Pub Date : 2025-11-19DOI: 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。
{"title":"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","authors":"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","doi":"10.1016/j.amjsurg.2025.116737","DOIUrl":"10.1016/j.amjsurg.2025.116737","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116737"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616362","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116732
Gabriele Eckerdt Lech , Ayla Gerk , Sofia Wagemaker Viana , Ana Maria Bicudo Diniz , Sarah Lopes Salomão , Paulo Henrique Moreira Melo , Cristina Pires Camargo , David P. Mooney , Lauren Kratky
Background
Gender disparities in surgery can impact personal and professional life. This meta-analysis aims to examine differences in well-being and parenting between genders in surgery in the Americas.
Methods
Inclusion criteria were cross-sectional studies conducted in the Americas that compared mental health and parenthood outcomes between male and female surgeons.
Results
We included 37 studies, comprising 42,434 participants (25,948 (61.15 %) males; 16,486 (38.85 %) females). Female surgeons had increased burnout rates (OR 1.32; p < 0.0001), depression (OR 1.31; p = 0.03), and exhaustion (OR 1.39; p < 0.0001). Female surgeons were less likely to have children (OR 0.39; p < 0.00001), with no differences across countries (p = 0.06), specialties (p = 0.93), or career levels (p = 0.22).
Conclusion
Female surgeons experience higher rates of burnout, depression, and exhaustion, and are less likely to have children than male surgeons. These findings underscore persistent gender inequities in surgical practice and emphasize the need for broader representation from underrepresented countries in the region to better understand and address these disparities.
手术中的性别差异会影响个人和职业生活。本荟萃分析旨在检查美洲手术中性别之间的幸福感和育儿差异。方法纳入标准是在美洲进行的横断面研究，比较男性和女性外科医生的心理健康和生育结果。结果纳入37项研究，共纳入42,434名受试者(男性25,948人（61.15%）；16,486名（38.85%）女性)。女性外科医生的倦怠率（OR 1.32; p < 0.0001）、抑郁率（OR 1.31; p = 0.03）和倦怠率（OR 1.39; p < 0.0001）均有所增加。女外科医生生孩子的可能性较低（OR 0.39; p < 0.00001），不同国家（p = 0.06）、专业（p = 0.93）或职业水平（p = 0.22）之间没有差异。结论与男性外科医生相比，女性外科医生的职业倦怠、抑郁和疲劳发生率较高，生育子女的可能性较低。这些发现强调了外科实践中持续存在的性别不平等现象，并强调需要在该地区代表性不足的国家获得更广泛的代表性，以更好地了解和解决这些差异。
{"title":"Exploring gender-related disparities in mental health and parenthood among surgeons: A systematic review and meta-analysis","authors":"Gabriele Eckerdt Lech , Ayla Gerk , Sofia Wagemaker Viana , Ana Maria Bicudo Diniz , Sarah Lopes Salomão , Paulo Henrique Moreira Melo , Cristina Pires Camargo , David P. Mooney , Lauren Kratky","doi":"10.1016/j.amjsurg.2025.116732","DOIUrl":"10.1016/j.amjsurg.2025.116732","url":null,"abstract":"<div><h3>Background</h3><div>Gender disparities in surgery can impact personal and professional life. This meta-analysis aims to examine differences in well-being and parenting between genders in surgery in the Americas.</div></div><div><h3>Methods</h3><div>Inclusion criteria were cross-sectional studies conducted in the Americas that compared mental health and parenthood outcomes between male and female surgeons.</div></div><div><h3>Results</h3><div>We included 37 studies, comprising 42,434 participants (25,948 (61.15 %) males; 16,486 (38.85 %) females). Female surgeons had increased burnout rates (OR 1.32; p < 0.0001), depression (OR 1.31; p = 0.03), and exhaustion (OR 1.39; p < 0.0001). Female surgeons were less likely to have children (OR 0.39; p < 0.00001), with no differences across countries (p = 0.06), specialties (p = 0.93), or career levels (p = 0.22).</div></div><div><h3>Conclusion</h3><div>Female surgeons experience higher rates of burnout, depression, and exhaustion, and are less likely to have children than male surgeons. These findings underscore persistent gender inequities in surgical practice and emphasize the need for broader representation from underrepresented countries in the region to better understand and address these disparities.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116732"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616365","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116736
Claire E Graves, Sima Naderi
{"title":"Better with a buddy: A multidisciplinary approach to starting a thyroid radiofrequency ablation (RFA) program.","authors":"Claire E Graves, Sima Naderi","doi":"10.1016/j.amjsurg.2025.116736","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116736","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116736"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627492","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116740
Elizabeth Pace, Kimberly M Ramonell, Elizabeth B Habermann, Kelly L McCoy, Sally E Carty, Pouneh K Fazeli, Linwah Yip, Alaa Sada
Background: Reoperative adrenalectomy, defined as subsequent ipsilateral adrenal resection, has been incompletely characterized. Utilizing a multi-institutional database, we investigated the outcomes of reoperative compared to primary adrenalectomy.
Methods: Using The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP), patients undergoing primary and reoperative adrenalectomy were identified. 30-day outcomes were compared using Chi square and Wilcoxon sum tests.
Results: Out of 3558 patients, 3469 (97 %) had primary and 89 (3 %) reoperative adrenalectomy. Indications for adrenalectomy varied between groups, p < 0.01. Reoperative adrenalectomy was associated with longer operative time and length of stay, and higher rates of intra-operative complications and readmission. There was no difference in the 30-day mortality rate between the groups.
Conclusions: Reoperative adrenalectomy is uncommon and is associated with increased morbidity. Patients should be counseled regarding possible operative complications. Although reoperation is associated with an extended length of stay and higher likelihood of readmission, there was no detriment to 30-day mortality.
{"title":"Reoperative adrenalectomy: Indications and outcomes.","authors":"Elizabeth Pace, Kimberly M Ramonell, Elizabeth B Habermann, Kelly L McCoy, Sally E Carty, Pouneh K Fazeli, Linwah Yip, Alaa Sada","doi":"10.1016/j.amjsurg.2025.116740","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116740","url":null,"abstract":"<p><strong>Background: </strong>Reoperative adrenalectomy, defined as subsequent ipsilateral adrenal resection, has been incompletely characterized. Utilizing a multi-institutional database, we investigated the outcomes of reoperative compared to primary adrenalectomy.</p><p><strong>Methods: </strong>Using The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP), patients undergoing primary and reoperative adrenalectomy were identified. 30-day outcomes were compared using Chi square and Wilcoxon sum tests.</p><p><strong>Results: </strong>Out of 3558 patients, 3469 (97 %) had primary and 89 (3 %) reoperative adrenalectomy. Indications for adrenalectomy varied between groups, p < 0.01. Reoperative adrenalectomy was associated with longer operative time and length of stay, and higher rates of intra-operative complications and readmission. There was no difference in the 30-day mortality rate between the groups.</p><p><strong>Conclusions: </strong>Reoperative adrenalectomy is uncommon and is associated with increased morbidity. Patients should be counseled regarding possible operative complications. Although reoperation is associated with an extended length of stay and higher likelihood of readmission, there was no detriment to 30-day mortality.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116740"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627563","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116724
Danielle Brabender , Apostolos Kolitsas , Patrick McGillen , Kazuhide Matsushima , Morgan Schellenberg , Kenji Inaba , Anaar Siletz , Matthew J. Martin
Recent guidelines discourage liberal utilization of ED thoracotomy(EDT), though proponents cite additional considerations (ex. training, ethics, organ donation). We examined these factors at a center with a liberal EDT policy through a mixed-methods study including an eight-year retrospective review and provider survey. Among 428 patients who underwent EDT, six groups were defined by mechanism, injury location and signs of life (SOL). Survival was highest in penetrating thoracic with SOL(8.3 %) and lowest in penetrating extrathoracic or blunt without SOL(0 %). ROSC was frequent across groups. Organ referral occurred in 79 %, yet only 1 % became donors(13 organs), all from blunt injury largely without SOL. Blood-product utilization was highest in penetrating thoracic and blunt with SOL. Surveys showed low support of EDT for teaching or blunt trauma without SOL, though nearly half supported for donation. Occupational exposure occurred in 17 %, with 50 % requiring prophylaxis. Ethical and practical guidance is needed to refine EDT utilization.
{"title":"Too quick to cut? Critical outcomes, resource utilization, and ethical perspectives with a liberal approach to emergency department thoracotomy","authors":"Danielle Brabender , Apostolos Kolitsas , Patrick McGillen , Kazuhide Matsushima , Morgan Schellenberg , Kenji Inaba , Anaar Siletz , Matthew J. Martin","doi":"10.1016/j.amjsurg.2025.116724","DOIUrl":"10.1016/j.amjsurg.2025.116724","url":null,"abstract":"<div><div>Recent guidelines discourage liberal utilization of ED thoracotomy(EDT), though proponents cite additional considerations (ex. training, ethics, organ donation). We examined these factors at a center with a liberal EDT policy through a mixed-methods study including an eight-year retrospective review and provider survey. Among 428 patients who underwent EDT, six groups were defined by mechanism, injury location and signs of life (SOL). Survival was highest in penetrating thoracic with SOL(8.3 %) and lowest in penetrating extrathoracic or blunt without SOL(0 %). ROSC was frequent across groups. Organ referral occurred in 79 %, yet only 1 % became donors(13 organs), all from blunt injury largely without SOL. Blood-product utilization was highest in penetrating thoracic and blunt with SOL. Surveys showed low support of EDT for teaching or blunt trauma without SOL, though nearly half supported for donation. Occupational exposure occurred in 17 %, with 50 % requiring prophylaxis. Ethical and practical guidance is needed to refine EDT utilization.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116724"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616366","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}
Pub Date : 2025-11-18DOI: 10.1016/j.amjsurg.2025.116727
En-Tzu Chang , Jeng-Kai Jiang , Shih-Ching Chang , Huann-Sheng Wang , Yuan-Tzu Lan , Chun-Chi Lin , Hung-Hsin Lin , Hou-Hsuan Cheng , Yi-Wen Yang , Yu-Zu Lin , Che-Yuan Chang , Sheng-Chieh Huang
This study aimed to evaluate the impact of the number of preoperative chemotherapy cycles on postoperative complications in patients with metastatic colon cancer. A total of 107 eligible patients with initially potentially resectable disease who received preoperative chemotherapy between 2008 and 2021 were retrospectively included in the analysis. The optimal cut-off of six cycles for predicting postoperative complications was determined by receiver operating characteristic (ROC) curve analysis. Patients who received more than six cycles of chemotherapy had a significantly higher complication rate compared with those who received six cycles or fewer (58.2 % vs. 17.5 %, p = 0.001). Multivariate analysis confirmed chemotherapy cycles as an independent predictor of surgical complications (odds ratio = 5.91, p = 0.002). These findings suggest that exceeding six cycles of chemotherapy before surgery increases postoperative risks. Surgical evaluation after six cycles may reduce morbidity and guide optimal treatment timing for patients with metastatic colon cancer.
本研究旨在评估术前化疗周期数对转移性结肠癌患者术后并发症的影响。在2008年至2021年期间接受术前化疗的107例符合条件的初始可能可切除疾病患者被回顾性纳入分析。通过受试者工作特征（ROC）曲线分析确定6个周期预测术后并发症的最佳截止时间。接受超过6个化疗周期的患者的并发症发生率明显高于接受6个或更少化疗周期的患者（58.2% vs 17.5%, p = 0.001）。多变量分析证实化疗周期是手术并发症的独立预测因子（优势比= 5.91,p = 0.002）。这些发现表明，术前化疗超过6个周期会增加术后风险。六个周期后的手术评估可以降低发病率，并指导转移性结肠癌患者的最佳治疗时机。
{"title":"The influence of neoadjuvant chemotherapy cycles on surgical complications in metastatic colon cancer","authors":"En-Tzu Chang , Jeng-Kai Jiang , Shih-Ching Chang , Huann-Sheng Wang , Yuan-Tzu Lan , Chun-Chi Lin , Hung-Hsin Lin , Hou-Hsuan Cheng , Yi-Wen Yang , Yu-Zu Lin , Che-Yuan Chang , Sheng-Chieh Huang","doi":"10.1016/j.amjsurg.2025.116727","DOIUrl":"10.1016/j.amjsurg.2025.116727","url":null,"abstract":"<div><div>This study aimed to evaluate the impact of the number of preoperative chemotherapy cycles on postoperative complications in patients with metastatic colon cancer. A total of 107 eligible patients with initially potentially resectable disease who received preoperative chemotherapy between 2008 and 2021 were retrospectively included in the analysis. The optimal cut-off of six cycles for predicting postoperative complications was determined by receiver operating characteristic (ROC) curve analysis. Patients who received more than six cycles of chemotherapy had a significantly higher complication rate compared with those who received six cycles or fewer (58.2 % vs. 17.5 %, p = 0.001). Multivariate analysis confirmed chemotherapy cycles as an independent predictor of surgical complications (odds ratio = 5.91, p = 0.002). These findings suggest that exceeding six cycles of chemotherapy before surgery increases postoperative risks. Surgical evaluation after six cycles may reduce morbidity and guide optimal treatment timing for patients with metastatic colon cancer.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116727"},"PeriodicalIF":2.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616363","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}
Pub Date : 2025-11-17DOI: 10.1016/j.amjsurg.2025.116726
Victoria Lai MD, MS
{"title":"Stepping out from the shadows – Asian American women in healthcare","authors":"Victoria Lai MD, MS","doi":"10.1016/j.amjsurg.2025.116726","DOIUrl":"10.1016/j.amjsurg.2025.116726","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116726"},"PeriodicalIF":2.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585836","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}
Pub Date : 2025-11-17DOI: 10.1016/j.amjsurg.2025.116721
Ayla Gerk , Shreenik Kundu , Elena Guadagno , Justina Seyi-Olajide , Dunya Moghul , Joaquim Murray Bustorff-Silva , Cristina Camargo , Dan Poenaru
Background
This review examines the application of intersectionality in surgical care within low and middle-income countries (LMICs). Intersectionality is an analytic lens that examines how overlapping social identities intersect within structural systems of power and inequality. In the context of health, it helps explain how these intersections shape people's exposure to risk, access to care, and overall outcomes. Applying this lens can help uncover cumulative disadvantages and inequities within surgical systems in LMICs.
Methods
Following PRISMA guidelines, we conducted a comprehensive search across eight databases to identify studies examining the relationship between the intersection of at least two marginalized social dimensions and surgical care in LMICs.
Results
From 7325 identified abstracts, 31 were included. While none explicitly mentioned intersectionality, an average of 4.3 social determinants were analyzed per study. The most frequently examined were income (100.0 %), location (87.1 %), gender/sex (77.4 %), and education (77.4 %). Beliefs were included in 54.8 % of studies. Other determinants, such as insurance, occupation, race/ethnicity, language, and caste, were less frequently reported.
Conclusion
Our findings support applying an intersectional lens to understand how social determinants interact, identify the most vulnerable groups, and inform targeted policies that address gaps in access to surgical care.
{"title":"Intersectionality in surgical care in LMICs: A systematic scoping review","authors":"Ayla Gerk , Shreenik Kundu , Elena Guadagno , Justina Seyi-Olajide , Dunya Moghul , Joaquim Murray Bustorff-Silva , Cristina Camargo , Dan Poenaru","doi":"10.1016/j.amjsurg.2025.116721","DOIUrl":"10.1016/j.amjsurg.2025.116721","url":null,"abstract":"<div><h3>Background</h3><div>This review examines the application of intersectionality in surgical care within low and middle-income countries (LMICs). Intersectionality is an analytic lens that examines how overlapping social identities intersect within structural systems of power and inequality. In the context of health, it helps explain how these intersections shape people's exposure to risk, access to care, and overall outcomes. Applying this lens can help uncover cumulative disadvantages and inequities within surgical systems in LMICs.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we conducted a comprehensive search across eight databases to identify studies examining the relationship between the intersection of at least two marginalized social dimensions and surgical care in LMICs.</div></div><div><h3>Results</h3><div>From 7325 identified abstracts, 31 were included. While none explicitly mentioned intersectionality, an average of 4.3 social determinants were analyzed per study. The most frequently examined were income (100.0 %), location (87.1 %), gender/sex (77.4 %), and education (77.4 %). Beliefs were included in 54.8 % of studies. Other determinants, such as insurance, occupation, race/ethnicity, language, and caste, were less frequently reported.</div></div><div><h3>Conclusion</h3><div>Our findings support applying an intersectional lens to understand how social determinants interact, identify the most vulnerable groups, and inform targeted policies that address gaps in access to surgical care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116721"},"PeriodicalIF":2.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616369","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}
Pub Date : 2025-11-13DOI: 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.
{"title":"Application of hepatic artery interventional therapies in the conversion treatment of unresectable hepatocellular carcinoma: A systematic review and meta-analysis","authors":"Yongchao Zeng, Zhiqiang Wang, Shixun Lin, Yihe Yan","doi":"10.1016/j.amjsurg.2025.116712","DOIUrl":"10.1016/j.amjsurg.2025.116712","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116712"},"PeriodicalIF":2.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555194","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}
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