Pub Date : 2026-01-20DOI: 10.1016/j.surg.2025.110074
Jung-Woo Woo MD , Jun Ho Lee MD, PhD , Han Shin Lee MD, PhD , Hyunsuk Suh MD , Eun Jung Jung MD, PhD
Background
Vocal cord dysfunction is a significant complication after thyroid surgery, typically evaluated with invasive laryngoscopy. This study assessed diagnostic accuracy and feasibility of lateral laryngeal ultrasound as a noninvasive alternative.
Methods
In a prospective, double-blind study at Gyeongsang National University Changwon Hospital (February 2016 to June 2023), 718 patients underwent preoperative and postoperative vocal cord assessment using laryngoscopy and lateral laryngeal ultrasound. Both patients and assessors were blinded to the counterpart modality. Sensitivity, specificity, and visualization rates were analyzed.
Results
Lateral laryngeal ultrasound visualized vocal cords in 99.6% of cases (715/718), with 100% sensitivity and 99.5% specificity for detecting vocal cord paralysis compared with laryngoscopy. No adverse effects were reported.
Conclusions
Lateral laryngeal ultrasound is a reliable, noninvasive tool for perioperative vocal cord evaluation, offering a patient-friendly alternative that may reduce the need for laryngoscopy in thyroid surgery.
{"title":"Lateral laryngeal ultrasound for vocal cord evaluation in neck surgery: A mutually double-blind comparative study with laryngoscopy","authors":"Jung-Woo Woo MD , Jun Ho Lee MD, PhD , Han Shin Lee MD, PhD , Hyunsuk Suh MD , Eun Jung Jung MD, PhD","doi":"10.1016/j.surg.2025.110074","DOIUrl":"10.1016/j.surg.2025.110074","url":null,"abstract":"<div><h3>Background</h3><div>Vocal cord dysfunction is a significant complication after thyroid surgery, typically evaluated with invasive laryngoscopy. This study assessed diagnostic accuracy and feasibility of lateral laryngeal ultrasound as a noninvasive alternative.</div></div><div><h3>Methods</h3><div>In a prospective, double-blind study at Gyeongsang National University Changwon Hospital (February 2016 to June 2023), 718 patients underwent preoperative and postoperative vocal cord assessment using laryngoscopy and lateral laryngeal ultrasound. Both patients and assessors were blinded to the counterpart modality. Sensitivity, specificity, and visualization rates were analyzed.</div></div><div><h3>Results</h3><div>Lateral laryngeal ultrasound visualized vocal cords in 99.6% of cases (715/718), with 100% sensitivity and 99.5% specificity for detecting vocal cord paralysis compared with laryngoscopy. No adverse effects were reported.</div></div><div><h3>Conclusions</h3><div>Lateral laryngeal ultrasound is a reliable, noninvasive tool for perioperative vocal cord evaluation, offering a patient-friendly alternative that may reduce the need for laryngoscopy in thyroid surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110074"},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019633","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 : 2026-01-17DOI: 10.1016/j.surg.2025.110045
Huu Phong Nguyen PhD , Sofia Garces-Palacios MD , Darian Hoagland MD , Nicole Wise MD , Kailen Wong BS , Sai Abhinav Pydimarry BS , Sharanya Vunnava BS , Daniel J. Scott MD , Dmitry Nepomnayshy MD , Ganesh Sankaranarayanan PhD
Background
The Advanced Training in Laparoscopic Suturing is a proficiency-based curriculum of 6 structured tasks. In the needle handling task, participants maneuver a needle through 6 standardized holes on a circular platform. Performance (completion time and errors) is currently evaluated in person or through manual video review. This study explored the potential of artificial intelligence models to automate the assessment of this task by predicting task duration and detecting needle drop errors.
Methods
A retrospective review was conducted of Advanced Training in Laparoscopic Suturing needle handling task videos collected from 2 tertiary centers. Two complementary artificial intelligence models were developed. First, videos were annotated across 10 distinct phases. A deep expandable three-dimensional convolutional network combined with hybrid adaptive k-nearest neighbors and smoothed moving average and exponential moving average was trained for phase segmentation and duration prediction. Second, a vision transformer model was trained to detect needle drop errors by classifying frame segments based on needle visibility.
Results
Phase segmentation accuracy improved from 82.06% ± 0.84% to 89.67% ± 1.27%, with the highest accuracy reaching 90.56% and an F1-score of 86.90% using the hybrid k-nearest neighbors and smoothed moving average model. The predicted task duration error had a mean error of 0.84%. The vision transformer model achieved a 95.16% classification accuracy on validation frames and detected 66.6% of needle drops >2 seconds and 63.6% of needle drops >5 seconds in test videos.
Conclusion
Artificial intelligence–based models exhibited high and moderate accuracy for task duration prediction and needle drop error, respectively, offering scalable solutions for objective surgical assessments.
{"title":"AI-driven prediction of completion time and errors in the Advanced Training in Laparoscopic Suturing (ATLAS) needle handling task: One step closer to automated surgical skill assessment","authors":"Huu Phong Nguyen PhD , Sofia Garces-Palacios MD , Darian Hoagland MD , Nicole Wise MD , Kailen Wong BS , Sai Abhinav Pydimarry BS , Sharanya Vunnava BS , Daniel J. Scott MD , Dmitry Nepomnayshy MD , Ganesh Sankaranarayanan PhD","doi":"10.1016/j.surg.2025.110045","DOIUrl":"10.1016/j.surg.2025.110045","url":null,"abstract":"<div><h3>Background</h3><div>The Advanced Training in Laparoscopic Suturing is a proficiency-based curriculum of 6 structured tasks. In the needle handling task, participants maneuver a needle through 6 standardized holes on a circular platform. Performance (completion time and errors) is currently evaluated in person or through manual video review. This study explored the potential of artificial intelligence models to automate the assessment of this task by predicting task duration and detecting needle drop errors.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of Advanced Training in Laparoscopic Suturing needle handling task videos collected from 2 tertiary centers. Two complementary artificial intelligence models were developed. First, videos were annotated across 10 distinct phases. A deep expandable three-dimensional convolutional network combined with hybrid adaptive k-nearest neighbors and smoothed moving average and exponential moving average was trained for phase segmentation and duration prediction. Second, a vision transformer model was trained to detect needle drop errors by classifying frame segments based on needle visibility.</div></div><div><h3>Results</h3><div>Phase segmentation accuracy improved from 82.06% ± 0.84% to 89.67% ± 1.27%, with the highest accuracy reaching 90.56% and an F1-score of 86.90% using the hybrid k-nearest neighbors and smoothed moving average model. The predicted task duration error had a mean error of 0.84%. The vision transformer model achieved a 95.16% classification accuracy on validation frames and detected 66.6% of needle drops >2 seconds and 63.6% of needle drops >5 seconds in test videos.</div></div><div><h3>Conclusion</h3><div>Artificial intelligence–based models exhibited high and moderate accuracy for task duration prediction and needle drop error, respectively, offering scalable solutions for objective surgical assessments.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110045"},"PeriodicalIF":2.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980613","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}
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。
{"title":"Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy","authors":"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","doi":"10.1016/j.surg.2025.110053","DOIUrl":"10.1016/j.surg.2025.110053","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%, <em>P</em> < .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, <em>P</em> = .002). Disease-free survival was comparable (55.2 vs 54.6 months, <em>P</em> = 1.000), but overall survival was lower in older patients (62 vs 91 months, <em>P</em> < .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110053"},"PeriodicalIF":2.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980612","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 : 2026-01-16DOI: 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.
{"title":"The surgeon advocate's role in shaping state and federal policy","authors":"Ross F. Goldberg MD","doi":"10.1016/j.surg.2025.110068","DOIUrl":"10.1016/j.surg.2025.110068","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110068"},"PeriodicalIF":2.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980617","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 : 2026-01-16DOI: 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.
{"title":"Surgical advocacy in action: The fight for coverage for lung cancer screening.","authors":"Douglas E Wood","doi":"10.1016/j.surg.2025.110067","DOIUrl":"https://doi.org/10.1016/j.surg.2025.110067","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"110067"},"PeriodicalIF":2.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994564","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 : 2026-01-15DOI: 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.
{"title":"Outcomes and quality of life in very elderly patients after ventral hernia repair","authors":"Courtney M. Collins MD , William T. Head MD , Li-Ching Huang PhD , Sharon Phillips MSPH , Benjamin Poulose MD , Courtney E. Collins MD","doi":"10.1016/j.surg.2025.110050","DOIUrl":"10.1016/j.surg.2025.110050","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .031), 30 days (<em>P</em> < .001), and 1 year (<em>P</em> = .007). Baseline and 1-year Patient-Reported Outcomes Measurement Information System pain 3A <em>t</em> scores were not different. The 30-day Patient-Reported Outcomes Measurement Information System pain 3A <em>t</em> scores were lower in the very elderly cohort (<em>P</em> = .016) and had greater decrease from baseline (<em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110050"},"PeriodicalIF":2.7,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980614","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 : 2026-01-14DOI: 10.1016/j.surg.2025.110064
{"title":"Introducing the Western Surgical Association","authors":"","doi":"10.1016/j.surg.2025.110064","DOIUrl":"10.1016/j.surg.2025.110064","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 110064"},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976170","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 : 2026-01-14DOI: 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
{"title":"Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair","authors":"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","doi":"10.1016/j.surg.2025.110069","DOIUrl":"10.1016/j.surg.2025.110069","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110069"},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980615","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}
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.
{"title":"Proposal and external validation of a prognosis-oriented TNM staging system for intrahepatic cholangiocarcinoma: A multicenter study from the Kansai region of Japan","authors":"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","doi":"10.1016/j.surg.2025.110051","DOIUrl":"10.1016/j.surg.2025.110051","url":null,"abstract":"<div><h3>Introduction</h3><div>The American Joint Committee on Cancer staging insufficiently reflects the prognosis of intrahepatic cholangiocarcinoma.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The proposed staging showed better prognostic stratification than the American Joint Committee on Cancer staging and was validated in an independent cohort.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110051"},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978953","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号