Surgery最新文献

{"title":"Variability of prospective general surgery trials by subspecialty: An analysis of the national clinical trials registry","authors":"Justin Bauzon MD ,&nbsp;Fadlullah Ba'th MD ,&nbsp;Brisa Escobedo MD ,&nbsp;Melody Y. Zhou BASc ,&nbsp;Allan Siperstein MD ,&nbsp;Gustavo Romero-Velez MD","doi":"10.1016/j.surg.2025.109901","DOIUrl":"10.1016/j.surg.2025.109901","url":null,"abstract":"<div><h3>Background</h3><div>Prospective clinical trials provide robust data to drive guideline recommendations and clinical practice. Surgical trials, as opposed to other medical specialties, have been underrepresented. Our aim was to examine how surgical practice is reflected in current prospective clinical trial activity.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study of <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. We identified all active phase I through IV surgery clinical trials using keywords represented by 5 surgical specialties: general, hepatobiliary, metabolic and bariatric, robotic/minimally invasive, and endocrine. Trials were categorized by intervention (diagnostic, treatment/prevention, surgical technique) and primary outcomes based on surgical phase of care (preoperative, intraoperative, postoperative). Descriptive statistics were used for analysis.</div></div><div><h3>Results</h3><div>Of 2,708 clinical trials identified, only 429 (16%) pertained to surgery. Hepatobiliary trials constituted a majority (68%) compared with other subspecialties. Among trial interventions, most (73%) focused on treatments, such as anticancer therapies, whereas a minority evaluated diagnostic modalities (12%) or assessed surgical technique (11%). Four out of 5 trial outcomes involved postoperative care (eg, complications or mortality); only 19 (4%) were intraoperative trials.</div></div><div><h3>Conclusions</h3><div>Surgery trials represent a minority of modern clinical trials. Surgical oncologic specialties make up a significant percentage of trials, likely due to their multidisciplinary nature and rigorous research approaches aimed at treating cancer. Very few trials are studying procedure-based outcomes in the intraoperative phase of care, mirroring the lack of high-quality evidence supporting practices such as surgical technique, and should be prioritized.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109901"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does neoadjuvant systemic therapy in clinical T1–2 N0 human epidermal growth factor receptor 2–positive breast cancer increase the extent of axillary surgery?","authors":"Christine C. Rogers BS ,&nbsp;Lauren N. Cohen BS ,&nbsp;Jan Irene C. Lloren RN, MPH ,&nbsp;Chiang-Ching Huang PhD ,&nbsp;Adrienne N. Cobb MD, MS, FSSO ,&nbsp;Amanda L. Kong MD, MS, FSSO, FACS ,&nbsp;Puneet Singh MD, MS, FSSO, FACS ,&nbsp;Mediget Teshome MD, MPH, FSSO, FACS ,&nbsp;Chandler S. Cortina MD, MS, FSSO, FACS","doi":"10.1016/j.surg.2025.109907","DOIUrl":"10.1016/j.surg.2025.109907","url":null,"abstract":"<div><h3>Background</h3><div>For patients with human epidermal growth factor receptor 2–positive breast cancer, an upfront surgery or neoadjuvant systemic therapy approach can influence the need for axillary lymph node dissection depending on pathologic nodal status. This study aimed to evaluate the impact of an upfront surgery versus neoadjuvant systemic therapy approach in women with cT1–2 human epidermal growth factor receptor 2–positive breast cancer on pathologic nodal status and odds of axillary lymph node dissection.</div></div><div><h3>Methods</h3><div>This retrospective study used the National Cancer Database and included female patients aged ≥18 years, diagnosed between 2016 and 2021, with cT1–2 N0 M0 human epidermal growth factor receptor 2–positive breast cancer. Demographic, clinicopathologic, and treatment data were collected. Analyses included analysis of variance, Kruskal-Wallis, χ², Fisher exact tests, and multivariable logistic regression analysis.</div></div><div><h3>Results</h3><div>A total of 62,927 women met inclusion criteria: 66.6% (<em>n</em> = 39,024) underwent upfront surgery, and 33.4% (<em>n</em> = 19,562) received neoadjuvant systemic therapy. The neoadjuvant systemic therapy cohort was younger (mean age: 53.8 vs 59.9 years, <em>P</em> &lt; .001), had fewer comorbidities (86.9% vs 82.7% with a Charlson-Deyo score of 0, <em>P</em> &lt; .001), and more frequently had cT2 tumors (71.7% vs 21.7%, <em>P</em> &lt; .001). On multivariable analysis, patients with upfront surgery were more likely to be pN+ (1–3 nodes: 14.7% vs 6.8%, odds ratio: 3.19, 95% confidence interval: 2.96–3.45 and ≥4 nodes: 2.0% vs 0.7%, odds ratio: 5.48, 95% confidence interval: 4.43–6.80); however, there was no difference in the odds of axillary lymph node dissection (odds ratio: 0.96, 95% confidence interval: 0.86–1.08).</div></div><div><h3>Conclusion</h3><div>Patients who underwent upfront surgery had a greater likelihood of being pN+; however, there was no difference in the likelihood of axillary lymph node dissection. Therefore, neoadjuvant systemic therapy use should be based on current systemic therapy guidelines and patient-centered shared multidisciplinary decision-making.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109907"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first full year of histotripsy for liver tumors: Local tumor control and preliminary oncologic efficacy","authors":"Chase J. Wehrle MD ,&nbsp;Ahmed F. Sayed Ahmed MD ,&nbsp;Emily Knott BA ,&nbsp;Hanna Hong BA ,&nbsp;Melis Uysal MD ,&nbsp;Andrea Schlegel MD, MBA ,&nbsp;Eren Berber MD ,&nbsp;R. Matthew Walsh MD ,&nbsp;JaeKeun Kim MD, PhD ,&nbsp;Federico Aucejo MD ,&nbsp;David C.H. Kwon MD, PhD","doi":"10.1016/j.surg.2025.109898","DOIUrl":"10.1016/j.surg.2025.109898","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Histotripsy is a novel, nonionizing, nonthermal, noninvasive method using focused ultrasound waves to mechanically destroy liver tumors. It received FDA clearance in October 2023. We report the first years' experience at our academic center including, to our knowledge, the first evidence of medium-term oncologic efficacy, reporting local tumor control with this novel approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients receiving histotripsy were included (December 20, 2023–November 30, 2024). Contrast-enhanced postoperative day 1, 30-, and 90-day scans are obtained in all patients. Tumor viability was determined by Response Evaluation Criteria in Solid Tumours/modified Response Evaluation Criteria in Solid Tumours criteria. Viable tumor on postoperative day 1 imaging was considered inadequate treatment; patients with nonviable tumors on postoperative day 1 were assessed for tumor control at postoperative day 30 and 90. Tumors with intentional partial treatment of a lesion were excluded from local control analyses. Palliative intent treatment refers to attempted immunologic antitumor priming and is pursued in very advanced tumor cases with no chance at curative therapy. All systemic therapy and anticoagulation are continued in the periprocedural period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In all, 109 lesions in 71 patients were treated with histotripsy, with 9% receiving curative intent treatment and 66% treated palliatively. Among those treated with curative intent, 70% showed nonviable lesions at both 30- and 90-day follow-ups, suggesting effective tumor ablation. Overall, 75% of treatments were aimed at complete lesion ablation. Complications were rare, with only 1 (1%) classified as Clavien grade ≥3. In cases of proper targeting, tumor control was excellent: 60 lesions were nonviable on postoperative day 1, all demonstrating nonviable tumors at 30 days. Among these, 23 also had postoperative day 90 imaging; 100% maintained tumor nonviability. Unfortunately, lesion targeting was imperfect, with 60 (74%) of the 82 lesions intended for complete treatment demonstrating postoperative day 1 tumor nonviability. Notably, 19 (23%) of the 82 lesions were treated with palliative intent, whereas 3 (4%) were treated with curative intent. Ten patients were treated with curative intent; 70% (&lt;em&gt;n =&lt;/em&gt; 7) had nonviable tumors on postoperative day 1. All such patients demonstrated persistent nonviability on postoperative days 30 and 90. Thus, 70% of patients treated with curative intent achieved no evidence of disease with 1 treatment, whereas 30% had persistent disease. Of these 3 cases, 2 were retreated with histotripsy and converted to no radiologic evidence of disease, with a total rate of no evidence of disease at 90%. There was a slight, although not significant improvement in targeting as providers gained more experience.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Histotripsy is a safe procedure that is starting to d","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109898"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon perspective on the treatment of acute diverticulitis: A survey-based analysis","authors":"Samuel A. Younan MD ,&nbsp;Andrea Fa MD ,&nbsp;Phillip J. Williams MD, MSc ,&nbsp;Danish Ali MD ,&nbsp;Marissa C. Kuo MD ,&nbsp;Aimal Khan MD ,&nbsp;Fei Ye PhD, MSPH ,&nbsp;Rebecca Irlmeier MS ,&nbsp;Bradley M. Dennis MD ,&nbsp;Alexander T. Hawkins MD, MPH","doi":"10.1016/j.surg.2025.110048","DOIUrl":"10.1016/j.surg.2025.110048","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> &lt; .001) was associated with a lower percentage of primary anastomoses performed.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110048"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective standardized surveillance of early-stage melanoma on the basis of anatomical staging and molecular profiling: Study design and interim analysis","authors":"Jason M. Aubrey MD ,&nbsp;Jesse Kelley MD ,&nbsp;Mariam Khan MD ,&nbsp;Hordur Kolbeinsson MD ,&nbsp;Hannah Liefeld MD ,&nbsp;Randa Preihs AGACNP ,&nbsp;Alexandra Bengel PA-C ,&nbsp;Chantelle Koch PA-C ,&nbsp;Lisa Martin PA-C ,&nbsp;Jennifer Charchan PA-C ,&nbsp;Kimberly Texley-Quigg NP ,&nbsp;Marianne Melnik MD ,&nbsp;G. Paul Wright MD","doi":"10.1016/j.surg.2025.109969","DOIUrl":"10.1016/j.surg.2025.109969","url":null,"abstract":"<div><h3>Background</h3><div>Gene expression profiling of cutaneous melanoma has become pervasive in clinical practice, with minimal independent, nonindustry-sponsored, data to guide implementation and influence practice patterns. We developed a scoring system on the basis of anatomic staging and molecular profiling to risk stratify patients into 4 categories for prospective surveillance.</div></div><div><h3>Methods</h3><div>Patients with cutaneous melanoma were recruited from 2019 to 2023 for enrollment into the study. Inclusion criteria included pathologic stage IA-IIC and use of a commercialized 31-gene expression profile system. Patients were stratified into 1 or 4 surveillance groups: A1 (stage IA-IIA/gene expression profiling class 1), A2 (stage IA-IIA/gene expression profiling class 2), B1 (stage IIB-IIC/gene expression profiling class 1), and B2 (stage IIB-IIC/gene expression profiling class 2). The primary outcome measure is rate of asymptomatic imaging-detected recurrence. Interim analysis has been performed at median follow-up of 24 months.</div></div><div><h3>Results</h3><div>A total of 200 patients were enrolled. Mean age was 61.0 years (standard deviation, 14.6 years) and 55.5% of the population was male. Primary lesions were distributed between the head and neck (<em>n</em> = 40, 20%), trunk (<em>n</em> = 76, 38%), and extremity (<em>n</em> = 84, 42%). Median depth was 1.1 mm (range, 0.3–8.8 mm) and 14% had ulceration present. Stage distribution was as follows: IA (<em>n</em> = 82, 41.0%), IB (<em>n</em> = 71, 35.5%), IIA (<em>n</em> = 27, 13.5%), IIB (<em>n</em> = 16, 8.0%), and IIC (<em>n</em> = 4, 2.0%). Gene expression profiling classification was class 1 (<em>n</em> = 145, 72.5%) and class 2 (<em>n</em> = 55, 27.5%). This provided a distribution of 71.0% in A1, 19.5% in A2, 2.0% in B1, and 7.5% in B2. Recurrences have been detected in 16 patients (8.0%) including 12 local/regional (6.0%) and 4 distant (2.0%) recurrences. Recurrence rates by surveillance group are: A1 = 4.9%, A2 = 10.3%, B1 = 0%, and B2 = 33.3%. Recurrences were detected by surveillance imaging in 3 (1.5%), history and physical examination in 10 (5.0%), and symptoms in 3 patient (1.5%), respectively.</div></div><div><h3>Conclusion</h3><div>Pragmatic implementation of a risk-stratified surveillance strategy has resulted in few instances of asymptomatic, imaging-detected recurrences among early-stage cutaneous melanoma patients at short-term follow-up benchmarks. Further follow-up is necessary to determine the validity of this approach.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109969"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival benefit of adjuvant chemotherapy for perihilar cholangiocarcinoma: Impact of log odds of metastatic lymph node count","authors":"Jun Kawashima MD ,&nbsp;Miho Akabane MD ,&nbsp;Odysseas P. Chatzipanagiotou MD ,&nbsp;Diamantis I. Tsilimigras MD, PhD ,&nbsp;Zayed Rashid MD ,&nbsp;Mujtaba Khalil MD ,&nbsp;Abdullah Altaf MD ,&nbsp;Yutaka Endo MD, PhD ,&nbsp;Kota Sahara MD, PhD ,&nbsp;Federico Aucejo MD ,&nbsp;Hugo P. Marques MD ,&nbsp;Beatriz Chumbinho MD ,&nbsp;Tom Hugh MD ,&nbsp;Shishir K. Maithel MD ,&nbsp;Bas Groot Koerkamp MD, PhD ,&nbsp;Andrea Ruzzenente MD, PhD ,&nbsp;Itaru Endo MD, PhD ,&nbsp;Timothy M. Pawlik MD, PhD, MPH","doi":"10.1016/j.surg.2025.109913","DOIUrl":"10.1016/j.surg.2025.109913","url":null,"abstract":"<div><h3>Objective</h3><div>We hypothesized that log odds of metastatic lymph nodes may be an indicator of cancer burden in perihilar cholangiocarcinoma and be used to identify patients who would benefit most from adjuvant chemotherapy. We sought to investigate the interplay between log odds of metastatic lymph nodes and survival benefit of adjuvant chemotherapy in patients with perihilar cholangiocarcinoma.</div></div><div><h3>Methods</h3><div>Data on patients undergoing curative-intent resection with lymph node dissection for perihilar cholangiocarcinoma were obtained from an international multi-institutional database. Overall survival was examined using multivariable Cox proportional hazards models, including an interaction term between log odds of metastatic lymph nodes and receipt of adjuvant chemotherapy.</div></div><div><h3>Results</h3><div>Among 388 patients, the median log odds of metastatic lymph nodes was −1.7 (interquartile range: −2.7, −1.1). On multivariable Cox regression, preoperative carbohydrate antigen 19-9 (hazard ratio 1.00, 95% confidence interval 1.00–1.00, <em>P</em> = .035) and undifferentiated tumors (hazard ratio 1.43, 95% confidence interval 1.05–1.95, <em>P</em> = .023) were independent predictors of overall survival. Notably, there was an interaction between log odds of metastatic lymph nodes and adjuvant chemotherapy (hazard ratio 0.79, 95% confidence interval 0.64–0.99, <em>P</em> = .039). In restricted cubic spline analysis, patients with log odds of metastatic lymph nodes ≥ −2.0 were more likely to benefit from adjuvant chemotherapy, whereas patients with log odds of metastatic lymph nodes &lt; −2.0 demonstrated no survival advantage. Among 228 patients with log odds of metastatic lymph nodes ≥ −2.0, adjuvant chemotherapy was associated with improved overall survival (31.3 months vs 20.1 months, <em>P</em> = .030), whereas there was no survival benefit in 160 patients with log odds of metastatic lymph nodes &lt; −2.0 (69.2 months vs 51.0 months, <em>P</em> = .560).</div></div><div><h3>Conclusion</h3><div>Log odds of metastatic lymph nodes is a predictor of survival benefit from adjuvant chemotherapy in perihilar cholangiocarcinoma. Patients with log odds of metastatic lymph nodes ≥ −2.0 derived survival benefits from adjuvant chemotherapy, whereas patients with log odds of metastatic lymph nodes &lt; −2.0 did not, highlighting the utility of log odds of metastatic lymph nodes to guide adjuvant treatment.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109913"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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 ,&nbsp;Hisashi Kosaka MD, PhD ,&nbsp;Masaki Ueno MD, PhD ,&nbsp;Hiroji Shinkawa MD, PhD ,&nbsp;Satoshi Yasuda MD, PhD ,&nbsp;Koji Komeda MD, PhD ,&nbsp;Haruki Mori MD, PhD ,&nbsp;Tsukasa Aihara MD, PhD ,&nbsp;Shinya Hayami MD, PhD ,&nbsp;Masahiko Kinoshita MD, PhD ,&nbsp;Nao Kawaguchi MD, PhD ,&nbsp;Atsushi Shiozaki MD, PhD ,&nbsp;Takeaki Ishizawa MD, PhD ,&nbsp;Shoji Kubo MD, PhD ,&nbsp;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 &gt;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":"2026-03-01","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}

{"title":"The new modified four-factor functional frailty index (mFF-4) in colorectal surgery: A retrospective cohort study","authors":"Alexandra Z. Agathis MD,&nbsp;Jeanne Wu MPH,&nbsp;Celia M. Divino MD","doi":"10.1016/j.surg.2025.109816","DOIUrl":"10.1016/j.surg.2025.109816","url":null,"abstract":"<div><h3>Background</h3><div>Since its introduction, the Modified Five-Factor Frailty Index (mFI-5) has been widely applied across subspecialties using the National Surgical Quality Improvement Program (NSQIP) database. Although the mFI-5 index is predictive, it predominantly focuses on comorbidities and does not represent functional frailty aspects. We sought to apply the new Modified Four-Factor Functional Frailty Index (mFF-4) to a colorectal population.</div></div><div><h3>Methods</h3><div>This retrospective study using NSQIP 2021-2022 includes patients &gt;75 years of age who underwent colon and rectal surgery. The mFF-4 frailty index is scored by adding one point for each present variable including history of falls, dementia, poor nutritional status (body mass index &lt;18.5), and nonindependent functional status. Patients were stratified into frailty groups: mFF-4=0, 1, 2+. Univariate and multivariate regressions were performed to assess 30-day postoperative outcomes. Area under the curve (AUC) and Akaike information criterion (AIC) values assessed predictability of the mFF-4 model, in reference to mFI-5.</div></div><div><h3>Results</h3><div>Our sample of n=27,875 included 21,573 in the mFF-4=0 (77.4%), 4,601 in mFF-4=1 (16.5%), and 1,701 in mFF-4=2+ (6.1%). The mFF-4 multivariate regressions had less error (lower AICs by &gt;2) and higher AUCs (most &gt;0.7) than the mFI-5 for predicting mortality, pneumonia, ventilator use &gt;48 hours, delirium, length of stay &gt;30 days, and nonhome discharge destination. For these complications, patients with high frailty (mFF-4=2+) had statistically significant odds ratios &gt;2.0.</div></div><div><h3>Conclusion</h3><div>This new frailty index, focused on functional capabilities, is more encompassing of phenotypical frailty and is more predictive than the mFI-5. This new scale will help risk-stratify our aging colorectal population.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109816"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145876920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of radiologic main duct dilatation in pancreatic intraductal papillary mucinous neoplasms","authors":"Pranav Kumar BA ,&nbsp;Chase J. Wehrle MD ,&nbsp;Abby Gross MD ,&nbsp;Muhammad A. Nadeem MD ,&nbsp;Breanna Perlmutter MD ,&nbsp;Hanna Hong BS ,&nbsp;Jenny Chang MD ,&nbsp;Robert Naples MD ,&nbsp;Kathryn Stackhouse MD ,&nbsp;John McMichael PhD ,&nbsp;Samer Naffouje MD ,&nbsp;Daniel Joyce MD ,&nbsp;Robert Simon MD ,&nbsp;Toms Augustin MD, MPH ,&nbsp;Daniela Allende MD ,&nbsp;R. Matthew Walsh MD","doi":"10.1016/j.surg.2025.109921","DOIUrl":"10.1016/j.surg.2025.109921","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Intraductal papillary mucinous neoplasms are cystic neoplasms of the pancreas with a risk of malignant transformation. They are categorized based on morphology and ductal involvement. Compared with side-branch intraductal papillary mucinous neoplasms, main duct intraductal papillary mucinous neoplasms and mixed-type intraductal papillary mucinous neoplasms are generally considered high risk. Radiologic main pancreatic duct dilatation is a recognized risk factor for high-grade dysplasia and/or invasive carcinoma. Studies thus far have not explored the association between radiologic main pancreatic duct dilatation and dysplasia of the main pancreatic duct epithelium on surgical pathology.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An institutional database of intraductal papillary mucinous neoplasms was queried for patients from 1997 to 2023 undergoing resection of a main duct or mixed-type intraductal papillary mucinous neoplasm with radiologic diagnosis of main pancreatic duct dilatation before surgery. The χ&lt;sup&gt;2&lt;/sup&gt; test, &lt;em&gt;t&lt;/em&gt; test, logistic regression modeling, and Youden's index analysis were performed to test the association between \"true\" main pancreatic duct dysplasia involvement in surgical pathology reports and main pancreatic duct dilatation, as well as high-risk pathology (high-grade dysplasia or invasive carcinoma).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 91 patients were included in the final analysis. Radiologic main duct intraductal papillary mucinous neoplasms were more likely to demonstrate \"true\" main duct involvement versus mixed-type intraductal papillary mucinous neoplasms (79% vs 41%, &lt;em&gt;P&lt;/em&gt; = .001). Among intraductal papillary mucinous neoplasms with true main pancreatic duct dysplasia, main duct intraductal papillary mucinous neoplasms were more likely than mixed-type intraductal papillary mucinous neoplasms to demonstrate invasive carcinoma on surgical pathology (27% vs 10%, &lt;em&gt;P&lt;/em&gt; = .047). Cyst size was not predictive of main pancreatic duct dysplasia for mixed-type intraductal papillary mucinous neoplasms. Main pancreatic duct &gt;9 mm at diagnosis was associated with increased likelihood of true main pancreatic duct dysplasia (odds ratio = 3.33, 95% confidence interval = 1.16–9.61 &lt;em&gt;P&lt;/em&gt; = .026). Youden's index analysis demonstrated that a main pancreatic duct cutoff of 8.5 mm provided the greatest capability to predict main pancreatic duct dysplasia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Mixed-type intraductal papillary mucinous neoplasm confers less dysplasia risk in the main pancreatic duct, supporting maintaining the distinction of mixed-type and main duct intraductal papillary mucinous neoplasm due to potentially different management. This study reaffirms the use of main pancreatic duct dilatation in intraductal papillary mucinous neoplasm risk stratification, because main pancreatic duct dilatation &gt;8 mm was predictive of main pancreatic duct epithelial dys","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109921"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of routine discharge after a 4-hour postanesthesia care stay following thyroid lobectomy","authors":"Ali M. Kara MD ,&nbsp;Susan M. Conte PA-C ,&nbsp;Abby Turza CNP ,&nbsp;Ramiro Cadena Semanate MD ,&nbsp;Ashwini R. Sehgal MD ,&nbsp;Christopher R. McHenry MD","doi":"10.1016/j.surg.2025.109968","DOIUrl":"10.1016/j.surg.2025.109968","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo thyroid lobectomy are routinely observed for 4 hours in the postanesthesia care unit and are discharged if there is no evidence of neck hematoma. The aim of this study was to determine the outcome of routine discharge after a 4-hour observation following thyroid lobectomy.</div></div><div><h3>Methods</h3><div>A retrospective review of consecutive patients who underwent thyroid lobectomy from 2008 to 2023 was completed. Patients were evaluated for neck hematoma requiring urgent evacuation, emergency department visits, and hospital readmission. Univariate analysis and multivariate regression analysis were used to analyze potential factors associated with an unsuccessful discharge after 4 hours of observation.</div></div><div><h3>Results</h3><div>A total of 494 patients underwent thyroid lobectomy; 330 (67%) were discharged after a 4-hour postanesthesia care unit stay (group I), and 164 (33%) were observed overnight (group II). Neck hematoma occurred in 2 (0.4%) patients before they were both discharged. Thirty-seven (7%) patients presented to the emergency department, 23 (7%) from group I and 14 (9%) from group II (<em>P</em> = .53). Six (1%) patients were readmitted, 3 (1%) from groups I and 3 (2%) from group II (<em>P</em> = .38). Factors independently associated with an overnight stay and their odds ratio and confidence interval were dependent status (10.76, 2.18–53.07), American Society of Anesthesiologists class ≥3 (5.32, 2.04–13.86), increased blood loss (4.00, 1.04–2.45), age &gt;50 years (2.68, 1.38–5.20 years), and substernal extension (1.60, 1.04–2.45).</div></div><div><h3>Conclusion</h3><div>Discharge to home after 4 hours of observation is safe after thyroid lobectomy. However, patients who are older, dependent, have an American Society of Anesthesiologists score ≥3, or undergo a more difficult operation should be prepared for overnight observation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109968"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744352","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}