American journal of surgery最新文献

英文中文

Application of hepatic artery interventional therapies in the conversion treatment of unresectable hepatocellular carcinoma: A systematic review and meta-analysis 肝动脉介入治疗在不可切除肝癌转化治疗中的应用：一项系统回顾和荟萃分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-13 DOI: 10.1016/j.amjsurg.2025.116712

Yongchao Zeng, Zhiqiang Wang, Shixun Lin, Yihe Yan

Background

The conversion therapy aims to transform initially unresectable hepatocellular carcinoma (uHCC) into a resectable state through systemic or locoregional treatment (LRT). However, there is no clear optimal conversion therapy strategy at present.

Methods

A systematic search was performed across PubMed, Web of Science, Cochrane Library, Embase to identify relevant studies. The primary endpoint was the conversion to surgery rate (CSR), with objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) analyzed as secondary endpoints.

Results

A total of 44 studies were included, comprising data from 5065 patients. The pooled CSR in each treatment group was as follows: 6 % in the conventional transcatheter arterial chemoembolization (cTACE) group, 9 % in the hepatic arterial infusion chemotherapy (HAIC) group, 20 % in the drug-eluting beads transarterial chemoembolization (DEB-TACE) group, 25 % in the transarterial radioembolization (TARE) group, 42 % in the combination of TACE and HAIC (TACE-HAIC) group. Among dual therapies, the pooled CSR was 13 % in the TACE combined with tyrosine kinase inhibitor (TKI) group, 15 % in the HAIC plus TKI group, 8 % in the TACE-HAIC plus TKI group. For triple therapies, the pooled CSR was 29 % in the TACE combined with TKI and immune checkpoint inhibitor (ICI) group, 29 % in the TACE-HAIC plus TKI and ICI group, 33 % in the HAIC plus TKI and ICI group, and 41 % in the DEB-TACE-HAIC plus TKI and ICI group.

Conclusions

Triple therapies yield significantly higher CSR than dual therapies, both surpassing single transarterial approaches. The DEB-TACE-HAIC + TKI + ICI regimen demonstrated the highest CSR. HAIC-based strategies outperformed cTACE-based approaches.

背景：转化疗法旨在通过全身或局部治疗（LRT）将最初不可切除的肝细胞癌（uHCC）转变为可切除状态。然而，目前尚无明确的最佳转化治疗策略。方法系统检索PubMed、Web of Science、Cochrane Library、Embase等相关文献。主要终点是手术转换率（CSR），次要终点是客观缓解率（ORR）、总生存期（OS）和无进展生存期（PFS）。结果共纳入44项研究，包括5065例患者的数据。各治疗组的总CSR为：常规经导管动脉化疗栓塞（cace）组6%，肝动脉输注化疗（HAIC）组9%，药物洗脱珠经动脉化疗栓塞（DEB-TACE）组20%，经动脉放射栓塞（TARE）组25%，TACE与HAIC联合（TACE-HAIC）组42%。在双重治疗中，TACE联合酪氨酸激酶抑制剂（TKI）组的总CSR为13%，HAIC + TKI组为15%，TACE-HAIC + TKI组为8%。对于三联疗法，TACE联合TKI和免疫检查点抑制剂（ICI）组的总CSR为29%，TACE-HAIC + TKI和ICI组为29%，HAIC + TKI和ICI组为33%，debe -TACE-HAIC + TKI和ICI组为41%。结论三重治疗的CSR明显高于双重治疗，均优于单一经动脉入路。DEB-TACE-HAIC + TKI + ICI方案的CSR最高。基于haic的策略优于基于cace的方法。

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引用次数: 0

It's the patient's decision, for better or for worse 这是病人的决定，是好是坏。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-10-23 DOI: 10.1016/j.amjsurg.2025.116677

Ambria S. Moten MD, MS

引用次数: 0

Intestinal discontinuity may be associated with worse outcomes in damage control laparotomy for trauma: An American association for the surgery of trauma prospective multicenter observational study 美国创伤外科协会的一项前瞻性多中心观察性研究表明，创伤控制性剖腹手术中肠不连续性可能与较差的预后相关

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.amjsurg.2025.116777

Elizabeth R. Benjamin , Demetrios Demetriades , Camilla Cremonini , Anaar Siletz , Subarna Biswas , Jennifer Mooney , Joe DuBose , Nori Bradley , David J. Skaurpa , Lucyna Krzywon , Paula Ferrada , Pak S. Leung , John D. Berne , Jason Young , Thomas M. Scalea

Introduction

In damage control laparotomy (DCL) for trauma, intestinal injuries are often left in discontinuity. This study compared outcomes in patients with intestinal discontinuity versus immediate anastomosis.

Methods

Prospective multicenter, AAST study, included patients requiring DCL with intestinal resection. Patients were categorized into bowel Discontinuity and Continuity groups.

Data collection included clinical characteristics, injury severity, peritoneal contamination, intraoperative blood products, crystalloids and vasopressors, operative time, takeback operative findings, fascia closure and postoperative complications. Outcomes included mortality, bowel ischemia, postoperative complications, fascia closure, and hospital stay.

Results

246 patients from 16 centers. Using propensity score matching, 132 patients in the Discontinuity group were well-matched with 66 in the Continuity group. Discontinuity was associated with significantly higher mortality and septic complications. Fascia closure was more likely to be achieved in the Continuity group at the 2nd takeback operation.

Conclusions

Intestinal discontinuity in DCL is associated with increased mortality and septic complications.

在创伤控制性剖腹手术（DCL）中，肠损伤往往是不连续的。本研究比较了肠不连续性患者与直接吻合患者的预后。方法前瞻性多中心AAST研究，纳入需要DCL合并肠切除术的患者。患者分为肠不连续性组和肠连续性组。收集的资料包括临床特征、损伤严重程度、腹膜污染、术中血液制品、晶体和血管升压药物、手术时间、恢复手术结果、筋膜闭合和术后并发症。结果包括死亡率、肠缺血、术后并发症、筋膜闭合和住院时间。结果来自16个中心的246例患者。使用倾向评分匹配，间断组132例患者与连续性组66例患者匹配良好。不连续性与明显较高的死亡率和脓毒性并发症相关。连续组在第二次收回手术时更容易实现筋膜闭合。结论DCL患者肠道不连续性与死亡率和脓毒性并发症增加有关。

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引用次数: 0

Assessing the performance of the updated 2021 Field Triage Guidelines with the Need For Trauma Intervention (NFTI) metric 评估更新的2021年现场分诊指南与创伤干预需求（NFTI）指标的绩效。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-21 DOI: 10.1016/j.amjsurg.2025.116729

Tyler J. Johnston , Dina M. Filiberto , Peter B. DePhillips , Chandler E. Morel , Peter E. Fischer , Andy J. Kerwin , Emily K. Lenart , Saskya E. Byerly

Background

Pre-hospital triage is critical for resource-allocation and patient-outcomes. This study aimed to assess the sensitivity (SN) of updated 2021 Field Triage Guidelines (FTGs) and trauma center activation criteria (TAC) related to Need for Trauma Intervention (NFTI).

Methods

Data were collected to identify FTGs Red Criteria (RC) and Yellow Criteria (YC) and NFTI: pRBC within 4 h, operating room within 90 min, interventional radiology, ICU length-of-stay ≥3 days, mechanical ventilation within 3 days, or death within 60 h. SN was analyzed for RC and TAC. Lastly, logistic regressions assessed covariates associated with under-triage (UT).

Results

319 patients were included. SN of RC and TAC were 79 % and 77 %, respectively. Regression analysis showed UT by RC and TAC was associated with blunt mechanism.

Conclusions

FTGs did not meet ACS goals of ≤5 % UT and ≤35 % OT with blunt mechanism being associated with UT.

院前分诊对资源分配和患者预后至关重要。本研究旨在评估更新的2021年现场分诊指南（FTGs）和与创伤干预需求（NFTI）相关的创伤中心激活标准（TAC）的敏感性（SN）。方法：收集资料，确定FTGs红色标准（RC）和黄色标准（YC）， NFTI: 4 h内pRBC， 90 min内手术室，介入放射学，ICU住院时间≥3天，3天内机械通气，或60 h内死亡。对RC和TAC进行SN分析。最后，逻辑回归评估了与分类不足（UT）相关的协变量。结果：共纳入319例患者。RC和TAC的SN分别为79%和77%。回归分析显示，经RC和TAC处理的UT与钝性机制相关。结论：FTGs未达到ACS的目标，UT≤5%和OT≤35%，钝性机制与UT相关。

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引用次数: 0

Rethinking transfusion timing: Evaluating preoperative transfusion morbidity using a national pediatric database 重新思考输血时机：使用国家儿科数据库评估术前输血发病率

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.amjsurg.2025.116731

Matthew T. Parrish , Katie Bews , Stephanie F. Polites , Elizabeth B. Habermann

Background

Transfusion within 72 h after surgery (BT) is associated with increased postoperative morbidity in pediatric patients, but the impact of preoperative transfusion (PBT), given within 48 h before surgery, is unclear. We hypothesize that PBT is associated with lower morbidity than BT.

Methods

Pediatric (<18-years-old) general surgery patients who received PBT or BT were identified from the 2012–2022 NSQIP-P files, excluding those with preoperative hematocrit <21 %. PBT and BT patients were propensity-score matched with rates of postoperative infection (PI) and surgical site infections (SSI) compared using logistic regression.

Results

Among 15,401 patients, 4559 (30 %) received PBT and 10,842 (70 %) received BT. After matching, 3439 PBT patients were compared to 3439 BT patients. PBT was associated with fewer PI (8 % vs 10 %; OR = 0.75, 95 % CI 0.64–0.89) and SSI (5 % vs 8 %, OR = 0.72, 95 % CI 0.59–0.87).

Conclusions

PBT was associated with lower odds of postoperative infections compared to BT in matched pediatric general surgery patients.

背景：儿科患者术后72小时内输血与术后发病率增加有关，但术前48小时内输血的影响尚不清楚。方法从2012-2022年NSQIP-P文件中确定接受PBT或BT的儿科（18岁）普外科患者，不包括术前红细胞压积21%的患者。采用logistic回归比较PBT和BT患者的倾向评分与术后感染（PI）和手术部位感染（SSI）的发生率相匹配。结果15401例患者中，4559例（30%）接受PBT治疗，10842例（70%）接受BT治疗，配对后，PBT患者3439例，BT患者3439例。PBT与较低的PI （8% vs 10%; OR = 0.75, 95% CI 0.64-0.89）和SSI （5% vs 8%, OR = 0.72, 95% CI 0.59-0.87）相关。结论在匹配的儿童普外科患者中，与BT相比，spbt与术后感染的发生率较低相关。

{"title":"Rethinking transfusion timing: Evaluating preoperative transfusion morbidity using a national pediatric database","authors":"Matthew T. Parrish , Katie Bews , Stephanie F. Polites , Elizabeth B. Habermann","doi":"10.1016/j.amjsurg.2025.116731","DOIUrl":"10.1016/j.amjsurg.2025.116731","url":null,"abstract":"<div><h3>Background</h3><div>Transfusion within 72 h after surgery (BT) is associated with increased postoperative morbidity in pediatric patients, but the impact of preoperative transfusion (PBT), given within 48 h before surgery, is unclear. We hypothesize that PBT is associated with lower morbidity than BT.</div></div><div><h3>Methods</h3><div>Pediatric (<18-years-old) general surgery patients who received PBT or BT were identified from the 2012–2022 NSQIP-P files, excluding those with preoperative hematocrit <21 %. PBT and BT patients were propensity-score matched with rates of postoperative infection (PI) and surgical site infections (SSI) compared using logistic regression.</div></div><div><h3>Results</h3><div>Among 15,401 patients, 4559 (30 %) received PBT and 10,842 (70 %) received BT. After matching, 3439 PBT patients were compared to 3439 BT patients. PBT was associated with fewer PI (8 % vs 10 %; OR = 0.75, 95 % CI 0.64–0.89) and SSI (5 % vs 8 %, OR = 0.72, 95 % CI 0.59–0.87).</div></div><div><h3>Conclusions</h3><div>PBT was associated with lower odds of postoperative infections compared to BT in matched pediatric general surgery patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116731"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616361","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

Assessing the utility of surveillance imaging in high-grade liver injury patients 评估监测成像在高级别肝损伤患者中的应用。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-12-01 DOI: 10.1016/j.amjsurg.2025.116757

Pooja Podugu , Amisha Paul , Ari Zlota , Priyash Hafiz , Tien Nguyen , Annabel Yang , Nikhil Madugula , Caleb Curry , Hope Carrane , Vanessa P. Ho , Justin Dvorak

Introduction

The utility of surveillance imaging (SI) after high-grade liver injury is unclear. We studied SI's detection rate and its association with unplanned interventions, emergency department (ED) visits, and mortality.

Methods

Adult patients with American Association for the Surgery of Trauma (AAST) grade III-V liver injury (2018–2024) were categorized by follow-up imaging: surveillance imaging (SI, no clinical change), clinically-prompted imaging (CI), or none. Outcomes included unplanned intervention, liver-related ED visits, and mortality.

Results

Among 252 patients, SI prompted intervention in 10 % of cases versus 31 % for CI. Unplanned interventions were more frequent after CI than SI (37 % vs. 18 %; p = 0.018). ED visits were marginally lower after SI versus CI (30 % vs. 43 %; p = 0.10). Mortality did not differ across groups.

Conclusions

SI identified complications in select patients and was associated with fewer unplanned interventions, marginally fewer ED visits, and no mortality difference compared to CI.

导读：监测成像（SI）在高级别肝损伤后的应用尚不清楚。我们研究了SI的检出率及其与计划外干预、急诊（ED）就诊和死亡率的关系。方法：美国创伤外科学会（AAST） III-V级肝损伤成年患者（2018-2024）按随访影像学分类：监测影像学（SI，无临床变化），临床提示影像学（CI），或无。结果包括计划外干预、肝脏相关急诊科就诊和死亡率。结果：在252例患者中，10%的病例采用SI，而31%的病例采用CI。CI后非计划干预比SI后更频繁（37%比18%；p = 0.018）。在SI和CI之后，急诊科的诊断率略低（30% vs 43%; p = 0.10）。死亡率在各组之间没有差异。结论：与CI相比，SI确定了部分患者的并发症，并且与计划外干预较少，ED就诊较少相关，且死亡率无差异。

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引用次数: 0

Reconsidering the timeline: Delayed cosyntropin stimulation testing in adrenalectomy patients receiving perioperative steroids 重新考虑时间：肾上腺切除术患者接受围手术期类固醇的延迟共syntropin刺激试验。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-28 DOI: 10.1016/j.amjsurg.2025.116596

Alexa Lisevick Kumar , George A. Taylor , Tracy S. Wang , Sophie Y. Dream

引用次数: 0

Society of Black Academic Surgeons (SBAS) diversity, equity and inclusion series: A review of surgical disparities in the vulnerable communities of the USA - The black community (Part I) 黑人学术外科医生协会（SBAS）多样性、公平和包容系列：美国弱势社区手术差异的回顾-黑人社区（第一部分）。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-14 DOI: 10.1016/j.amjsurg.2025.116578

Paris D. Butler , Erin King-Mullins , Bridget A. Oppong , Steven D. Wexner , Martin S. Karpeh , Luz María Rodríguez

引用次数: 0

Duodenal diverticulectomy: A novel surgical technique 十二指肠憩室切除术：一种新的手术技术。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-16 DOI: 10.1016/j.amjsurg.2025.116582

Savannah R. Smith MD , Juan M. Sarmiento MD, FACS

引用次数: 0

Clinical impact of percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy in patients with moderate to severe acute cholecystitis: A propensity score-matched case-control study 中重度急性胆囊炎患者经皮经肝胆囊引流后腹腔镜胆囊切除术的临床影响：一项倾向评分匹配的病例对照研究

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.amjsurg.2025.116737

Kyong Joo Lee , Jang Han Jung , Se Woo Park , Da Hae Park , Hye Won Cha , Dong Hee Koh , Jin Lee , Jung Min Lee , Jung Woo Lee , Eunae Cho

Percutaneous transhepatic gallbladder drainage (PTGBD) is frequently performed for moderate to severe acute cholecystitis (AC) when early laparoscopic cholecystectomy (LC) is not feasible. While PTGBD relieves symptoms, its impact on surgical outcomes is uncertain. We retrospectively analyzed 505 patients with grade II or III AC undergoing LC (2012–2022). After propensity score matching, 122 received PTGBD and 122 underwent direct LC. PTGBD was associated with longer time to surgery (10.1 vs. 3.6 days), higher ICU admission (44.3 % vs. 22.1 %), and prolonged hospital stay (18.2 vs. 11.3 days), without reducing postoperative complications. Importantly, delayed hospital presentation (>4 days from symptom onset) independently increased postoperative complications (OR:3.01, 95 % CI:1.16–7.81, P = 0.023). Early LC yielded shorter hospital and ICU stays compared with delayed surgery. These findings indicate that PTGBD may extend hospitalization and ICU use without improving outcomes, underscoring the importance of timely admission and early LC in moderate to severe AC.

当早期腹腔镜胆囊切除术（LC）不可行的情况下，经皮经肝胆囊引流术（PTGBD）常用于中重度急性胆囊炎（AC）。虽然PTGBD可以缓解症状，但其对手术结果的影响尚不确定。我们回顾性分析了505例接受LC治疗的II级或III级AC患者（2012-2022）。倾向评分匹配后，122人接受PTGBD， 122人接受直接LC。PTGBD与较长的手术时间（10.1对3.6天）、较高的ICU住院率（44.3%对22.1%）和较长的住院时间（18.2对11.3天）相关，但没有减少术后并发症。重要的是，延迟住院（症状出现后4天）单独增加了术后并发症（OR:3.01, 95% CI: 1.16-7.81, P = 0.023）。与延迟手术相比，早期LC的住院时间和ICU时间较短。这些研究结果表明，PTGBD可能延长住院时间和ICU使用时间，但不会改善预后，强调了及时入院和早期LC对中重度AC的重要性。

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