American journal of surgery最新文献

Purpose: Recurrence remains a significant challenge following curative resection for hepatocellular carcinoma (HCC).

Methods: To analyze the patterns, and predictive factors of HCC recurrence following liver resection.

Results: 398 patients were included. Recurrence occurred in 177 patients (44.5%). 146 patients experienced early recurrence (36.7%) and 31 patients experienced late recurrence (7.8%). Most recurrences occurred inside the remnant liver (75.1%) and were bilobar (39.5%). Lung was the commonest site for extra-hepatic recurrence (9.6%). The 1-, 3-, and 5-years DFS were 71.8%, 47.7%, and 32.1%, respectively. The 1-, 3-, and 5-years OS for were 83.3%, 67.3%, and 47.6%, respectively. Predictive factors for early recurrence included alpha-feto protein, and microvascular invasion. Predictive factors for late recurrence included tumor site and multifocal tumor.

Conclusion: Early HCC recurrence is linked to aggressive pathological features, whereas late recurrence is due to multicentric carcinogenesis. Identifying patients at higher risk can guide postoperative monitoring and improve survival outcomes.

Background: Laparoscopic hepatectomy (LH) for tumors in complex segments (Couinaud I, IVa, VII, VIII) is technically challenging. This study evaluates an integrated 3D-guided planning system combining preoperative 3D reconstruction with intraoperative ultrasonography and 3D laparoscopy.

Methods: In this retrospective study of 217 patients undergoing LH, outcomes were compared between a 3D-guided planning group (n = 105) and a routine group (n = 112) using 1:1 propensity score matching (PSM).

Results: After PSM (65 pairs), the 3D group had significantly reduced intraoperative blood loss (80 vs. 160 mL, P < 0.001) and bile leakage rate (3.1% vs. 15.4%, P = 0.015). In the special-segment subgroup, the 3D group also demonstrated shorter operative time (180 vs. 250 min, P < 0.001) and lower bile leakage (9.5% vs. 42.9%, P = 0.014).

Conclusion: The integrated 3D-guided planning system substantially reduces intraoperative blood loss during LH, especially for tumors located in the special segments designated by the Louisville Statement.

Background: Abdominoperineal resection (APR) for low rectal cancer is associated with substantial morbidity and psychosocial burden. This randomized controlled trial evaluated whether integrating resilience-oriented cognitive behavioral therapy and behavioral sleep regulation into enhanced recovery after surgery (ERAS) improves clinical and oncologic outcomes.

Methods: In this single-center trial, 192 patients undergoing curative APR were randomized to standard ERAS or ERAS plus a structured multidomain behavioral intervention. The primary endpoint was 2-year disease-free survival (DFS). Key secondary outcomes included recovery metrics, clinically significant complications, inflammatory markers, and patient-reported outcomes.

Results: The intervention group demonstrated faster bowel recovery, shorter hospitalization, fewer Clavien-Dindo grade ≥ II complications, and lower postoperative CRP, IL-6, and TNF-α levels. Two-year DFS and overall survival favored the intervention.

Conclusions: Integrating resilience- and sleep-based interventions into ERAS was associated with improved recovery, attenuated perioperative inflammation, and superior 2-year DFS after APR.

In academic surgery, success has long been defined by titles, leadership roles, productivity, and other visible measures of achievement. Without intentional reflection, these signifiers can become a proxy for self-worth, driving surgeons to seek external validation at the expense of what they find most meaningful. This editorial examines how early conditioning shapes the pursuit of achievement and how institutional reward systems reinforce it. A coaching approach is proposed to help surgeons reflect and reconnect with their internal motivation and align it with organizational expectations, creating a definition of success that is both personally meaningful and professionally relevant.

The optimal management of recurrent papillary thyroid carcinoma (PTC) in cervical lymph nodes remains a clinical challenge. Lymphadenectomy is the gold standard, but reoperative procedures have a well-documented increase in morbidity. Radiofrequency ablation (RFA) has emerged as a promising alternative for the management of nodal metastases. In this study, nine patients with ten sites of PTC nodal recurrence were treated with RFA. At one month, there was a statistically significant reduction in nodule size (P = .022). By the end of follow-up, all patients achieved a volume reduction ratio (VRR) > 90%, and three-quarters demonstrated complete sonographic resolution. One patient experienced transient voice change. No major complications occurred. These findings support RFA as a safe and effective therapy that can play a complementary role to surgery and radioactive iodine in the management of nodal recurrence of PTC.

Introduction: There are conflicting recommendations surrounding the use of intraoperative wound irrigation (IOWI) to reduce surgical site infections (SSIs) for patients undergoing laparotomy. This study aimed to perform a systematic review and network meta-analysis of randomised clinical trials (RCTs) to elucidate the most appropriate IOWI solution to reduce SSIs following laparotomy.

Methods: A systematic review and network meta-analysis (NMA) was performed as per preferred reporting items for systematic reviews and meta-analysis (PRISMA)-NMA extension. Data analytics were performed using shiny and R.

Results: 11 RCTs were included involving 2943 patients. Overall, 1292 patients were randomised to normal saline (NS) (43.9%), 771 to povidone iodine (PI) (26.2%), 519 to polyhexidine (PH) (17.6%), 180 to electrolysed strongly acidic aqueous solution (ESAAS) (6.1%), 102 to none (control) (3.5%) and 79 to olanexidine (O) (2.7%). Non-significant differences in patient age, gender, body mass indices, or American Society of Anaesthesiologist grade were observed for each IOWI group (all P > 0.050). At NMA, IOWI using PH significantly reduced all cause SSIs in patients undergoing laparotomy (odds ratio (OR): 0.54, 95% confidence interval (CI): 0.36 - 0.80). Furthermore, IOWI using PH (OR: 0.54, 95% CI: 0.36 - 0.80) and ESAAS (OR: 0.36, 95% CI: 0.13 - 0.98) significantly reduced superficial SSI (SSSI) in patients undergoing laparotomy. For patients undergoing laparotomy in the elective setting, PH significantly reduced both SSI (OR: 0.41, 95% CI: 0.25 - 0.68) and SSSI (OR: 0.42, 95% CI: 0.22 - 0.82) rates.

Conclusion: IOWI with PH reduces SSIs in patients undergoing laparotomy and should therefore be considered in patients undergoing this procedure.

Background: This study aimed to assess the diagnostic ability of routine laboratory biomarkers and develop machine learning (ML) models to improve differentiation between LH and AA.

Methods: A total of 873 patients (209 LH; 664 AA) were retrospectively analyzed. Laboratory parameters, including CRP, WBC, neutrophils, lymphocytes, monocytes, NLR (neutrophil to lymphocyte ratio), LMR (lymphocyte to monocyte ratio), PLR (platelet to lymphocyte ratio), and PIV (pan immune inflammation value), were used to build logistic regression, Naive Bayes, neural network, and gradient boosting models. Diagnostic performance was evaluated using AUC, accuracy, precision, recall, and F1 score.

Results: All biomarkers differed significantly between LH and AA (p < 0.001). AA patients exhibited higher CRP, WBC, neutrophil count, NLR, PLR, and PIV, whereas LH demonstrated higher LMR values. Logistic regression yielded the best performance (AUC 0.918; accuracy 0.869), followed closely by Naive Bayes (AUC 0.917) and neural network (AUC 0.914). SHAP-based model interpretability analysis further identified LMR and NLR as the most influential features driving model predictions.

Conclusion: Routine hematologic biomarkers combined with ML-based modeling provide a robust, non-invasive tool for differentiating LH from AA.

Background: Disparities in gastrointestinal (GI) cancer care are well-documented but underexplored from the provider's perspective. This study aimed to identify provider-perceived barriers and actionable targets to advance equity.

Methods: A cross-sectional survey was conducted among purposively sampled multidisciplinary GI cancer providers. Items assessed practice-based challenges and provider-driven solutions. Quantitative data were analyzed descriptively; qualitative data underwent thematic analysis.

Results: Seventy-six out of 120 (63%) providers participated. Barriers were most prominent during initial treatment planning. Two major themes emerged: 1) challenges related to health literacy and insurance, and 2) the substantial time providers spend addressing these barriers, reported by 55% of physicians as 10-30% of their workday and by 38% of nurses as 30-50%.

Conclusions: Providers invest significant time managing non-medical barriers in GI cancer care, particularly around insurance and health literacy. Findings will inform a multidisciplinary care team model aimed at reducing administrative burden and promoting equity.