Journal of Gastrointestinal Surgery最新文献

Background: Preoperative optimization is widely recommended for patients undergoing ventral hernia repair. However, the clinical impact of individual risk factors remains uncertain. This study aimed to evaluate the association of obesity, diabetes mellitus, and smoking with postoperative outcomes and to compare these findings with surgeon practices and existing literature.

Methods: The augmented evidence review (AER) was performed using 3 evidence streams to answer the unified question: "What are the key components of preoperative patient optimization for ventral hernia repair?" Empiric evidence was gathered using a retrospective analysis of the Abdominal Core Health Quality Collaborative database. Social media evidence was gathered by surveying practicing surgeons via the International Hernia Collaboration social media group. Artificial intelligence (AI) evidence was obtained from the OpenEvidence platform, which performed a data-driven literature review. Each evidence stream was analyzed independently before integrating it in the AER.

Results: Obesity was associated with increased wound complications, but showed no significant association with systemic complications. Diabetes status and glycemic control were not associated with postoperative complications. Smoking was associated with increased surgical site occurrence and pneumonia. Survey results demonstrated that most surgeons consider these risk factors important. However, implementation varied, with individualized approaches favored for obesity and smoking, whereas defined thresholds were used for glycemic control. AI-derived evidence demonstrated similar heterogeneity.

Conclusion: The evaluated risk factors demonstrated modest differences in postoperative outcomes, some of which were statistically significant. However, the clinical significance is mainly determined by the surgeon, as reflected by our survey. Most surgeons favored an individualized approach for obesity, followed by smoking, and less so for diabetes mellitus.

Background: Conversion surgery, namely curative-intent resection for patients with initially unresectable stage IV gastric or esophagogastric junction cancer whose tumors become resectable after systemic therapy, has become an important treatment strategy. However, the selection criteria for conversion surgery in the era of first-line nivolumab remain unclear.

Methods: This single-institutional retrospective study included 140 patients who received systemic chemotherapy for advanced gastric or esophagogastric junction cancer. Data were compared between treatments with and without first-line nivolumab, and 1:2 propensity score matching was performed to adjust for baseline tumor burden and metastatic status. Predictors of conversion surgery were evaluated using logistic regression, and survival outcomes were analyzed using Kaplan-Meier and Cox regression models.

Results: Conversion surgery was performed in 22 (15.7%) patients. The conversion surgery rate was significantly higher in patients receiving first-line nivolumab than in those receiving chemotherapy alone, both before and after propensity score matching (41.7% vs 8.3%; P =.001). In a multivariate analysis, the use of nivolumab as a first-line treatment was an independent predictor of conversion surgery both before and after matching. Minimally invasive surgery was performed in 12 (54.5%) patients, 9 of whom had received nivolumab. In the multivariate analysis of the propensity score-matched population, first-line nivolumab and male sex were favorable prognostic factors for advanced gastric cancer.

Conclusion: First-line nivolumab-based chemotherapy may increase the likelihood of conversion surgery in patients with advanced gastric or esophagogastric junction cancer. Although conversion surgery was associated with improved progression-free survival, its impact on overall survival remains uncertain.

Background: Preoperative hypoalbuminemia is a risk factor for complications after hepatectomy for hepatocellular carcinoma (HCC). The impacts of preopeRative sErum Albumin Levels on postoperative outcomes in Chinese HCC Patients treated with surgical operation (REAL) studyaimed to evaluate the impact of preoperative human albumin administration on postoperative outcomes in patients with HCC and hypoalbuminemia undergoing hepatectomy.

Methods: This retrospective study analyzed patients with HCC and preoperative hypoalbuminemia (serum albumin < 36 g/L) who underwent liver resection at Zhongshan Hospital, Fudan University. Patients were categorized into those who received albumin supplementation and those who did not. Surgical outcomes included durations of hospital and intensive care unit (ICU) stay, incidence and grade of posthepatectomy liver failure (PHLF), 30-day complication rates, and hospital mortality.

Results: Patients with hypoalbuminemia who did not receive supplementation had significantly higher rates of PHLF grades A/B and 30-day complications compared with the normal albumin group, along with a shorter overall survival. However, patients with hypoalbuminemia who received supplementation achieved outcomes comparable to those of the normal albumin group, with no significant differences in hospital stay, ICU stay, PHLF grade distribution, or 30-day complication rates. Among patients with hypoalbuminemia, those who received albumin supplementation had a significantly lower PHLF rate. No in-hospital mortality occurred in any group.

Conclusion: Preoperative albumin supplementation in patients with hypoalbuminemiais associated with significantly improved postoperative outcomes in this retrospective cohort. These real-world findings provide preliminary evidence supporting targeted albumin supplementation to reduce surgical risk among such vulnerable patients. However, large prospective randomized controlled trials are still required to validate our conclusions before widespread clinical application.

Background: Enhanced-view totally extraperitoneal (eTEP) repair enables minimally invasive retromuscular and preperitoneal mesh placement while avoiding contact with intraperitoneal mesh. Reported complication rates differ depending on the definition and data source. We developed an augmented evidence review (AER) to address "What are the key tips to avoid common eTEP complications?"

Methods: The AER integrated 3 evidence streams: (i) empiric, the Abdominal Core Health Quality Collaborative, including elective adult eTEP-consistent ventral hernia repairs with 30-day follow-up (N = 8434; October 2013 to December 2025); (ii) social media, an International Hernia Collaboration (IHC) expert poll ranking prioritized eTEP hazards; and (iii) artificial intelligence (AI), OpenEvidence synthesis with manual source verification. Outcomes were classified as consequential (readmission, reoperation, surgical site infection [SSI], surgical site occurrence or infection [SSO/I], and prolonged length of stay [LOS]) vs nonconsequential/burden. Adjusted analyses compared transeversus abdominis release (TAR) vs no-TAR and robotic vs laparoscopic approaches.

Results: The incidence of 30-day outcomes was as follows: readmission, 2.4%; reoperation, 1.3%; SSI, 1.1%; any SSO, 9.5%; and SSO/I, 1.8%. Defect width showed strong graded associations with adverse outcomes, with SSO/I rising from 0.5% (<4 cm) to 4.6% (>10 cm). In adjusted models, TAR was strongly associated with a LOS ≥ 2 days (odds ratio, 3.51; 95% CI, 2.96-4.16) but not with readmission or reoperation. After adjustment, the laparoscopic approach was not independently associated with the primary consequential endpoints compared with the robotic approach. The IHC poll prioritized posterior-layer disruption with intraparietal or internal herniation (29%), crossover-related linea alba injury (27%), midline bulging (23%), and trocar-exit bleeding (18%). OpenEvidence synthesis identified plane discipline and posterior-layer closure as primary prevention strategies, which were concordant with IHC poll priorities.

Conclusion: In a large cohort of elective minimally invasive surgery extraperitoneal sublay procedures, 30-day high-consequence events were uncommon, and most postoperative issues reflected nonprocedural wound occurrences. Defect width is the primary risk factor. Registry outcomes, expert polling, and AI synthesis all support eTEP as a safe and effective approach when performed with disciplined plane control and mechanism-based prevention strategies.