World Journal of Surgery最新文献

Background: Traditionally, large tumor size is associated with poor survival in colon cancer, but its impact remains limited and controversial. Recently, the impact of small tumor size on prognosis has gained attention. This study aimed to investigate whether small tumor size can be an additional parameter for T3N1 colon cancer prognosis.

Methods: We retrospectively analyzed 162 consecutive patients with pT3N1 colon cancer between 2010 and 2021. The optimal cutoff value of tumor size was calculated through receiver operating characteristic curve analysis. We evaluated survival through the Kaplan-Meier method, and the risk of prognosis through multivariate Cox models.

Results: The optimal cutoff value of tumor size was 45 mm. The recurrence rate was significantly higher in tumor size < 45 mm than in ≥ 45 mm (25.7% vs. 12.0%, p = 0.037). Tumor size < 45 mm also had lower overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) than its counterpart (p = 0.03 for all). In multivariate analyses, age ≥ 70 years, undifferentiated histological type, and tumor size < 45 mm were independent prognostic factors for OS (p = 0.025, p = 0.001, p < 0.04, respectively), whereas tumor size < 45 mm was the only independent prognostic factor for RFS (p = 0.043). Meanwhile, the independent prognostic factors for CSS were undifferentiated histological type and tumor size < 45 mm (p = 0.008 for both).

Conclusions: Small tumor size is associated with poor prognosis in pT3N1 colon cancer cases. Thus, small tumors potentially have biologically aggressive features.

Introduction: Transarterial chemoembolization (TACE) has an established role in advanced HCC. The present study evaluates the role of TACE as a neoadjuvant modality in the management of intermediate HCC [Hong Kong Liver Cancer (HKLC) stage IIB].

Materials and methods: A retrospective analysis of HCC patients treated between January 2010 and August 2022 was performed. Patients belonging to intermediate-stage HCC (HKLC IIB) were divided into two groups, upfront surgery (UPS) and post-TACE (pTACE). Propensity score matching was done, and the primary endpoint of the study was overall survival (OS).

Results: A total of 247 patients of HKLC IIB were identified during this period. Of these, 77 patients in each group were considered for analysis after propensity matching. The median follow-up was 36.4 months (0.46-144.26). In the propensity matched population (n = 154), on an intention-to-treat analysis, the median OS of the UPS group and the pTACE group was 30.06 and 39.26 months, respectively (p value = 0.77). In patients who underwent curative resection, the median OS of the UPS group was 30.68 versus 90.97 months in the pTACE group (p value = 0.006) and median DFS was 13.56 months for the UPS group versus 44.02 months in the pTACE group, respectively (p value = 0.013).

Conclusion: In intermediate-stage hepatocellular carcinoma (HKLC IIB), pTACE can be used to better select patients with borderline resectability. Survival was significantly improved in patients who received pTACE and were able to undergo surgical resection.

Introduction: While there are no widely accepted diversity, equity, and inclusion (DEI) metrics for journals, geographic and sex diversity across a journal's editorial board may provide a surrogate measure of its commitment to DEI. We explored the association between journal quality and DEI metrics for cardiothoracic surgery (CTS) journals and investigated whether editorial diversity correlates with diversity across published articles.

Methods: We collected the following data for 30 CTS journals: country of publication (categorized by income level), journal quality metrics (citation-based metrics, e.g., impact factor (IF) or H-index), and sex and geographic representation across editorial boards and published articles. Bivariate correlations between numeric variables were assessed using Spearman's correlation.

Results: Female representation across editorial boards was 12.1%. Most editorial board members belonged to the United States (35.2%), with only 7.4% from the lower-middle-income countries and 0% from low-income countries. IF showed a strong positive correlation with female editorial representation (r = 0.70) but an inverse correlation with low- and middle-income countries (LMICs) editorial representation (r = -0.45). Female editorial representation demonstrated a significant positive correlation with female first authorship (r = 0.45), whereas LMIC editorial representation correlated strongly with LMIC corresponding authorship (r = 0.85).

Conclusion: Women and researchers from LMICs are in the minority across editorial boards of CTS journals. However, a strong correlation between journal H-index and female editorial representation indicates that top-ranked journals are spearheading efforts to improve equitable sex-based and gender representations. Similar efforts are required to ensure more global geographic representation across editorial boards and top-ranked CTS journals are the best placed to lead by example.

Background: The postoperative impact of short-term changes in skeletal muscle loss (SML) and adipose tissue loss (ATL) on treatment outcomes is unclear in patients with gastric cancer (GC). We investigate the role of SML and ATL at 1 month after surgery in determining postoperative survival and recurrence rates in patients with GC.

Methods: We analyzed 540 patients with GC and assessed their skeletal muscle mass, visceral fat mass, and subcutaneous fat mass using computed tomography scans preoperatively and 1 month postoperatively. Patients were categorized into high and low groups based on their levels of SML, visceral ATL (v-ATL), and subcutaneous ATL (s-ATL). Additionally, they were classified into three groups (high ATL, intermediate ATL, and low ATL) based on their v-ATL and s-ATL measurements.

Results: Patients with higher v-ATL and s-ATL had lower overall survival (OS) and recurrence-free survival (RFS) rates. High ATL was an independent prognostic factor for decreased OS (hazard ratio [HR] 2.27; 95% confidence interval [CI] 1.16-4.42; and P = 0.02) and RFS (HR 2.51; 95% CI 1.34-4.71; and P = 0.004) rates.

Conclusion: A reduction in adipose tissue volume shortly after surgery (1 month) could potentially indicate an increased risk of recurrence and mortality in patients with GC.

Background: Postoperative survival of esophageal cancer patients has improved with advances in technology and treatment modalities. However, squamous cell carcinoma (SCC) often affects the esophagus together with the head and neck regions, with second primary head and neck cancer (SPHNC) adversely influencing the patients' quality of life. Therefore, patients with esophageal squamous cell carcinoma (ESCC) should be carefully followed up postoperatively. This study evaluated the risk of developing SPHNCs after an esophagectomy for ESCC.

Methods: Patients with ESCC who underwent curative esophagectomy from January 2008 to December 2017 from two tertiary medical centers, Taipei Veteran General Hospital and Kaohsiung Veteran General Hospital, were retrospectively reviewed. SPHNC development was documented according to the anatomic region and the cumulative incidence rate and risk factors were analyzed.

Results: The median follow-up period of the 435 patients included in our study was 48.5 months [interquartile range (IQR) 16.7-92.4 months]. Among the ESCC patients after curative esophagectomy, younger age <50 [hazard ratio 4.13, 95% CI: 2.53-6.75, p < 0.001) was the only independent factor for developing SPHNCs in the multivariable analysis. The cumulative incidence rate of SPHNCs of patients aged <50 years old was 14.3%, 22.1%, and 34.2% after 3, 5, and 10 years, respectively.

Conclusions: There was a high risk of secondary cancer after ESCC in the upper aerodigestive tract, especially the head and neck regions; therefore, active surveillance is strongly recommended, especially in younger patients.

Background: Vacuum-assisted abdominal closure (VAC) is being increasingly used as an adjunctive procedure in the surgical treatment of secondary peritonitis. This study compared postoperative mortality and complication rates between VAC and primary abdominal closure (PAC).

Method: This retrospective chart review included all patients diagnosed with secondary peritonitis who underwent laparotomy between 2010 and 2019. Data were collected from six hospitals within Southern Denmark, covering a population of approximately 1,225,000 inhabitants.

Results: The study involved 315 patients (139 in the PAC and 176 in the VAC groups). In the VAC group, BMI, ASA, SOFA, MPI, and four quadrant contamination was significantly higher at the index operation. There were no significant differences in nonadjusted and adjusted postoperative mortality at 30 days, 90 days, and 1 year, with cumulative values of 13%, 16%, and 21%, respectively, compared with 16%, 21%, and 31%, in the PAC group (p = 0.519, p = 0.380, and p = 0.051, respectively). Cumulative adjusted surgical postoperative complications at 30 days, 90 days, and 1 year, as assessed by the comprehensive complication index, was significantly higher in the PAC group. Reoperations were significantly more common in the PAC group. The total length of the intensive care unit admission was significantly longer in the VAC group, with a mean of 9.0 ± 12.1 versus 6.7 ± 12.1 days (p < 0.001).

Conclusion: VAC after laparotomy for secondary peritonitis did not significantly reduce mortality but increased ICU stay, whereas primary closure led to higher surgical complication rates and reoperations.

Background: The history of inguinal hernia repair has been marked by the description of several therapies over ages, each with its own approach to managing the hernial sac. An analysis of hernia sac transection (with or without high ligation) versus reduction (invagination) in adults who underwent Lichtenstein open tension-free inguinal hernia repair and in adult and pediatric patients who underwent suture repair has been the primary aim of this systematic review and meta-analysis.

Methods: The authors conducted a comprehensive review and meta-analysis. A comprehensive literature search yielded 15 publications, consisting of 12 randomized controlled trials (RCTs) including 1598 patients and 3 controlled clinical trials (CCTs) including 243 patients. In total, the included patients amounted to 1.841.

Results: Analysis of the data revealed a lower rate of recurrence in patients who had sac reduction (0.35% in randomized controlled trials and 0 in clinical trials) compared to patients who had sac excision and ligation (0.86% in randomized controlled trials and 0.93% in clinical trials). However, this difference was not statistically significant (RCTs: relative risk 2.94 [0.30, 29.24]-CCTs: relative risk 4.46 [0.18, 111.36]).

Conclusion: The reduction of sacs does not result in a statistically significant decrease in recurrence compared to patients who underwent sac excision and subsequent ligation. This study has demonstrated that the various courses of treatment for the inguinal hernia sac have similar primary and secondary outcomes in both adult and pediatric patients.

Background: The purpose of this investigation is to assess how effective it is to exclude individuals from the liver transplant (LT) using the body mass index (BMI) as a criterion.

Methods and materials: A retrospective longitudinal analysis of patients with liver transplant outcomes from January 2001 to May 2020 was conducted using the United Network for Organ Sharing (UNOS) database.

Results: A total of 118,486 LT cases included in the study. Based on their BMI, patients were split into three groups: a BMI < 35 kg/m², a 35 ≤ BMI < 40 kg/m², and a BMI ≥ 40 kg/m². The data analysis revealed a significant improvement in 10-year graft survival in the 2011-2020 group compared to the 2001-2010 group (mean 70% vs. 53% and P < 0.001). Interestingly, a BMI above 35 kg/m² did not have a significant effect on the graft survival, and in both time frames, there was no clinically significant difference between the recipients of the different BMI spectrum. The patient's survival was also characterized by the same pattern. Primary graft failure was the most significant cause of allograft transplant failure in all the BMI spectrum, except recipients with a BMI < 35 kg/m², in 2011-2020 group.

Conclusion: The outcomes of LT in patients requiring a LT are not significantly affected using the BMI, considering the advancements in surgical techniques and postoperation improvements, and excluding obese patients based on the BMI alone would be inappropriate.