authors":"Kaori Kusuda DSci , Kazuhiko Yamashita DEng , Emiko Morishita BN , Nao Ishibashi BN , Yoshito Shiraishi MD, DMed , Hiromitsu Yamaguchi MD, DMed","doi":"10.1016/j.jss.2024.09.087","DOIUrl":"10.1016/j.jss.2024.09.087","url":null,"abstract":"<div><h3>Introduction</h3><div>To improve patient safety and reduce burden on healthcare professionals and institutions, the individual management of surgical instruments is essential. There are two methods for individual item management: radio-frequency identification (RFID) and barcoding. However, there has been no examination of efficiency regarding reading times. Therefore, this study aimed to compare the reading times of RFID-tagged and barcode-engraved surgical instruments and evaluate the influence of operator proficiency.</div></div><div><h3>Methods</h3><div>The participants included 8 individuals and 41 surgical instruments from a varicose vein set. RFID tags and barcodes were attached to the surgical instruments. Five trials were conducted for each, and the reading times were measured.</div></div><div><h3>Results</h3><div>The reading times for RFID-tagged surgical instruments in the skilled and unskilled groups were 64.0 ± 9.0s and 79.4 ± 17.0 s, respectively, whereas those for barcode-engraved surgical instruments were 190.4 ± 28.1 s and 212.3 ± 40.3 s, respectively. Barcodes took 3.0 and 2.7 times longer to read than RFID-tagged instruments for the skilled and unskilled groups, respectively. Additionally, skilled operators using barcodes required 2.4 times more time than unskilled operators using RFID. Even nonmedical individuals were able to achieve quick and accurate readings with RFID. The estimated labor hours per person were $24,146-$42,322 for RFID and $71,078-$110,898 for barcode scanning for a year (working 8 h/d for 250 d).</div></div><div><h3>Conclusions</h3><div>RFID-tagged surgical instruments impose a lighter workload and financial burden than barcode-engraved surgical instruments. RFID technology may also improve patient safety due to less dependency on operator proficiency.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 121-125"},"PeriodicalIF":1.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.jss.2024.10.013
Henri R. Ford MD, MHA, FACS, MAMSE, FRCS(Eng), FWACS, FAAP
{"title":"The Association for Academic Surgery: The Gateway to Transformative Leadership in American Surgery","authors":"Henri R. Ford MD, MHA, FACS, MAMSE, FRCS(Eng), FWACS, FAAP","doi":"10.1016/j.jss.2024.10.013","DOIUrl":"10.1016/j.jss.2024.10.013","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 147-151"},"PeriodicalIF":1.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622941","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}
Pub Date : 2024-11-13DOI: 10.1016/j.jss.2024.10.010
Phillip Staibano MD MSc , Michael K. Gupta MD MSc FRCSC , Fay Alresaini MD , Michael Au MD MHI FRCSC , Keean Nanji MD , Emily Oulousian , Maya Senthilkumaran BHSc , Sarah Oulousian , Jesse D. Pasternak MD MPH FRCSC , Tyler McKechnie MD MSc , Eric Monteiro MD MSc FRCSC , Alex Thabane MSc , Han Zhang MD FRCSC
Introduction
Tall cell subtype papillary thyroid cancer (TCS-PTC) is associated with aggressive disease features and worse patient outcomes. It remains unclear whether adjuvant radioactive iodine (RAI) ablation following thyroidectomy is associated with improved survival in TCS-PTC. The purpose of this review and meta-analysis was to determine whether adjuvant RAI was associated with improved survival in patients with TCS-PTC.
Methods
We included any study design that investigated survival outcomes in adult patients diagnosed with TCS-PTC who underwent either thyroidectomy following by adjuvant RAI or thyroidectomy alone. We searched MEDLINE, EMBASE, Scopus, and CENTRAL databases from inception with no restrictions. All screening and review stages were performed in duplicate. Risk of bias was evaluated using ROBINS-I and certainty of evidence were evaluated using GRADE. Meta-analysis was performed using a random effects model and we calculated pooled hazard ratios (HRs), where applicable. All analyses were performed in RevMan 5.3 (Cochrane, UK).
Results
Seven nonrandomized studies were included with 9611 TCS-PTC patients, of which 6296 (65.5%) underwent adjuvant RAI. All studies were at high risk of bias. Based on low certainty evidence, we found that adjuvant RAI was possibly associated with improved overall survival in TCS-PTC (HR = 0.60, 95% confidence interval: 0.42-0.85). This benefit was maintained in studies that performed propensity score matching, but we did not find a significant association with tumor size. Sensitivity analysis to remove studies with potentially overlapping data changed the HR to 0.74 (95% CI: 0.46-1.19) with considerable heterogeneity (I2 = 70%). Based on very low certainty evidence, we were uncertain where adjuvant RAI was associated with cancer-specific or recurrence-free survival.
Conclusions
Adjuvant RAI may be associated with improved overall survival in TCS-PTC, but future high-quality randomized studies with risk stratification are needed.
导言：高细胞亚型甲状腺乳头状癌（TCS-PTC）具有侵袭性疾病特征，患者预后较差。目前仍不清楚甲状腺切除术后辅助放射性碘（RAI）消融是否与TCS-PTC生存率的提高有关。本综述和荟萃分析旨在确定辅助 RAI 是否与 TCS-PTC 患者生存率的提高有关：我们纳入了所有研究设计，这些设计调查了确诊为 TCS-PTC 的成年患者在接受甲状腺切除术后辅助 RAI 或单独接受甲状腺切除术的生存结果。我们对 MEDLINE、EMBASE、Scopus 和 CENTRAL 数据库进行了无限制检索。所有筛选和审查阶段均一式两份。使用 ROBINS-I 评估偏倚风险，使用 GRADE 评估证据的确定性。采用随机效应模型进行 Meta 分析，并酌情计算汇总危险比 (HR)。所有分析均在RevMan 5.3（Cochrane，英国）中进行：共纳入了 7 项非随机研究，9611 名 TCS-PTC 患者接受了 RAI 辅助治疗，其中 6296 人（65.5%）接受了 RAI 辅助治疗。所有研究均存在高偏倚风险。基于低确定性证据，我们发现辅助 RAI 可能与 TCS-PTC 总生存率的改善有关（HR = 0.60，95% 置信区间：0.42-0.85）。在进行倾向评分匹配的研究中，这种益处得以保持，但我们没有发现与肿瘤大小有显著关联。通过敏感性分析剔除数据可能重叠的研究后，HR 变为 0.74（95% 置信区间：0.46-1.19），异质性相当大（I2 = 70%）。基于确定性极低的证据，我们无法确定辅助 RAI 与癌症特异性生存或无复发生存的相关性：结论：RAI辅助治疗可能与TCS-PTC总生存率的改善有关，但未来还需要进行风险分层的高质量随机研究。
{"title":"Adjuvant Radioactive Iodine Ablation in Tall Cell Subtype Papillary Thyroid Cancer: A Systematic Review and Meta-analysis","authors":"Phillip Staibano MD MSc , Michael K. Gupta MD MSc FRCSC , Fay Alresaini MD , Michael Au MD MHI FRCSC , Keean Nanji MD , Emily Oulousian , Maya Senthilkumaran BHSc , Sarah Oulousian , Jesse D. Pasternak MD MPH FRCSC , Tyler McKechnie MD MSc , Eric Monteiro MD MSc FRCSC , Alex Thabane MSc , Han Zhang MD FRCSC","doi":"10.1016/j.jss.2024.10.010","DOIUrl":"10.1016/j.jss.2024.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Tall cell subtype papillary thyroid cancer (TCS-PTC) is associated with aggressive disease features and worse patient outcomes. It remains unclear whether adjuvant radioactive iodine (RAI) ablation following thyroidectomy is associated with improved survival in TCS-PTC. The purpose of this review and meta-analysis was to determine whether adjuvant RAI was associated with improved survival in patients with TCS-PTC.</div></div><div><h3>Methods</h3><div>We included any study design that investigated survival outcomes in adult patients diagnosed with TCS-PTC who underwent either thyroidectomy following by adjuvant RAI or thyroidectomy alone. We searched MEDLINE, EMBASE, Scopus, and CENTRAL databases from inception with no restrictions. All screening and review stages were performed in duplicate. Risk of bias was evaluated using ROBINS-I and certainty of evidence were evaluated using GRADE. Meta-analysis was performed using a random effects model and we calculated pooled hazard ratios (HRs), where applicable. All analyses were performed in RevMan 5.3 (Cochrane, UK).</div></div><div><h3>Results</h3><div>Seven nonrandomized studies were included with 9611 TCS-PTC patients, of which 6296 (65.5%) underwent adjuvant RAI. All studies were at high risk of bias. Based on low certainty evidence, we found that adjuvant RAI was possibly associated with improved overall survival in TCS-PTC (HR = 0.60, 95% confidence interval: 0.42-0.85). This benefit was maintained in studies that performed propensity score matching, but we did not find a significant association with tumor size. Sensitivity analysis to remove studies with potentially overlapping data changed the HR to 0.74 (95% CI: 0.46-1.19) with considerable heterogeneity (I<sup>2</sup> = 70%). Based on very low certainty evidence, we were uncertain where adjuvant RAI was associated with cancer-specific or recurrence-free survival.</div></div><div><h3>Conclusions</h3><div>Adjuvant RAI may be associated with improved overall survival in TCS-PTC, but future high-quality randomized studies with risk stratification are needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 136-146"},"PeriodicalIF":1.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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