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Laparoscopic Rectal Cancer Resection With Pelvic Autonomic Nerve Preservation in Males: A Prospective Single-Center Study. 男性腹腔镜直肠癌切除保留盆腔自主神经:一项前瞻性单中心研究。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-30 DOI: 10.1002/wjs.70224
Yequan Xie, Guangyu Zhong, Bin Yang, Fanghai Han, Shengning Zhou, Jianan Tan

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.

背景:PANP已应用于腹腔镜直肠癌根治术,显著降低了泌尿生殖功能障碍的发生率;然而,它并没有消除性功能和泌尿功能障碍。将泌尿生殖系统功能作为主要预后的前瞻性试验很少。目的确认腹腔镜直肠癌根治术保留盆腔自主神经(PANP)对性功能和泌尿功能的保护作用,探讨术后性功能障碍的危险因素。方法:对中山大学中山纪念医院适合腹腔镜手术的男性直肠腺癌患者进行前瞻性、单中心、单臂试验。纳入泌尿生殖功能正常的患者,以术后6个月的性功能改变为主要观察指标。结果:入选的91例患者中,70例接受了腹腔镜手术。术后6个月,5例患者失访,IIEF-5评分与术前比较分别为22.85±3.66比24.10±1.21 (p = 0.003)和2.11±2.06比1.89±1.86 (p = 0.018)。5例(7.69%)存在性功能障碍,2例(3.08%)存在中度尿功能障碍。术中大部分自主神经系统可见且保存完好。94.29%(66/70)患者TME质量完全,5.71%(4/70)患者TME质量部分完整。本研究中CRM阳性为2.86%(2/70),远端切缘阳性为1.43%(1/70)。术后平均住院时间为7.80±2.44天。单因素分析显示,手术方式、肿瘤到AV的距离、临床TNM分期、nCRT、造口、自主神经系统的完整性是术后性功能障碍的危险因素;然而,在多变量分析中,它们都不是独立的危险因素。结论:PANP在腹腔镜直肠根治术中有效地保留了性功能和泌尿功能,且不影响肿瘤预后。它在高流量中心和经验丰富的外科医生中是安全可行的。
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引用次数: 0
Post-Discharge Opioid Prescribing After Elective Colorectal Resection: An International Survey. 选择性结直肠切除术后阿片类药物处方:一项国际调查。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-29 DOI: 10.1002/wjs.70245
Ghadeer Olleik, Hiba Elhaj, Samin Shirzadi, Francesca Fermi, Maxime Lapointe-Gagner, Sender Liberman, Mohsen Alhashemi, Tahereh Najafi Ghezeljeh, Fatemeh Rajabiyazdi, Nawar Touma, Pepa Kaneva, Agnihotram V Ramanakumar, Badma Bashankaev, Alexandra Sidorova, Stephen J Chapman, Chuan-Gang Fu, Lucia Oliveira, Sofia Valanci, Audrius Dulskas, Steven Wexner, Lawrence Lee, Liane S Feldman, Marylise Boutros, Julio F Fiore

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.

背景:结直肠手术后过量的阿片类药物处方可导致不良事件并导致阿片类药物危机。了解国际处方模式对指导实践和未来研究至关重要。结直肠手术后镇痛(ACORE)调查旨在描述国际上择期结直肠切除术后阿片类药物处方的特点。方法:这项国际横断面调查遵循既定的方法学指南。符合条件的参与者是结直肠、胃肠和普通外科医生,以及外科实习生。招募是通过国际外科学会的邮件列表、社交媒体和个人网络进行滚雪球抽样的。主要研究结果是开放和MIS择期结肠直肠癌切除术后的出院后阿片类药物处方。次要结局包括吗啡毫克当量(MMEs)处方量。数据分析采用描述性统计和逻辑回归与贝叶斯模型平均。结果:817名参与者中,88%为外科医生,12%为实习生,62%在专科医院实习,67%在医院实习5年以上。总体而言,57%的参与者报告在出院时开阿片类药物处方(开放手术后55%,微创手术后54%)。阿片类药物通常由澳大利亚和新西兰(100%)、北美(92%)、北欧(68%)和东南亚(71%)执业的外科医生开出。相比之下,东欧(11%)、东亚(22%)、拉丁美洲和加勒比(26%)、南欧(19%)和北非(0%)的处方频率较低。出院时阿片类药物处方的中位数差异很大(30-200毫微当量)。在考虑外科医生和执业特征的回归分析中,执业地区是唯一与阿片类药物处方独立相关的因素。结论:阿片类药物处方的广泛全球差异强调了临床平衡,并挑战了出院后阿片类药物对结肠直肠癌患者普遍必要的假设。
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引用次数: 0
Roadmap to Creating a Global Health Equity Training Program Within US Anesthesiology Residency Programs. 在美国麻醉学住院医师计划中创建全球健康公平培训计划的路线图。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-27 DOI: 10.1002/wjs.70212
Betelehem M Asnake, Maziar M Nourian, Ana M Crawford, Bantayehu Sileshi, Sheida Tabaie
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引用次数: 0
A New N2 Descriptor for Resectable Non-Small Cell Lung Cancer: The Classification Based on Skip Metastasis and the Number of N2 Station Involvement. 可切除非小细胞肺癌新的N2描述符:基于跳跃转移和N2站累及数量的分类。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-24 DOI: 10.1002/wjs.70241
Xiaolong Huang, Fengkai Xu, Tao Cheng, Huiqin Yang, Chunlai Lu, Teng Ma, Lin Wang, Di Ge

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.

背景:非小细胞肺癌(NSCLC)患者是一个异质性群体,具有不同的疾病模式。跳跃性纵隔淋巴结转移是N2型肺癌患者预后的重要因素。本研究的目的是评估基于跳过N2疾病和第九版N2分类的新N2描述符的临床意义和预后价值。方法:对533例pN2期NSCLC患者进行回顾性分析。最终将患者分为跳过N2a、跳过N2b/非跳过N2a和非跳过N2b三类。分析各组患者的临床特点、生存结局及转移模式。结果:细分N2描述符(skip N2a vs. skip N2b/nonskip N2a和p)患者的预后存在显著差异。结论:与第九种N2分类相比,新的N2描述符可能是一个更可靠和准确的预后决定因素,值得在现行肿瘤、淋巴结和转移(TNM)分期系统的修订中考虑。
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引用次数: 0
Predictors of Postoperative Morbidity in Pediatric Liver Hydatid Disease: Role of Comorbidities and Multisite Infection. 儿童肝包虫病术后发病率的预测因素:合并症和多部位感染的作用
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70246
Mohamed Zouari, Oumaima Jarboui, Manel Belhajmansour, Manar Hbaieb, Asma Issaoui, Mahdi Ben Dhaou, Riadh Mhiri

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.

背景:小儿肝包虫病手术治疗后的术后发病率仍然是一个值得关注的问题,特别是在流行地区。本研究的目的是确定儿童肝包虫病术后发病率的独立预测因素,以改善术前风险评估。方法:这项回顾性观察性研究纳入了2010年7月1日至2025年6月30日期间在突尼斯Sfax Hedi Chaker大学医院接受肝包虫病手术治疗的连续儿科患者。术后发病率定义为术后30天内发生的任何并发症。结果:共纳入117例患儿。中位年龄为8岁,性别分布几乎相等(男性59岁,女性58岁)。小儿合并症指数(SPCI)中位数为1 [IQR, 0-2]。平均囊肿大小为8±2.4 cm,累及右肺叶83例(70.9%)。合并肝外包虫病23例(19.7%)。术后并发症25例(21.4%)。在多因素分析中,三个因素与术后发病率独立相关:SPCI≥3 (OR 5.748, 95% CI 1.696-19.482, p = 0.005)、囊肿大小bbb8 cm (OR 5.020, 95% CI 1.172-21.513, p = 0.030)、合并肝外包虫病(OR 6.355, 95% CI 1.710-23.620, p = 0.006)。结论:小儿肝包虫病术后发病率居高不下。除囊肿大小外,儿童合并症负担和多部位包虫病成为不良术后结果的新的独立预测因素。
{"title":"Predictors of Postoperative Morbidity in Pediatric Liver Hydatid Disease: Role of Comorbidities and Multisite Infection.","authors":"Mohamed Zouari, Oumaima Jarboui, Manel Belhajmansour, Manar Hbaieb, Asma Issaoui, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1002/wjs.70246","DOIUrl":"https://doi.org/10.1002/wjs.70246","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Burn Management in Low-Resource Settings. 爆炸性武器创伤护理集体(EXTRACCT)爆炸伤害临床实践指南:低资源环境下的烧伤管理。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70190
Aron Egelko, Barclay Stewart, Eleanor Curtis, Kwesi Nsaful, Lisa Rae, Manish Yadav

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.

本临床实践指南来自爆炸性武器创伤护理集体(EXTRACCT)小组,概述了目前在资源匮乏的冲突环境中烧伤创面管理的最佳实践。绝大多数烧伤创面发生在低收入和中等收入国家,但国际共识指南主要基于高收入国家采用的高度资源密集型做法。该指南提供了初步评估的建议,包括气道管理和烧伤大小的估计、复苏策略、伤口护理和最终手术处理的方法。
{"title":"Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Burn Management in Low-Resource Settings.","authors":"Aron Egelko, Barclay Stewart, Eleanor Curtis, Kwesi Nsaful, Lisa Rae, Manish Yadav","doi":"10.1002/wjs.70190","DOIUrl":"https://doi.org/10.1002/wjs.70190","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of an ERAS-Based Surgical Care Bundle Implementation for Preventing Anastomotic Leakage in Minimally Invasive Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study. 基于erass的手术护理包实施对预防直肠癌微创前低位切除术吻合口漏的影响:一项回顾性队列研究。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70242
Koji Tamura, Takaaki Fujimoto, Jinghui Zhang, Kinuko Nagayoshi, Yusuke Mizuuchi, Kohei Horioka, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura

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.

背景:尽管微创(MI)技术有所进步,吻合口漏(AL)仍然是直肠癌低位前切除术(LAR)后的一个严重并发症。本研究旨在评估以手术为中心的护理包的影响,实施基于手术后恢复(ERAS)的围手术期方案,预防AL和改善MI-LAR患者的术后预后。方法:在这项回顾性历史对照队列研究中,共纳入2011年至2024年间接受MI-LAR治疗的306例患者。将接受基于erass方案的护理包的晚期队列(n = 81)(从2019年9月开始)与历史早期队列(n = 225)进行比较。以手术为重点的护理包包括机器人手术、术前口服抗生素、吲哚菁绿血流评估、转移造口、经肛门引流管和吻合口加固。我们的机构ERAS协议是根据ERAS协会的指导方针制定的。使用倾向评分匹配(PSM)来调整队列之间的基线差异。结果:实施捆绑包后,AL率从14.7%(33/225)显著下降至2.5%(2/81)。(p)结论:实施以手术为重点的护理捆绑包,结合基于erass的围手术期框架,显著减少了MI-LAR后的AL、严重并发症和ssi,表明通过改善短期术后结果可能带来长期益处。
{"title":"Impact of an ERAS-Based Surgical Care Bundle Implementation for Preventing Anastomotic Leakage in Minimally Invasive Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study.","authors":"Koji Tamura, Takaaki Fujimoto, Jinghui Zhang, Kinuko Nagayoshi, Yusuke Mizuuchi, Kohei Horioka, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura","doi":"10.1002/wjs.70242","DOIUrl":"https://doi.org/10.1002/wjs.70242","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to the Letter to the Editor. 对给编辑的信的回应。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70238
Yuman Fong, Dennis Fowler, Jordana Bernard
{"title":"Response to the Letter to the Editor.","authors":"Yuman Fong, Dennis Fowler, Jordana Bernard","doi":"10.1002/wjs.70238","DOIUrl":"https://doi.org/10.1002/wjs.70238","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Invisible Barriers to Sustainable Surgical Practice. 可持续外科实践的无形障碍。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70244
Mina Sarofim
{"title":"The Invisible Barriers to Sustainable Surgical Practice.","authors":"Mina Sarofim","doi":"10.1002/wjs.70244","DOIUrl":"https://doi.org/10.1002/wjs.70244","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Everything Must Go Right: Textbook Outcome as an Aspirational Measure of Surgical Quality. 当一切都必须顺利:教科书结果作为外科手术质量的理想衡量标准。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-21 DOI: 10.1002/wjs.70240
Dhananjaya Sharma
{"title":"When Everything Must Go Right: Textbook Outcome as an Aspirational Measure of Surgical Quality.","authors":"Dhananjaya Sharma","doi":"10.1002/wjs.70240","DOIUrl":"https://doi.org/10.1002/wjs.70240","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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World Journal of Surgery
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