IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-16 DOI: 10.1016/j.surg.2025.110053

Giovanni Taffurelli MD, PhD , Isacco Montroni MD, PhD , Federico Ghignone MD , Francesca Sivieri MD , Davide Zattoni MD , Giacomo Frascaroli MD , Federico Mazzotti MD , Giampaolo Ugolini MD, PhD

Background

As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.

Methods

We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (<80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.

Results

Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index >6 in 68.3% vs 22.3%, P < .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, P = .002). Disease-free survival was comparable (55.2 vs 54.6 months, P = 1.000), but overall survival was lower in older patients (62 vs 91 months, P < .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index >6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.

Conclusions

Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.

随着人口老龄化，越来越多的八十多岁老人被诊断为结直肠癌。他们的高合并症和死亡风险使辅助治疗和监测的决定复杂化。本研究比较了老年和年轻患者的右半结肠切除术的结果，并确定了非癌症死亡率的预测因素。方法回顾性分析2017-2024年在某三级中心行选择性腹腔镜右半结肠切除术的I-III期右侧结肠癌患者400例。患者按年龄分层（80岁vs≥80岁）；年龄≥70岁者进行虚弱筛查。结果包括短期发病率、无病生存期、总生存期和非癌症死亡率。细灰色回归确定了非癌症死亡的预测因子。结果400例患者中，年龄≥80岁的有180例（45%）。80多岁老人的合并症较高（年龄校正Charlson合并症指数>；6分别为68.3%和22.3%,P < 001）。腹腔镜手术在各组中是安全的，转换率和漏出率相似，但90天死亡率不同（4.4% vs 0%, P = 0.002）。无病生存期相当（55.2个月vs 54.6个月，P = 1.000），但老年患者的总生存期较低（62个月vs 91个月，P < 0.001）。年龄≥80岁（亚分布风险比4.55,95%可信区间1.63-12.7）和年龄校正Charlson共病指数>；6（亚分布风险比2.45,95%可信区间1.15-6.0）独立预测非癌性死亡率，年龄≥80岁高共病患者5岁时非癌性死亡率达到40.4%。结论腹腔镜右半结肠切除术对80多岁老人是安全的，其复发结果与年轻患者相当。然而，具有显著合并症的非癌症死亡率限制了辅助治疗和强化监测的益处。术后管理应根据合并症负担而不是年龄进行调整。

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引用次数: 0

The surgeon advocate's role in shaping state and federal policy 外科医生倡导者在制定州和联邦政策中的作用

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-16 DOI: 10.1016/j.surg.2025.110068

Ross F. Goldberg MD

Although most surgeons dedicate their careers to clinical excellence, education, and research, many overlook a critical fourth pillar of the profession, advocacy. Surgeons already advocate daily, whether guiding patients through care plans, performing technically complex operations, or navigating insurance barriers. However, few recognize their potential to influence broader health policies that directly affect their surgical practices. This article emphasizes the urgent need for surgeons to engage in both legislative and regulatory processes. Policy decisions, ranging from scope of practice laws to Medicare reimbursement rates, have profound and often immediate impacts on how surgeons deliver care. Although surgeons may be familiar with legislative processes, many underestimate the influence of regulatory bodies such as the Centers for Medicare & Medicaid Services, Food and Drug Administration, and state health departments. These agencies interpret and implement laws, often through unilateral decisions, without direct votes and with minimal physician input. Surgeons are often absent from critical discussions at both state and federal levels, allowing other stakeholders such as the insurers, hospitals, and device manufacturers to shape the narrative and outcome. To counteract this, surgeons must proactively engage with legislators, build long-term relationships, support political action efforts, and participate in organized medicine. These steps do not require holding office or mastering policy intricacies but just consistent, informed involvement. Advocacy is a professional responsibility, an extension of surgical leadership that goes beyond the operating room. By becoming more engaged, surgeons can protect the integrity of their practice, ensure patients maintain access to high-quality surgical care, and shape a health care system that values expertise and evidence-based care. The call to action is clear; if surgeons want a seat at the decision-making table, they must claim it. The scalpel may heal patients, but the pen shapes the system, and both are needed to lead the future of surgery.

尽管大多数外科医生将他们的职业生涯奉献给了临床卓越、教育和研究，但许多人忽视了这个职业的第四个关键支柱——倡导。外科医生每天都在倡导，无论是指导病人完成护理计划，执行技术复杂的手术，还是克服保险障碍。然而，很少有人认识到他们影响直接影响其手术实践的更广泛的卫生政策的潜力。这篇文章强调外科医生迫切需要参与立法和监管程序。政策决定，从执业法律范围到医疗保险报销率，对外科医生如何提供护理有着深远的、往往是直接的影响。尽管外科医生可能熟悉立法程序，但许多人低估了监管机构的影响，如医疗保险和医疗补助服务中心、食品和药物管理局以及州卫生部门。这些机构往往通过单方面决定来解释和实施法律，没有直接投票，医生的投入也很少。外科医生经常缺席州和联邦层面的关键讨论，允许其他利益相关者，如保险公司、医院和设备制造商来塑造叙述和结果。为了应对这种情况，外科医生必须主动与立法者接触，建立长期关系，支持政治行动努力，并参与有组织的医学。这些步骤不需要掌权或掌握错综复杂的政策，只需要始终如一、知情地参与。倡导是一种职业责任，是外科领导的延伸，超越了手术室。通过更多地参与，外科医生可以保护其执业的完整性，确保患者能够获得高质量的外科护理，并塑造一个重视专业知识和循证护理的卫生保健系统。行动的呼吁是明确的；如果外科医生想要在决策桌上占有一席之地，他们必须提出要求。手术刀可以治愈病人，但笔塑造了系统，这两者都需要引领外科手术的未来。

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引用次数: 0

Surgical advocacy in action: The fight for coverage for lung cancer screening. 手术宣传的行动：争取肺癌筛查的覆盖率。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-16 DOI: 10.1016/j.surg.2025.110067

Douglas E Wood

Advocacy by professional societies, patient organizations, coalitions, and individuals has been pivotal to each inflection point in US lung cancer screening policy. After the National Lung Screening Trial that demonstrated a 20% reduction in lung cancer mortality with screening, 2012 guidelines from the National Comprehensive Cancer Network recommended lung cancer screening for individuals at high risk for lung cancer. However, guidelines did not change policy or insurance coverage, and individuals continued to be denied access to early lung cancer detection. In 2012-2014, advocates helped to translate the National Lung Screening Trial evidence into a US Preventive Services Task Force grade B recommendation and a first-ever Medicare national coverage determination that formalized eligibility and quality safeguards. As further experience accrued, the National Comprehensive Cancer Network guidelines evolved, and a second wave of advocacy leveraged new evidence and equity analyses to expand eligibility in the US Preventive Services Task Force recommendation and to modernize Medicare coverage. The National Comprehensive Cancer Network created the first guidelines recommending lung cancer screening and has continued to set the standard of eligibility for others to follow. The National Comprehensive Cancer Network guidelines have helped advocates educate and influence policymakers and have progressively simplified guidelines to help improve access to screening. The American Cancer Society National Lung Cancer Round Table has brought together diverse organizations that have helped further the implementation of early detection but also the full continuum of care for patients with lung cancer. This article synthesizes advocacy mechanisms (public comments, coalition letters, implementation toolkits, and media campaigns) and traces their imprint on policy text and program operations.

专业协会、患者组织、联盟和个人的倡导对美国肺癌筛查政策的每个拐点都至关重要。在国家肺部筛查试验表明筛查可以降低20%的肺癌死亡率之后，2012年国家综合癌症网络的指南建议对肺癌高危人群进行肺癌筛查。然而，指导方针并没有改变政策或保险范围，个人仍然无法获得早期肺癌检测。2012-2014年，倡导者帮助将国家肺部筛查试验证据转化为美国预防服务工作组B级建议，并首次确定医疗保险全国覆盖范围，正式确定了资格和质量保障。随着经验的积累，国家综合癌症网络指南不断发展，第二波宣传利用新的证据和公平分析，扩大了美国预防服务工作组建议的资格，并使医疗保险覆盖范围现代化。国家综合癌症网络制定了第一个推荐肺癌筛查的指导方针，并继续为其他人设定资格标准。国家综合癌症网络指导方针帮助倡导者教育和影响决策者，并逐步简化指导方针，以帮助改善获得筛查的机会。美国癌症协会全国肺癌圆桌会议汇集了不同的组织，这些组织帮助进一步实施早期发现，并为肺癌患者提供全面的连续护理。本文综合了倡导机制（公众评论、联盟信函、实施工具包和媒体活动），并追溯了它们对政策文本和项目运作的影响。

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引用次数: 0

Outcomes and quality of life in very elderly patients after ventral hernia repair 高龄腹疝修补术后患者的预后和生活质量

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-15 DOI: 10.1016/j.surg.2025.110050

Courtney M. Collins MD , William T. Head MD , Li-Ching Huang PhD , Sharon Phillips MSPH , Benjamin Poulose MD , Courtney E. Collins MD

Background

Elderly patients have higher risk of perioperative and postoperative complications. As the US life expectancy continues to increase, more patients aged ≥75 years are undergoing surgical procedures. We chose to evaluate postoperative and quality of life outcomes in elderly versus very elderly patients undergoing elective ventral hernia repair.

Methods

A retrospective cohort study was performed with data from the Abdominal Core Health Collaborative from 2013 to 2020. Patients were aged ≥65 years who underwent elective ventral hernia repair with retromuscular mesh placement. Those missing 30-day follow-up or without baseline and 30-day Hernia-Related Quality-of-Life Survey scores were excluded. Propensity score matching was used, and statistical analyses were performed with Fisher exact test, Pearson test, and Wilcoxon test.

Results

Of 1,514 patients, 1,219 (81%) were 65–75 years old (elderly) and 295 (19%) were 76–90 years old (very elderly). There was no difference in 30-day mortality, readmissions, hernia recurrences, surgical site infections, surgical site occurrences, or other complications. The very elderly cohort had higher Hernia-Related Quality-of-Life Survey scores at baseline (P = .031), 30 days (P < .001), and 1 year (P = .007). Baseline and 1-year Patient-Reported Outcomes Measurement Information System pain 3A t scores were not different. The 30-day Patient-Reported Outcomes Measurement Information System pain 3A t scores were lower in the very elderly cohort (P = .016) and had greater decrease from baseline (P < .001).

Conclusion

The risk profile and outcomes associated with ventral hernia repair were comparable between cohorts. Very elderly patients achieved equitable, if not greater, quality of life improvements.

背景老年患者围手术期和术后并发症发生率较高。随着美国人预期寿命的持续增加，越来越多≥75岁的患者接受外科手术。我们选择评估老年和高龄患者择期腹疝修补术的术后和生活质量。方法采用2013 - 2020年腹部核心健康协作组织的数据进行回顾性队列研究。患者年龄≥65岁，接受择期腹疝修补术，肌后补片置入。那些缺少30天随访或没有基线和30天疝气相关生活质量调查评分的患者被排除在外。采用倾向得分匹配，统计学分析采用Fisher精确检验、Pearson检验和Wilcoxon检验。结果1514例患者中，65 ~ 75岁（老年）1219例（81%），76 ~ 90岁（高龄）295例（19%）。在30天死亡率、再入院率、疝气复发、手术部位感染、手术部位发生或其他并发症方面没有差异。老年队列在基线（P = 0.031）、30天（P < 0.001）和1年（P = 0.07）时的疝气相关生活质量调查得分较高。基线和1年患者报告结果测量信息系统疼痛3A评分无差异。30天患者报告结果测量信息系统疼痛3A评分在老年队列中较低（P = 0.016），与基线相比有更大的下降（P < 0.001）。结论与腹疝修补术相关的风险概况和结果在队列之间具有可比性。高龄患者的生活质量得到了相当程度的改善，如果不是更大的话。

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引用次数: 0

Information for readers 读者资讯

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-14 DOI: 10.1016/S0039-6060(25)00910-9

引用次数: 0

Introducing the Western Surgical Association 介绍西方外科协会

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-14 DOI: 10.1016/j.surg.2025.110064

引用次数: 0

Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair 布比卡因脂质体局部浸润与腹前疝修补术后住院率降低有关

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-14 DOI: 10.1016/j.surg.2025.110069

Johnathan V. Torikashvili BS, Rachel L. Wolansky MD, Emily A. Grimsley MD, Tyler Zander MD, Joseph Sujka MD, Paul C. Kuo MD, MS, MBA, Melissa A. Kendall MD

引用次数: 0

Proposal and external validation of a prognosis-oriented TNM staging system for intrahepatic cholangiocarcinoma: A multicenter study from the Kansai region of Japan 以预后为导向的肝内胆管癌TNM分期系统的建议和外部验证：一项来自日本关西地区的多中心研究

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-14 DOI: 10.1016/j.surg.2025.110051

Yusuke Yamamoto MD, PhD , Hisashi Kosaka MD, PhD , Masaki Ueno MD, PhD , Hiroji Shinkawa MD, PhD , Satoshi Yasuda MD, PhD , Koji Komeda MD, PhD , Haruki Mori MD, PhD , Tsukasa Aihara MD, PhD , Shinya Hayami MD, PhD , Masahiko Kinoshita MD, PhD , Nao Kawaguchi MD, PhD , Atsushi Shiozaki MD, PhD , Takeaki Ishizawa MD, PhD , Shoji Kubo MD, PhD , Masaki Kaibori MD, PhD

Introduction

The American Joint Committee on Cancer staging insufficiently reflects the prognosis of intrahepatic cholangiocarcinoma.

Methods

Overall, 496 patients from 8 hospitals in the Kansai region (2006–2023) were analyzed. A training set of 405 patients was used to construct the modified TNM staging, and a validation set of 91 patients was used to evaluate its performance.

Results

In the training set, 5-year survival rates exceeded 80% for intraductal growth-type tumors ≤50 mm and mass-forming or periductal infiltrating-type tumors ≤20 mm without vascular invasion, supporting their classification as T1. Extrahepatic vascular invasion, including involvement of the left, right, or main portal vein (median survival time, 16.2 months), inferior vena cava (9.0 months), or hepatic artery (8.4 months), was classified as T4. Tumors with prognostic factors in the multivariate analysis (tumor size >5 cm, vascular invasion, and multifocality [marginally significant]) were classified as T3, whereas tumors measuring 2–5 cm without these factors were classified as T2. Lymph node metastasis was classified as N0 (0 nodes, median survival time: 57.6 months), N1 (1–3 nodes, 22.5 months), and N2 (≥4 nodes, 11.2 months). The stages were defined as follows: IA (T1N0M0), IB (T2N0M0), II (T3N0M0), III (T4N0M0 or anyTN1M0), IVA (anyTN2M0), and IVB (M1). In the validation set, the American Joint Committee on Cancer staging showed overlapping survival for T1b–T4, whereas the new staging stratified survival well.

Conclusion

The proposed staging showed better prognostic stratification than the American Joint Committee on Cancer staging and was validated in an independent cohort.

美国癌症分期联合委员会不能充分反映肝内胆管癌的预后。方法对2006-2023年关西地区8家医院的496例患者进行分析。使用405例患者的训练集构建改进的TNM分期，使用91例患者的验证集评估其性能。结果在训练集中，≤50 mm的导管内生长型肿瘤和≤20 mm无血管侵犯的肿块形成型或导管周围浸润型肿瘤的5年生存率均超过80%，支持T1分类。肝外血管侵犯，包括累及左、右或主门静脉（中位生存时间16.2个月）、下腔静脉（9.0个月）或肝动脉（8.4个月），归为T4。在多因素分析中，有预后因素（肿瘤大小>； 5cm，血管浸润，多灶性[边际显著性]）的肿瘤被归类为T3，而没有这些因素的2-5 cm的肿瘤被归类为T2。淋巴结转移分为N0（0个淋巴结，中位生存时间57.6个月）、N1（1-3个淋巴结，22.5个月）和N2（≥4个淋巴结，11.2个月）。分期定义如下：IA （T1N0M0）、IB （T2N0M0）、II （T3N0M0）、III （T4N0M0或anyTN1M0）、IVA （anyTN2M0）、IVB （M1）。在验证集中，美国癌症分期联合委员会显示T1b-T4的生存重叠，而新的分期分层生存良好。结论与美国癌症分期联合委员会相比，提出的分期具有更好的预后分层，并在独立队列中得到验证。

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引用次数: 0

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

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-14 DOI: 10.1016/S0039-6060(25)00908-0

引用次数: 0

Surgeon perspective on the treatment of acute diverticulitis: A survey-based analysis 外科医生对急性憩室炎治疗的看法：基于调查的分析。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-12 DOI: 10.1016/j.surg.2025.110048

Samuel A. Younan MD , Andrea Fa MD , Phillip J. Williams MD, MSc , Danish Ali MD , Marissa C. Kuo MD , Aimal Khan MD , Fei Ye PhD, MSPH , Rebecca Irlmeier MS , Bradley M. Dennis MD , Alexander T. Hawkins MD, MPH

Background

Although primary anastomosis (with or without proximal diversion) offers improved morbidity and higher reversal rates compared with Hartmann procedure, little is known about real-world factors influencing surgical decision making in acute diverticulitis.

Methods

We conducted a mixed methods survey of surgeons treating diverticulitis, recruited through national colorectal and acute care/trauma surgical organizations. Surgeons were surveyed on their decision-making process, patient considerations, personal experience, and practice structure using a web-based survey. The primary outcome was percentage of primary anastomoses performed for diverticulitis in the past year.

Results

We recorded 439 survey responses; 233 (53%) were colorectal surgeons and 99 (23%) acute care surgeons. The median (interquartile range) number of primary anastomoses and Hartmann procedures performed for acute diverticulitis in the past year was 3.0 (1.0, 5.0) and 4.0 (2.0, 6.0), respectively, per surgeon. Roughly a third of surgeons reported performing primary anastomosis a majority (58.3%–100%) of the time. High anticipated surgical difficulty and hemodynamic instability were considered the most important situational and patient factors when deciding to perform a Hartmann procedure over a primary anastomosis. On multivariable analysis, acute care surgical specialty (odds ratio 0.41, 95% confidence interval 0.26–0.65; P < .001) was associated with a lower percentage of primary anastomoses performed.

Conclusions

In this national survey, only one-third of surgeons performed primary anastomosis most of the time for diverticulitis. Patient acuity, high anticipated surgical difficulty, and the presence of proper operative assistance are some of the most important factors surgeons consider when deciding between a Hartmann procedure and primary anastomosis.

背景：虽然与Hartmann手术相比，初级吻合（伴或不伴近端分流）的发病率更高，逆转率更高，但对影响急性憩室炎手术决策的现实因素知之甚少。方法：我们对治疗憩室炎的外科医生进行了一项混合方法调查，这些外科医生是通过国家结直肠和急性护理/创伤外科组织招募的。使用基于网络的调查对外科医生的决策过程、患者考虑、个人经验和实践结构进行了调查。主要结果是在过去一年中憩室炎的一期吻合术的百分比。结果：我们记录了439份调查回复；233名（53%）为结直肠外科医生，99名（23%）为急症外科医生。在过去的一年中，每位外科医生对急性憩室炎进行一期吻合术和Hartmann手术的中位数（四分位数范围）分别为3.0例（1.0,5.0）和4.0例（2.0,6.0）。大约三分之一的外科医生报告说，大多数情况下（58.3%-100%）进行了一期吻合。在决定采用Hartmann吻合术而非一期吻合术时，高度预期的手术难度和血流动力学不稳定被认为是最重要的情况和患者因素。在多变量分析中，急症外科专科（优势比0.41,95%可信区间0.26-0.65;P < 0.001）与较低的一期吻合率相关。结论：在这项全国调查中，只有三分之一的外科医生在憩室炎的大多数时间内进行了一期吻合。患者的视力、高预期的手术难度和适当的手术辅助是外科医生在决定采用Hartmann手术还是初级吻合时考虑的一些最重要的因素。

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引用次数: 0

Surgery最新文献

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