Surgery最新文献 - Book学术

Cover 1(with editorial board) 封面1（附编委）

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-25 DOI: 10.1016/S0039-6060(25)00211-9

引用次数: 0

Information for readers 读者资讯

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-25 DOI: 10.1016/S0039-6060(25)00213-2

引用次数: 0

Editors' note 编者注

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-25 DOI: 10.1016/j.surg.2025.109356

Caitlin W. Hicks MD, MS, FACS, FAHA, DFSVS, Steven D. Wexner MD, PhD

引用次数: 0

Association of psychosocial risk factors with acute outcomes of elective cancer resection in the United States 美国择期癌症切除的急性预后与社会心理风险因素的关系

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-24 DOI: 10.1016/j.surg.2025.109354

Konmal Ali, Amulya Vadlakonda BS, Sara Sakowitz MPH, MS, Adedunmola P. Adewale BS, Syed Shaheer Ali, Melissa Justo MD, Ayesha Ng MPH, Peyman Benharash MD

Background

Psychosocial risk factors, including psychiatric disorders, substance use, limited cognitive comprehension, and low socioeconomic or uninsured status, are increasingly recognized in cancer care. However, their independent effects on acute postoperative outcomes after elective cancer surgery remain unclear. This study evaluates the association between psychosocial risk factors and clinical and financial outcomes in patients undergoing cancer resections.

Methods

All adult (≥18 years) records entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, and colon cancer were tabulated from the 2016–2021 Nationwide Readmissions Database. After entropy balancing, multivariable regression models were developed to ascertain the independent association of psychosocial risk factors. with mortality, complications, length of stay, and nonhome discharge.

Results

Of ∼655,376 patients, 223,035 (34.2%) were considered to comprise psychosocial risk factors. Relative to others, the psychosocial risk factors cohort was more commonly female (51.9 vs 47.1%, P < .001), and had a greater Elixhauser Comorbidity Index (4 [3–5] vs 3 [2–4], P < .001). Both groups most frequently underwent resection for colectomy (51.9% vs 51.1%%, P < .001), yet those with psychosocial risk factors had greater rates of lobectomy (27.8% vs 25.8%, P < .001), compared with their counterparts. After entropy balancing, psychosocial risk factors were linked to greater odds of mortality (adjusted odds ratio, 1.43, 95% confidence interval, 1.31–1.57), respiratory (adjusted odds ratio, 1.25; 95% confidence interval, 1.21–1.31) and infectious (adjusted odds ratio, 1.17; 95% confidence interval, 1.12–1.21) complications. Furthermore, patients with psychosocial risk factors faced incrementally increased resource use.

Conclusion

Psychosocial risk factors independently predict adverse clinical and financial outcomes after elective cancer operations. Systematic screening for psychosocial risk factors may facilitate targeted interventions to improve care for high-risk patients.

心理社会风险因素，包括精神障碍、药物使用、有限的认知理解、低社会经济或无保险状况，在癌症治疗中越来越被认识到。然而，它们对选择性癌症手术后急性术后结局的独立影响尚不清楚。本研究评估了接受癌症切除术的患者的社会心理风险因素与临床和财务结果之间的关系。方法从2016-2021年全国再入院数据库中列出所有需要择期切除肺癌、食管癌、胃癌、胰腺癌、肝癌和结肠癌的成人（≥18岁）记录。在熵平衡之后，我们建立了多变量回归模型来确定心理社会危险因素的独立关联。死亡率，并发症，住院时间和非家庭出院。结果在655,376例患者中，223,035例（34.2%）被认为包含社会心理风险因素。与其他人群相比，心理社会风险因素队列中女性更为常见(51.9 vs 47.1%, P <；.001)，且Elixhauser合并症指数更高(4 [3 - 5]vs 3 [2-4], P <；措施)。两组最常行结肠切除术(51.9% vs 51.1%, P <；.001)，但有社会心理危险因素者的肺叶切除率更高(27.8% vs 25.8%, P <；.001)。经过熵平衡后，心理社会风险因素与更高的死亡率（校正优势比为1.43,95%可信区间为1.31-1.57）、呼吸(校正优势比为1.25；95%可信区间，1.21-1.31)和传染性(校正优势比，1.17；95%可信区间，1.12-1.21)并发症。此外，具有社会心理风险因素的患者面临着逐渐增加的资源使用。结论心理社会风险因素独立预测选择性癌症手术后的不良临床和财务结果。对社会心理危险因素的系统筛查可能有助于有针对性的干预措施，以改善对高危患者的护理。

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引用次数: 0

Isolated surgical valve replacement for tricuspid regurgitation: An international multicenter study 孤立外科瓣膜置换术治疗三尖瓣反流：一项国际多中心研究

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-23 DOI: 10.1016/j.surg.2025.109370

Massimo Baudo MD , Besart Cuko MD , Julien Ternacle MD , Elena Magrini MS , Olivier Busuttil MD , Nabil Dib MD , Serge Sicouri MD , Louis Labrousse MD, PhD , Thomas Modine MD, PhD , Basel Ramlawi MD

Background

Although the management of tricuspid regurgitation during mitral surgery is standardized, the approach to patients with isolated tricuspid regurgitation is less clearly defined. This study examined the surgical outcomes of patients who underwent isolated surgical tricuspid valve replacement at 2 medical centers, providing insights into the postoperative and midterm outcomes.

Methods

This retrospective observational study analyzed data from 2 tertiary cardiac surgery centers. All patients underwent isolated surgical tricuspid valve replacement between 2010 and 2023. The primary end point included 30-day and midterm survival. The secondary end points included postoperative and valve-related complications.

Results

A total of 64 patients were included. The mean age was 58 ± 17 years, and 51.6% (33/64) were male patients. The median European System for Cardiac Operative Risk Evaluation II, TRISCORE, and Model for End-Stage Liver Disease scores were 2.16 [1.38–3.42], 3.00 [1.00–4.00], and 10.50 [9.00–16.25], respectively. More than 60% of the procedures were conducted on a beating heart. Thirty-day mortality was 7.8%. European System for Cardiac Operative Risk Evaluation II underestimated mortality, whereas the Model for End-Stage Liver Disease score was a more reliable predictor. Ten patients finally received a permanent pacemaker upon discharge. The overall survival rates at 1 and 6 years were 88.8 ± 4.0% and 80.3 ± 7.3%, respectively. Freedom from tricuspid valve reintervention rates at 1 and 6 years were 96.2 ± 2.6% and 75.0 ± 9.6%, respectively.

Conclusion

This study demonstrated that isolated surgical tricuspid valve replacement can be undertaken without exposing patients to an excessively high mortality risk. Risk assessment using specific scores may be useful in this regard. Nevertheless, these patients are at risk of postoperative complications, particularly permanent pacemaker implantation.

背景：虽然二尖瓣手术中三尖瓣反流的处理是标准化的，但孤立性三尖瓣反流患者的治疗方法却不太明确。本研究调查了在2个医疗中心接受孤立手术三尖瓣置换术的患者的手术结果，提供了对术后和中期结果的见解。方法回顾性观察分析2个三级心脏外科中心的资料。所有患者均在2010年至2023年间接受了分离性三尖瓣置换术。主要终点包括30天和中期生存期。次要终点包括术后和瓣膜相关并发症。结果共纳入64例患者。平均年龄58±17岁，男性占51.6%（33/64）。欧洲心脏手术风险评估系统II、TRISCORE和终末期肝病模型评分的中位数分别为2.16[1.38-3.42]、3.00[1.00-4.00]和10.50[9.00-16.25]。超过60%的手术是在一颗跳动的心脏上进行的。30天死亡率为7.8%。欧洲心脏手术风险评估系统II低估了死亡率，而终末期肝病评分模型是一个更可靠的预测因子。10名患者最终在出院时接受了永久性起搏器。1年和6年总生存率分别为88.8±4.0%和80.3±7.3%。1年和6年三尖瓣再干预率分别为96.2±2.6%和75.0±9.6%。结论：本研究表明，孤立的三尖瓣置换术可以在不使患者面临过高死亡风险的情况下进行。在这方面，使用特定分数进行风险评估可能是有用的。然而，这些患者有术后并发症的风险，特别是永久性起搏器植入。

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引用次数: 0

The smallest suffer stroke: Understanding stroke and treatment patterns in children with blunt cerebrovascular injury within the Trauma Quality Improvement Program database 最小的遭受中风：在创伤质量改善计划数据库中了解钝性脑血管损伤儿童的中风和治疗模式

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-22 DOI: 10.1016/j.surg.2025.109353

Catherine C. Dawson-Gore MD, MSc , Emily K. Myers MD , Emily H. Cooper MS , Lauren L. Evans MD , Steven G. Schauer DO , Shannon Acker MD

Background

Stroke rate and treatment patterns for children with blunt cerebrovascular injury are not well-described. There exists a gap in knowledge of how children with blunt cerebrovascular injury are treated, the stroke rate associated with antithrombotic therapy, and the optimal time to start treatment.

Methods

A retrospective review of the Trauma Quality Improvement Program database was conducted from 2016 to 2022 for children with blunt injury (<18 years) with blunt cerebrovascular injury. Analysis of all children with blunt cerebrovascular injury and subgroups of children without traumatic brain injury, as well as those without contraindications to antithrombotic therapy (no traumatic brain injury, solid-organ injury, or blood transfusion within 24 hours) was performed. Stroke rate and treatment patterns were compared between age groups (0–6, 7–11, 12–14, 15–17 years) and injury grades.

Results

Among 685,631 blunt injured children, 2,336 incurred blunt cerebrovascular injury (0.34%). Stroke rate was greatest in the youngest patients (6.2% 0–6 years; 2.0% 7–11 years) who had the lowest rates of antithrombotic therapy. Fifty-two percent of patients received no antithrombotic therapy during their hospitalization. Children who received antithrombotic therapy had greater rates of stroke compared with those untreated (6.1% vs 2.1%, P < .001) regardless of age group. Low-molecular weight heparin was the most common antithrombotic therapy (28.2%) followed by heparin (14.2%), and aspirin (5.1%).

Conclusion

Children aged 0–11 years had the greatest rates of stroke and were least likely to receive antithrombotic therapy. More than one half of children did not receive antithrombotic therapy. Patients who received antithrombotic therapy had greater stroke rates than untreated patients, which may reflect antithrombotic therapy given after stroke occurred. Treatment guidelines are needed for children with blunt cerebrovascular injury.

背景钝性脑血管损伤儿童的卒中率和治疗模式尚未得到很好的描述。在如何治疗钝性脑血管损伤儿童、抗血栓治疗相关的卒中率以及开始治疗的最佳时间等方面存在知识空白。方法对 2016 年至 2022 年创伤质量改进计划数据库中的钝性损伤（<18 岁）儿童钝性脑血管损伤进行了回顾性审查。对所有钝性脑血管损伤患儿、无外伤性脑损伤患儿亚组以及无抗血栓治疗禁忌症（无外伤性脑损伤、实体器官损伤或24小时内输血）的患儿进行了分析。比较了不同年龄组（0-6 岁、7-11 岁、12-14 岁、15-17 岁）和不同损伤等级的中风率和治疗模式。结果在 685,631 名受钝器伤的儿童中，有 2,336 人发生了钝器性脑血管损伤（0.34%）。年龄最小的患者中风率最高（0-6 岁为 6.2%；7-11 岁为 2.0%），他们接受抗血栓治疗的比例最低。52%的患者在住院期间没有接受抗血栓治疗。与未接受抗血栓治疗的儿童相比，接受抗血栓治疗的儿童发生中风的比例更高（6.1% vs 2.1%，P < .001），与年龄组无关。低分子量肝素是最常见的抗血栓治疗药物（28.2%），其次是肝素（14.2%）和阿司匹林（5.1%）。超过一半的儿童没有接受抗血栓治疗。与未接受治疗的患者相比，接受抗血栓治疗的患者中风率更高，这可能反映了在中风发生后才进行抗血栓治疗。需要为钝性脑血管损伤儿童制定治疗指南。

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引用次数: 0

Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study 胰十二指肠切除术后伴有或不伴有临床相关胰瘘的C级出血的差异：一项回顾性队列研究

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-17 DOI: 10.1016/j.surg.2025.109355

Yuran Dai MD , Jingyue Fu MD , Xiaozhi Lu MD , Yazhou Wang PhD, MD , Kai Zhang MD , Kuirong Jiang PhD, MD , Yi Miao PhD, MD , Jishu Wei PhD, MD

Background

Pancreatic fistula is a major cause of late postpancreatectomy hemorrhage; however, it is not always accompanied by a postoperative pancreatic fistula, indicating other potential etiologies and characteristics. We investigated the role of clinically relevant postoperative pancreatic fistula in grade C postpancreatectomy hemorrhage and its potential as a classification criterion.

Methods

In this retrospective cohort study, we identified patients who developed grade C postpancreatectomy hemorrhage with or without concomitant clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy at the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2023. The patients' demographics, bleeding patterns, and outcomes were retrieved from their medical records and analyzed.

Results

Overall, 90 patients with grade C postpancreatectomy hemorrhage (52 [57.8%] with clinically relevant postoperative pancreatic fistula) were included in this study. Patients with clinically relevant postoperative pancreatic fistula had longer bleeding intervals (13.5 vs 7 days; P = .007). Although the gastroduodenal artery stump (32.7%) was the most common bleeding site in the fistula group, the hepatic artery and its branches (23.7%) and other bleeding points in the surgical area (23.7%) were predominant in the non-fistula group (P = .041). The fistula group had a greater mortality rate (38.5% vs 10.5%; P = .003), longer median length of hospital stay (42 vs 30 days; P = .047), longer intensive care unit stay (2 vs 0 days; P = .004), and greater hospitalization costs (RMB 283,632.73 vs RMB 189,087.6; P = .004).

Conclusion

The bleeding patterns and outcomes of grade C postpancreatectomy hemorrhage with and without concomitant clinically relevant postoperative pancreatic fistula varied. Therefore, postoperative pancreatic fistula could be considered as a new classification criterion for late postpancreatectomy hemorrhage.

胰瘘是胰腺切除术后晚期出血的主要原因；然而，它并不总是伴有术后胰瘘，这表明其他潜在的病因和特征。我们研究了临床相关的术后胰瘘在胰切除术后C级出血中的作用及其作为分类标准的潜力。方法回顾性队列研究选取南京医科大学第一附属医院2014年1月至2023年12月期间发生胰十二指肠切除术后C级出血伴或不伴临床相关胰瘘的患者。从患者的医疗记录中检索并分析患者的人口统计学、出血模式和结果。结果本研究共纳入90例胰腺切除术后C级出血患者，其中52例（57.8%）伴有临床相关的术后胰瘘。具有临床相关性的术后胰瘘患者出血间隔较长(13.5 vs 7天；p = .007)。虽然胃十二指肠动脉残端（32.7%）是瘘组最常见的出血部位，但非瘘组以肝动脉及其分支（23.7%）和手术区域其他出血点（23.7%）为主（P = 0.041）。瘘管组的死亡率更高(38.5% vs 10.5%；P = 0.003)，中位住院时间更长(42天vs 30天；P = 0.047)，重症监护病房住院时间较长(2天vs 0天；P = 0.004)，住院费用更高(283,632.73元对189,087.6元；p = .004)。结论胰切除术后C级出血伴和不伴临床相关胰瘘的出血模式和结局不同。因此，术后胰瘘可作为胰腺切除术后晚期出血的新分类标准。

{"title":"Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study","authors":"Yuran Dai MD , Jingyue Fu MD , Xiaozhi Lu MD , Yazhou Wang PhD, MD , Kai Zhang MD , Kuirong Jiang PhD, MD , Yi Miao PhD, MD , Jishu Wei PhD, MD","doi":"10.1016/j.surg.2025.109355","DOIUrl":"10.1016/j.surg.2025.109355","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic fistula is a major cause of late postpancreatectomy hemorrhage; however, it is not always accompanied by a postoperative pancreatic fistula, indicating other potential etiologies and characteristics. We investigated the role of clinically relevant postoperative pancreatic fistula in grade C postpancreatectomy hemorrhage and its potential as a classification criterion.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we identified patients who developed grade C postpancreatectomy hemorrhage with or without concomitant clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy at the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2023. The patients' demographics, bleeding patterns, and outcomes were retrieved from their medical records and analyzed.</div></div><div><h3>Results</h3><div>Overall, 90 patients with grade C postpancreatectomy hemorrhage (52 [57.8%] with clinically relevant postoperative pancreatic fistula) were included in this study. Patients with clinically relevant postoperative pancreatic fistula had longer bleeding intervals (13.5 vs 7 days; <em>P</em> = .007). Although the gastroduodenal artery stump (32.7%) was the most common bleeding site in the fistula group, the hepatic artery and its branches (23.7%) and other bleeding points in the surgical area (23.7%) were predominant in the non-fistula group (<em>P</em> = .041). The fistula group had a greater mortality rate (38.5% vs 10.5%; <em>P</em> = .003), longer median length of hospital stay (42 vs 30 days; <em>P</em> = .047), longer intensive care unit stay (2 vs 0 days; <em>P</em> = .004), and greater hospitalization costs (RMB 283,632.73 vs RMB 189,087.6; <em>P</em> = .004).</div></div><div><h3>Conclusion</h3><div>The bleeding patterns and outcomes of grade C postpancreatectomy hemorrhage with and without concomitant clinically relevant postoperative pancreatic fistula varied. Therefore, postoperative pancreatic fistula could be considered as a new classification criterion for late postpancreatectomy hemorrhage.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109355"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838698","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}

引用次数: 0

Prognostic value of immune infiltration in colorectal cancer: Development of a histopathology-related immunoscore via multiplexed immunohistochemistry 结直肠癌免疫浸润的预后价值：通过多重免疫组化技术开发组织病理学相关免疫分数

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-14 DOI: 10.1016/j.surg.2025.109350

Shiqi Zhou MD , Zhaofu Qin MS , Shunv Cai MD , Ting Ma MS , Luyi Lin MD , Longhai Feng MD , Xinyi Gao MD , Dening Ma MD

Background

Our objective was to evaluate the prognostic value of immune infiltration within the intratumoral and peritumoral tissues and to establish a novel histopathology-related immunoscore associated with postoperative colorectal cancer prognosis.

Methods

In the tissue microarrays, a total of 104 patients with colorectal cancer were enrolled and randomly assigned to the derivation cohort (n = 61) or the validation cohort (n = 43). Eighteen prognostic immune biomarkers in both intratumoral and peritumoral tissues were examined by the multiplexed immunohistochemistry method, with quantification performed through digital pathology. The histopathology-related immunoscore score was constructed using least absolute shrinkage and selection operator Cox analysis by selected immune features. On the basis of the Cox regression analysis, 3 predictive models were established. Harrell C-statistics were used to assess the performance of those models.

Results

The area under the curve was 0.743 (confidence interval, 0.457–1.000) in the derivation cohort and 0.739 (confidence interval, 0.538–0.940) in the validation cohort. Subsequently, the groups were classified on the basis of the optimal cutoff value, with the high-risk group exhibiting a poorer prognosis. Furthermore, 3 predictive clinical models were constructed, incorporating the significant risk factors and histopathology-related immunoscore score. The first model incorporating both histopathology-related immunoscore score and statistically significant factors identified through univariate analysis demonstrated superior predictive capability for survival across all 3 models, with an area under the curve of 0.852 and C-index of 0.837.

Conclusion

The histopathology-related immunoscore score offers a novel means of estimating of survival in patients with colorectal cancer. These findings indicated that the immunoscore and the clinical factors might serve as complementary tools to TNM staging to improve the accuracy of patient survival prediction.

我们的目的是评估肿瘤内和肿瘤周围组织内免疫浸润的预后价值，并建立一种与结直肠癌术后预后相关的新型组织病理学相关免疫评分。方法采用组织微阵列技术，共纳入104例结直肠癌患者，随机分为衍生组（n = 61）和验证组（n = 43）。采用多重免疫组织化学方法检测肿瘤内和肿瘤周围组织中的18种预后免疫生物标志物，并通过数字病理学进行量化。组织病理学相关的免疫评分评分采用最小绝对收缩和选择算子Cox分析选定的免疫特征。在Cox回归分析的基础上，建立了3个预测模型。使用Harrell c统计量来评估这些模型的性能。结果衍生队列的曲线下面积为0.743（置信区间为0.457 ~ 1.000），验证队列的曲线下面积为0.739（置信区间为0.538 ~ 0.940）。随后，根据最佳截断值进行分组，高危组预后较差。结合显著危险因素和组织病理学相关免疫评分，构建3个预测临床模型。第一个结合组织病理学相关免疫评分评分和单变量分析确定的统计学显著因素的模型在所有3个模型中均显示出较好的生存预测能力，曲线下面积为0.852，c指数为0.837。结论组织病理学相关免疫评分为评估结直肠癌患者的生存提供了一种新的方法。这些结果表明，免疫评分和临床因素可以作为TNM分期的补充工具，以提高患者生存预测的准确性。

{"title":"Prognostic value of immune infiltration in colorectal cancer: Development of a histopathology-related immunoscore via multiplexed immunohistochemistry","authors":"Shiqi Zhou MD , Zhaofu Qin MS , Shunv Cai MD , Ting Ma MS , Luyi Lin MD , Longhai Feng MD , Xinyi Gao MD , Dening Ma MD","doi":"10.1016/j.surg.2025.109350","DOIUrl":"10.1016/j.surg.2025.109350","url":null,"abstract":"<div><h3>Background</h3><div>Our objective was to evaluate the prognostic value of immune infiltration within the intratumoral and peritumoral tissues and to establish a novel histopathology-related immunoscore associated with postoperative colorectal cancer prognosis.</div></div><div><h3>Methods</h3><div>In the tissue microarrays, a total of 104 patients with colorectal cancer were enrolled and randomly assigned to the derivation cohort (<em>n</em> = 61) or the validation cohort (<em>n</em> = 43). Eighteen prognostic immune biomarkers in both intratumoral and peritumoral tissues were examined by the multiplexed immunohistochemistry method, with quantification performed through digital pathology. The histopathology-related immunoscore score was constructed using least absolute shrinkage and selection operator Cox analysis by selected immune features. On the basis of the Cox regression analysis, 3 predictive models were established. Harrell C-statistics were used to assess the performance of those models.</div></div><div><h3>Results</h3><div>The area under the curve was 0.743 (confidence interval, 0.457–1.000) in the derivation cohort and 0.739 (confidence interval, 0.538–0.940) in the validation cohort. Subsequently, the groups were classified on the basis of the optimal cutoff value, with the high-risk group exhibiting a poorer prognosis. Furthermore, 3 predictive clinical models were constructed, incorporating the significant risk factors and histopathology-related immunoscore score. The first model incorporating both histopathology-related immunoscore score and statistically significant factors identified through univariate analysis demonstrated superior predictive capability for survival across all 3 models, with an area under the curve of 0.852 and C-index of 0.837.</div></div><div><h3>Conclusion</h3><div>The histopathology-related immunoscore score offers a novel means of estimating of survival in patients with colorectal cancer. These findings indicated that the immunoscore and the clinical factors might serve as complementary tools to TNM staging to improve the accuracy of patient survival prediction.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109350"},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825598","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}

引用次数: 0

A nomogram for predicting early biliary complications in adult liver recipients of deceased donor grafts: Integrating artery resistive index and clinical risk factors 预测死亡供体肝移植成人早期胆道并发症的nomogram：动脉阻力指数与临床危险因素的整合

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-10 DOI: 10.1016/j.surg.2025.109352

Zepeng Lin MD , Xue Ma MS , Haibin Ji MD , Yibo Hou MD , Xiaoshun He MD, PhD , Xiaofeng Zhu MD, PhD , Anbin Hu MD, PhD

Background

This study aimed to identify predictors of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts.

Methods

The study retrospectively analyzed adult patients who underwent liver transplantation from January 2016 to December 2021 using deceased donor grafts in our center. Patients were randomly divided into training and validation cohorts (7:3 ratio). A nomogram was developed using least absolute shrinkage and selection operator logistic regression for feature selection, followed by a 2-way stepwise approach in multivariate logistic regression. Model performance was assessed with the C-index, receiver operating characteristic area under the curve, calibration curves, and decision curve analysis.

Results

A total of 757 patients were included, of whom 76 developed early biliary complications. Least absolute shrinkage and selection operator binary logistic analysis showed that postoperative day 1 arterial resistance index, acute rejection, acute-on-chronic liver failure, hepatic artery thrombosis, recipient body mass index, and donor age were independent predictors of biliary complications within 90 days. A nomogram was established on the basis of these factors. The C-index for the final nomogram was 0.822. The area under the curve in the training cohort was 0.837 (95% confidence interval, 0.780–0.893) and 0.771 (95% confidence interval, 0.677–0.865) in the validation cohort. Calibration curves demonstrated good agreement between predicted and actual outcomes. Decision curve analysis confirmed the clinical utility of the nomogram.

Conclusion

Low arterial resistance index (≤0.57) on the first postoperative day is a predictor of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts. The nomogram provides a practical tool for predicting complications and guiding clinical decisions.

背景：本研究旨在确定成人死亡供体肝移植后90天内胆道并发症的预测因素。方法回顾性分析2016年1月至2021年12月在我中心接受肝移植的成人患者。患者随机分为训练组和验证组（7:3）。使用最小绝对收缩和选择算子逻辑回归进行特征选择，然后在多元逻辑回归中采用双向逐步方法开发了nomogram。采用c指数、受试者工作特征曲线下面积、校正曲线和决策曲线分析对模型性能进行评价。结果共纳入757例患者，其中76例出现早期胆道并发症。最小绝对收缩和选择操作者二元logistic分析显示，术后第1天动脉阻力指数、急性排斥反应、急性慢性肝衰竭、肝动脉血栓形成、受体体重指数和供体年龄是90天内胆道并发症的独立预测因子。在这些因素的基础上建立了一个nomogram。最终模态图的c指数为0.822。训练组曲线下面积为0.837(95%可信区间0.780-0.893)，验证组曲线下面积为0.771（95%可信区间0.777 - 0.865）。校正曲线显示预测结果与实际结果吻合良好。决策曲线分析证实了nomogram的临床应用价值。结论术后第一天动脉阻力指数低（≤0.57）可预测成人死亡供体肝移植术后90天内胆道并发症的发生。图为预测并发症和指导临床决策提供了实用的工具。

{"title":"A nomogram for predicting early biliary complications in adult liver recipients of deceased donor grafts: Integrating artery resistive index and clinical risk factors","authors":"Zepeng Lin MD , Xue Ma MS , Haibin Ji MD , Yibo Hou MD , Xiaoshun He MD, PhD , Xiaofeng Zhu MD, PhD , Anbin Hu MD, PhD","doi":"10.1016/j.surg.2025.109352","DOIUrl":"10.1016/j.surg.2025.109352","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to identify predictors of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed adult patients who underwent liver transplantation from January 2016 to December 2021 using deceased donor grafts in our center. Patients were randomly divided into training and validation cohorts (7:3 ratio). A nomogram was developed using least absolute shrinkage and selection operator logistic regression for feature selection, followed by a 2-way stepwise approach in multivariate logistic regression. Model performance was assessed with the C-index, receiver operating characteristic area under the curve, calibration curves, and decision curve analysis.</div></div><div><h3>Results</h3><div>A total of 757 patients were included, of whom 76 developed early biliary complications. Least absolute shrinkage and selection operator binary logistic analysis showed that postoperative day 1 arterial resistance index, acute rejection, acute-on-chronic liver failure, hepatic artery thrombosis, recipient body mass index, and donor age were independent predictors of biliary complications within 90 days. A nomogram was established on the basis of these factors. The C-index for the final nomogram was 0.822. The area under the curve in the training cohort was 0.837 (95% confidence interval, 0.780–0.893) and 0.771 (95% confidence interval, 0.677–0.865) in the validation cohort. Calibration curves demonstrated good agreement between predicted and actual outcomes. Decision curve analysis confirmed the clinical utility of the nomogram.</div></div><div><h3>Conclusion</h3><div>Low arterial resistance index (≤0.57) on the first postoperative day is a predictor of biliary complications within 90 days after liver transplantation in adult recipients of deceased donor grafts. The nomogram provides a practical tool for predicting complications and guiding clinical decisions.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109352"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808329","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}

引用次数: 0

Combat orthopedic trauma care: Challenges and innovations in Ukraine's wartime response 战斗骨科创伤护理：乌克兰战时应对的挑战和创新

IF 3.2 2区医学 Q1 SURGERY

Surgery

Pub Date : 2025-04-10 DOI: 10.1016/j.surg.2025.109313

Caroline S. Epstein MD , Grygorii Prokhorenko MD , Dmytro Los MD , Roman Pavchak MD

Orthopedic trauma care in Ukraine, shaped by the ongoing conflict since the Donbas invasion in 2014 and further intensified by the 2022 Russian invasion, reflects the complexity of treating modern wartime injuries in the face of resource constraints and evacuation challenges. Ukrainian medical teams have to the greatest extent possible adhered to Western medical standards, using a tiered care system that spans from the point of injury, to forward surgical teams leading, finally to advanced procedures in tertiary facilities. However, resource shortages and delayed evacuations have led to significant complications, including tourniquet-related kidney injury and limb amputations. These realities compel the need for innovation in medical protocols and sustained international support to address the demands of conflict-zone care.

自2014年顿巴斯入侵以来，乌克兰的骨科创伤护理受到持续冲突的影响，并因2022年俄罗斯入侵而进一步加剧，反映了面对资源限制和疏散挑战，治疗现代战时创伤的复杂性。乌克兰医疗队尽可能遵守西方医疗标准，采用分层护理制度，从受伤点到前沿外科小组，最后到三级设施的先进程序。然而，资源短缺和延迟疏散导致了严重的并发症，包括与止血带有关的肾损伤和截肢。这些现实迫使我们必须在医疗规程方面进行创新，并提供持续的国际支持，以满足冲突地区的医疗需求。

引用次数: 0