World Journal of Surgery最新文献

Background: Atrial fibrillation (AF) is the most common cardiovascular complication following esophagectomy. The aim of this study was to identify the risk factors for new-onset perioperative (intraoperative and/or postoperative) AF in patients undergoing minimally invasive esophagectomy (MIE).

Methods: This study used a single-center retrospective design and included 814 patients who were diagnosed with esophageal cancer and underwent McKeown MIE. The patients' characteristics and perioperative data were collected from the electronic medical records and analyzed.

Results: New-onset perioperative AF occurred in 5.3% of the patients (43/814), with 4 patients developing intraoperative AF and 39 patients developing postoperative AF. Multivariate logistic regression analysis identified age (odds ratio [OR] 1.081 and p < 0.001), history of coronary heart disease (OR 4.269 and p < 0.001), and intraoperative blood loss (OR 1.004 and p = 0.008) as independent risk factors for perioperative AF following MIE. The area under the receiver operating characteristic curve for the multivariate logistic regression model was 0.735 (95% confidence interval 0.660-0.810). The incidences of postoperative pulmonary complications and anastomotic leakage were significantly higher in patients with perioperative AF than in those without perioperative AF (both p = 0.011). Patients with perioperative AF also had a longer hospital stay (15.0 vs. 13.0 days and p = 0.034).

Conclusions: Increasing age, history of coronary heart disease, and intraoperative blood loss were associated with new-onset perioperative AF following MIE. However, the impact of intraoperative blood loss on AF is likely to be of marginal clinical relevance. The observed AF fell below projected estimates, resulting in inadequate statistical power for the study outcomes.

Trial registration: Chinese Clinical Trial Registry (No. ChiCTR2300074003; date of registration, 27/07/2023).

Background: Extreme oncoplastic breast-conserving surgery (eOBCS), euphemism for radical conservation, expands the indications of breast conservation for tumor that typically requires a mastectomy. Existing data show no discernible survival differences between mastectomy and breast-conserving surgery; however, limited evidence exists regarding local recurrences between these groups. We report the oncological outcomes of eOBCS in terms of margin safety and disease recurrence at our institute. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Methodology: 47 patients underwent eOBCS between July'17 and June'22. Mean follow-up was 54 (24-84) months. Primary endpoints were the resection margin status and need for reoperation. Secondary endpoints were 5-year local and distant recurrence free and overall survivals. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Results: Mean age at diagnosis was 46.8 (±13.2) years. IDC (70.2%) was the commonest histological type. 32% of cancers were >5 cm in size, 30% were multifocal, and 40.4% were node positive. 25% were triple negative whereas, 7% were Her2Neu positive. Therapeutic mammoplasty (44.4%) was the frequently performed surgical procedure followed by local rotational flaps (27.6%). Mean pretreatment mammographic tumor size was 50 mm (±7.5) mm. 40.4% of the patients qualified for neoadjuvant therapies and 91.5% received radiation. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Conclusion: eOBCS is an innovative and aesthetically promising surgical technique enabling successful breast conservation in patients necessitating mastectomy. Our data substantiate the oncological safety of eOBCS; however, it requires appropriate patient selection and multidisciplinary planning.

Background: Women are significantly underrepresented in surgical specialties, particularly in Southeast Asia. The factors influencing this gender disparity remain poorly understood. This study aims to explore the motivations, challenges, and barriers faced by female medical doctors in pursuing surgical careers in Malaysia.

Methods: An exploratory qualitative study was conducted between May 2016 and November 2017, using semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with male and female senior surgeons, medical officers, and surgical trainees. A coding tree was constructed and refined after initial rounds of data analysis. Thematic content analysis was performed using the NVivo 11 Pro (Windows) qualitative data analysis software.

Results: Ten IDIs and five FGDs (N = 34 participants) revealed three key themes: (A) influences on trainees' career choices, (B) challenges encountered during surgical training, and (C) trainee empowerment. Participants highlighted the demanding nature of surgical training, the lack of flexibility in work schedules, and the male-dominated work environment as significant barriers for women. Despite these challenges, supportive family structures and strong mentorship were found to be critical for the retention of women in surgery.

Conclusion: Institutional support, mentorship opportunities, and culture change are essential for improving the representation and retention of female surgeons in Malaysia. Tailored policies that acknowledge the unique challenges faced by women in surgery could foster a more inclusive and supportive environment.

Background: To determine a population-based comparative matched overall survival analysis for patients undergoing curative resection for sigmoid, rectosigmoid, and rectal cancers stage by stage.

Methods: Patients who underwent curative surgery for nonmetastatic adenocarcinoma of the sigmoid, rectosigmoid, and rectum between 2000 and 2020 were identified using the US SEER cancer registry data. Each anatomical subsegment was matched in a 1:1 ratio based on age, sex, time of surgery, grade of differentiation, and histopathological stage. Multivariate (MV) Cox regression analysis was conducted.

Results: A total of 19,607 patients fulfilled the criteria per group. Whereas chemotherapy rates were comparable among groups, radiotherapy rates were significantly higher in the rectum. Compared to the initial time period (2000-2005), there was a significant improvement in 3- and 5-year overall survival rates for each stage in the time period of 2016-2020. During the study period, a 10% improvement was observed for Stage-2 and Stage-3 patients for each site (p < 0.05). MV analysis showed that sex (p < 0.001), primary cancer site (p < 0.001), year category (p < 0.001), age (p < 0.001), stage (p < 0.001), degree of differentiation (p < 0.001), and CTx status (p < 0.001) were independently associated with overall survival.

Conclusion: This large population-based, comprehensive registry study demonstrates significant survival differences among sigmoid, rectosigmoid, and rectal cancers. Further studies defining distinct landmarks between rectal and colon cancers may improve treatment approaches, cancer care, and survival.

Background: Peptic ulcer perforation is a potentially life-threatening complication of peptic ulcer disease. Several scoring systems have been developed to predict outcomes in these patients. The red cell distribution width-to-albumin ratio (RAR) has shown promise as a prognostic marker in various conditions, yet its role in peptic ulcer perforation remains unclear. This study aimed to evaluate the predictive value of RAR in patients with peptic ulcer perforation.

Methods: This retrospective study was conducted between 2016 and 2024 on patients who underwent surgery for peptic ulcer perforation. Patient demographics, clinical features, laboratory values, and surgical outcomes were analyzed. The main outcomes were major postoperative complications and 30-day mortality. Multivariate regression analysis was used to identify independent predictors of these outcomes. The ability of RAR to predict outcomes was also assessed.

Results: The study included 187 patients with a median age of 49.7 years, of whom 78.6% were males. Major complications occurred in 18.1% of the patients and the 30-day mortality rate was 9.6%. Multivariate analysis identified age, surgical delay, elevated C-reactive protein and RAR as independent predictors of major complications. For 30-day mortality, only age and RAR remained significant in the multivariate model. Receiver operating characteristic curve analysis showed that RAR had high diagnostic accuracy for predicting both major complications (AUC = 0.883) and mortality (AUC = 0.944).

Conclusion: With its high sensitivity and specificity for predicting major complications and mortality in patients with peptic ulcer perforation, RAR has significant potential as a prognostic marker in conjunction with traditional risk factors in clinical practice.

Background: Pathological complete response (PCR) is the surrogate marker of the outcome of a breast cancer patient. Breast cancer (BC) patients have variable responses to neoadjuvant chemotherapy (NACT). The effect of chemotherapy on mammographic density (MD) is unclear in the literature. Also, MD and PCR correlation is not extensively studied. The aim of the present study is to find MD's potential as a PCR predictor in a resource-constrained setting.

Methods: The study included all patients of BC-related surgery from January 2018 to June 2021 with follow-up till June 2023. MD was classified by the American College of Radiology (ACR) (classes A-D) based on breast composition. The chi-square test and logistic regression analysis were used to calculate p-values.

Results: Out of 557 patients, 554 were female with a mean age 46.8 years (premenopausal 54.5%). ACR grades of MD A, B, C, and D were 18.1% (n = 101), 56% (n = 312), 21.5% (n = 120), and 4.3% (n = 24), respectively. The odds of having PCR with MD B, C, and D were 0.51, 0.04, and 0.03, respectively, with respect to MD A. There was a significant inverse association of PCR and Ki-67 with MD on multivariate analysis. HER2 positive, TNBC, Ki 67 > 15%, and grade 3 had significantly high PCR.

Conclusion: MD had an inverse correlation with PCR and Ki-67. Low MD, HER2 positive, TNBC, high Ki-67 subtypes, and grade 3 were good predictors for PCR.