Journal of Surgical Research最新文献

{"title":"Evaluating Safety and Durability of Adolescent Metabolic and Bariatric Surgery","authors":"","doi":"10.1016/j.jss.2024.09.010","DOIUrl":"10.1016/j.jss.2024.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Metabolic bariatric surgery (MBS) has demonstrated safety in its usage in the adolescent population and can aid in curbing the rising obesity epidemic. However, long-term data surrounding durability of MBS in this population is limited. This study aims to examine both short and long-term outcomes of MBS in adolescents, as well as identify patient characteristics and demographics that may impact operative safety and durability.</div></div><div><h3>Methods</h3><div>The New York Statewide Planning and Research Cooperative System was utilized to identify patients 12-19 y old who underwent a bariatric procedure from 2007 to 2018. Patients were followed for the need for revisional or conversion (RC) procedures. Safety was defined by 30-d readmission, length of stay (LOS), and in-hospital complications. Durability was characterized by the incidence of RC after the initial procedure. Variables that were significantly associated with each outcome on univariable analysis were selected for in multivariable regression models.</div></div><div><h3>Results</h3><div>2241 adolescents underwent MBS in the study time frame; 58.46% of them underwent sleeve gastrectomy (SG). The median LOS was 1.66 ± 1.04 d. The overall in-hospital complication rate was 3.44%; 30-d readmission rate was 3.17%. Roux-en-Y Gastric Bypass (RYGB) patients were more likely to have a 30-d readmission than SG (OR = 1.75 95% CI 1.03-2.96). Factors associated with in hospital complications were preexisting hypertension (OR = 2.008 95% CI 1.141-3.535) and hypothyroidism (OR = 2.459 95% CI 1.132-5.341). Overall, the RC rate was 6.65%. RC rate following laparoscopic adjustable gastric banding (LAGB), RYGB, and SG was 27.33%, 2.08%, and 1.22%, respectively. The incidence of RC was significantly different between patients undergoing different types of bariatric surgery (<em>P</em>-value&lt;0.0001), and it was significantly higher after LAGB comparing to RYGB (HR = 16.16, 95% CI: 7.56-34.51) as well as comparing to SG (HR = 9.22, 95% CI: 5.07-16.78). Insurance status, race or ethnicity, and socioeconomic disadvantage were not significantly associated with 30-d readmissions, in-hospital complications, LOS, or RC.</div></div><div><h3>Conclusions</h3><div>Adolescent patients experience a low rate of postoperative adverse events following MBS. These procedures remain durable over time for this patient cohort. These positive results are regardless of race, ethnicity, and insurance status. This study identifies that female patients and LAGB patients are at highest risk for need for eventual RC, suggesting the need for closer postoperative follow-up for these specific patient cohorts.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427356","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":"Negative Pressure Dressing Versus Conventional Passive Dressing in Pilonidal Surgery: A Randomized Controlled Trial","authors":"","doi":"10.1016/j.jss.2024.09.016","DOIUrl":"10.1016/j.jss.2024.09.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgically treated pilonidal sinus disease (PSD) has high rates of postoperative wound complications, with surgical wound dehiscence (SWD) rates up to 44%. Negative pressure wound therapy (NPWT) is proposed to reduce rates of SWD for other high risk surgical wounds. Our aim was to investigate whether NPWT would reduce rates of SWD compared to conventional passive (CP) dressings for PSD excisions with off-midline primary closure. Our secondary outcomes included patient quality of life and time taken return to normal activities.</div></div><div><h3>Method</h3><div>We performed a prospective, crossover pediatric/adult randomized controlled trial for patients (12-40 y) with PSD, requiring excision and off-midline primary closure. Participants were randomized to receive a CP (Primapore or Opsite) or NPWT (SNAP) dressing. Follow-up occurred on D3, D7, D10, D14 and then weekly until wound healing. Patients were sent a 2-month postoperative online survey to assess quality of life outcomes.</div></div><div><h3>Results</h3><div>Fifty patients were recruited, 25 to NPWT &amp; 25 to CP. Mean age and body mass index were 22.6 ± 6.7 y and 26.1 ± 4.5 kg/m², respectively. 36/50 (76%) were male. The overall dehiscence rate was 42% (21/50); 12/25 (48%) for NPWT &amp; 9/25 (36%) for CP, <em>P</em> = 0.6. Five deep (≥5 mm) SWDs occurred in each group, <em>P</em> &gt; 0.9. SWD was associated with increased excision dimensions in the NPWT group only, <em>P</em> = 0.03. Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] <em>versus</em> NPWT 21.0 [16.0-24.0] days, <em>P</em> = 0.7). There were no differences in mean time to the following: return to school/work (NPWT 26.1 ± 18.2 <em>versus</em> CP 29.3 ± 14.7 d, <em>P</em> = 0.6), sit normally (NPWT 22.3 ± 16.2 <em>versus</em> CP 20.1 ± 9.4 d, <em>P</em> = 0.7), or return to physical activity (NPWT21.6 ± 17.2 <em>versus</em> CP40.3 ± 2.4 d, <em>P</em> = 0.2).</div></div><div><h3>Conclusions</h3><div>NPWT did not improve outcomes after excision of PSD with off-midline primary closure. Despite the limited population size, our results do not support its use as a routine preventative measure.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406549","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":"Gender Parity Among Vascular Surgeons: Progress and Attrition","authors":"","doi":"10.1016/j.jss.2024.09.021","DOIUrl":"10.1016/j.jss.2024.09.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Improving representation of women in medicine and surgery has been tempered by higher rates of attrition from residencies and from academic medicine among women compared to men. The attrition of women from the practicing vascular surgery workforce has not been studied.</div></div><div><h3>Methods</h3><div>We utilized the Center for Medicare and Medicaid Services’ Doctors and Clinicians database to study vascular surgery employment patterns from 2015 to 2022. We examined gender balance within the workforce and attrition rates among male and female vascular surgeons. We utilized a logistic regression to calculate the odds of attrition by gender.</div></div><div><h3>Results</h3><div>The percentage of female vascular surgeons grew from 11% to 16% between 2015 and 2022, with each graduating class since 2005 having between 20% and 38% women. Yet, female surgeons were 2.05 (95% confidence interval: 1.36-3.08) times more likely to leave practice than their male counterparts when controlling for graduation year and practice in academic medicine.</div></div><div><h3>Conclusions</h3><div>The proportion of women in vascular surgery is increasing as more women graduate into the specialty. Despite increasing representation, women are more likely than men to leave the workforce.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400575","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":"A Genome-wide Association Study Reveals a Novel Susceptibility Locus for Pancreas Divisum at 3q29","authors":"","doi":"10.1016/j.jss.2024.09.028","DOIUrl":"10.1016/j.jss.2024.09.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Pancreas divisum (PD) is a common congenital anomaly of the pancreas, but its genetic basis remains unknown. The purpose of this genome-wide association study was to identify genetic loci associated with PD.</div></div><div><h3>Methods</h3><div>Using the Mass General Brigham Biobank, patients diagnosed with PD were identified. Quality control and imputation were performed using standard approaches. Single nucleotide polymorphisms (SNPs) with minor allele frequency (MAF) ≥ 5% were tested for association with PD using mixed linear model-based association analysis. The significance threshold was set at 5 × 10⁻⁸.</div></div><div><h3>Results</h3><div>A total of 13,940 subjects were included, of which 251 (1.8%) were diagnosed with PD. A genetic locus in chromosome 3q29 was found to be associated with PD (lead SNP rs3850646, MAF_PD = 34.6% vs. MAF_controls = 26.4%, beta = 0.0106, <em>P</em> = 1.47 × 10⁻⁸). The identified locus is located in the phosphatidylinositol glycan anchor biosynthesis class Xand p21 activated kinase 2genes. The heritability of PD was estimated at 27.5%. (Expression quantitative trait loci) and chromatin interaction analysis found 12 genes whose expression may be regulated by SNPs in this genomic locus.</div></div><div><h3>Conclusions</h3><div>The results of this study suggest that a genetic locus at 3q29 is associated with PD. This locus is in the phosphatidylinositol glycan anchor biosynthesis class X and p21 activated kinase 2 genes. Twelve candidate genes were identified whose expression may be regulated by this locus. These findings may help us understand both normal and aberrant pancreatic development and may aid in clinical evaluation and genetic counseling of patients with PD and associated diseases, such as acute pancreatitis.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406546","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":"Animal Models Within Surgical Simulation: A Novel Approach to the 3 Rs","authors":"","doi":"10.1016/j.jss.2024.09.030","DOIUrl":"10.1016/j.jss.2024.09.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Development of technical skills is a vital component of surgical residency. The use of animal tissues for operative simulation leads to both the loss of animal life and financial costs for the institution. We hypothesized that maximizing tissue use from investigational large animal models after euthanasia could reduce loss of animal life and institutional costs by replacing commercially purchased tissues.</div></div><div><h3>Methods</h3><div>After animal euthanization, a resident and medical student team harvested porcine tissue commonly used for surgical simulation: abdominal wall, kidney, heart, spleen, and small intestine. Tissues were vacuum-sealed and frozen for future educational use. Outcomes of harvest yield and time and estimated commercial pricing of harvested porcine tissues were analyzed.</div></div><div><h3>Results</h3><div>Three timed procurements were performed with decreasing operative times (36:30, 34:00, and 30:54) and increasing harvest yields (100 cm, 160 cm, and 200 cm small bowel). Procurements were conducted within 15 min of animal euthanization. Harvested tissue was considered to be of similar quality to commercially purchased tissue. Estimated cost of procured tissues from a commercial vendor was $847 compared to $109 for direct procurement from euthanized porcine models.</div></div><div><h3>Conclusions</h3><div>Maximizing tissue use from large animal research models is an innovative approach to adhering to the three Rs of animal research: replace, reduce, and refine. Tissue procurement provides valuable tissues for resident education and simulation, increases surgical trainee operative exposure, and decreases institutional costs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400573","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":"Development and Validation of a 30-Day Point-Scoring Risk Calculator for Open Groin Vascular Surgery: The George Washington Groin Score","authors":"","doi":"10.1016/j.jss.2024.09.008","DOIUrl":"10.1016/j.jss.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Open groin vascular surgeries are important in managing peripheral arterial diseases. Given its inherent risks and the diverse patient profiles, there is a need for risk assessment tools. This study aimed to develop a 30-d point-scoring risk calculator for patients undergoing open groin vascular surgeries.</div></div><div><h3>Methods</h3><div>Patients underwent open groin vascular surgery, including aortobifemoral, axillofemoral, femorofemoral, iliofemoral, femoral-popliteal, and femoral-tibial bypass as well as thromboendarterectomy, were identified in American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2021. Patients were randomly sampled into experimental (2/3) and validation (1/3) groups. The George Washington (GW) groin score, a weighted point-scoring system, was developed for 30-d mortality from multivariable regression on preoperative risk variables by Sullivan's method. GW groin score was subjected to internal and external validation. Furthermore, the effectiveness of GW groin score was evaluated in 30-d major surgical complications.</div></div><div><h3>Results</h3><div>A total of 129,424 patients were analyzed, with 86,715 allocated to experimental group and 42,709 to validation group. GW groin score is derived as follows: aortobifemoral bypass (2 points), axillofemoral bypass (1 point), age (&gt;75 y, 2 points; 65-75 y, 1 point), disseminated cancer (2 points), emergent presentation (1 point), American Society of Anesthesiology score 4 or 5 (1 point), dialysis (1 point), and preoperative sepsis (1 point).GW groin score exhibited robust discrimination (<em>c</em>-statistic = 0.794, 95% CI = 0.786-0.803) and calibration (Brier score = 0.029). The transition from individual preoperative variables (<em>c</em>-statistic = 0.809, 95% CI = 0.801-0.818) to the point-scoring system was successful and external validation of the score was confirmed (<em>c</em>-statistic = 0.789, 95% CI = 0.777-0.801, Brier score = 0.030). Furthermore, GW groin score can effectively discriminate major surgical complications.</div></div><div><h3>Conclusions</h3><div>This study developed GW groin score, a concise and comprehensive 10-point risk calculator. This well-validated score demonstrates robust discriminative and predictive abilities for 30-d mortality and major surgical complications following open groin vascular surgeries. GW groin score can anticipate potential perioperative complications and guide treatment decisions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406547","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":"Does Functional Status Predict Worse 30-D Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms? A Propensity-Score Matched Study From ACS-NSQIP Targeted Database From 2012 to 2022","authors":"","doi":"10.1016/j.jss.2024.09.034","DOIUrl":"10.1016/j.jss.2024.09.034","url":null,"abstract":"<div><h3>Introduction</h3><div>In patients undergoing endovascular aneurysm repair (EVAR), existing studies have identified an association between dependent functional status (DFS) and poorer outcomes after EVAR. However, noted limitations, especially the lack of differentiation between ruptured and nonruptured abdominal aortic aneurysm (AAA), potentially affect the extrapolation of these findings to specific patient groups. Thus, this study aimed to evaluate the association between functional status and 30-d outcomes after EVAR in ruptured and nonruptured AAA patients separately.</div></div><div><h3>Methods</h3><div>Patients who underwent infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012-2022. Patients with DFS and those with independent functional status (IFS) were stratified into the two study cohorts. In nonruptured AAA, a 1:1 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distal extent of the aneurysm, anesthesia, and concomitant procedures between patients with DFS and IFS. The sample size for ruptured patients with AAA was too small for meaningful statistical analysis so only qualitative description was provided. Thirty-d postoperative mortality and morbidities of EVAR were assessed.</div></div><div><h3>Results</h3><div>For nonruptured cases, there were 380 (2.55%) DFS and 14,545 (97.45%) patients with IFS, where 453 patients with IFS were matched to the DFS cohort. For ruptured AAA, there were 17 (6.39%) DFS and 249 (93.61%) IFS. After matching, nonruptured DFS and patients with IFS had similar 30-d mortality rates (2.37% vs 2.11%, <em>P</em> = 1.00). However, patients with DFS had a higher risk of bleeding requiring transfusion (18.42% vs 11.84%, <em>P</em> = 0.01) and longer length of stay (median 3.00 [Q1 1.00, Q3 6.00] vs median 2.00 [Q1 1.00, Q3 4.00] d, <em>P</em> &lt; 0.01). All other outcomes, including major adverse cardiovascular events, cardiac complications, stroke, pulmonary complications, renal complications, sepsis, venous thromboembolism, wound complications, lower extremity ischemia, ischemic colitis, postoperative ruptured aneurysm, unplanned reoperation, 30-d readmission, were not different between patients with DFS and IFS. Qualitatively, ruptured patients with DFS had higher crude rates of 30-d mortality and morbidities compared to patients with IFS.</div></div><div><h3>Conclusions</h3><div>Contrary to previous literature, patients with DFS with nonruptured AAA undergoing EVAR were found to have largely comparable outcomes to patients with IFS, although extra attention should be paid to postoperative bleeding.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406548","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":"Association of Pre-Existing Type 2 Diabetes on Kidney Transplant Outcomes and Factors Correlating With Survival: A Single-Center Analysis","authors":"","doi":"10.1016/j.jss.2024.09.017","DOIUrl":"10.1016/j.jss.2024.09.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Kidney transplantation (KT) is the treatment of choice for end-stage renal disease. Diabetes mellitus is the most common indication for KT, with most recipients having type 2 diabetes mellitus (T2DM). Previous studies have shown inferior patient survival in T2DM KT recipients. This single-center study aimed to understand the individual factors associated with negative long-term outcomes.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective analysis of adult KT recipients, with and without T2DM from 2012 to 2017 with a follow-up through December 2022. Primary Outcomes were graft loss and patient survival. Univariate, Multivariate Cox regression, and Kaplan–Meier analyses were used to assess KT outcomes.</div></div><div><h3>Results</h3><div>We analyzed 1185 patients, 288 (24.3%) with T2DM. T2DM patients tended to be older, 56.6 ± 9.8 <em>versus</em> 47.1 ± 13.7 y. (<em>P</em> &lt; 0.01), male (66.3% <em>versus</em> 58.2% <em>P</em> &lt; 0.001) had a higher body mass index, 31.3 ± 5.4 <em>versus</em> 27.4 ± 5.7 <em>P</em> &lt; 0.01) and less likely to get a living donor transplant (46.5% <em>versus</em> 58.4%, <em>P</em> &lt; 0.01). T2DM patients after KT had a 50% higher risk for graft loss (hazard ratio 1.509, 95% CI 1.15-1.95, <em>P</em> &lt; 0.001) and a 106% higher risk of death (hazard ratio 2.06 (95% CI 1.48-2.87, <em>P</em> &lt; 0.0001). Among the T2DM patients, the most common cause of death was infection (39.9%). The average HbA1c at 1 y after transplant was 7.8%.</div></div><div><h3>Conclusions</h3><div>The present study shows that T2DM is strongly associated with an increased risk of graft loss and death after KT, particularly in older recipients of deceased donor transplants with longer cold ischemia time that experience delayed graft function. This underscores the importance of avoiding delayed graft function in older, type 2 diabetic kidney transplant recipients and prioritizing living donors.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400574","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":"Robotic-Assisted Versus Open Hemi-Hepatectomy: A Propensity Score Analysis","authors":"","doi":"10.1016/j.jss.2024.09.001","DOIUrl":"10.1016/j.jss.2024.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The robotic-assisted surgical system has been widely used in hepatectomy. However, the effectiveness and feasibility of robotic-assisted hemi-hepatectomy (RH) has not been well-documented.</div></div><div><h3>Methods</h3><div>Patients who underwent RH or open hemi-hepatectomy (OH) performed by a single surgeon at our hospital between January 2010 and August 2023 were included in this study. A stabilized inverse probability of treatment weighting adjusted analysis was performed.</div></div><div><h3>Results</h3><div>Of the 163 consecutive patients identified, 60 underwent RH, and 103 underwent OH. After stabilized inverse probability of treatment weighting adjustment, RH demonstrated less blood loss than OH. In subgroup analyses, robotic-assisted left hemi-hepatectomy was associated with a shorter postoperative stay, a lower postoperative complication rate, and less blood loss compared with open left hemi-hepatectomy. While robotic-assisted right hemi-hepatectomy (RRH) was associated with less blood loss and a lower intraoperative blood transfusion rate, but a longer operation time compared with open right hemi-hepatectomy.</div></div><div><h3>Conclusions</h3><div>RH is a safe and effective technique. In addition to less blood loss, robotic-assisted left hemi-hepatectomy had advantages in postoperative complications and postoperative stay, while RRH had advantages in intraoperative blood transfusions. However, operation time was longer for RRH than for open right hemi-hepatectomy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400576","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":"Role of Adjuvant Chemotherapy After Curative Resection in Stage II and III Rectal Cancer","authors":"","doi":"10.1016/j.jss.2024.09.022","DOIUrl":"10.1016/j.jss.2024.09.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with resected locally advanced rectal cancer (LARC) and an incomplete total mesorectal excision (TME) have worse oncologic outcomes. The associations between TME grade, adjuvant therapy receipt, and oncologic outcomes have not been well-studied. We aimed to determine the association between adjuvant chemotherapy and oncologic outcomes in patients who underwent neoadjuvant chemoradiation (CRT) or short-course radiotherapy (SCRT) followed by proctectomy and to evaluate this association stratified by TME grade.</div></div><div><h3>Materials and methods</h3><div>We analyzed a retrospective multi-institutional cohort of primary LARC patients diagnosed between 2010 and 2018 who received neoadjuvant CRT/SCRT followed by proctectomy. Complete TME was defined as complete mesorectal excision, and noncomplete TME was defined as near-complete or incomplete TME. We used adjusted Cox proportional hazards regression to test the association between adjuvant chemotherapy and mortality or locoregional recurrence (LRR) across groups.</div></div><div><h3>Results</h3><div>We identified 746 eligible patients. On final pathology, 101 (13.5%) had noncomplete and 645 (86.5%) had complete TME. Rates of adjuvant chemotherapy receipt were similar between noncomplete and complete TME groups (70.3% and 69.5%, respectively). Mean follow-up interval was 35 mo. Adjuvant chemotherapy was associated with lower risk of mortality (HR 0.27, 95% CI 0.19-0.39, <em>P</em> &lt; 0.001); the same association existed when stratifying patients by TME grade. For patients with a complete TME, adjuvant chemotherapy was associated with lower LRR (HR 0.08, 95% CI 0.01-0.56, <em>P</em> = 0.01). The LRR model for the noncomplete TME group did not converge due to few captured recurrences.</div></div><div><h3>Conclusions</h3><div>These data show an association between adjuvant chemotherapy and positive outcomes in LARC patients receiving neoadjuvant CRT/SCRT followed by proctectomy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391424","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}