World Journal of Surgery最新文献

Background: Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recurrence and chronic pain and to optimize population health impact. This study aims to assess the burden and trends of hernia in Arabian Gulf Region from 1990 to 2023.

Methods: A comparative, multi-country analysis was conducted for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates using Global Burden of Disease (GBD) 2023 estimates. Outcomes included age-standardized incidence (ASIR), prevalence (ASPR), years lived with disability (YLDs), and disability-adjusted life years (DALYs), reported per 100,000 by year (1990-2023), sex, and age. Temporal trends were evaluated with Joinpoint regression to derive average annual percent change (AAPC). Forecasts to 2033 applied linear regression, Exponential Smoothing (ETS), ARIMA, and Neural Network Autoregression (NNAR) models; the best model for each indicator-country-sex combination was selected using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE), with 95% prediction intervals. Analyses were performed in R (forecast package) and the NCI Joinpoint program.

Results: In 2023, the Gulf Cooperation Council (GCC) recorded approximately 1.1 million prevalent hernia cases. While absolute counts rose 12.4% since 1990, attributable to population aging, age-standardized metrics declined across countries and sexes. YLDs comprised 75%-80% of DALYs, confirming a predominantly non-fatal burden. Male prevalence exceeded female prevalence in all states; Qatar and Bahrain formed a higher-burden cluster, whereas the United Arab Emirates and Saudi Arabia exhibited lower rates. Age-specific analyses showed marked improvements at 60-79 years but persistent or paradoxical increases in ≥ 85 years. Forecasts indicated continued declines in ASIR/ASPR to 2033, with vigilance warranted for very-elderly cohorts.

Conclusion: The GCC experienced sustained reductions in age-standardized hernia burden since 1990 despite rising absolute numbers from demographic change. Findings support guideline-concordant expansion of elective repair, registry-based quality measurement, and targeted capacity for the oldest adults to further compress disability.

Background: HER2-low breast cancer (BC) has recently emerged as a therapeutically targetable entity, yet its biological and clinical relevance remains debatable. Limited data are available about HER2-low from non-Western populations, particularly the Middle East, where distinct tumor biology may influence phenotype and treatment response.

Methods: We retrospectively analyzed 1097 Saudi breast cancer patients for HER2 status by immunohistochemistry (IHC), classifying tumors as HER2-zero (IHC 0) or HER2-low (IHC 1+/2+ and FISH-negative). Clinicopathological characteristics, biomarker profiles (ER, PR, Ki-67), molecular alterations (PIK3CA, TP53, BRCA) and survival outcomes (overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and distant disease-free survival (DDFS)) were compared.

Results: HER2-low tumors comprised 34.5% (n = 378) of the cohort and were significantly associated with ER (p < 0.0001) and PR (p = 0.0226) positivity, lower triple-negative phenotype (p < 0.0001), and reduced Ki-67 proliferation index (p = 0.0136) compared to HER2-zero tumors. Trends toward higher PIK3CA mutation (p = 0.0875) and lower BRCA mutation (p = 0.0892) rates were observed in HER2-low tumors, though not statistically significant. Despite these favorable biological features, survival analyses revealed no significant differences between HER2-low and HER2-zero subtypes with regards to OS, CSS, DFS, and DDFS.

Conclusion: In this large, ethnically homogenous Saudi cohort, HER2-low breast cancer represents a distinct molecular and clinicopathological subtype with luminal like features, yet no prognostic advantage. These findings reinforce the therapeutic, rather than prognostic, significance of HER2-low status, highlighting its relevance in targeted antibody-drug conjugate-based therapies rather than influencing baseline risk stratification.

Background: Postoperative urinary retention (POUR) is a common complication, but its incidence and risk factors after thyroidectomy are not well-defined. We investigated the incidence of POUR after thyroidectomy and its risk factors.

Methods: We conducted a retrospective review of 511 consecutive patients who underwent thyroidectomy by a single surgeon. POUR was defined as the inability to void within 6 h of the last preoperative void performed immediately prior to transfer to the operating room, with bladder volume > 500 mL requiring catheterization. Univariable and multivariable logistic regressions were performed separately for male and female.

Results: Among 511 patients (368 females, 143 males; mean age 49.6 years), 412 (80.6%) underwent lobectomy, 71 (13.9%) total thyroidectomy without lateral neck dissection, and 28 (5.5%) total thyroidectomy with lateral neck dissection. Surgical access was open in 333 (65.2%), transoral robotic in 158 (30.9%), and transoral endoscopic in 20 (3.9%). Overall, 68 patients (13.3%) developed POUR. In males, independent predictors were benign prostatic hyperplasia (BPH) (adjusted odds ratio [aOR] 7.890; 95% confidence interval [CI], 1.814-34.318; p = 0.006) and body mass index (BMI) < 25 kg/m² (aOR 0.245; 95% CI, 0.066-0.909; p = 0.036; reference ≥ 25 kg/m²). In females, age ≥ 50 years (aOR 2.417; 95% CI, 1.273-4.588; p = 0.007), BMI < 25 kg/m² (aOR 0.465; 95% CI, 0.228-0.947; p = 0.035; reference ≥ 25 kg/m²), and operative time ≥ 60 min (aOR 1.939; 95% CI, 1.014-3.709; p = 0.045). Surgical approach, extent of surgery, pathology, and postoperative opioid use were not independently associated with POUR in either sex.

Conclusions: POUR occurred in 13.3% of thyroidectomy patients. Sex-stratified analysis showed BPH and lower BMI as key risks in males, whereas older age, lower BMI, and longer operative time were significant in females. Recognizing these factors may support targeted perioperative screening and postoperative monitoring to reduce retention-related delays and complications.

Background: Colorectal and small bowel surgery in transplant (TX) recipients presents unique perioperative challenges due to immunosuppression and comorbidities, with poorly defined risks.

Methods: A retrospective analysis was conducted on 237 TX recipients who underwent colorectal or small bowel surgery at a specialized center between 2008 and 2024. Patient characteristics (transplant type, time since TX, immunosuppression, Charlson Comorbidity Index) and surgical details were analyzed in relation to postoperative outcomes (ICU stay, in-hospital mortality, length of stay, major morbidity [Dindo-Clavien ≥ 3]).

Results: Most patients had prior kidney (45.6%) or liver TX (28.3%). The incidence of all adverse endpoints was significantly higher in emergencies as compared to elective surgery (mortality 25.6% vs. 6.2%, morbidity 52.3% vs. 35.4%, LOS 24.9d vs. 15.7d, ICU stay 10.7d vs. 2.9d; all p ≤ 0.001). 14.8% had surgical site infections, 9.7% cardiopulmonary complications. Primary anastomosis was not correlated with worse outcome. Multivariate regression showed emergency surgery (OR 8.48 (2.68-26.8) p = 0.001), colorectal surgery (OR 3.26 (1.54-6.90) p = 0.002) and heart TX (OR 4.35 (1.10-17.23) p = 0.036) as independent risk factors, patients receiving prednisolone had reduced risk (OR 0.28 (0.13-0.60) p = 0.001). Heart TX and emergency surgery correlated with longer ICU stay, hematopoetic stem cell transplantation with longer LOS.

Conclusions: TX recipients undergoing colorectal or small bowel surgery face considerable perioperative risks, especially in emergency situations and after heart transplantation. The feasibility of primary anastomosis in selected patients suggests that surgical strategies should be tailored, emphasizing the need for specialized, multidisciplinary care to optimize outcomes in this vulnerable population.

Background: Understanding health related information is crucial for informed consent and active participation in surgical care. Language barriers between patients and health care professionals pose the risk of misunderstandings and incomplete information exchange. This can significantly impair the quality of health care. Little is known about the impact of language barriers in hepatobiliary and pancreatic surgery and its consequences for postoperative recovery.

Method: We performed a retrospective study in a University Medical Center in Germany assessing patients from 2020 to 2023 who underwent hepatobiliary or pancreatic surgery. Primarily we investigated whether length of stay (LOS) differed between patients with and without language barrier. Secondary we examined (Enhanced Recovery After Surgery) ERAS-compliance, preoperative education, postoperative mobilization habits, readmission, mortality, occurrence of complications, and certain postoperative complications between both groups.

Results: We included 848 patients in our study, 57 (6.5%) patients of whom had a language barrier. The length of stay did not differ significantly between the two groups (12.8 days; (CI 95%: 11.9-13.7) versus 14.4 days; (CI 95%: 11.1-17.7) (p = 0.320). The interpreting service in our cohort was rarely used overall. Patients with language barriers were younger (CI 95%: 46.7-56.7 vs. 59.9-61.9; p = 0.001) and differed in terms of their diagnoses (p = 0.001). We found no differences in ERAS Compliance, complication rate and mortality. Among secondary outcomes, patients with language barriers showed higher rates of specific postoperative complications, including pulmonary embolism (p = 0.026), and paralytic ileus (p = 0.047). Patients without language barriers were more likely to be mobilized on day of surgery (p = 0.009) and received preoperative ERAS-education more frequently (p = 0.035).

Conclusion: Patients experiencing language barriers constitute a small group. Length of stay did not differ between the two groups. However, with respect to postoperative complications further investigation with larger patient cohorts is needed. Our findings emphasize the need for additional research and development of practical and patient-centered strategies to effectively address language barriers in clinical care.

Background: Healthcare across Europe was affected by COVID-19 pandemic lockdowns. How different national healthcare systems coped with this impact remains unclear. Healthcare in Switzerland differs significantly from that in Scotland, for example, in terms of centralization. The aim of this study was to assess the impact of the COVID-19 pandemic on the diagnosis and surgical treatment of colorectal cancer (CRC) in contrasting healthcare systems.

Patients and methods: This retrospective cohort study was conducted in south-east Scotland and in the extended north-west of Switzerland from January 1st, 2019 to February 28th, 2023. All patients diagnosed with CRC were included. The primary outcomes were the time from CRC diagnosis to treatment and the UICC stage at diagnosis, assessed prior to, during, and following the period of lockdown. The lockdown in Scotland lasted from March 2020 to October 2020 and in Switzerland from March 2020 to April 2020.

Results: A total of 6745 patients were included (4127 from Scotland and 2618 from Switzerland). Median time from diagnosis to treatment remained unaltered during the lockdown period in both countries. However, after the lockdown, the median time from diagnosis to treatment increased from 59 to 76 days in Scotland. The median number of patients who were diagnosed per annual quarter declined from 177 (IQR: 171-190) to 152 (IQR: 150-154), and the median number of who received treatment from declined from 256 (IQR: 253-259) to 203 (IQR: 186-218) during lockdown in Scotland. In multivariable logistic regression, the odds of being diagnosed with UICC stage IV increased by 42% for patients diagnosed during lockdown (95%-CI: 12%-81%). In Switzerland, the time from diagnosis to treatment increased slightly after the pandemic. However, the other effects described above were not observed in Switzerland.

Conclusions: This descriptive study demonstrated that the impact of the pandemic on colorectal cancer care was less pronounced in Switzerland, but considerable in Scotland. Because separate subgroup analyses were conducted, direct comparisons cannot be made between Scotland and Switzerland.

Trial registration: This trial is registered on clinicaltrials.gov as part of the EvaCol study (NCT04550156).

Background: Patients in low- and middle-income countries (LMICs) lack access to safe and affordable surgical and anesthetic care. Standardized evidence-based perioperative care recommendations and instruments to assess guideline compliance and results are needed. Enhanced recovery after surgery (ERAS) protocols are already in use and have evidence supporting its efficacy. Although ERAS programs have been beneficial in various fields of surgery, they are not widely used in developing countries compared to developed countries. Difference in dietary patterns, living standards, healthcare innovations, and sociodemographic indexes may preclude the direct adoption of existing protocols. The aim of this study is to adapt the ERAS protocol for gastrointestinal (GI) and hepatopancreaticobiliary (HPB) elective surgeries in a way that is feasible, sustainable, and effective for Ethiopian tertiary hospitals.

Methods: A modified Delphi process was used to devise an ERAS protocol for perioperative care of patients who undergo elective gastrointestinal and hepatopancreaticobiliary surgery from preexisting guidelines to fit the Ethiopian context. Thirty-two panelists were invited from target disciplines to participate in the Delphi after being sampled using purposive and snowballing sampling techniques. Two rounds were conducted until a consensus of 80% was reached on different components of the protocol. Data are presented in aggregate after deidentification.

Results: Thirty-two experts completed round one and 24/32 completed round two after which mature consensus was achieved. There are eight preoperative recommendations, seven intraoperative recommendations, and six postoperative recommendations that have been adapted from existing guidelines and six novel components. These guidelines were deemed appropriate for 7 types of surgical procedures.

Conclusions: This adapted protocol consisting of 27 recommendations represents a critical step toward implementing standardized resource-appropriate ERAS pathways for GI and HPB surgeries in Ethiopia.