Annals of Surgical Treatment and Research最新文献

Purpose: Neoadjuvant therapy (NAT) followed by surgical resection is the standard treatment for borderline resectable pancreatic cancer. The optimal timing for surgery after NAT, however, is unclear.

Methods: This study retrospectively analyzed 83 patients who underwent NAT followed by resection between January 2018 and December 2021.

Results: Before NAT, 22.9% of patients had resectable disease, 57.8% had borderline resectable disease, and 19.3% had locally advanced disease. After NAT, 26.5% of patients showed a downstaging of their clinical stage. After NAT, median CA 19-9 levels decreased from 148.0 to 31.7, mean tumor size from 3.1 to 2.3 cm, and the mean PET-CT maximum standardized uptake value from 6.3 to 3.6. Three-year overall survival (OS) and recurrence-free survival (RFS) were 46.7% and 22.6%, respectively. RFS and OS were significantly associated with CA 19-9 levels, lymph node metastasis, and postsurgical pathological stage, while OS was also significantly associated with tumor size and NAT. Patients with elevated CA 19-9 (> 37) which normalized after NAT showed a 3-year RFS of 32.5% compared to 0.0% in those who did not. In patients with elevated CA 19-9, OSs were 58.3% and 25.0% for those with a post-NAT decrease of ≥70% vs. those with no decrease, respectively, while RFSs were 22.6% and 0%.

Conclusion: Timing of surgery after NAT should be decided considering post-NAT tumor size and CA 19-9 levels.

Purpose: The hospitalist system, formally adopted in South Korea in 2021 after a pilot program in 2016, has been associated with improvements in inpatient care outcomes and patient satisfaction. However, a persistent shortage of hospitalists- recently worsened by increasing demands on inpatient care-has raised concerns regarding workforce stability. This study aimed to compare job satisfaction and its determinants between medical and surgical hospitalists in South Korea.

Methods: A nationwide cross-sectional online survey was conducted in February 2024 among 389 board-certified hospitalists registered with the Korean Society of Hospital Medicine and the Korean Society of Surgical Hospital Medicine. The survey included questions on demographics, work environment, job satisfaction (monetary and nonmonetary), and career intentions. Statistical analyses included chi-square tests, Mann-Whitney U-tests, and multiple linear regression.

Results: A total of 94 hospitalists responded (67 medical and 27 surgical). Surgical hospitalists reported significantly longer weekly working hours (47.9 hours vs. 40.9 hours, P = 0.013) and higher patient loads (19.5 patients vs. 15.4 patients, P = 0.003). Despite these differences, overall satisfaction levels were similar between the groups. Eligibility for faculty appointment and availability of research and education funding were significantly associated with nonmonetary satisfaction. Annual salary was the most significant predictor of monetary satisfaction, explaining 17.2% of the variance.

Conclusion: Surgical hospitalists experienced higher workloads but maintained comparable satisfaction levels to their medical counterparts. Enhancing academic opportunities and tailoring financial incentives may be effective strategies to improve job satisfaction and support workforce retention across specialties.

Purpose: Laparoscopic excision of choledochal cysts (CC) has become increasingly popular in pediatric surgical practice in Korea. This study aimed to evaluate the efficacy and safety of laparoscopic CC excision in pediatric patients by comparing its outcomes with those of open surgery at a national children's hospital.

Methods: We retrospectively reviewed patients aged <19 years who underwent CC excision with Roux-en-Y hepaticojejunostomy between 2010 and 2024 at our center. The patients were divided into laparoscopic and open surgery groups, and their clinical and perioperative outcomes were compared. Variables included demographics, clinical characteristics, operative details, and preoperative and postoperative laboratory findings.

Results: Seventy-nine patients (17 boys and 62 girls) were included, of whom 33 (41.8%) underwent laparoscopic excision, and 46 underwent open surgery. There were no clinically meaningful differences between the groups in terms of laboratory parameters or the incidence of cholangitis and pancreatitis. The mean operative time was significantly longer in the laparoscopic group (322.3 ± 63.3 minutes vs. 278.2 ± 53.9 minutes, P = 0.002) but decreased with increasing experience. There were no significant differences in the incidence of short- or long-term complications between the groups.

Conclusion: Laparoscopic CC excision is a safe and effective alternative to open surgery in pediatric patients. Although the operation was initially longer, it decreased with accumulated surgical experience. This study shows that laparoscopic CC excision can be safely and effectively implemented in a national children's hospital located outside the capital region, supporting its broader application across diverse clinical settings.

Purpose: Postoperative delirium (POD) is a frequent acute cognitive disorder that occurs after surgery. Enhanced recovery after surgery (ERAS) has been suggested to decrease its incidence. Due to the lack of conclusive evidence on the topic, we conducted a meta-analysis to investigate the potential impact of ERAS on POD.

Methods: We included randomized controlled trials involving adult patients undergoing elective surgery. The ERAS group received management based on ERAS principles during the perioperative period, while the control group implemented traditional management strategies. The major evaluation indicators included the incidence of POD, the timing of its first occurrence, and the duration of POD. The secondary evaluation indicators were the content of Mini-Mental State Examination (MMSE) scores, the time to first ambulation, total complication rates, and length of hospital stay.

Results: The results indicated that ERAS significantly reduced the overall incidence of POD (relative risk [RR] = 0.38, P < 0.00001) and the incidence of delirium on the first and second postoperative days (RR = 0.20, P = 0.03; RR = 0.21, P = 0.01). It also delayed the first occurrence of POD (mean difference [MD] = -1.5, P < 0.0001), reduced its duration (MD = -2.15, P = 0.005), improved MMSE scores (MD = 1.95, P < 0.00001), sped up ambulation (MD = -1.53, P < 0.00001), decreased total complication rates (RR = 0.21, P = 0.0003), and shortened hospital stays (MD = -4.61, P < 0.00001).

Conclusion: In conclusion, ERAS significantly reduces POD and related complications while facilitating rapid recovery in surgical patients.

Purpose: Papillary thyroid cancer (PTC), a common malignancy among women of reproductive age, is increasingly common during pregnancy because of routine prenatal imaging. However, the optimal timing for surgical treatment remains controversial. This study aimed to assess the safety and practicality of performing thyroid surgery during pregnancy through a comparative analysis of perioperative and pathological outcomes between pregnant and nonpregnant women.

Methods: We conducted a retrospective case-control study of 100 female patients aged 20-39 years who underwent thyroid surgery for PTC between January 2019 and December 2024. Patients were grouped into pregnant (n = 14) and nonpregnant (n = 86) cohorts. Clinical, surgical, and pathological data were compared.

Results: Most pregnant patients underwent surgery during the second trimester. The operative duration was significantly shorter in the pregnant group than in the nonpregnant group (71.4 ± 26.35 minutes vs. 87.2 ± 5.17 minutes, P = 0.025), and there was a trend towards a lower drain volume on postoperative day 1 (25.2 ± 15.23 mL vs. 32.7 ± 0.18 mL, P = 0.077). No significant differences were observed in terms of complication rates. Despite a higher frequency of extrathyroidal extension (P = 0.003) and advanced T stage (P = 0.038) in the pregnant group, the surgical outcomes were favorable. One neonate experienced mild intraventricular hemorrhage that resolved without sequelae.

Conclusion: Thyroid surgery during pregnancy, particularly in the second trimester, appears feasible in selected patients. Given the small sample and retrospective nature of this study, larger prospective studies are needed to validate these findings.

Purpose: The BRAF^V600E mutation is a common genetic alteration in papillary thyroid carcinoma (PTC) and is associated with poor prognostic factors. Accurate detection is crucial for risk stratification. This study compares the performance of direct Sanger sequencing (SS), immunohistochemistry (IHC), and droplet digital PCR (ddPCR) in detecting the BRAF^V600E mutation in PTC.

Methods: Tumor samples from patients undergoing thyroidectomy were analyzed for BRAF^V600E using SS, IHC, and ddPCR. A mutant allele fraction >1% was considered ddPCR positive. Sensitivity and concordance rates were evaluated.

Results: A total of 48 PTC and 9 benign samples were tested. All benign samples were negative for BRAF^V600E by both SS and ddPCR. Among PTC cases, the mutation was detected in 72.9% by SS, 89.6% by IHC, and 83.3% by ddPCR. Both IHC and ddPCR were significantly more sensitive than SS (P = 0.001 and P < 0.001, respectively). Concordant results across all 3 methods were seen in 83.3% of PTC cases. Among the 8 discordant samples (all SS-negative), 5 were positive by both IHC and ddPCR, and 3 were IHC-positive only. Of these, 6 showed adenine peaks on SS chromatograms, with a mean ddPCR mutant allele fraction of 14.5%, compared to 0.36% in the 2 without adenine peaks.

Conclusion: IHC and ddPCR demonstrated superior sensitivity compared to SS for detecting BRAF^V600E mutations in PTC. These findings support the use of IHC and ddPCR as more reliable alternatives to SS in clinical practice.

Purpose: Accurate data collection and analysis are crucial in clinical research, particularly for extracting information from unstructured medical records in cancer research. Traditional methods often struggle with this task. Large language models (LLMs) specializing in natural language processing (NLP), like ChatGPT (OpenAI), show potential for automating this process. This study evaluated whether GPT-4 could accurately extract clinical stages of colorectal cancer (CRC) from imaging reports.

Methods: Using specific prompts based on the American Joint Committee on Cancer TNM staging system, GPT-4 was tested on the unstructured abdominal imaging reports of 100 CRC patients. The results were evaluated by a colorectal surgical oncologist and compared with data manually extracted by a nonspecialist data manager.

Results: GPT-4 demonstrated high accuracy in extracting lesion locations (96.0%) and T (89.0%), N (90.0%), and M (85.0%) stages, with an overall TNM stage extraction accuracy of 69.0%. The combined accuracy for TNM stage and lesion location was 67.0%. Human data managers had similar TNM stage accuracy but lower lesion-location accuracy (76.0%). Higher accuracy was observed when reports directly mentioned stages and were in English only.

Conclusion: This study confirms that LLM-based NLP, with proper prompt engineering, can accurately extract clinical stages from CRC imaging reports, particularly in English-only contexts.

Purpose: Single-port robotic platforms represent an emerging approach in head and neck surgery, yet their comparative effectiveness against traditional multiport systems remains unclear.

Methods: A systematic review of PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to January 17, 2025. From 93 potentially relevant articles, 5 retrospective comparative studies met the inclusion criteria, comprising 1,000 patients (single-port, 453; multiport, 547). Random-effects meta-analysis was performed for operative parameters.

Results: Single-port surgery demonstrated shorter docking times (pooled effect size, -1.05; 95% confidence interval [CI], -1.47 to -0.64) with moderate heterogeneity (I² = 74.27%). Console times showed no significant difference between approaches (effect size, -0.05; 95% CI, -0.35 to 0.25). Total operative times, reported in 2 studies, indicated modest reductions with the single-port approach (295 ± 92 minutes vs. 315 ± 101 minutes; 101.9 ± 23.6 minutes vs. 114.9 ± 32.8 minutes). Major complication rates were comparable (single-port, 1.8%-9.7%; multiport, 2.7%-4.3%). Negative margin rates favored single-port procedures (57%-100% vs. 48%-92.6%).

Conclusion: This systematic review suggests that single-port robotic surgery offers advantages in docking time while maintaining comparable safety profiles to multiport approaches in head and neck procedures. However, the quality of evidence remains low due to the observational nature of available studies and heterogeneity in outcome reporting.

Purpose: This study was performed to analyze whether adjuvant radiotherapy (RT) can improve the survival outcome for pathological node-negative (ypN0) breast cancer patients who underwent surgery after neoadjuvant chemotherapy (NAC).

Methods: In this meta-analysis, we reviewed papers related to adjuvant RT in ypN0 patients after NAC published between January 2010 and November 2024 using PubMed, EMBASE via Elsevier, Cochrane Library with keywords: "breast neoplasms," "neoadjuvant therapy," and "radiotherapy." The effectiveness of post-mastectomy RT (PMRT) after mastectomy and regional nodal irradiation (RNI) after breast-conserving surgery (BCS) was evaluated. The end point of this study was overall survival (OS).

Results: We selected 11 retrospective papers for this meta-analysis out of 4,164 English full-text articles. There were 7 PMRT-related and 5 RNI-related papers (1 duplicated) for final analysis. Overall, PMRT in ypN0 patients improved OS (hazard ratio [HR], 0.862; 95% confidence interval [CI], 0.766-0.972; P = 0.015) after mastectomy. Moreover, OS (HR, 0.774; 95% CI, 0.600-0.999; P = 0.049) was also improved by RNI for ypN0 patients after BCS.

Conclusion: For patients with ypN0 breast cancer who have undergone NAC and surgery, PMRT positively affected the survival outcome of patients. Therefore, it is necessary to undergo adjuvant RT to improve survival for ypN0 breast cancer patients.