Background: Lymph node metastasis is a crucial factor in predicting the prognosis of patients with pathologic T1-2 esophageal squamous cell carcinoma, but the optimal extent of lymphadenectomy remains unclear. This study aims to determine the prognostic significance of high-risk lymph node stations and identify risk factors for high-risk lymph node station involvement.
Methods: Patients with pathologic T1-2 esophageal squamous cell carcinoma who underwent esophagectomy with lymph node dissection were enrolled between January 2014 and December 2019. The incidence of metastasis at each regional lymph node station was assessed, and the efficacy index was calculated to evaluate the therapeutic value of dissection.
Results: In total, 695 patients with T1-2 esophageal squamous cell carcinoma were included. Lymph node stations 2, 7, 8, 16, and 17 were defined as high-risk stations, with metastasis rates of 6.47%, 4.17%, 11.37%, 5.90%, and 7.34%, respectively, which were greater than those of the other stations. Patients with high-risk lymph node station metastasis exhibited elevated efficacy index values (1.67-5.44) and significantly worse overall survival (P < .001). High-risk lymph node station metastasis was an independent prognostic factor (hazard ratio, 1.986; 95% confidence interval, 1.452-2.716, P < .001). Logistic regression identified body mass index, tumor differentiation, tumor size, and tumor location as independent risk factors for high-risk lymph node station involvement.
Conclusion: Lymph node stations 2, 7, 8, 16, and 17 were high-risk stations associated with poor prognosis and high therapeutic value. Identification of these high-risk lymph node stations may guide a more tailored lymphadenectomy strategy in patients with T1-2 esophageal squamous cell carcinoma.
{"title":"Lymph node metastasis mapping and identification of high-risk stations in pathological T1-2 esophageal squamous cell carcinoma: A retrospective cohort study.","authors":"Kai-Yuan Jiang, Jing Chen, Jin-Zhu Nan, Wen-Long Hu, Heng-Tao Lin, Dai-Yuan Ma, Kai-Di Li, Hai-Ning Zhou, Long-Qi Chen, Dong Tian","doi":"10.1016/j.surg.2025.110024","DOIUrl":"https://doi.org/10.1016/j.surg.2025.110024","url":null,"abstract":"<p><strong>Background: </strong>Lymph node metastasis is a crucial factor in predicting the prognosis of patients with pathologic T1-2 esophageal squamous cell carcinoma, but the optimal extent of lymphadenectomy remains unclear. This study aims to determine the prognostic significance of high-risk lymph node stations and identify risk factors for high-risk lymph node station involvement.</p><p><strong>Methods: </strong>Patients with pathologic T1-2 esophageal squamous cell carcinoma who underwent esophagectomy with lymph node dissection were enrolled between January 2014 and December 2019. The incidence of metastasis at each regional lymph node station was assessed, and the efficacy index was calculated to evaluate the therapeutic value of dissection.</p><p><strong>Results: </strong>In total, 695 patients with T1-2 esophageal squamous cell carcinoma were included. Lymph node stations 2, 7, 8, 16, and 17 were defined as high-risk stations, with metastasis rates of 6.47%, 4.17%, 11.37%, 5.90%, and 7.34%, respectively, which were greater than those of the other stations. Patients with high-risk lymph node station metastasis exhibited elevated efficacy index values (1.67-5.44) and significantly worse overall survival (P < .001). High-risk lymph node station metastasis was an independent prognostic factor (hazard ratio, 1.986; 95% confidence interval, 1.452-2.716, P < .001). Logistic regression identified body mass index, tumor differentiation, tumor size, and tumor location as independent risk factors for high-risk lymph node station involvement.</p><p><strong>Conclusion: </strong>Lymph node stations 2, 7, 8, 16, and 17 were high-risk stations associated with poor prognosis and high therapeutic value. Identification of these high-risk lymph node stations may guide a more tailored lymphadenectomy strategy in patients with T1-2 esophageal squamous cell carcinoma.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110024"},"PeriodicalIF":2.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158609","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}
Pub Date : 2026-02-01Epub Date: 2025-12-09DOI: 10.1016/j.surg.2025.109929
Sean Huu-Tien Nguyen MD , Catherine B. Jensen MD, MSc, , Carolina Larrain MD , Zachary D. Leslie , James V. Harmon MD, PhD , Sayeed Ikramuddin MD, MHA
Background
The use of minimally invasive adrenalectomy has expanded. Although ambulatory minimally invasive adrenalectomy has demonstrated safety and feasibility in select settings, trends in utilization, surgical indication, and outcomes remain limited. This study aimed to evaluate national trends in the adoption and incidence of inpatient and ambulatory minimally invasive adrenalectomy in the United States from 2016 to 2022.
Methods
We conducted a retrospective cross-sectional study using the Nationwide Ambulatory Surgery Sample and National Inpatient Sample to identify adults aged ≥20 years who underwent elective minimally invasive adrenalectomy. Surgical indication, laterality, patient demographics, and hospital characteristics were assessed. Outcomes included charge, discharge disposition, and mortality. Age- and sex-adjusted incidence was reported per 100,000 adults.
Results
Among a weighted total of 35,242 minimally invasive adrenalectomies, 8,917 (25.3%) were ambulatory. Ambulatory incidence rose from 0.22 to 0.59 per 100,000 adults (incidence rate ratio: 2.75, 95% confidence interval: 2.34–3.24), whereas inpatient incidence increased at a lower rate (incidence rate ratio: 1.24, 95% confidence interval: 1.07–1.43). Benign adrenal neoplasm was the most common indication in both settings. Ambulatory incidence increased for all indications except primary malignant neoplasms. Both left- and right-sided ambulatory adrenalectomies increased, with left-sided procedures being more common. Charges were lower in ambulatory settings. Overall, non-home discharge and mortality were rare.
Conclusion
Incidence of ambulatory adrenalectomy has nearly tripled in less than a decade, primarily driven by benign adrenal neoplasms and outpacing increases in inpatient adrenalectomy. Given the substantial rise, societal guidelines and further evaluation of adrenalectomy-specific outcomes are needed to identify patients who may benefit from ambulatory adrenalectomy.
{"title":"National trends in ambulatory and inpatient minimally invasive adrenalectomy in the United States","authors":"Sean Huu-Tien Nguyen MD , Catherine B. Jensen MD, MSc, , Carolina Larrain MD , Zachary D. Leslie , James V. Harmon MD, PhD , Sayeed Ikramuddin MD, MHA","doi":"10.1016/j.surg.2025.109929","DOIUrl":"10.1016/j.surg.2025.109929","url":null,"abstract":"<div><h3>Background</h3><div>The use of minimally invasive adrenalectomy has expanded. Although ambulatory minimally invasive adrenalectomy has demonstrated safety and feasibility in select settings, trends in utilization, surgical indication, and outcomes remain limited. This study aimed to evaluate national trends in the adoption and incidence of inpatient and ambulatory minimally invasive adrenalectomy in the United States from 2016 to 2022.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study using the Nationwide Ambulatory Surgery Sample and National Inpatient Sample to identify adults aged ≥20 years who underwent elective minimally invasive adrenalectomy. Surgical indication, laterality, patient demographics, and hospital characteristics were assessed. Outcomes included charge, discharge disposition, and mortality. Age- and sex-adjusted incidence was reported per 100,000 adults.</div></div><div><h3>Results</h3><div>Among a weighted total of 35,242 minimally invasive adrenalectomies, 8,917 (25.3%) were ambulatory. Ambulatory incidence rose from 0.22 to 0.59 per 100,000 adults (incidence rate ratio: 2.75, 95% confidence interval: 2.34–3.24), whereas inpatient incidence increased at a lower rate (incidence rate ratio: 1.24, 95% confidence interval: 1.07–1.43). Benign adrenal neoplasm was the most common indication in both settings. Ambulatory incidence increased for all indications except primary malignant neoplasms. Both left- and right-sided ambulatory adrenalectomies increased, with left-sided procedures being more common. Charges were lower in ambulatory settings. Overall, non-home discharge and mortality were rare.</div></div><div><h3>Conclusion</h3><div>Incidence of ambulatory adrenalectomy has nearly tripled in less than a decade, primarily driven by benign adrenal neoplasms and outpacing increases in inpatient adrenalectomy. Given the substantial rise, societal guidelines and further evaluation of adrenalectomy-specific outcomes are needed to identify patients who may benefit from ambulatory adrenalectomy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109929"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726277","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}
Pub Date : 2026-02-01Epub Date: 2025-12-01DOI: 10.1016/j.surg.2025.109938
Carlos Balthazar da Silveira MD , Sakura Horiuchi MD , Ana Dias Rasador MD , William Bradley BS , Vikram Deka MD , Hahn Soe-Lin MS, MD, FACS , James Bogert MD , Thomas Gillespie MD, FACS , Jordan Weinberg MD , Conrad Ballecer MS, MD
Introduction
Blunt traumatic lateral abdominal-wall hernias are complex injuries often resulting from high-energy mechanisms. These injuries commonly involve disruption of the transversus abdominis muscle, obliques, as well as potential injury avulsion of the diaphragm in thoracoabdominal hernias. Because of the variety of injury patterns, blunt traumatic lateral abdominal-wall hernias present unique reconstructive challenges, particularly when involving the iliac crest or costal margin. Despite increasing use of robotic-assisted techniques for abdominal wall reconstruction, limited data exist on their use in traumatic hernias.
Methods
We conducted a retrospective review of patients undergoing ventral hernia repair at our high-volume hernia center. Patients with lateral hernias secondary to blunt trauma were identified. Demographics, hernia characteristics, operative techniques, and outcomes were analyzed. Subgroup analysis was performed for patients undergoing robotic transversus abdominis release.
Results
Of 109 lateral hernia repairs, 21 (19.3%) were trauma-related. Most were due to motor vehicle collisions (76.2%) and commonly involved flank (L2) and lumbar (L4) regions. Robotic repair was performed in all cases, including robotic transversus abdominis release in 38.1% and conversion to open transversus abdominis release in 9.5%. Mean hernia width was 10.7 cm, with a mean mesh area of 455.5 cm2. Complications included 3 asymptomatic seromas (14.3%) and 1 deep muscle abscess requiring readmission. No hernia recurrences were observed during a median follow-up of 1 year.
Conclusion
Robotic repair of blunt traumatic lateral abdominal-wall hernias is feasible and safe, with low complication and recurrence rates. These injuries frequently coexist with midline defects and may require advanced techniques, underscoring the importance of surgical expertise and optimization.
{"title":"Robotic management of complex traumatic hernias: A single-center experience","authors":"Carlos Balthazar da Silveira MD , Sakura Horiuchi MD , Ana Dias Rasador MD , William Bradley BS , Vikram Deka MD , Hahn Soe-Lin MS, MD, FACS , James Bogert MD , Thomas Gillespie MD, FACS , Jordan Weinberg MD , Conrad Ballecer MS, MD","doi":"10.1016/j.surg.2025.109938","DOIUrl":"10.1016/j.surg.2025.109938","url":null,"abstract":"<div><h3>Introduction</h3><div>Blunt traumatic lateral abdominal-wall hernias are complex injuries often resulting from high-energy mechanisms. These injuries commonly involve disruption of the transversus abdominis muscle, obliques, as well as potential injury avulsion of the diaphragm in thoracoabdominal hernias. Because of the variety of injury patterns, blunt traumatic lateral abdominal-wall hernias present unique reconstructive challenges, particularly when involving the iliac crest or costal margin. Despite increasing use of robotic-assisted techniques for abdominal wall reconstruction, limited data exist on their use in traumatic hernias.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients undergoing ventral hernia repair at our high-volume hernia center. Patients with lateral hernias secondary to blunt trauma were identified. Demographics, hernia characteristics, operative techniques, and outcomes were analyzed. Subgroup analysis was performed for patients undergoing robotic transversus abdominis release.</div></div><div><h3>Results</h3><div>Of 109 lateral hernia repairs, 21 (19.3%) were trauma-related. Most were due to motor vehicle collisions (76.2%) and commonly involved flank (L2) and lumbar (L4) regions. Robotic repair was performed in all cases, including robotic transversus abdominis release in 38.1% and conversion to open transversus abdominis release in 9.5%. Mean hernia width was 10.7 cm, with a mean mesh area of 455.5 cm<sup>2</sup>. Complications included 3 asymptomatic seromas (14.3%) and 1 deep muscle abscess requiring readmission. No hernia recurrences were observed during a median follow-up of 1 year.</div></div><div><h3>Conclusion</h3><div>Robotic repair of blunt traumatic lateral abdominal-wall hernias is feasible and safe, with low complication and recurrence rates. These injuries frequently coexist with midline defects and may require advanced techniques, underscoring the importance of surgical expertise and optimization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109938"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662198","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}
Palliative care can improve patient satisfaction, decrease pain, and reduce costs but is relatively underused in colorectal surgery. We characterized patients with colorectal cancer undergoing surgery, hypothesizing regional and temporal differences in palliative care use.
Methods
Patients with colorectal cancer undergoing colon resection, rectal resection, or ostomy formation were identified in the 2016–2021 National Inpatient Sample. The cohort was divided into elective and nonelective subgroups. The primary study end points were trends and regional differences in palliative care use. Multivariable regression models were developed to identify the independent association of palliative care with length of stay and costs.
Results
Of 599,275 adult patients undergoing surgery for colorectal cancer, 2.5% received palliative care. From 2016 to 2021, use of PC increased (2.1 vs 2.8%, nptrend <0.001). Patients in the Northeast less frequently received palliative care. A greater burden of comorbidities (Elixhauser: adjusted odds ratio, 1.10 per unit; 95% confidence interval, 1.05–1.16) was associated with a greater likelihood of receipt of palliative care in the elective cohort. Minority race (Black: adjusted odds ratio; 0.78, 95% confidence interval, 0.67–0.91; Hispanic: adjusted odds ratio, 0.78; 95% confidence interval, 0.66–0.92; Asian/Pacific Islander adjusted odds ratio, 0.76; 95% confidence interval, 0.58–0.98) and care at rural (adjusted odds ratio, 0.54; 95% confidence interval, 0.44–0.65) or urban non-teaching centers (adjusted odds ratio, 0.74; 95% confidence interval, 0.66–0.82) were associated with reduced odds of palliative care in the nonelective cohort. Patients receiving palliative care had increased LOS (β + 3.82 days, 95% confidence interval, 3.41–4.23) and hospitalization costs (β+$12,000, 95% confidence interval, $10,000–13,000).
Conclusions
Palliative care after surgery for colorectal cancer has increased over time but remains infrequent. Minority race and geographic region remain associated with reduced use. Better characterization of factors influencing palliative care use and outcomes is needed.
背景姑息治疗可以提高患者满意度，减少疼痛，降低成本，但在结直肠手术中的应用相对不足。我们对接受手术的结直肠癌患者进行了特征描述，假设姑息治疗使用的区域和时间差异。方法选取2016-2021年全国住院患者样本中接受结肠切除术、直肠切除术或造口术的结直肠癌患者。该队列被分为选择性和非选择性亚组。主要研究终点是姑息治疗使用的趋势和地区差异。我们开发了多变量回归模型，以确定姑息治疗与住院时间和费用之间的独立关联。结果599,275例接受结直肠癌手术的成年患者中，2.5%接受了姑息治疗。从2016年到2021年，PC的使用增加了（2.1% vs 2.8%, nptrend <0.001）。东北部的患者接受姑息治疗的频率较低。在选择性队列中，更大的合并症负担（Elixhauser：校正优势比，1.10 /单位；95%可信区间，1.05-1.16）与接受姑息治疗的可能性更大相关。少数族裔（黑人：调整优势比为0.78,95%可信区间为0.67-0.91；西班牙裔：调整优势比为0.78,95%可信区间为0.66-0.92；亚洲/太平洋岛民调整优势比为0.76,95%可信区间为0.58-0.98）和农村（调整优势比为0.54,95%可信区间为0.44-0.65）或城市非教学中心（调整优势比为0.74,95%可信区间为0.66-0.82）的护理与非选择性队列中姑息治疗的几率降低相关。接受姑息治疗的患者LOS （β+ 3.82天，95%可信区间，3.41-4.23）和住院费用（β+ 12,000美元，95%可信区间，10,000-13,000美元）增加。结论结直肠癌术后姑息治疗随着时间的推移而增加，但仍不常见。少数民族和地理区域仍然与减少使用有关。需要更好地描述影响姑息治疗使用和结果的因素。
{"title":"Temporal trends and regional variation in the use of palliative care after colorectal cancer surgery","authors":"Elsa Kronen BS , Troy Coaston BS , Syed Shaheer Ali , Emili Elkins , Zihan Gao MHSc , Sara Sakowitz MS, MPH , Peyman Benharash MD , Hanjoo Lee MD","doi":"10.1016/j.surg.2025.109824","DOIUrl":"10.1016/j.surg.2025.109824","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care can improve patient satisfaction, decrease pain, and reduce costs but is relatively underused in colorectal surgery. We characterized patients with colorectal cancer undergoing surgery, hypothesizing regional and temporal differences in palliative care use.</div></div><div><h3>Methods</h3><div>Patients with colorectal cancer undergoing colon resection, rectal resection, or ostomy formation were identified in the 2016–2021 National Inpatient Sample. The cohort was divided into elective and nonelective subgroups. The primary study end points were trends and regional differences in palliative care use. Multivariable regression models were developed to identify the independent association of palliative care with length of stay and costs.</div></div><div><h3>Results</h3><div>Of 599,275 adult patients undergoing surgery for colorectal cancer, 2.5% received palliative care. From 2016 to 2021, use of PC increased (2.1 vs 2.8%, nptrend <0.001). Patients in the Northeast less frequently received palliative care. A greater burden of comorbidities (Elixhauser: adjusted odds ratio, 1.10 per unit; 95% confidence interval, 1.05–1.16) was associated with a greater likelihood of receipt of palliative care in the elective cohort. Minority race (Black: adjusted odds ratio; 0.78, 95% confidence interval, 0.67–0.91; Hispanic: adjusted odds ratio, 0.78; 95% confidence interval, 0.66–0.92; Asian/Pacific Islander adjusted odds ratio, 0.76; 95% confidence interval, 0.58–0.98) and care at rural (adjusted odds ratio, 0.54; 95% confidence interval, 0.44–0.65) or urban non-teaching centers (adjusted odds ratio, 0.74; 95% confidence interval, 0.66–0.82) were associated with reduced odds of palliative care in the nonelective cohort. Patients receiving palliative care had increased LOS (β + 3.82 days, 95% confidence interval, 3.41–4.23) and hospitalization costs (β+$12,000, 95% confidence interval, $10,000–13,000).</div></div><div><h3>Conclusions</h3><div>Palliative care after surgery for colorectal cancer has increased over time but remains infrequent. Minority race and geographic region remain associated with reduced use. Better characterization of factors influencing palliative care use and outcomes is needed.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109824"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340709","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}
Pub Date : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.surg.2025.109812
Sara Ardila MD , Kristin Lupinacci DO , Quratulain Sabih MD , Jennifer Steiman MD , Kathrine Kelly DO , Priscilla F. McAuliffe MD, PhD , Erin M. Bayley MD, MSc
{"title":"Research Letter: Variable parental leave allowances during Society of Surgical Oncology fellowships: Due for change","authors":"Sara Ardila MD , Kristin Lupinacci DO , Quratulain Sabih MD , Jennifer Steiman MD , Kathrine Kelly DO , Priscilla F. McAuliffe MD, PhD , Erin M. Bayley MD, MSc","doi":"10.1016/j.surg.2025.109812","DOIUrl":"10.1016/j.surg.2025.109812","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109812"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340710","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}
Pub Date : 2026-02-01Epub Date: 2025-11-03DOI: 10.1016/j.surg.2025.109847
Wen-rui Shen MB , Xin-ran Shi MB , Yi-bo He MSc , Zhe-zhong Zhang MSc , Shi-liang Chen MSc
Background
In the field of cancer immunotherapy, the cGAS-stimulator of interferon genes pathway has emerged as a novel target for antitumor immune strategies, making stimulator of interferon genes agonists a research hotspot. Various types of stimulator of interferon genes agonists have been studied and have shown promise in preclinical and clinical studies.
Methods
This review summarizes the research progress of stimulator of interferon genes agonists in cancer immunotherapy. The primary categories and components of stimulator of interferon genes agonists are first introduced, with a focus on the clinical and preclinical studies of CDN-based agonists, non-CDN-based agonists, metal-based agonists, and indirect agonists. The reasons for the limited efficacy of stimulator of interferon genes agonists when used as monotherapy are analyzed, and the direction of combination therapy research is summarized. In particular, the mechanisms, impact on the immune microenvironment, and optimization strategies for combining stimulator of interferon genes agonists with immune checkpoint blockade therapy are thoroughly discussed.
Results
The review examines the progress in stimulator of interferon genes agonists for cancer immunotherapy. Activation of the cGAS-stimulator of interferon genes pathway is critical for antitumor immunity. Various stimulator of interferon genes agonists have shown great potential in preclinical and clinical studies. However, monotherapy with classic stimulator of interferon genes agonists has limitations. Combination therapies of stimulator of interferon genes agonists, particularly with immune checkpoint blockade therapy, are expected to significantly enhance the therapeutic effect.
Conclusion
Stimulator of interferon genes agonists have broad prospects in cancer therapy, but their monotherapy is somewhat restricted. Combination therapies of stimulator of interferon genes agonists, particularly with immune checkpoint blockade therapy, are expected to further enhance the efficacy of stimulator of interferon genes agonists in cancer treatment and enable them to play a more important role.
{"title":"Research advances in stimulator of interferon genes (STING) agonists for cancer immunotherapy","authors":"Wen-rui Shen MB , Xin-ran Shi MB , Yi-bo He MSc , Zhe-zhong Zhang MSc , Shi-liang Chen MSc","doi":"10.1016/j.surg.2025.109847","DOIUrl":"10.1016/j.surg.2025.109847","url":null,"abstract":"<div><h3>Background</h3><div>In the field of cancer immunotherapy, the cGAS-stimulator of interferon genes pathway has emerged as a novel target for antitumor immune strategies, making stimulator of interferon genes agonists a research hotspot. Various types of stimulator of interferon genes agonists have been studied and have shown promise in preclinical and clinical studies.</div></div><div><h3>Methods</h3><div>This review summarizes the research progress of stimulator of interferon genes agonists in cancer immunotherapy. The primary categories and components of stimulator of interferon genes agonists are first introduced, with a focus on the clinical and preclinical studies of CDN-based agonists, non-CDN-based agonists, metal-based agonists, and indirect agonists. The reasons for the limited efficacy of stimulator of interferon genes agonists when used as monotherapy are analyzed, and the direction of combination therapy research is summarized. In particular, the mechanisms, impact on the immune microenvironment, and optimization strategies for combining stimulator of interferon genes agonists with immune checkpoint blockade therapy are thoroughly discussed.</div></div><div><h3>Results</h3><div>The review examines the progress in stimulator of interferon genes agonists for cancer immunotherapy. Activation of the cGAS-stimulator of interferon genes pathway is critical for antitumor immunity. Various stimulator of interferon genes agonists have shown great potential in preclinical and clinical studies. However, monotherapy with classic stimulator of interferon genes agonists has limitations. Combination therapies of stimulator of interferon genes agonists, particularly with immune checkpoint blockade therapy, are expected to significantly enhance the therapeutic effect.</div></div><div><h3>Conclusion</h3><div>Stimulator of interferon genes agonists have broad prospects in cancer therapy, but their monotherapy is somewhat restricted. Combination therapies of stimulator of interferon genes agonists, particularly with immune checkpoint blockade therapy, are expected to further enhance the efficacy of stimulator of interferon genes agonists in cancer treatment and enable them to play a more important role.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109847"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446122","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}
Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.surg.2025.109924
Yeon Su Kim MD , Seung Yoon Yang MD , Na Reum Kim MD , Im Kyung Kim MD, PhD , Eun Joo Jung MD, PhD , Yoo Min Kim MD, PhD , Sung Hyun Kim MD, MS
Background
The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases.
Methods
We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The Clavien-Dindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared.
Results
Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (r = 0.795, P < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (r) 0.770 vs 0.571, P < .001; cost (r) 0.784 vs 0.645, P < .001).
Conclusion
The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity.
背景：Clavien-Dindo分类已被广泛用于评估术后并发症；然而，它只捕获了最严重的事件，可能低估了总体发病率负担。综合并发症指数是为了解决这一局限性而开发的，它将所有并发症汇总为一个连续的评分。对不同主要腹部外科手术的Clavien-Dindo分类和综合并发症指数的综合评估很少，大多数现有研究受相对较小的队列限制，并且侧重于特定疾病。方法：我们回顾性分析了2020年1月至2022年12月在单一三级中心接受选择性腹部大手术（全胃切除术、结直肠手术合并肝切除术、肝大切除术和胰十二指肠切除术）的824例患者。利用术后资料计算每位患者的Clavien-Dindo分级和综合并发症指数，并评估其与住院时间和费用的相关性。比较综合并发症指数与Clavien-Dindo分级的相关性。结果：Pearson相关分析显示，综合并发症指数与Clavien-Dindo分型相关性较强（r = 0.795, P < 0.001）。当使用相关系数检查与临床结果的关系时，综合并发症指数与住院时间和费用的相关性比Clavien-Dindo分类强(综合并发症指数与Clavien-Dindo分类：住院时间(r) 0.770 vs 0.571, P < 0.001；成本(r) 0.784 vs 0.645, P < 0.001)。结论：在腹部大手术中，综合并发症指数与住院时间和费用的相关性比Clavien-Dindo分级更强，支持其作为评估术后发病率的更全面、更全面的工具。
{"title":"Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative complication severity in major abdominal surgery","authors":"Yeon Su Kim MD , Seung Yoon Yang MD , Na Reum Kim MD , Im Kyung Kim MD, PhD , Eun Joo Jung MD, PhD , Yoo Min Kim MD, PhD , Sung Hyun Kim MD, MS","doi":"10.1016/j.surg.2025.109924","DOIUrl":"10.1016/j.surg.2025.109924","url":null,"abstract":"<div><h3>Background</h3><div>The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The Clavien-Dindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared.</div></div><div><h3>Results</h3><div>Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (<em>r</em> = 0.795, <em>P</em> < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (<em>r</em>) 0.770 vs 0.571, <em>P</em> < .001; cost (<em>r</em>) 0.784 vs 0.645, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109924"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688243","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}
Opioids are essential for perioperative analgesia, yet their impact on postoperative cognitive dysfunction remains unclear. Evidence is limited in older adults undergoing laparoscopic cholecystectomy and hernia repair. We sought to evaluate the association between perioperative opioid dose, expressed as morphine milligram equivalents, and postoperative cognitive dysfunction, assessed using Addenbrooke's Cognitive Examination-III at 24 hours and 30 days.
Methods
This prospective observational study enrolled patients >60 years undergoing elective laparoscopic surgery (80 cholecystectomies and 20 hernia repairs) from March 2023 and January 2024. Patients with pre-existing cognitive impairment, open conversion, or early discharge were excluded. Total perioperative opioid dose (morphine milligram equivalents/kg) was the primary predictor, and postoperative cognitive dysfunction (Addenbrooke's Cognitive Examination–III decline at 24 h and 30 days) was the outcome. Analysis included t tests, Fisher exact test, Pearson correlation, and multivariable regression with subgroup comparison.
Results
Of 102 patients, 100 were analyzed (80 cholecystectomy, 20 hernia repair; mean age 67.8 ± 6.3 years). Postoperative cognitive dysfunction occurred in 36% at 24 hours and 12% at 30 days. Incidence was 35% versus 40% at 24 hours and 13.8% versus 5% at 30 days for cholecystectomy and hernia, respectively. Greater opioid doses correlated with lower Addenbrooke's Cognitive Examination–III scores (r = –0.6439, P < .0001). Multivariable analysis showed increased odds of early postoperative cognitive dysfunction with greater opioid use (odds ratio, 1.59; 95% confidence interval, 1.30–1.96, P < .0001), whereas greater body mass index and male gender were protective.
Conclusions
Greater opioid doses were significantly associated with early postoperative cognitive dysfunction, whereas greater body mass index and male gender appeared protective. Larger studies are needed to confirm these findings.
{"title":"Dose-dependent effects of perioperative opioids on cognitive outcomes in older adults undergoing laparoscopic cholecystectomy and hernia repair: A prospective observational study","authors":"Dipayan Mistry MBBS , Nitin Choudhary MD , Ankita Maheshwari PhD , Rohit Verma MD , Rahul Kumar Anand MD , Bikash Ranjan Ray MD , Akhil Kant Singh MD , Ajay Singh MSc , Puneet Khanna MD","doi":"10.1016/j.surg.2025.109922","DOIUrl":"10.1016/j.surg.2025.109922","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are essential for perioperative analgesia, yet their impact on postoperative cognitive dysfunction remains unclear. Evidence is limited in older adults undergoing laparoscopic cholecystectomy and hernia repair. We sought to evaluate the association between perioperative opioid dose, expressed as morphine milligram equivalents, and postoperative cognitive dysfunction, assessed using Addenbrooke's Cognitive Examination-III at 24 hours and 30 days.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled patients >60 years undergoing elective laparoscopic surgery (80 cholecystectomies and 20 hernia repairs) from March 2023 and January 2024. Patients with pre-existing cognitive impairment, open conversion, or early discharge were excluded. Total perioperative opioid dose (morphine milligram equivalents/kg) was the primary predictor, and postoperative cognitive dysfunction (Addenbrooke's Cognitive Examination–III decline at 24 h and 30 days) was the outcome. Analysis included <em>t</em> tests, Fisher exact test, Pearson correlation, and multivariable regression with subgroup comparison.</div></div><div><h3>Results</h3><div>Of 102 patients, 100 were analyzed (80 cholecystectomy, 20 hernia repair; mean age 67.8 ± 6.3 years). Postoperative cognitive dysfunction occurred in 36% at 24 hours and 12% at 30 days. Incidence was 35% versus 40% at 24 hours and 13.8% versus 5% at 30 days for cholecystectomy and hernia, respectively. Greater opioid doses correlated with lower Addenbrooke's Cognitive Examination–III scores (r = –0.6439, <em>P</em> < .0001). Multivariable analysis showed increased odds of early postoperative cognitive dysfunction with greater opioid use (odds ratio, 1.59; 95% confidence interval, 1.30–1.96, <em>P</em> < .0001), whereas greater body mass index and male gender were protective.</div></div><div><h3>Conclusions</h3><div>Greater opioid doses were significantly associated with early postoperative cognitive dysfunction, whereas greater body mass index and male gender appeared protective. Larger studies are needed to confirm these findings.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109922"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690866","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}
Pub Date : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.surg.2025.109857
Zongyang Mou MD , Parisa Oviedo MD , Louis Perkins MD , Todd W. Costantini MD , Jeanne G. Lee MD , Allison E. Berndtson MD , Laura N. Haines MD , Aaron Marshall MD , Jarrett E. Santorelli MD
Introduction
Timely initiation of venous thromboembolism chemoprophylaxis remains a challenge in trauma and is recognized as a quality benchmark for the American College of Surgeons Trauma Quality Improvement Program. There are several workflow-related barriers that limit timely administration of venous thromboembolism chemoprophylaxis. Tools embedded within the electronic health record can aid protocol compliance as they are integrated in the care workflow. We hypothesized that implementing an electronic health record–based clinical decision support tool improves venous thromboembolism chemoprophylaxis administration in patients with trauma admission.
Methods
We conducted a pre- and postintervention study in patients admitted to a level 1 trauma center with a hospital length of stay greater than 2 days from November 2018 to May 2021. An electronic health record tool updated in real time indicating venous thromboembolism chemoprophylaxis status was incorporated into the daily handoff list in February 2020. No other initiatives were implemented at this time. Outcomes were the change in percentage of patients receiving at least 1 venous thromboembolism chemoprophylaxis dose during hospitalization and time to first chemoprophylaxis dose.
Results
There were 4,311 patients: 2,174 in the preintervention group and 2,137 in the postintervention group. The percentage of patients receiving venous thromboembolism chemoprophylaxis increased from 57.9% before intervention to 81.8% after intervention (P < .001). Concurrently, there was a decrease in average time to initiation of pharmacologic venous thromboembolism chemoprophylaxis from 2.2 days to 1.6 days (P < .001).
Conclusion
We found that implementing an electronic health record–embedded tool increased the proportion of patients receiving venous thromboembolism chemoprophylaxis and decreased the time to first dose of venous thromboembolism chemoprophylaxis. This demonstrates the benefits of using electronic health record–based tools to support trauma protocol compliance.
{"title":"Implementation of an electronic health record–based tool increases administration of venous thromboembolism chemoprophylaxis in trauma","authors":"Zongyang Mou MD , Parisa Oviedo MD , Louis Perkins MD , Todd W. Costantini MD , Jeanne G. Lee MD , Allison E. Berndtson MD , Laura N. Haines MD , Aaron Marshall MD , Jarrett E. Santorelli MD","doi":"10.1016/j.surg.2025.109857","DOIUrl":"10.1016/j.surg.2025.109857","url":null,"abstract":"<div><h3>Introduction</h3><div>Timely initiation of venous thromboembolism chemoprophylaxis remains a challenge in trauma and is recognized as a quality benchmark for the American College of Surgeons Trauma Quality Improvement Program. There are several workflow-related barriers that limit timely administration of venous thromboembolism chemoprophylaxis. Tools embedded within the electronic health record can aid protocol compliance as they are integrated in the care workflow. We hypothesized that implementing an electronic health record–based clinical decision support tool improves venous thromboembolism chemoprophylaxis administration in patients with trauma admission.</div></div><div><h3>Methods</h3><div>We conducted a pre- and postintervention study in patients admitted to a level 1 trauma center with a hospital length of stay greater than 2 days from November 2018 to May 2021. An electronic health record tool updated in real time indicating venous thromboembolism chemoprophylaxis status was incorporated into the daily handoff list in February 2020. No other initiatives were implemented at this time. Outcomes were the change in percentage of patients receiving at least 1 venous thromboembolism chemoprophylaxis dose during hospitalization and time to first chemoprophylaxis dose.</div></div><div><h3>Results</h3><div>There were 4,311 patients: 2,174 in the preintervention group and 2,137 in the postintervention group. The percentage of patients receiving venous thromboembolism chemoprophylaxis increased from 57.9% before intervention to 81.8% after intervention (<em>P</em> < .001). Concurrently, there was a decrease in average time to initiation of pharmacologic venous thromboembolism chemoprophylaxis from 2.2 days to 1.6 days (<em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>We found that implementing an electronic health record–embedded tool increased the proportion of patients receiving venous thromboembolism chemoprophylaxis and decreased the time to first dose of venous thromboembolism chemoprophylaxis. This demonstrates the benefits of using electronic health record–based tools to support trauma protocol compliance.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109857"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549949","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}
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