Surgery最新文献

{"title":"Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients","authors":"Adi Vinograd MD, MPH ,&nbsp;Lital Keinan Boker MD, PhD ,&nbsp;Rita Dichtiar MPH ,&nbsp;Alina Rosenberg PhD ,&nbsp;Orly Romano-Zelekha PhD ,&nbsp;Inbal Globus PhD","doi":"10.1016/j.surg.2026.110083","DOIUrl":"10.1016/j.surg.2026.110083","url":null,"abstract":"<div><h3>Background</h3><div>One-anastomosis gastric bypass is a commonly performed metabolic bariatric surgery, yet comprehensive comparisons of its midterm outcomes with Roux-en-Y gastric bypass and sleeve gastrectomy remain limited. The study aimed to assess midterm outcomes, including weight loss and 3-year post–metabolic bariatric surgery complications, in a nationwide cohort.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients aged ≥18 years who underwent one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or sleeve gastrectomy between 2016 and 2019, using data from the National Metabolic Bariatric Surgery Registry and Maccabi Health Services, the second largest health provider. Adjusted odds ratios for study outcomes were estimated using multivariable logistic regressions and propensity score matching.</div></div><div><h3>Results</h3><div>The study comprised 2,249 one-anastomosis gastric bypass (36.1%), 447 Roux-en-Y gastric bypass (7.2%), and 3,538 sleeve gastrectomy (56.8%) patients. Preoperative mean body mass index values were 41.3 ± 4.9, 40.4 ± 4.7, and 41.6 ± 4.9 kg/m² for one-anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy, respectively. One-anastomosis gastric bypass achieved the greatest weight-loss efficacy of 30.9% at 3 years of follow-up (<em>P</em> &lt; .001). One-anastomosis gastric bypass was associated with higher odds of anal fissure (adjusted odds ratio, 1.85; 95% confidence interval, 1.38–2.49) alongside lower odds of constipation (adjusted odds ratio, 0.62; 95% confidence interval, 0.49–0.79), compared with sleeve gastrectomy. Both one-anastomosis gastric bypass and Roux-en-Y gastric bypass were associated with a higher likelihood of abdominal pain, diarrhea, and stomach ulcers compared with sleeve gastrectomy, after adjustment for potential confounders.</div></div><div><h3>Conclusion</h3><div>One-anastomosis gastric bypass demonstrated a greater magnitude of weight loss compared with sleeve gastrectomy but was associated with a higher incidence of specific gastrointestinal complications. These findings suggest additional considerations when selecting the optimal metabolic bariatric surgery approach, alongside tailored postoperative surveillance.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110083"},"PeriodicalIF":2.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin White MD, PhD ,&nbsp;Manish Chand MBA, PhD ,&nbsp;Danny A. Sherwinter MD ,&nbsp;Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD ,&nbsp;Solafah Abdalla MD, PhD ,&nbsp;Aurélien Amiot MD, PhD ,&nbsp;Antoine Meyer MD, PhD ,&nbsp;Franck Carbonnel MD, PhD ,&nbsp;Christophe Penna MD, PhD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m², and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A missed opportunity to discuss treatment costs? A qualitative analysis of preoperative conversations about thyroid cancer treatment","authors":"Emily V. Crowley MS ,&nbsp;Catherine B. Jensen MD, MSc ,&nbsp;Elizabeth M. Bacon MPH ,&nbsp;Benjamin C. James MD, MS ,&nbsp;Susan C. Pitt MD, MPHS","doi":"10.1016/j.surg.2025.110075","DOIUrl":"10.1016/j.surg.2025.110075","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110075"},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of spatiotemporal features into machine learning assessment of open surgical skills","authors":"Armin Alipour MS ,&nbsp;Jeffrey Balian BS ,&nbsp;Kevin Tabibian BS ,&nbsp;Oh Jin Kwon MD ,&nbsp;Nguyen Le MS ,&nbsp;Areti Tillou MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.110079","DOIUrl":"10.1016/j.surg.2025.110079","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate and objective assessment of operative skills is essential for improving training paradigms, patient safety, and quality of surgery. Advances in machine learning have facilitated automated assessment of minimally invasive and robotic operations. This study aims to develop a novel machine learning model for evaluation of open surgical proficiency.</div></div><div><h3>Methods</h3><div>This study used the AIxSuture data set. A global rating score was assigned for each video, categorizing individuals into novice (<em>n</em> = 119), intermediate (<em>n</em> = 79), and proficient (<em>n</em> = 116) classes. Hybrid convolutional neural network and long-short-term-memory networks were employed to train the video classifier model. ResNet50, an image classification model, served as a spatial feature extractor to perform nonlinear transformations. Long-short-term-memory networks selectively retained and discarded both significant and insignificant changes in frame sets that capture the subject's movements. The class-wise F1 score was measured to assess harmonic performance.</div></div><div><h3>Results</h3><div>Our assessment achieved a mean F1 score of 80.1% in determining the performance level of each subject, outperforming previous models. Additionally, the model classified performance with 90.1% accuracy for the novice group, 65.7% for the intermediate group, and 86.3% for the proficient group. Despite lower accuracy in the intermediate class, this metric outperformed other models in this group by nearly 10%. The present model classified each video into appropriate skill levels at an estimated 10.2 ± 0.4 seconds.</div></div><div><h3>Conclusions</h3><div>Our machine learning model provides a robust framework for skill assessment in open surgery. The application of machine learning in clinical practice should be considered to evaluate surgeons' skills and help improve training and outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110079"},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost comparison analysis of environmentally sustainable interventions in colorectal surgery","authors":"Rabiya Aseem MBBS, MSc, MRCS ,&nbsp;Siya Lodhia MBBS, MRCS ,&nbsp;Timothy Rockall MBBS, MD, FRCS ,&nbsp;Daniel Jackson BSc, MSc, PhD","doi":"10.1016/j.surg.2025.110054","DOIUrl":"10.1016/j.surg.2025.110054","url":null,"abstract":"<div><h3>Background</h3><div>Operating theaters are significant contributors to hospital carbon emissions, with colorectal surgery offering substantial opportunities for sustainable transformations. Financial assessments are critical to aid sustainable implementation within health care organizations. We conducted a cost comparison analysis of substituting disposable surgical items with their reusable counterparts in colorectal surgeries.</div></div><div><h3>Methods</h3><div>This was a prospective cost comparison study across 65 consecutive elective laparoscopic colorectal resections at a single UK center. Interventions included reusable laparoscopic ports/trocars, a reusable harmonic device, and reusable textiles (gowns, drapes, and slide sheets). Costs were analyzed using a per-case unit (capital amortized over expected lifetime + per-use sterilization/laundering). We also conducted a two-way sensitivity analysis and a threshold (break-even) analysis with 6% discounting over a 5-year life span.</div></div><div><h3>Results</h3><div>The total observed savings across 65 cases were £14,239.03. The reusable harmonic device remained cost-saving in all two-way combinations, with savings of £24.7k–£28.5k over 65 cases (baseline of £26.6k). Reusable textiles were consistently cheaper than disposables across modeled volumes. Reusable ports did not demonstrate cost savings at observed volumes and prices and did not reach parity on threshold analysis. Findings were driven by processing costs, capital price, and utilization.</div></div><div><h3>Conclusion</h3><div>Selectively adopted reusables can deliver measurable financial savings, particularly the harmonic device and theatre textiles, whereas other items may remain cost-increasing at current volumes and prices. The per-case, two-way sensitivity framework is transferable and can be populated with local inputs to inform implementation decisions aligned with sustainability aims.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110054"},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial","authors":"Vasileios Gkanis MD, MSc ,&nbsp;Konstantinos Nastos MD, PhD ,&nbsp;Konstantinos Ntalaperas MD ,&nbsp;Evangelia Agianni MD ,&nbsp;Spyridon Lainas MD ,&nbsp;Panagiota Raikou MD ,&nbsp;Nikolaos Dafnios MD, PhD ,&nbsp;Ioannis Papakonstantinou MD, PhD ,&nbsp;Sophocles Lanitis MD, PhD","doi":"10.1016/j.surg.2025.110071","DOIUrl":"10.1016/j.surg.2025.110071","url":null,"abstract":"<div><h3>Background</h3><div>Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, <em>n</em> = 300) or standard postoperative care (group B, <em>n</em> = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ², Student’s <em>t</em> test, Mann-Whitney <em>U</em> test, and odds ratio and 95% confidence interval.</div></div><div><h3>Results</h3><div>Laboratory hypocalcemia (serum calcium &lt;8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, <em>P</em> &lt; .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, <em>P</em> &lt; .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, <em>P</em> &lt; .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (<em>P</em> &lt; .001) and a shorter hospital stay (1.25 days vs 1.7 days, <em>P</em> &lt; .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.</div></div><div><h3>Conclusion</h3><div>Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110071"},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a robotic pancreatoduodenectomy program: Navigating the learning curve with a liberal patient selection and conversion strategy","authors":"Zhi Ven Fong MD, MPH, DrPH ,&nbsp;Chee-Chee Stucky MD ,&nbsp;Po Hong Tan MBBS ,&nbsp;Dillon Cheung MD ,&nbsp;Stephanie Yu MD ,&nbsp;Anita M. Moyer RN, OCN ,&nbsp;Julie L. Hildebrand PA-C, MS ,&nbsp;Hoe Yan Hor MBBS ,&nbsp;Melody Tu MBBS ,&nbsp;Rick Bold MD, MBA ,&nbsp;Yu-Hui Chang MS, PhD ,&nbsp;Nabil Wasif MD, MPH","doi":"10.1016/j.surg.2025.110070","DOIUrl":"10.1016/j.surg.2025.110070","url":null,"abstract":"<div><h3>Background</h3><div>The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.</div></div><div><h3>Results</h3><div>A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, <em>P</em> &lt; .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, <em>P</em> &lt; .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, <em>P</em> = .02), shorter length of stay (−2.0 days, <em>P</em> &lt; .001), and similar 30-day major morbidity (−9.3%, <em>P</em> = .14) and readmission (+7.3%, <em>P</em> = .13), as well as mortality rates (−1.7%, <em>P</em> = .45) after program implementation.</div></div><div><h3>Conclusion</h3><div>A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110070"},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of young surgeons in surgical health policy advocacy engagement","authors":"Amy E. Liepert MD ,&nbsp;Anthony Douglas MD ,&nbsp;Alexandra Johns MD, MPH ,&nbsp;Jay J. Doucet MD ,&nbsp;Christina Colosimo DO, MS","doi":"10.1016/j.surg.2025.110066","DOIUrl":"10.1016/j.surg.2025.110066","url":null,"abstract":"<div><h3>Background</h3><div>Despite its critical importance, health policy advocacy remains vastly underutilized among surgeons and represents a critical area for professional development. Yet, interest is growing among younger physicians, particularly early-career surgeons who increasingly view advocacy as integral to patient care. Amid a rapidly evolving health care landscape, advocacy is defined as physician efforts to influence social, economic, and political factors affecting health and is essential for addressing systemic challenges.</div></div><div><h3>Methods</h3><div>Millennials and GenZ are now entering in early to mid-stages of surgical practice and are transforming advocacy approaches. These generational cohorts have been shaped by digital technology, health care and insurance debates, and public health emergencies (eg firearm violence and COVID-19). They bring new energy and methods to health policy advocacy engagement. These digital natives prefer multichannel communication and virtual platforms, both of which facilitate participation while reducing clinical disruptions. Younger physicians see advocacy not as an optional task, but a professional responsibility aligned with leadership, autonomy, and systemic change.</div></div><div><h3>Results</h3><div>Despite support from competency frameworks such as Accreditation Council for Graduate Medical Education, formal training in advocacy remains limited, often relying on mentorship or experiential learning. It is imperative that we improve our engagement and education of surgeons interested in advocacy as we know there are benefits for the surgeons themselves, the surgical community, and society as a whole. Engaging in policy can help young surgeons influence major legislative and hospital-level decisions. It also builds skills in leadership, negotiation, and communication, while fostering resilience and reducing moral injury through agency and systemic change, and allows young surgeons to shape the future of their profession.</div></div><div><h3>Conclusion</h3><div>Engagement of young surgeons in advocacy is vital for improving patient care, ensuring professional autonomy and sustainability, and translating science into impactful health policy. Academic surgery programs can contribute to the improvement in education of residents and early-career surgeons with mentorship programs and collaborations with other departments to develop a robust network of surgeon health policy advocates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110066"},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer","authors":"Shusheng Zhu MM ,&nbsp;Zhihua Li MM ,&nbsp;Wenzheng Xu MD ,&nbsp;Zhicheng He MD ,&nbsp;Liang Chen MD ,&nbsp;Weibing Wu MD","doi":"10.1016/j.surg.2025.110080","DOIUrl":"10.1016/j.surg.2025.110080","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>Patients with peripheral small-sized non–small cell lung cancer (≤2 cm) who underwent sublobar resection or lobectomy between 2020 and 2023 were screened. Surgical procedures were determined through discussion under the guidance of 3-dimensional computed tomography bronchography and angiography. A surgical margin equal to or larger than the maximum tumor diameter was considered sufficient. Logistic regression analyses were used to screen factors associated with the feasibility and margin quality of sublobar resection. Predictive nomograms were developed for segmentectomy and wedge based on independent factors, respectively.</div></div><div><h3>Results</h3><div>There were 383 (51.3%), 286 (38.3%), and 78 patients (10.4%) undergoing wedge resection, segmentectomy, and lobectomy, respectively. The likelihood of achieving sufficient margins was 90.9% for segmentectomy and 74.4% for wedge resection. Overall, 545 of 747 patients (73.0%) received sublobar resection with sufficient margins. The multivariable logistic regression analysis (segmentectomy with insufficient margins or lobectomy = 1, segmentectomy with sufficient margins = 0) showed that tumor size, radiologic types, located lobes, tumor-to-segmental bronchus distance, and subsegmental attribution were significantly associated with the feasibility and margin quality of segmentectomy. For wedge resection, tumor size and Lewis types were significantly associated with its feasibility or margin quality. The predictive models exhibited good performance, with an area under the curve of 0.821 for segmentectomy and 0.765 for wedge resection.</div></div><div><h3>Conclusion</h3><div>Tumor size, radiologic types, located lobe, tumor-to-segmental bronchus distance, Lewis types, and subsegmental attribution types were associated with the feasibility and margin quality of sublobar resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110080"},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}