World Journal of Surgery最新文献

Background: PANP has been applied in laparoscopic radical rectal cancer resection, significantly reducing the incidence of genitourinary dysfunction; however, it has not eliminated sexual and urinary dysfunction. Prospective trials focusing on genitourinary function as a primary outcome are rare. To confirm the protective effect on sexual and urinary function in laparoscopic radical resection of rectal cancer with pelvic autonomic nerve preservation (PANP), and explore the risk factor of postoperative sexual dysfunction.

Methods: A prospective, single-center, single-arm trial was conducted on male patients with rectal adenocarcinoma suitable for laparoscopic surgery with PANP at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Patients with normal genitourinary function were included, and the primary outcome was the change in sexual function 6 months after the operation.

Results: Of 91 patients enrolled, 70 underwent a laparoscopic operation. Six months after the operation, 5 patients were lost to follow-up, and the IIEF-5 and IPSS scores were 22.85 ± 3.66 versus 24.10 ± 1.21 (p = 0.003) and 2.11 ± 2.06 versus 1.89 ± 1.86 (p = 0.018), respectively, compared with preoperative values. Five patients (7.69%) suffered from sexual disorders, and 2 patients (3.08%) developed moderate urinary dysfunction. The majority of the autonomic nerve system was visible and preserved intraoperatively. Quality of TME was complete in 94.29% (66/70) and partially complete in 5.71% (4/70) of patients, respectively. Positive CRM in this study was 2.86% (2/70), and positive distal resection margin was 1.43% (1/70). The mean postoperative hospital stay was 7.80 ± 2.44 days. Surgical procedure, distance of tumor to AV, clinical TNM stage, nCRT, stoma, and completeness of the autonomic nervous system were risk factors of postoperative sexual dysfunction in univariate analysis; however, none of them was an independent risk factor in multivariate analysis.

Conclusions: PANP in laparoscopic radical rectal resection effectively preserves sexual and urinary function without compromising oncological outcomes. It is safe and feasible in high-flow centers and for experienced surgeons.

Background: Excessive opioid prescribing after colorectal surgery can lead to adverse events and contribute to the opioid crisis. Understanding international prescribing patterns is essential for guiding practice and future research. The Analgesia After Colorectal Surgery (ACORE) survey aimed to characterize international opioid prescribing practices after elective colorectal resection.

Method: This international cross-sectional survey followed established methodological guidelines. Eligible participants were colorectal, gastrointestinal, and general surgeons, as well as surgery trainees. Recruitment followed snowball sampling via international surgical societies' mailing lists, social media, and personal networks. The primary outcome of interest was post-discharge opioid prescribing after open and MIS elective colorectal resection. Secondary outcomes included prescription quantity in morphine milligram equivalents (MMEs). Data were analyzed using descriptive statistics and logistic regression with Bayesian model averaging.

Results: Among 817 participants, 88% were surgeons, 12% were trainees, 62% practiced in academic hospitals, and 67% had over 5 years in practice. Overall, 57% of the participants reported prescribing opioids at discharge (55% after open and 54% after minimally invasive procedures). Opioids were commonly prescribed by surgeons practicing in Australia and New Zealand (100%), Northern America (92%), Northern Europe (68%), and South-eastern Asia (71%). In contrast, they were less frequently prescribed in Eastern Europe (11%), Eastern Asia (22%), Latin America and the Caribbean (26%), Southern Europe (19%), and Northern Africa (0%). The median quantity of opioids prescribed at discharge varied widely (30-200 MMEs). In regression analysis accounting for surgeon and practice characteristics, region of practice was the only factor independently associated with opioid prescribing.

Conclusion: The extensive global variation in opioid prescribing underscores clinical equipoise and challenges the assumption that post-discharge opioids are universally necessary for patients undergoing colorectal resection.

Background: Patients with non-small cell lung cancer (NSCLC) are a heterogeneous group with varied patterns of disease. The skip mediastinal lymph node metastasis is quite frequent and a prognostic factor for patients with N2 lung cancer. The aim of this study is to assess the clinical significance and prognostic value of a new N2 descriptor based on skip N2 disease and ninth edition N2 classification.

Methods: A retrospective review of 533 patients with stage pN2 NSCLC was undertaken. Patients were finally classified into three categories (skip N2a, skip N2b/nonskip N2a, and nonskip N2b). The clinic characteristics, survival outcomes, and metastasis pattern were analyzed among groups.

Results: Significant prognostic differences were found between patients of subdivided N2 descriptor (skip N2a vs. skip N2b/nonskip N2a and p < 0.001 for both OS and DFS and skip N2b/nonskip N2a vs. nonskip N2b, p = 0.037 for OS and p = 0.029 for DFS). Better prognostic value in predicting survival, including a smaller Akaike Information Criterion value and a higher Harrell C-index, was observed for the new N2 descriptor relative to the ninth edition N2 classification. Skip patients had better survival outcomes and different lymph node metastasis pattern compared with nonskip patients.

Conclusions: When compared to the ninth N2 classification, the new N2 descriptor could be a more reliable and accurate prognostic determinant, which is worth considering in the revision of the current tumor, node, and metastasis (TNM) staging system.

Background: Postoperative morbidity remains a significant concern following the surgical treatment of pediatric liver hydatid disease, particularly in endemic regions. The aim of this study was to identify independent predictors of postoperative morbidity in pediatric liver hydatid disease in order to improve preoperative risk assessment.

Methods: This retrospective observational study included consecutive pediatric patients who underwent surgical treatment for liver hydatid disease at Hedi Chaker University Hospital, Sfax, Tunisia, between 1 July 2010 and 30 June 2025. Postoperative morbidity was defined as any complication occurring within 30 days after surgery.

Results: A total of 117 children were included. The median age was 8 years, with a nearly equal sex distribution (59 males and 58 females). The median Sun Pediatric Comorbidity Index (SPCI) was 1 [IQR, 0-2]. The mean cyst size was 8 ± 2.4 cm, with right lobe involvement observed in 83 patients (70.9%). Concomitant extrahepatic hydatid disease was identified in 23 children (19.7%). Postoperative complications occurred in 25 patients (21.4%). In multivariate analysis, three factors were independently associated with postoperative morbidity: SPCI ≥ 3 (OR 5.748, 95% CI 1.696-19.482; p = 0.005), cyst size > 8 cm (OR 5.020, 95% CI 1.172-21.513; p = 0.030), and concomitant extrahepatic hydatid disease (OR 6.355, 95% CI 1.710-23.620; p = 0.006).

Conclusion: Postoperative morbidity after pediatric liver hydatid surgery remains frequent. Beyond cyst size, pediatric comorbidity burden and multisite hydatid disease emerge as novel and independent predictors of adverse postoperative outcomes.

This clinical practice guideline from the Explosive Weapons Trauma Care Collective (EXTRACCT) group provides a review of current best practice for management of burn wounds in low-resource conflict settings. The vast majority of burn wounds occur in low-and middle-income countries and yet international consensus guidelines are largely based on highly resource-intensive practices utilized in high-income countries. The guideline provides recommendations for initial evaluation, including airway management and estimation of burn size, resuscitation strategies, wound care, and approaches to definitive surgical management.

Background: Anastomotic leakage (AL) remains a severe complication after low anterior resection (LAR) for rectal cancer, despite advances in minimally invasive (MI) techniques. This study aimed to evaluate the impact of a surgery-focused care bundle, implemented on an enhanced recovery after surgery (ERAS)-based perioperative protocol, on preventing AL and improving postoperative outcomes in patients with MI-LAR.

Methods: In this retrospective historically controlled cohort study, a total of 306 patients who underwent MI-LAR between 2011 and 2024 were included. A late-phase cohort (n = 81) receiving the care bundle with an ERAS-based protocol (from September 2019) was compared with a historical early-phase cohort (n = 225). The surgery-focused care bundle included robot surgery, preoperative oral antibiotics, indocyanine green blood flow evaluation, diverting stoma, transanal drainage tubes, and anastomotic reinforcement. Our institutional ERAS protocol was developed in accordance with the ERAS Society guidelines. Propensity score matching (PSM) was used to adjust for baseline differences between cohorts.

Results: The AL rate significantly decreased from 14.7% (33/225) to 2.5% (2/81) after bundle implementation (p < 0.01). Post-PSM, AL rates remained significantly lower in the late-phase cohort (18.0% vs. 1.3% and p < 0.001). Severe complications (Clavien-Dindo grade ≥ 3) and surgical site infections (SSIs) were also significantly reduced, and no reoperations were required in the late-phase cohort. Multivariate analysis identified lack of care bundle (odds ratio [OR]: 6.36, 95% confidence interval [CI]: 1.42-28.4, and p = 0.01) and male sex (OR: 3.05, 95% CI: 1.24-7.52, and p = 0.01) as significant risk factors for AL.

Conclusions: Implementation of a surgery-focused care bundle, integrated within an ERAS-based perioperative framework, significantly reduced AL, severe complications, and SSIs after MI-LAR, suggesting potential long-term benefits by improving short-term postoperative outcomes.