World J Surg [JOURNAL]
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200 papers
Postoperative Function and Quality of Life of Patients With Low Rectal Cancer: A Multidimensional Comparison Between Low Anterior Resection and Abdominoperineal Resection.
Ju J, Li Y, He Q … +1 more , Wang Y
World J Surg · 2026 May · PMID 42216875 · Publisher ↗
BACKGROUND: The choice between low anterior resection (LAR) and abdominoperineal resection (APR) for low rectal cancer involves complex trade-offs between sphincter preservation and functional outcomes. OBJECTIVE: This s...
BACKGROUND: The choice between low anterior resection (LAR) and abdominoperineal resection (APR) for low rectal cancer involves complex trade-offs between sphincter preservation and functional outcomes. OBJECTIVE: This study aimed to compare overall quality of life (QoL), colorectal-specific symptoms, and functional outcomes between LAR and APR at ≥ 12 months post-surgery and to identify influencing factors. METHODS: This single-center retrospective cohort study included patients who underwent LAR or APR for low rectal cancer (≤ 5 cm from the anal verge) between January 2019 and December 2023. Patients completed validated questionnaires 12-60 months post-surgery. Inverse probability of treatment weighting was employed to adjust for baseline imbalances. RESULTS: Out of 168 eligible patients, 142 (84.5%) completed assessments (LAR n = 78, APR n = 64). After adjustment, the mean global health status was 68.3 ± 18.5 for LAR versus 71.2 ± 16.8 for APR (adjusted mean difference -2.9, p = 0.302). Major low-anterior resection syndrome affected 44.9% of LAR patients, whereas 31.3% of APR patients reported poor stoma-related QoL. Sexual dysfunction was prevalent in both groups. Neoadjuvant chemoradiotherapy and tumor distance ≤ 3 cm predicted major LARS. LARS severity did not perfectly align with QoL impairment; 20.0% of patients with minor LARS reported poor QoL, whereas 22.9% with major LARS maintained good QoL. CONCLUSIONS: No clinically meaningful difference in overall QoL was observed between LAR and APR at long-term follow-up. However, procedure-specific challenges exist; major LARS affects nearly half of LAR patients, and one-third of APR patients report poor stoma-related QoL. These findings support individualized surgical decision-making based on patient priorities and risk factors.
ERAS Is More Than Just a 48-Hour Stay and a Drained Abdomen: A Perspective on Cultural Shift and Data-Driven Surgery.
Cesana G, Olmi S, Vitale G … +2 more , Perniola C, Ghezzi K
World J Surg · 2026 May · PMID 42216874 · Publisher ↗
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Data Harmonization for Collaborative Research Among Australian and US Registries: A Case Study in Medullary Thyroid Cancer (MTC).
Moore EC, Serpell J, Ruseckaite R … +10 more , Ioannou L, Bauzon J, Romero-Velez G, Shin J, Siperstein A, Papachristos A, Sidhu S, Sywak M, Ahern S, Pourghaderi A
World J Surg · 2026 May · PMID 42210507 · Publisher ↗
BACKGROUND: Medullary thyroid cancer (MTC) is a neuroendocrine tumor comprising approximately 1%-2% of all thyroid malignancies. The rarity and more aggressive biology of MTC requires robust sample sizes to enhance our u...
BACKGROUND: Medullary thyroid cancer (MTC) is a neuroendocrine tumor comprising approximately 1%-2% of all thyroid malignancies. The rarity and more aggressive biology of MTC requires robust sample sizes to enhance our understanding of this complex disease. Harmonization is the process of standardizing raw data from multiple sources, by resolving differences in format and terminology, to create a unified dataset that can be analyzed for a common purpose. The aim of this project was to assess the feasibility of collaboration, data mapping, and harmonization among clinical sites investigating MTC internationally. METHODS: The Maelstrom guidelines were used to perform retrospective data harmonization from three clinical networks in Australia and the Unites States for adult patients with MTC, between 2018 and 2021. Data received were categorized as an exact, close, or low match. Exact and close matches were combined to form a harmonized dataset. A logistic regression analysis was then performed to determine pre-operative factors associated with the presence of cervical lymph node metastases. RESULTS: Data were received from three separate clinical networks. This comprised 114 patients, 17 hospitals and 4674 data points. The completeness of data received ranged from 57.4% to 97.3%. Overall, 80.8% of data received were suitable for harmonization including basic demographics, basis of diagnosis, genetic testing (but not results), select clinical findings, pre-operative investigations, operative details, histopathology, and TNM staging. The prevalence of palpable lymph node involvement at presentation in the harmonized dataset was 15.8%. Younger patients (less than 55 years) and patients with abnormal nodes on ultrasound were strongly associated with cervical lymph node metastases. Conversely, patients with an incidental diagnosis of MTC had markedly lower odds of presenting with cervical lymph node metastases. CONCLUSION: Data mapping and harmonization across national and international sites is feasible and enables meaningful modeling that would not be possible with individual datasets. The Maelstrom guidelines provide a useful template regarding how to achieve this efficiently. This manuscript is a white paper for clinicians and researchers studying rare diseases, such as MTC, regarding how to share heterogeneous raw data and collaborate with other clinical sites.
Association Between Preoperative Calcium Levels and the Occurrence of Postoperative PE in Trauma Patients: A Retrospective Multicenter Cohort Study.
Xiong X, Zhou M, Ren Y … +3 more , Hu P, Chen X, Mao Q
World J Surg · 2026 May · PMID 42210499 · Publisher ↗
BACKGROUNDS: Trauma patients who undergo surgery are at high risk for acute pulmonary embolism (PE). We aimed to investigate the connection between the preoperative serum calcium level of trauma patients and their risk o...
BACKGROUNDS: Trauma patients who undergo surgery are at high risk for acute pulmonary embolism (PE). We aimed to investigate the connection between the preoperative serum calcium level of trauma patients and their risk of postoperative PE. METHODS: We included 5598 trauma patients from four centers (2017-2023). Patients were categorized as Hypocalcemia (< 2.2 mmol/L) and Non-hypocalcemia (≥ 2.2 mmol/L). Propensity score matching (PSM) was used to match Hypocalcemia group and Non-hypocalcemia group 1:1. We applied logistic regression to determine the correlation between preoperative hypocalcemia and the risk of postoperative PE. We plotted the receiver operating characteristic (ROC) curve to assess the predictive value of preoperative serum calcium levels for postoperative PE. RESULTS: The overall incidence of PE in trauma patients was 2.1% (120/5598). Before and after PSM, PE in the Hypocalcemia group was significantly higher than that in the Non-hypocalcemia group [2.9% vs. 1.6%, p = 0.001] and [2.9% vs. 1.9%, p = 0.039]. Post-PSM logistic regression revealed that trauma patients with preoperative hypocalcemia had a 1.54-fold increased risk of postoperative PE formation (95% CI 1.04-2.30, p = 0.032). Within the observed range of this cohort, for every 1 mmol/L increase in preoperative serum calcium, the risk of postoperative PE formation was reduced by 62% (OR 0.38, 95% CI 0.22-0.73; p = 0.001). ROC results showed that the area under the curve (AUC) of preoperative serum calcium in predicting the occurrence of PE was 0.59 (95% CI 0.54-0.64), p = 0.001. CONCLUSION: Preoperative hypocalcemia is significantly associated with an increased risk of postoperative PE formation in trauma patients. TRIAL REGISTRATION: ChiCTR2300078097.
Outcomes After Intraoperative Hypovolemic Phlebotomy in Patients Undergoing Liver Surgery: A Meta-Analysis.
Sayed MS, Shalaby NK, Almetwaly RM … +5 more , Ibrahim AMA, Omar YM, Abu Nahla U, Abokhozima A, Abdelazeem H
World J Surg · 2026 May · PMID 42202069 · Publisher ↗
BACKGROUND: The risk of blood loss in liver surgery remains a recent concern. Recent investigations have shown that intraoperative hypovolemic phlebotomy (HP) is effective at reducing blood loss and transfusions during l...
BACKGROUND: The risk of blood loss in liver surgery remains a recent concern. Recent investigations have shown that intraoperative hypovolemic phlebotomy (HP) is effective at reducing blood loss and transfusions during liver surgery. In this meta-analysis, we seek to assess the effects of HP on patients undergoing liver surgery. METHODS: Electronic databases, PubMed, Embase, and Web of Science, were searched from inception to January 2025, with an update in November 2025. Our eligibility criteria included randomized controlled trials (RCTs) or observational studies comparing HP to standard care in patients undergoing liver surgery. A random effects model was used for analysis pooling the mean differences (MD) and risk ratios (RRs) with corresponding 95% confidence intervals (CIs). RESULTS: A total of 13 studies, with 4577 patients, were analyzed. Compared with the control group, the use of HP was associated with a lower incidence of perioperative RBC transfusion (RR: 0.55, 95% CI: [0.46 to 0.67], p < 0.0001, and I = 18.50%). Subgroup analyses showed consistent results across different subgroups according to the type of surgery: liver resection subgroup (RR: 0.57, 95% CI: [0.43 to 0.75], I = 27.87%) and liver transplantation subgroup (RR: 0.52, 95% CI: [0.42 to 0.63], I = 18.74%) (p = 0.85), and study design: RCTs subgroup (RR: 0.65, 95% CI: [0.44 to 0.96], I = 14.15%) and the observational cohort studies subgroup (RR: 0.52, 95% CI: [0.40 to 0.67], I = 34.34%) (p = 0.34). Similarly, the use of HP significantly reduced the intraoperative RBC transfusions rate (RR: 0.46, 95% CI: [0.31 to 0.68], p < 0.0001), postoperative RBC transfusions rate (RR: 0.60, 95% CI: [0.44 to 0.82], p < 0.0001), and estimated blood loss (MD: -237 mL, 95% CI: [-383.43 to -90.98], p < 0.001) compared with the control group. Secondary and safety outcomes, such as central venous pressure, hospital stay duration, and overall complications, were comparable between the two groups. The GRADE assessment indicated that the certainty of evidence for perioperative RBC transfusions was high in the RCTs subgroup but low in the observational subgroup. CONCLUSION: Among patients undergoing liver surgery, the use of HP was associated with a lower blood transfusion rate and blood loss, while maintaining an acceptable safety profile. Further large clinical trials are necessary to clarify the exact mechanism involved.
Dynamic Evolution of HER2 Expression Following Neoadjuvant Therapy and Its Association With Treatment Response and Prognosis in Breast Cancer: A Large-Scale Retrospective Study.
Wang S, Liu T, Liu X … +5 more , Liu L, Ma T, Shi Z, Liu J, Zhang J
World J Surg · 2026 May · PMID 42202038 · Publisher ↗
BACKGROUND: HER2 status in heterogeneous breast cancer (BC) can change dynamically during treatment, and is associated with prognosis and clinical decisions. Understanding the patterns of these changes may inform risk st...
BACKGROUND: HER2 status in heterogeneous breast cancer (BC) can change dynamically during treatment, and is associated with prognosis and clinical decisions. Understanding the patterns of these changes may inform risk stratification and treatment planning. METHODS: This retrospective study analyzed 3748 BC patients with residual disease following neoadjuvant therapy (NAT) (2015-2021). HER2 status was assessed according to ASCO/CAP guidelines and pathological response by the Miller-Payne grading system. Multinomial logistic regression and Cox models identified factors linked to HER2 conversion and its association with treatment response and survival outcomes. RESULTS: HER2 status post-NAT showed 22.9% overall discordance (11.2% loss; 11.7% gain), predominantly between HER2-0 and HER2-low. Multivariate analysis revealed that age ≥ 50 years was associated with reduced likelihood of HER2 gain (adjusted OR 0.69, p < 0.001), whereas HR-positivity was associated with increased likelihood (adjusted OR 1.35, p = 0.027). Intratumoral calcification (adjusted OR 0.75, p = 0.006) and clinical stage III (adjusted OR 0.77, p = 0.016) were associated with decreased risk of HER2 loss. Conversion from HER2-0 to HER2-low status was significantly associated with poorer pathological response (adjusted OR 0.47, p = 0.011) and independently predicted inferior RFS (adjusted HR 1.33, p = 0.009) and OS (adjusted HR 1.40, p = 0.032). The adverse prognostic impact of HER2 evolution was particularly pronounced in HR-positive patients (interaction p < 0.05). CONCLUSION: Dynamic alterations in HER2 status following NAT are significantly associated with treatment response and survival outcomes. For patients without pathological complete response, reassessment of HER2 status after NAT may help identify those with distinct prognostic profiles and who are potential candidates for emerging antibody-drug conjugate therapies.
Perioperative Outcomes and Complications of Laparoscopic Cholecystectomy in End-Stage Renal Disease Patients: A Prospective Comparative Study.
Manglik S, Ansari MAA, Kumar N … +3 more , Dubey SK, Ray DS, Narayan P
World J Surg · 2026 May · PMID 42185213 · Publisher ↗
BACKGROUND: End-stage renal disease (ESRD) patients have increased gallstone disease prevalence and unique perioperative challenges. In ESRD patients awaiting renal transplantation, asymptomatic gallstones identified dur...
BACKGROUND: End-stage renal disease (ESRD) patients have increased gallstone disease prevalence and unique perioperative challenges. In ESRD patients awaiting renal transplantation, asymptomatic gallstones identified during pre-transplant evaluation carry additional clinical significance given the disproportionate risk of post-transplant biliary emergencies. Limited literature exists regarding laparoscopic cholecystectomy (LC) outcomes in this population. METHODS: True prospective observational study, CTRI-registered (CTRI/2016/12/007489) was conducted from December 2016 to March 2020 at a tertiary hospital in Eastern India. ESRD patients (n = 109) on maintenance hemodialysis were matched 1:2 with controls (n = 224) based on age, sex, BMI, and gallstone characteristics. Primary outcomes included ICU admission rate, major complications (Clavien-Dindo ≥ 3), and conversion to open surgery. RESULTS: ESRD patients demonstrated significantly higher complication rates (61.5% vs. 15.2%, p < 0.001), ICU admission requirements (81.7% vs. 8.0%, p < 0.001), and conversion rates (7.3% vs. 1.8%, p = 0.009). Major complications occurred in 18.3% versus 0.9% (p < 0.001). Cardiovascular complications affected 22.0% of ESRD patients versus 1.3% of controls (p < 0.001). Mean operative time was longer (89.3 ± 28.4 vs. 76.2 ± 24.1 min, p < 0.001). Hospital stay was extended (4.2 ± 2.8 vs. 2.3 ± 1.1 days, p < 0.001). Independent risk factors for major complications included hemoglobin < 8 g/dL (OR 3.24), LVEF < 50% (OR 2.89), and ASA Grade IV (OR 4.17). Subgroup analysis showed no significant difference in comorbidity burden between asymptomatic (n = 57) and symptomatic (n = 52) ESRD patients (all p > 0.05). Thirty-day mortality was 0.9% versus 0%. CONCLUSIONS: For ESRD patients awaiting transplantation, elective pre-transplant LC is remains feasible with appropriate patient selection, preoperative optimization, and intensive postoperative monitoring, and is justified given the severe consequences of post-transplant biliary emergencies, with LC-related post-transplant complications occurring in only 12.2% of transplanted patients, all Clavien-Dindo Grade I. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2016/12/007489).
Operative Versus Selective Non-operative Management in Adult Penetrating Abdominal Trauma With Bowel or Omental Evisceration: A Systematic Review and Meta-Analysis.
Mohamed M, Makhadi S, Moeng M
World J Surg · 2026 May · PMID 42178488 · Publisher ↗
BACKGROUND: Penetrating abdominal trauma with bowel or omental evisceration has traditionally mandated exploratory laparotomy due to perceived high risk of intra-abdominal injury. Selective nonoperative management (SNOM)...
BACKGROUND: Penetrating abdominal trauma with bowel or omental evisceration has traditionally mandated exploratory laparotomy due to perceived high risk of intra-abdominal injury. Selective nonoperative management (SNOM) has gained acceptance in stable patients, but evidence specific to evisceration remains limited and controversial. OBJECTIVE: To compare outcomes of operative management versus SNOM in adults with penetrating abdominal trauma and documented evisceration. METHODS: Systematic review conducted per PRISMA 2020 guidelines. Databases searched were as follows: PubMed, Scopus, Wits Summon, and Google Scholar (1980-2025). Inclusion were as follows: adults ≥ 18 years, penetrating (stab/gunshot) trauma, documented bowel/omental evisceration, operative versus SNOM comparison, and outcomes (mortality, missed injuries, delayed therapeutic laparotomy, complications, and length of stay). Risk of bias via Newcastle-Ottawa Scale; evidence certainty via GRADE. Random-effects meta-analysis performed where feasible PROSPERO registration number: (CRD420261345559). RESULTS: From 292 records, 152 remained after deduplication; 47 full texts assessed; 20 studies included in qualitative synthesis; and 13 in meta-analysis. SNOM significantly reduced nontherapeutic laparotomy (pooled OR 0.61, 95% CI 0.46-0.80; I = 26%; and p < 0.001) without increased mortality or morbidity. Subgroup analysis showed SNOM particularly safe in isolated omental evisceration (failure < 15%), with higher therapeutic rates in bowel/organ cases. Evidence certainty was moderate (downgraded for observational design and heterogeneity). CONCLUSIONS: In hemodynamically stable patients with penetrating abdominal trauma and evisceration, SNOM appears safe and preferable in selected cases reducing unnecessary laparotomies without compromising outcomes. Prospective trials are needed to refine indications.
Building Surgical Capacity Through Multidisciplinary Laparoscopic Cholecystectomy Training in Kampong Cham, Cambodia.
Sorensen LM, Pengleap S, Darelli-Anderson AM … +12 more , Martinez AFH, Borin S, Pho K, Saman O, Vithiea D, Vutha M, Kossadyn K, Price MD, Elvira L, Richards J, Richards NG, Price RR
World J Surg · 2026 May · PMID 42177731 · Publisher ↗
BACKGROUND: Laparoscopy was first introduced in Phnom Penh, Cambodia in 2000, but remained largely confined to urban centers because of equipment costs, limited training opportunities, and infrastructural barriers. METHO...
BACKGROUND: Laparoscopy was first introduced in Phnom Penh, Cambodia in 2000, but remained largely confined to urban centers because of equipment costs, limited training opportunities, and infrastructural barriers. METHODS: A collaborative laparoscopic training program was launched at Calmette Hospital in 2022 and expanded to Kampong Cham Provincial Hospital (KCPH) in 2023. Training included didactic lectures, simulation-based skills practice, and supervised laparoscopic cholecystectomy with graduated operative responsibility before transition to independent practice by the Cambodian surgical team. Surgical volume and outcomes were compared before (January 2022-February 2023) and after program implementation (February 2023-February 2025). RESULTS: The year prior to program implementation, KCPH performed 55 open cholecystectomies. Following implementation, a total of 272 cholecystectomies were completed, including 249 laparoscopic and 23 open procedures, representing a 188.3% increase in average monthly cholecystectomy volume (3.93 vs. 11.33 and p < 0.001). Of the 249 laparoscopic cases, 19 (7.6%) were performed during the initial supervised training period (15 mentored and 4 proctored), 15 (6.0%) during a follow-up proctored visit 7 months later, and 215 (86.3%) independently by the KCPH surgical team. Nine laparoscopic procedures (4.2%) required conversion to open surgery, and seven patients (3.3%) experienced complications requiring reoperation or endoscopic intervention. The median length of stay was 4 days (IQR 3-5), and no perioperative mortality occurred. CONCLUSION: Structured multidisciplinary training enabled safe adoption of laparoscopic cholecystectomy in a Cambodian provincial hospital. The program increased access, maintained safety, and offers early evidence of a replicable model for expanding minimally invasive surgery in Cambodia.
How to Promote Minimally Invasive Esophagectomy Safely and Contribute to Improved Prognosis of Esophageal Cancer Patients in the Neoadjuvant Treatment Era?
Nabeya Y, Shuto K
World J Surg · 2026 May · PMID 42177671 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Impact of Early Oral Feeding on Post-Operative Morbidity After Esophagectomy: A Systematic Review and Meta-Analysis.
Jena D, Feng L, Addo-Osafo K … +7 more , Rouhi A, Kung JY, Jatana S, Verhoeff K, Jogiat U, Turner SR, Bédard ELR
World J Surg · 2026 May · PMID 42177669 · Publisher ↗
BACKGROUND: Anastomotic leak and post-operative pneumonia are major contributors to postoperative morbidity following esophagectomy and have traditionally led to delays in oral feed initiation. Newer evidence, however, s...
BACKGROUND: Anastomotic leak and post-operative pneumonia are major contributors to postoperative morbidity following esophagectomy and have traditionally led to delays in oral feed initiation. Newer evidence, however, suggests early initiation of feeds may be safe. The aim of this systematic review and meta-analysis is to assess the safety of initiation of oral feeds on postoperative day one versus delayed initiation. METHODS: A systematic search was conducted on six databases and studies were included if they compared safety outcomes of adult esophagectomy patients initiating feeds on postoperative day one versus delayed imitation. A random-effects meta-analysis with restricted maximum likelihood was performed and study quality was assessed with the Newcastle-Ottawa Scale. RESULTS: Ten studies with a total of 1714 patients were included. Our primary outcome of anastomotic leak showed no significant between the early and delayed oral feeding group (8 studies, OR 0.92, 95% CI 0.59-1.41, p = 0.69). For the secondary outcomes, there was no difference in length of stay (4 studies, mean difference -2.27 days, 95% CI -5.13 to 0.60, p = 0.12) and there was decreased odds of postoperative pneumonia (9 studies, OR 0.74, 95% CI 0.58-0.95, p = 0.02). CONCLUSIONS: Initiating oral intake on postoperative day one after esophagectomy does not increase length of stay or risk of anastomotic leak and postoperative pneumonia. These findings support consideration of early oral feeding as a safe component of perioperative care when applied appropriately.
Who Should Undergo Drain Studies After Percutaneous Drainage in Complicated Diverticulitis?
Froehlich MH, Wady H, Roy IV … +5 more , Smithy WB, Yelika SB, Ahn NJ, Denoya PI, Nagle DA
World J Surg · 2026 May · PMID 42161572 · Publisher ↗
INTRODUCTION: This study evaluated the role of interval drain studies following percutaneous abscess drainage in complicated diverticulitis. We sought to identify patients who would benefit from these studies by assessin...
INTRODUCTION: This study evaluated the role of interval drain studies following percutaneous abscess drainage in complicated diverticulitis. We sought to identify patients who would benefit from these studies by assessing predictive factors for a positive drain study (PDS). METHODS: A single institution cohort study was performed on patients undergoing interval drain study following percutaneous abscess drainage for complicated diverticulitis. PDS was defined as persistence of abscess, increased size of abscess, or fistula formation. Demographics, admission data, drain study-specific findings, and readmission rates were assessed. RESULTS: A total of 133 patients underwent drain studies. A total of 28 (21.1%) patients had a PDS and 105 (78.9%) had negative drain studies (NDS). PDS patients were more likely to have prior episodes of diverticulitis (50.0% vs. 33.3%, p = 0.045). Mean percent decrease in pre-to post-drain WBC was smaller in PDS patients (-8.7 vs. -17.9%, p < 0.001). A total of 78.6% of PDS patients had a persistent abscess and 14.3% had an increase in size of their abscess. Re-admission rate was higher in PDS patients (39.3% vs. 19.0%, p = 0.025). Prior history of diverticulitis, elevated BMI, and elevated pre- and post-drain WBC were predictors of PDS. Only prior history of diverticulitis (HR: 3.21, 95% CI: 1.14-9.03) was an independent predictor of PDS on multivariate analysis. CONCLUSION: Patients with prior episodes of diverticulitis were more likely to have PDS following percutaneous abscess drainage in complicated diverticulitis, with elevated BMI and percent decrease in pre-drain leukocytosis also being associated with PDS. These patients should receive stronger consideration for interval drain study.
Exploring the Impact of Anesthesia on Postoperative Frailty Trajectories in Older Adults.
Wubet HB, Gobezie NZ, Belete KG … +5 more , Deress GM, Demissie B, Abate BJ, Simegn A, Asmare TB
World J Surg · 2026 May · PMID 42161534 · Publisher ↗
PURPOSE: Frailty is a dynamic perioperative condition influenced by anesthetic care; however, limited data exist on how anesthesia affects postoperative frailty trajectories. This scoping review examines the effects of p...
PURPOSE: Frailty is a dynamic perioperative condition influenced by anesthetic care; however, limited data exist on how anesthesia affects postoperative frailty trajectories. This scoping review examines the effects of perioperative anesthesia techniques on frailty trajectories in older surgical patients. SOURCES: We searched PubMed, ScienceDirect, the Directory of Open Access Journals (DOAJ), and Google Scholar for studies on preoperative and postoperative frailty assessments, along with anesthesia-related data, focusing on individuals aged 60 and older undergoing surgery. We extracted key information regarding frailty, anesthesia methods, study design, and patient characteristics. PRINCIPAL FINDINGS: A total of 34 studies were included, screening 41,313 records across 16 countries, with the majority originating from China (29.4%) and the United States (14.7%). Preoperative frailty was reported in 18.3%-43.9% of patients and was a strong predictor of negative postoperative outcomes, including mortality, delirium, prolonged ICU stays, and extended hospitalization. The evidence also suggests that the type of anesthesia and targeted perioperative management strategies-particularly regional anesthesia, multimodal approaches, and intraoperative hemodynamic control mechanisms-significantly improve postoperative frailty trajectories and cognitive outcomes. CONCLUSION: Frailty is a dynamic perioperative condition significantly influenced by anesthesia, rather than being merely a static preoperative risk indicator. This scoping review demonstrates that regional and multimodal anesthetic techniques can positively influence postoperative frailty trajectories and reduce neurocognitive decline, especially when combined with hemodynamic optimization. Therefore, integrated perioperative pathways, tailored anesthetic selection, and routine frailty screening have become essential for practicing surgeons and anesthesiologists. In the increasingly aging surgical population, we conclude that optimizing anesthesia care represents a crucial yet underutilized opportunity to maintain functional independence, reduce complications, and enhance long-term recovery.
Trends in Female Representation Across Five Competitive Surgical Specialties (2013-2025): A Call for Sustained Equity Efforts.
Sharma M, Sharma V, Sinnott B … +6 more , Davis A, LaChance D, Das A, Homlar K, Isales C, Fulzele S
World J Surg · 2026 May · PMID 42157463 · Publisher ↗
BACKGROUND: Parity in medical school admissions has improved, yet female representation remains disproportionately low in many competitive surgical specialties. Although initiatives promoting equity by sex in medicine ha...
BACKGROUND: Parity in medical school admissions has improved, yet female representation remains disproportionately low in many competitive surgical specialties. Although initiatives promoting equity by sex in medicine have gained momentum, their long-term impact on surgical residency programs across various specialties remains unclear. OBJECTIVE: This study evaluated 12-year trends (2013-2025) in sex representation among applicants and residents in five highly competitive US surgical specialties: neurosurgery, orthopedic surgery, plastic surgery (integrated), thoracic surgery (integrated), and vascular surgery (integrated). METHODS: Publicly available data from the Accreditation Council for Graduate Medical Education (ACGME) and Association of American Medical Colleges (AAMC) were analyzed to assess sex-based trends among U.S. medical school matriculants and quantify yearly changes in the number and percentage of female applicants and active residents. Longitudinal trends were assessed to evaluate both proportional representation and retention across specialties. RESULTS: From 2013 to 2025, female matriculants to US M.D.-granting schools rose from 47.20% to 55.10%, exceeding 50% since 2017. All five surgical specialties showed an increase in the number of female applications, with orthopedic surgery showing the greatest number of applicants (127-419). Plastic surgery showed the highest percentage of female applicants in 2024-2025 (53.38%), followed by vascular surgery (33.19%), thoracic surgery (31.58%), neurosurgery (27.43%), and orthopedic surgery (23.77%). Representation of active female residents and acceptance rates also increased across all surgical specialties. Upward trends were consistent in neurosurgery, orthopedic surgery, and plastic surgery, whereas thoracic surgery and vascular surgery exhibited more fluctuation. CONCLUSIONS: Despite rising acceptance rates, sex-based inequity remains in competitive surgical specialties. Plastic surgery is an outlier, with female applicants constituting the majority, in line with trends in medical school matriculation. However, women remain underrepresented in orthopedic surgery and neurosurgery. Sustaining progress will require targeted efforts to address cultural and institutional barriers, expand mentorship, and foster supportive training environments.
Medical Versus Surgical Management of Acute Appendicitis in a Regional Hospital in South Africa: A Six-Year Review.
Hall JD, Nel D, Stark AH … +4 more , van de Vyver M, Nguyen P, Seedat N, Hall DR
World J Surg · 2026 May · PMID 42153580 · Publisher ↗
BACKGROUND: Appendectomy is the current standard of care for acute appendicitis. However, accumulating international evidence suggests that medical antibiotic therapy is not inferior to appendectomy. Local factors may wo...
BACKGROUND: Appendectomy is the current standard of care for acute appendicitis. However, accumulating international evidence suggests that medical antibiotic therapy is not inferior to appendectomy. Local factors may work for and against a medical approach. While prospective randomized trials are still to be performed in a South African setting, this study aimed to describe existing data within a geographically defined area. MATERIALS AND METHODS: A retrospective audit from 01/01/2018-31/12/2023 was performed at George Regional Hospital, South Africa. All adults and children over 12 years with a clinical or radiological diagnosis of acute appendicitis, without complicated disease mandating direct surgical appendectomy, were identified and separated into two groups, namely, those with initial medical management and those who underwent direct appendectomy. The primary aims were to compare the presentations and outcomes of acute appendicitis managed by antibiotic therapy or appendectomy. Secondary aims included describing the proportion of cases eligible for medical management, as well as post-treatment complications, including the recurrence rate. Analysis was descriptive and comparative with patients grouped as Direct Surgery (DS), Antibiotics Successful (AS) and Antibiotics Unsuccessful (AU). RESULTS: Direct surgical appendectomy was performed on 44% of the 650 cases. Of 365 (56%) cases that received antibiotic therapy, 190 (52%) were discharged without symptoms (AS), while 175 (48%) failed antibiotic therapy and underwent surgical appendectomy (AU) during first admission. Of the 190 patients who were discharged after antibiotic therapy only, 16 had recurrent symptoms, of which 14 underwent surgery and 2 had repeat antibiotic therapy. When comparing the AS to AU group, AS cases had a lower median heart rate (89 vs. 95 bpm; p < 0.05), lower C-reactive protein level (51 vs. 108 mg/L; p < 0.01) and lower Alvarado score (6 vs. 7; p < 0.01). Patients in the AS group had a median hospitalization of one day less than the DS group (p < 0.001), and two days less than the AU group (p < 0.001). When compared with DS, patients in the AU group experienced significantly fewer (p < 0.001) Clavien-Dindo grade 3-5 events. CONCLUSION: Half of patients with acute appendicitis treated medically, safely avoided appendectomy. In this context, antibiotic therapy may be considered in selected patients.
Liberating Surgical Capacity Through Enhanced Recovery: Health-System Effects of ERAS Adherence in Resource-Constrained Surgical Systems.
Kesharwani R, Raj S, Raikar AR … +6 more , Godinho SF, Singaraju RR, Patel D, Vishnoi A, Ali R, Vaghani R
World J Surg · 2026 May · PMID 42153572 · Publisher ↗
Limited surgical capacity remains a major barrier to timely care, particularly in resource-constrained health systems. An estimated five billion people lack access to safe and affordable surgical care, emphasizing the ne...
Limited surgical capacity remains a major barrier to timely care, particularly in resource-constrained health systems. An estimated five billion people lack access to safe and affordable surgical care, emphasizing the need to improve efficiency within existing resources. Enhanced recovery after surgery (ERAS) pathways improve postoperative recovery through standardized perioperative care, and higher protocol adherence is associated with better clinical outcomes. However, the broader health-system effects of ERAS adherence, particularly on hospital bed utilization and surgical capacity, remain insufficiently quantified. This study evaluated the association between ERAS adherence and postoperative outcomes and estimated its impact on hospital bed utilization.
Application of AmCAD-UT in Active Surveillance of Papillary Thyroid Microcarcinoma and Suspicious Subcentimeter Thyroid Nodules: A Prospective Agreement Study.
Ge Y, Zheng B, He Y
World J Surg · 2026 May · PMID 42153565 · Publisher ↗
Bland-Altman plots for agreement between radiologist and AmCAD‑UT measurements.
Bland-Altman plots for agreement between radiologist and AmCAD‑UT measurements.
Worse Prognosis of Patients With Hepatocellular Carcinoma and Portal Vein Invasion Underestimated by Imaging.
Nakamura M, Okamura Y, Aramaki O … +8 more , Yoshida N, Mitsuka Y, Abe H, Inagaki S, Yamagishi S, Okumura Y, Okada M, Masuda S
World J Surg · 2026 May · PMID 42153560 · Publisher ↗
BACKGROUND: Portal vein invasion is closely linked to poor prognosis in hepatocellular carcinoma (HCC). However, no study has directly compared preoperative imaging with postoperative histopathological diagnoses of porta...
BACKGROUND: Portal vein invasion is closely linked to poor prognosis in hepatocellular carcinoma (HCC). However, no study has directly compared preoperative imaging with postoperative histopathological diagnoses of portal vein invasion. This study evaluated the prognostic impact of underdiagnosed portal vein invasion in patients undergoing hepatectomy. METHODS: We retrospectively reviewed 1328 patients who underwent initial hepatectomy for HCC from January 2000 to December 2020. Portal vein invasion was classified as Image-Vp0-4 based on preoperative imaging and vp0-4 based on postoperative pathology. Underdiagnosis was defined as IVp < vp; otherwise, IVp ≥ vp. Gross invasion was defined as vp2-4, and non-gross invasion as vp0/1. RESULTS: Pathological staging stratified overall survival (OS) more clearly than imaging (median OS: vp0 = 7.9 years; vp1 = 5.6; vp2 = 2.5; vp3 = 1.6; vp4 = 0.5), while Image-Vp showed less consistent trends (Vp0-4 = 7.9; 7.6; 9.5; 1.6; 0.5 years). Underdiagnosis occurred most frequently in Image-Vp0 and vp1 cases (16.7%). Patients with IVp < vp had significantly worse OS than those with IVp ≥ vp (5.6 vs. 7.9 years, p < 0.001). Among vp0/1 patients, OS was significantly shorter in underdiagnosed cases (5.8 vs. 7.9 years, p < 0.001), whereas in vp2-4 cases, underdiagnosis had no significant effect (3.9 vs. 1.6 years, p = 0.317). CONCLUSIONS: Underdiagnosis of vp1 was associated with significantly reduced survival in HCC patients, despite negative imaging findings. These results highlight the critical role of postoperative histopathology in accurately assessing portal vein invasion.
Management of Radial Scars and Complex Sclerosing Lesions of the Breast: To Excise or Not to Excise?
Zakem N, Addie M, Josey V … +4 more , Florea A, Prakash I, Wong SM, Meterissian S
World J Surg · 2026 May · PMID 42148712 · Publisher ↗
BACKGROUND: Radial scars (RS) and complex sclerosing lesions (CSL) are benign breast lesions often detected incidentally on imaging. Although historically managed with surgical excision, emerging evidence suggests that c...
BACKGROUND: Radial scars (RS) and complex sclerosing lesions (CSL) are benign breast lesions often detected incidentally on imaging. Although historically managed with surgical excision, emerging evidence suggests that conservative management may be appropriate in selected patients. This study evaluated rates of upgrade and progression of RS and CSL and examined factors associated with surgical management and these outcomes. METHODS: A retrospective cohort study was conducted at two academic centers affiliated with McGill University. Adult patients diagnosed with RS or CSL on image-guided core needle biopsy between 2010 and 2024 were included. Upgrade or progression was defined as a subsequent diagnosis of invasive carcinoma, carcinoma in situ (including ductal carcinoma in situ [DCIS] or pleomorphic lobular carcinoma in situ), or high-risk lesion (HRL), including atypical ductal hyperplasia (ADH). Descriptive statistics and univariate analysis were used to evaluate associations between clinicopathologic factors and outcomes. RESULTS: Among 185 patients, 49 (26.5%) underwent surgical excision and 136 (73.5%) were managed non-operatively. Surgical pathology revealed 1 invasive carcinoma (2.0%), 5 DCIS (10.2%), and 4 HRL (8.2%). In the non-surgical group, 3 patients (2.2%) subsequently developed invasive carcinoma; no DCIS or HRL developed over a median follow-up of 37 months. Presence of a palpable mass was the only factor that predicted surgical management (OR 2.65, 95% CI 1.06-6.60, p = 0.036); no other clinicopathologic or imaging features were associated with upgrade or progression. CONCLUSIONS: Although the surgical cohort demonstrated a higher-than-expected upgrade rate, most upgrades consisted of DCIS or HRL, and progression among non-surgically managed patients was rare after more than 3 years of follow-up. These findings suggest that RS and CSL are rarely associated with clinically significant disease, supporting surveillance as an appropriate management strategy in contemporary practice.
A SEER Registry-Based Analysis of the Management Strategies and Survival Outcomes of Colorectal Cancer With Isolated Synchronous Lung Metastases.
Emile SH, Perets M, Kahana N … +2 more , Boutros M, Wexner SD
World J Surg · 2026 May · PMID 42143670 · Publisher ↗
BACKGROUND: Current treatment guidelines for stage IV colorectal cancer (CRC) with isolated synchronous lung metastases are limited. This study aimed to assess the association between management strategies and cancer-spe...
BACKGROUND: Current treatment guidelines for stage IV colorectal cancer (CRC) with isolated synchronous lung metastases are limited. This study aimed to assess the association between management strategies and cancer-specific survival (CSS). METHODS: This study was a retrospective cohort analysis of patients with stage IV colorectal adenocarcinoma and isolated synchronous lung metastases from the SEER registry (2010-2022). Patients were grouped by treatment strategy: surgery-only, chemotherapy-only, or combined surgery and chemotherapy. The main outcome measure was 3-year CSS, assessed by Kaplan-Meier statistics and multivariable Cox regression to adjust for survival confounders. RESULTS: 5666 (6.9%) of 82,502 patients with stage IV CRC had isolated lung metastases. 736 (13%) were treated with surgery-only, 1870 (33%) chemotherapy-only, and 1908 (33.6%) surgery and chemotherapy; no treatment was recorded in 20.3% of patients. Chemotherapy alone was increasingly used over time (from 33.8% to 51.1%), whereas combined treatment decreased. Combined surgery and chemotherapys was associated with the highest 3-year CSS (55.1%) compared with chemotherapy-only (26.1%) and surgery-only (21.7%) (p < 0.001). Resection of both primary CRC and lung metastases combined with chemotherapy conferred the best 3-year CSS (66.2%). Combined surgery for primary and metastatic tumors and chemotherapy was associated with significant mortality risk reduction (HR 0.31, p < 0.001) compared with chemotherapy-only. Older age, signet-ring cell histology, poor differentiation, N2 primary disease, elevated CEA, and perineural invasion were associated with reduced CSS. CONCLUSIONS: Combined resection of primary CRC and synchronous lung metastases with chemotherapy was associated with the best survival outcomes. However, use of this combined strategy is employed in select patients and has decreased over time.
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