Piffaretti G, Pelozzi M, Villa F
… +4 more, Rivolta N, Tozzi M, Cervarolo MC, Franchin M
World J Surg
· 2026 Jun · PMID 42304708
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BACKGROUND: To analyze the outcomes of two different patch materials during femoral endarterectomies (FEA). METHODS: It is a ingle center, observational, retrospective cohort study. We identified all patients operated be...BACKGROUND: To analyze the outcomes of two different patch materials during femoral endarterectomies (FEA). METHODS: It is a ingle center, observational, retrospective cohort study. We identified all patients operated between January 1st, 2016-December 31st, 2023. An exact match analysis was used to identify two groups based on the type of patch: pericardial, and dacron. The primary outcomes were the freedom from patch-related complications and/or reoperations during follow-up. Secondary outcomes were the perioperative complication rate and limb salvage rate. RESULTS: We analyzed 275 patch reconstructions: 139 (50.5%) with pericardial patch, and 136 (49.5%) with dacron patch. There was no difference between the two groups either for the duration of intervention [190 (IQR, 130-262) vs. 172 (IQR, 118.7-257); p = 0.131] or the blood loss [250 (IQR, 150-500) vs. 200 (IQR, 100-500); p = 0.130]. We observed no intraprocedural deaths and only 1 (0.4%) in-hospital death. Overall, we observed 87 (31.3%) complications of which 35 (12.7%) were major. The median follow-up was 32 (IQR, 16-58) months. Overall, estimated cumulative survival was 82% ± 2 at 12 months (95% CI: 79.6-85.2) and 52% ± 3 at 60 months (95% CI: 45.3-58.9) with no difference between the two groups (p = 0.282). We encountered 19 (6.9%) patch-related reinterventions: restenosis in 10 (52.6%) and pseudoaneurysm/infection in 9 (47.4). %) cases. Freedom from patch-related reoperation was estimated 92% ± 9 at 60 months (95% CI: 87.4-94.9) without significant differences between the two groups (p = 0.810). Cox regression did not identify any predictive factors. The need for patch-related reintervention was not associated with an increased mortality (p = 0.972) or risk of major amputation was observed (p = 0.080). CONCLUSIONS: Femoral endarterectomy is safe, and mid-term outcomes are independent of the patch material used for its reconstruction.
World J Surg
· 2026 Jun · PMID 42287082
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BACKGROUND: Patients with locally advanced breast cancer (LABC) undergoing axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NACT) face substantial risk of arm morbidity and lymphedema. Axillary rever...BACKGROUND: Patients with locally advanced breast cancer (LABC) undergoing axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NACT) face substantial risk of arm morbidity and lymphedema. Axillary reverse mapping (ARM) may preserve upper-limb lymphatic drainage; however, evidence in post-NACT LABC particularly from resource-constrained settings is limited. This phase I study evaluated the feasibility of a low-cost dual-dye ARM and its impact on arm-related quality of life using LYMPH-Q. METHODS: In this prospective study, 32 patients with LABC undergoing axillary surgery after NACT were included: 16 underwent standard ALND and 16 underwent ALND with ARM. ARM was performed using fluorescein sodium injected into the ipsilateral first web space and methylene blue injected subareolarly. ARM structures were preserved when oncologically safe. LYMPH-Q Upper Extremity scores were assessed at baseline, 6 months, and 12 months. Arm circumference and lymphedema incidence were recorded. RESULTS: Baseline clinico-pathologic characteristics were comparable between groups. ARM did not significantly increase operative time (p = 0.166) or compromise nodal yield (p = 0.239). Fluorescent lymphatic channels were identified and preserved in 15/16 ARM cases. At 12 months, LYMPH-Q Symptoms scores were significantly higher in the ARM group (p = 0.039), with greater improvement from baseline p = 0.017). Lymphedema incidence was lower with ARM, though not statistically significant (p = 0.600). Increases in mid-upper arm and forearm circumference were significantly lower. CONCLUSION: Low-cost dual-dye ARM is feasible following NACT in LABC and may improve patient-reported arm symptoms while maintaining comparable operative and pathological outcomes.
Tso J, Katave C, Ehsan AN
… +16 more, Saha S, Jones A, Goyal R, Hathi P, Ranganathan S, Thiyagarajan SK, Santhaseelan Y, Choubey U, Vyas M, Vengadassalapathy S, Chauhan S, Ganesh P, Rao Venkata Mahipathy SR, Singhal M, Sabapathy SR, Ranganathan K
World J Surg
· 2026 Jun · PMID 42287071
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BACKGROUND: Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have qu...BACKGROUND: Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient-identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients. METHODS: A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi-structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach. RESULTS: A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long-term social distress. Themes for patient-proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non-medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance. CONCLUSIONS: Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient-reported solutions to mitigate FT is vital to improving patient outcomes after surgery.
Santagiuliana L, Marchetti A, Corvino G
… +7 more, Pea A, Landoni L, Esposito A, Paiella S, Malleo G, De Pastena M, Salvia R
World J Surg
· 2026 Jun · PMID 42287070
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The Cattell-Imanaga reconstruction (CIR) is considered a more physiologic reconstruction after pancreaticoduodenectomy, as it promotes a more physiological mixing of alimentary and biliopancreatic secretions and facilita...The Cattell-Imanaga reconstruction (CIR) is considered a more physiologic reconstruction after pancreaticoduodenectomy, as it promotes a more physiological mixing of alimentary and biliopancreatic secretions and facilitates endoscopic access to the anastomoses compared with traditional techniques. However, its application after total pancreatectomy (TP) has not previously been reported. This study describes the surgical technique and institutional experience with CIR, named modified CIR (mCIR), in patients undergoing open TP at a high-volume pancreatic surgery center. The mCIR positions the gastro-/duodeno-jejunostomy (G/DJ) proximally and the hepatico-jejunostomy (HJ) distally on a single transmesocolic limb. 89 patients underwent open TP with mCIR. Both en bloc and stepwise TP were performed; stepwise was mainly used for positive frozen margins (51.7%), high POPF risk (34.8%), or need for vascular resection to reduce POPF-related vascular complications (12.4%). Grade B-C biliary fistula occurred in 6.7% of patients, cholangitis secondary to hepatico-jejunostomy (HJ) stricture in 2.2%, delayed gastric emptying (DGE) in 11%, and duodeno-jejunostomy (DJ) leakage in 1.1%. An endoscopic interventional approach was generally preferred for the management of HJ complications. Major morbidity and 90-day mortality were 23.6% and 3.4%, respectively. The readmission rate was 9.7%, mainly due to infected or symptomatic collections. This is the first study to describe mCIR following TP and to report postoperative outcomes in line with previously reported results for traditional reconstruction techniques.
Cos H, Valenzuela CD, Moaven O
… +10 more, Leonard G, Stauffer J, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski A, Cha C, Cummins K, Russell G, Shen P
World J Surg
· 2026 Jun · PMID 42286966
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BACKGROUND: Readmission is considered as a surgical quality indicator. More data regarding predictors of readmission and outcomes after surgery for colorectal liver metastasis are needed. Using a propensity score match t...BACKGROUND: Readmission is considered as a surgical quality indicator. More data regarding predictors of readmission and outcomes after surgery for colorectal liver metastasis are needed. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant. METHODS: Retrospectively examined 935 patients with CLM from 2000 to 2018. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant. RESULTS: 935 patients were included in the initial sample with 896 eligible for inclusion in the propensity matching. The average age of the population was 59% and 59% male. Overall readmission rate was 8.0%. Median time to readmission was 14 days. In the propensity score matched sample, readmitted patients had higher rates of organ space infection (28% vs 2% and p < 0.0001), bile leak (26% vs 1% and p < 0.0001), and liver failure (9% vs 2% and p = 0.042). There was no difference in LOS (7 days versus six days and p = 0.40), overall survival (median 39.7 vs 41.0 months and p = 0.79), or rate of adjuvant therapy (68% for both and p > 0.99). CONCLUSION: Patients readmitted for intermediate and late complications after surgery for CLM can recover and receive adjuvant therapy with no adverse effect on overall survival. Organ space infection, bile leak, and liver failure are highly associated with readmission.
World J Surg
· 2026 Jun · PMID 42281307
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BACKGROUND: Laparoscopic liver resection (LLR) for posterosuperior (PS) segments remains technically challenging. Prior meta-analyses comparing LLR to open liver resection (OLR) often incorporated unmatched retrospective...BACKGROUND: Laparoscopic liver resection (LLR) for posterosuperior (PS) segments remains technically challenging. Prior meta-analyses comparing LLR to open liver resection (OLR) often incorporated unmatched retrospective data, introducing severe selection bias, and predated recent randomized controlled trials (RCTs). This systematic review and meta-analysis evaluates the safety, short-term recovery, and oncological efficacy of LLR versus OLR specifically for parenchymal-preserving liver resection in PS segments (Couinaud segments 1, 4a, 7, and 8). METHODS: A systematic literature search of PubMed, EMBase, Cochrane Library, and ClinicalTrials.gov was conducted through March 2026. Inclusion was strictly limited to RCTs and propensity score-matched (PSM) retrospective cohorts comparing LLR and OLR for tumors in PS segments. Major hepatectomies were intentionally excluded. Evaluated outcomes included estimated blood loss (EBL), operative time, major complications (Clavien-Dindo ≥ III), length of hospital stay (LOS), and R0 resection rate. RESULTS: Sixteen studies (2 RCTs, 14 PSM cohorts) encompassing 2372 patients (LLR = 1125; OLR = 1247) were included. In the PSM cohort, LLR significantly reduced EBL (MD = -161.07 mL; p < 0.00001) and major complications (OR = 0.55; p = 0.002), whereas RCTs showed no statistical difference but exhibited extreme heterogeneity. Both study designs confirmed LLR significantly shortened LOS (RCT: MD = -1.50 days, p = 0.003; PSM: MD = -2.30 days, p < 0.00001). For tumors isolated in segments 7 and 8, LLR required marginally longer operative time (MD = 32.59 min; p = 0.09). Oncological radicality was identical between approaches in the PSM cohorts with zero statistical heterogeneity (I = 0%). CONCLUSIONS: LLR for parenchymal-preserving resection of PS liver tumors offers a highly favorable risk-to-benefit profile. Despite a modest increase in operative time, LLR significantly reduces blood loss, lowers major complication rates, and accelerates hospital discharge without compromising R0 resection rates. This minimally invasive approach should be strongly considered as a safe alternative to OLR in specialized, high-volume hepatobiliary centers performing over 30 to 50 of these procedures annually.
Sun Y, Xu Z, Wang X
… +4 more, Tang Z, Jiang W, Huang Y, Chi P
World J Surg
· 2026 Jun · PMID 42272043
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BACKGROUND: Low rectal cancer poses unique surgical challenges due to its anatomy, complicating the balance between radical resection and functional preservation. Early-onset low rectal cancer (EO-LRC, < 50 years) adds c...BACKGROUND: Low rectal cancer poses unique surgical challenges due to its anatomy, complicating the balance between radical resection and functional preservation. Early-onset low rectal cancer (EO-LRC, < 50 years) adds complexity: it has distinct, more aggressive biological/clinical features but no age-stratified surgical guidelines. Moreover, laparoscopic surgery's efficacy in EO-LRC is controversial-though non-inferior in general low rectal cancer, EO-LRC's aggressiveness may offset its benefits. This study aims to compare oncologic outcomes of laparoscopic versus open surgery in EO-LRC patients. PATIENTS AND METHODS: In this post-hoc analysis of the LASRE trial, the cohort included 240 EO-LRC and 799 late-onset low rectal cancer (LO-LRC, ≥ 50 years) patients, and were randomly assigned to open or laparoscopic resection. Primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS). RESULTS: EO-LRC exhibited better ECOG performance status and lower ASA scores; however, they presented with more advanced disease and received more preoperative therapy. The operative time and blood loss were comparable. EO-LRC patients had a higher proportion of pN2 stage and poorly differentiated tumors. The total mesorectal excision quality and negative margins were similar. The 3-year OS (laparoscopic 91.3% vs. open 95.5%, p = 0.270) and DFS (laparoscopic 78.6% vs. open 76.1%, p = 0.657) were comparable between groups. Multivariate analysis identified preoperative therapy and pN classification as significant prognostic factors for DFS. No significant differences in oncologic outcomes were observed between groups. CONCLUSIONS: Laparoscopic TME provides non-inferior oncologic control in EO-LRC patients. The small EO-LRC sample size necessitates cautious interpretation of findings, requiring validation in larger cohorts.
Angez M, Rashid Z, Chatzipanagiotou OP
… +4 more, Mevawalla A, Abdulaziz E, Alizai Q, Pawlik TM
World J Surg
· 2026 Jun · PMID 42265895
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BACKGROUND: Prehabilitation, including preoperative exercise, nutrition optimization, behavioral support, and smoking cessation services, may improve physiological reserve in patients undergoing surgery; however, large a...BACKGROUND: Prehabilitation, including preoperative exercise, nutrition optimization, behavioral support, and smoking cessation services, may improve physiological reserve in patients undergoing surgery; however, large administrative and claims-based real-world evaluations across diverse procedure types have remained limited. METHODS: This retrospective cohort study used IBM MarketScan claims (2010-2020) to identify adults undergoing coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Prehabilitation was defined as claims for physical therapy, nutrition counseling, psychological/behavioral counseling, and smoking cessation services within 30-90 days preoperatively. Multivariable logistic regression assessed outcomes, including any major postoperative complication, readmission, and costs, adjusting for baseline patient and hospital factors. RESULTS: Among 136,674 patients, 6.6% (n = 9077) received prehabilitation. The median age was 56 (49-60), and 42.0% (n = 57,035) were female. Patients who received prehabilitation more commonly underwent pneumonectomy (15.8% vs. 11.3%) or AAA repair (4.7% vs. 3.2%) and received care at urban/metropolitan hospitals (86.9% vs. 84.7%) compared with individuals who did not undergo prehabilitation (all p < 0.001). Prehabilitation was associated with lower odds of any index complication (aOR 0.94, 95% CI 0.90-0.99) and lower risk of myocardial infarction (MI) at index hospitalization (aOR 0.78, 95% CI 0.71-0.85), 30 days (aOR 0.79, 95% CI 0.72-0.86), and 90 days (aOR 0.81, 95% CI 0.74-0.89). Moreover, patients who received prehabilitation experienced higher costs, both preoperatively (β 4227, 95% CI 3834-4621) and postoperatively (β 4020, 95% CI 2866-5173). In sub-analyses, the association between prehabilitation and lower odds of MI was maintained among CABG patients (aOR 0.83, 95% CI 0.76-0.90). CONCLUSIONS: Prehabilitation was associated with lower postoperative cardiac events but higher perioperative costs; the most favorable associations were observed among CABG patients, although these subgroup findings should be interpreted cautiously.
Allocati E, Gerardi C, Ceresoli M
… +3 more, Salminen P, Starinieri B, Podda M
World J Surg
· 2026 Jun · PMID 42251641
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BACKGROUND: This systematic review with meta-analysis aims to evaluate the current evidence comparing antibiotic therapy with the surgical gold standard (appendectomy) for the treatment of uncomplicated acute appendiciti...BACKGROUND: This systematic review with meta-analysis aims to evaluate the current evidence comparing antibiotic therapy with the surgical gold standard (appendectomy) for the treatment of uncomplicated acute appendicitis (UAA) in children and adolescents. METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO, CRD420251011305. MEDLINE and CENTRAL were systematically searched up to March 2025. Randomized controlled trials (RCTs) comparing antibiotic therapy and appendectomy in patients aged 0-18 years with UAA were included. Summary data were extracted from published reports of eligible RCTs. Full text eligibility and data extraction were performed independently by two reviewers. Primary outcome was the complication-free treatment success rate at 30 days. Secondary outcomes included recurrence and complicated appendicitis at surgery. Risk ratios (RR) with 95% CIs were calculated using a random effects model. RESULTS: Of 815 records screened, six studies met inclusion criteria and were included in the review. A clinically relevant difference emerged in terms of complication-free treatment success between the two groups (1333 participants; RR 0.90, 95% CI 0.84-0.96; I 63%; and moderate certainty of evidence) favoring surgical management over antibiotic therapy among the five studies included in the meta-analysis. Recurrence after successful NOM occurred in 6%-24% of patients at 1 year CONCLUSION: Antibiotic therapy could represent a feasible treatment option for UAA in children and adolescents, although in terms of complication-free treatment success, appendectomy remains the gold standard. TRIAL REGISTRATION: CRD420251011305.
Mammana M, Pagliarini G, Catelli C
… +5 more, Verzeletti V, Comacchio GM, Schiavon M, Dell'Amore A, Rea F
World J Surg
· 2026 Jun · PMID 42237466
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BACKGROUND: Adult, benign tracheoesophageal fistula is a life-threatening condition. The aim of this study is to report our experience with its surgical treatment, including short- and long-term outcomes. METHODS: We con...BACKGROUND: Adult, benign tracheoesophageal fistula is a life-threatening condition. The aim of this study is to report our experience with its surgical treatment, including short- and long-term outcomes. METHODS: We conducted a retrospective, single-center review of patients who underwent surgical repair of tracheoesophageal fistula at a single center from 1997 to 2023. We compared clinical characteristics and outcomes between patients operated on by different surgical techniques. Furthermore, we analyzed long-term outcomes including survival, decannulation rate, and resumption of oral intake. RESULTS: Overall, 60 patients underwent fistula repair during the study period. The main etiology was post-intubation injury (78.3%). The airway defect was repaired by direct suture, airway resection-anastomosis or flap/patch interposition in 8 (13.3%), 30 (50.0%) and 22 (36.7%) cases, respectively. The esophageal defect was repaired by double-layered suture in 56 (93.3%) cases and esophageal diversion in 4 (6.7%). Morbidity was observed in 32 patients (53.3%), including fistula relapse in 2 cases. In-hospital mortality occurred in two patients (3.3%). The overall survival, the cumulative incidence of decannulation, and of resumption of oral feeding at 5 years were 70.5%, 68.4%, and 86.6%, respectively. CONCLUSIONS: Surgical correction of tracheoesophageal fistula is challenging and requires an individualized approach. Healing of the fistula can be achieved in the majority of cases, including patients with extensive defects or under mechanical ventilation. Long-term outcomes are less satisfactory, and seem to be determined mainly by patients' comorbidities.
World J Surg
· 2026 Jun · PMID 42234620
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Colorectal cancer rates are continually increasing in Western countries exceeding over 3 million new cases annually. Hematogenous spread to the liver is the most common metastatic route, followed by transcoelomic dissemi...Colorectal cancer rates are continually increasing in Western countries exceeding over 3 million new cases annually. Hematogenous spread to the liver is the most common metastatic route, followed by transcoelomic dissemination to the peritoneum. Colorectal peritoneal metastases (CRPM) affect 5%-8% at the time of initial diagnosis and a further 10%-20% who develop recurrence. Cytoreductive surgery (CRS) is the gold-standard treatment for selected patients to achieve locoregional control.
Abdelsamad A, Alqedra J, Khalil I
… +8 more, Mohammed MK, Selim OEM, Elserafy A, Ahmed OA, Mohsen M, Elsherif A, Gebauer F, Mohamed KA
World J Surg
· 2026 Jun · PMID 42227606
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BACKGROUND: The optimal interventional approach for necrotizing pancreatitis remains debated. We performed a systematic review with network meta-analysis and proportional meta-analysis to compare endoscopic trans-gastric...BACKGROUND: The optimal interventional approach for necrotizing pancreatitis remains debated. We performed a systematic review with network meta-analysis and proportional meta-analysis to compare endoscopic trans-gastric necrosectomy (EN), minimally invasive surgical necrosectomy (MIN), and open necrosectomy (ON). METHODS: Databases were searched from inception through March 2026. Eligible studies included randomized and observational comparative studies enrolling adults with necrotizing pancreatitis requiring necrosectomy and comparing ON, MIN, and/or EN. Nine binary outcomes were assessed in a frequentist random-effects network meta-analysis. Separate proportional meta-analysis of single-arm studies pooled mortality, clinical success, complications, and need for additional surgery. Risk of bias was assessed using RoB 2 and ROBINS-I, and confidence in network estimates was assessed using CINeMA. RESULTS: Thirty-three studies were included. Nine comparative studies were included in the network meta-analysis, and 24 single-arm studies were analyzed separately. EN was associated with lower mortality, fewer complications, less new-onset multiple organ failure, less exocrine insufficiency, fewer new ICU admissions, and better overall treatment ranking than ON. EN also outperformed MIN for complications and new-onset multiple organ failure, whereas MIN was superior to ON for multiple organ failure, exocrine insufficiency, incisional hernia, and ICU admission. Bleeding, re-intervention, and new-onset diabetes did not differ significantly across techniques. In single-arm pooling, EN and MIN showed comparable mortality, clinical success, complications, and need for additional surgery. CONCLUSIONS: Endoscopic necrosectomy appears to offer the most favorable overall profile for necrotizing pancreatitis, whereas minimally invasive surgical approaches also improve several outcomes compared with open necrosectomy. Open surgery should likely remain reserved for selected rescue situations.
Peralta R, Cardona-Collazos S, Msheik A
… +4 more, Gonzalez WD, Restrepo AS, Loaiza-Cardona LM, Rubiano AM
World J Surg
· 2026 Jun · PMID 42227605
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BACKGROUND: Traumatic brain injury (TBI) remains a major cause of death and disability worldwide. Traditional classification based on the Glasgow Coma Scale (GCS) provides a shared clinical language but insufficiently ca...BACKGROUND: Traumatic brain injury (TBI) remains a major cause of death and disability worldwide. Traditional classification based on the Glasgow Coma Scale (GCS) provides a shared clinical language but insufficiently captures the biological heterogeneity, imaging variability, and contextual modifiers that influence outcomes. In January 2024, the National Institute of Neurological Disorders and Stroke (NINDS) convened a multidisciplinary working group to propose the Clinical-Biomarkers-Imaging-Modifiers (CBI-M) framework. This review aims to summarize the rationale, structure, and potential clinical relevance of the CBI-M framework for trauma and acute care surgeons. METHODS: A narrative literature review was conducted using PubMed and Scopus databases with the terms "traumatic brain injury," "classification," "biomarkers," "neuroimaging," and "personalized medicine." Articles published between 2000 and 2024 were prioritized, with emphasis on consensus statements, multicenter cohort studies (e.g., TRACK-TBI, CENTER-TBI), and materials from the NINDS TBI Classification and Nomenclature Workshop. Reference lists were manually screened to identify additional relevant publications. The review synthesizes conceptual foundations, domain structure, and practical implementation considerations of the CBI-M model. RESULTS: The CBI-M framework introduces a multidimensional and dynamic approach to TBI characterization by integrating four domains: Clinical assessment (detailed GCS components, pupillary reactivity, post-traumatic amnesia, and structured symptom documentation); Biomarkers, including GFAP, UCH-L1, S100 B, NfL, and pTau, which provide objective measures of neuronal and astroglial injury with defined temporal kinetics; Imaging, emphasizing standardized CT terminology within the first 24 h and harmonized radiologic lexicons; and Modifiers, incorporating psychosocial, environmental, and comorbidity factors that influence outcomes. This integrated model may support more comprehensive characterization of TBI, facilitate interdisciplinary communication, and enable structured documentation across trauma systems. CONCLUSIONS: The CBI-M framework represents a conceptual shift from severity-based classification toward a multidomain approach to TBI characterization. For trauma surgeons, it offers a structured framework that may support more comprehensive documentation and facilitate integration with registry-based quality improvement and translational research. At present, its role is best understood as an evolving model with potential for future clinical applicability, pending prospective validation and assessment of feasibility across diverse trauma systems.