World Journal of Surgery最新文献

Objective: This meta-analysis aims to evaluate the efficacy of adjuvant therapy (ADJ) in patients with resected invasive IPMNs, compared with follow-up (FUP).

Methods: A random effects meta-analysis was performed. Meta-regression analysis was used to clarify heterogeneity. The trial sequential analysis was used to test Type I and Type II errors, defining the required information size (RIS). The primary endpoint was OS, and the secondary endpoint was DFS.

Results: The accrued sample size (AIS) was 2422 patients for OS and 493 patients for DFS. OS and DFS in the ADJ arm were similar to the FUP arm (HR 1.21; 95% CI 0.81-1.79, p = 0.349 and HR 0.98; 95% CI 0.64-1.51, p = 0.936). The RIS were 2422 for OS and 254 for DFS, allowing the exclusion of Type II errors. For the primary endpoint, heterogeneity was high (I² = 98%). Meta-regression analysis showed that, although considering two groups equal for confounding covariates, OS in the ADJ and FUP arms remains similar. A subgroup analysis showed that node-positive patients have improved OS after adjuvant therapy administration (HR 1.86; 95% CI 1.39; 2.47, p < 0.001).

Conclusion: Adjuvant therapy should not be administered indiscriminately to all patients. Node-positive invasive IPMN seems to have an improved OS.

Trial registration: PROSPERO 2024 CRD42024561326.

Background: Access to guideline-concordant global-standard breast cancer care remains limited in many low- and middle-income countries (LMICs), where high-cost technologies for diagnostics, surgical diagnosis and treatment (such as radioisotope mapping, ICG fluorescence, and intraoperative margin assessment) are not widely available. The BRIDGE Course (Breast Surgery Resource Integration & Development for Global Excellence) was designed as a short, virtual educational program to educate and update surgeons with validated, low-cost techniques that ensure oncologic safety while addressing resource constraints.

Methods: A 7-h online course was designed and conducted in September 2025 with participation from international and national faculty. Content emphasized pragmatic adaptations of global guidelines, including triple assessment, surgical decision-making for mastectomy versus breast conservation, sentinel lymph node biopsy (SLNB) using methylene blue and fluorescein torch, and low-cost oncoplastic approaches. Pre- and post-course surveys assessed baseline practice, perceived barriers, satisfaction, confidence, and intent to implement. Descriptive statistics were analyzed.

Results: Seventy-five participants completed the pre-course survey and 66 completed the post-course survey. At baseline, mastectomy was the most common primary operation (30.7%), whereas only 20% predominantly performed breast-conserving surgery; SLNB was mainly performed using methylene blue (68.5%). Reported barriers included lack of resources, training gaps, and patient mindset. Post-course, ≥ 85% of participants reported improved confidence across all domains: triple assessment (83% strongly agreed), mastectomy versus BCS decision-making (74%), SLNB with low-cost tracers (66%), and complication management (60%). Implementation intent was high, with nearly all (96%) planning to adopt at least one new technique and all intending to share knowledge with colleagues or trainees.

Conclusion: The BRIDGE Course successfully enhanced knowledge and confidence in resource-adapted breast cancer surgery, with strong intent to implement and improve practices. Such short, focused virtual programs may serve as a scalable model for narrowing disparities in breast cancer care across LMICs.

Background: Recent retrospective and prospective studies have demonstrated the safety of delayed surgery for acute appendicitis. However, evidence regarding delayed surgery in elderly patients is limited, and it is unclear whether it is safe to delay appendectomy in this patient population.

Methods: The outcomes of patients aged 65 years and older who underwent appendectomy for suspected appendicitis at a single institution were reviewed and analyzed. The outcomes investigated were perforation rate and complication rate. Multivariable logistic regression analysis was performed to adjust for risk factors and calculate adjusted odds ratios (aOR) for in-hospital delay.

Results: A total of 525 patients aged 65 years and older underwent appendectomy for suspected appendicitis. The perforation rate was 44.4% (233 of 525) and the complication rate was 25.1%. The multivariable analysis showed no association between a waiting time of more than 12 h compared to less than 12 h and perforation rate (aOR 0.96; 95% CI 0.55-1.70; p = 0.90) or complication rate (aOR 0.93; 95% CI 0.49-1.76; p = 0.83). A risk factor for perforation in the multivariable analysis was an elevated CRP level ≥ 50 mg/L and risk factors for complications were suspected perforation on preoperative imaging (p = 0.004), anticoagulant use (p = 0.04), and CRP levels ≥ 150 mg/L (p < 0.001).

Conclusion: This large retrospective analysis showed that it is safe to delay surgery by 12 h in patients aged 65 years and older. Delayed surgery was not associated with a higher rate of perforation or complications after adjusting for risk factors. These results open the possibility of optimizing coagulation or possible comorbidities in elderly patients before surgery or postponing surgery when more critical cases require more urgent treatment. In patients with suspected perforation on imaging, the decision to delay surgery should me made with caution, taking into account the patient's overall presentation, comorbidities, and vital signs.

Background: Artificial intelligence (AI) has transformed many facets of general surgery. A quantitative bibliometric overview can map publication trends, research fronts, and collaborative patterns to guide future work. Our study provides a comprehensive analysis of the literature on AI in general surgery, identifying key trends and influential contributors.

Methods: We retrieved 536 "Article" and "Review" records from Scopus and Web of Science from January 2005 through June 2025. After a rigorous deduplication process, 536 unique publications remained. We analyzed annual scientific production, top journals, authors, keyword co-occurrence, and highly cited papers using descriptive and relational bibliometric analyses.

Results: Annual publications grew exponentially, accelerating significantly after 2019 and peaking at 160 publications in 2024. Annals of Surgery (n = 28), Surgical Endoscopy (n = 25), and Journal of Medical Internet Research (n = 20) were the most productive journals. Palenzuela DL (n = 7), Dayan D (n = 6), and Liu J (n = 6) were the most prolific authors. The most frequent keywords were "Artificial intelligence" (64), "General surgery" (43), and "Surgery" (31). Keyword co-occurrence analysis revealed five thematic clusters: AI language models, clinical outcomes/risk prediction, surgical education, socio-professional themes, and core surgical practice. The most cited articles focused on surgical phase recognition, medical education, and large-language models.

Conclusions: AI in general surgery has seen a period of exponential growth, moving from exploratory discourse to applied research. While research is concentrated among a few authors and journals, its thematic diversity suggests a nascent, fragmented field without a dominant intellectual core. Future work should prioritize prospective validation, data-sharing infrastructures, and ethical frameworks to ensure responsible clinical translation. We propose an ethical-educational-technological (EET) framework to guide the responsible integration of AI into surgical practice and training.

Objective: To evaluate the survival outcomes of breast cancer patients with metastatic bone disease and to assess whether these patients exhibit different prognoses compared to those with more extensive metastatic involvement.

Background: Systemic therapy including endocrine therapy, chemotherapy and targeted agents remains the cornerstone of treatment for patients with stage IV breast cancer, particularly those with bone metastases. Palliative radiotherapy also plays a key role in bone metastases, especially for symptom control and managing skeletal and complications. Although these modalities have significantly improved outcomes, the prognostic variation among patients with bone-only disease-ranging from solitary to widespread metastases-warrants further investigation. This study aims to evaluate survival outcomes among breast cancer patients with varying patterns of bone metastases.

Methods: This retrospective cohort study analyzed data from 4000 breast cancer patients treated between 2006 and 2024. Patients were evaluated for bone metastases, which were confirmed through imaging reviewed via the Picture Archiving and Communication System (PACS). Patients with confirmed bone metastases were categorized into solitary, oligometastatic (2-5 sites), or multiple metastases groups. Data on demographics, tumor characteristics, treatment regimens, surgery types, and survival outcomes were collected. Survival analyses were conducted using Kaplan-Meier curves and compared using log-rank tests.

Results: One hundred and eighty-seven patients with metastatic bone disease were identified. 21 patients had solitary bone metastases only with a mean survival of 14.6 years. Additionally, 30 patients had oligometastatic bone disease only with a mean survival of 7 years. Another 31 patients had multiple bone only metastases, with also a mean survival of 7 years. Finally, 105 of the 187 patients had other metastases alongside bone metastases in other organs including the lung, liver, and brain with a mean survival of 6.3 years.

Conclusion: These findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard these findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard, these findings highlight the need for further research into whether selected patients may benefit from integrating local treatment approaches, including surgery, into their management.