Mohamedahmed AY, Zaman S, Mohammed S
… +5 more, Saleh SAJ, Adam MA, Louw J, Chao TE, Chu K
World J Surg
· 2026 May · PMID 42138184
·
Publisher ↗
BACKGROUND: Laparoscopic surgery offers substantial benefits compared to open surgery, yet access to structured laparoscopic training remains limited in low- and middle-income countries (LMICs). This systematic review ai...BACKGROUND: Laparoscopic surgery offers substantial benefits compared to open surgery, yet access to structured laparoscopic training remains limited in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence on training interventions, methods, and outcomes of laparoscopic education programs in LMICs. METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was performed from 1990 to September 2025, including studies that reported laparoscopic training programs conducted in LMICs as defined by the World Bank classification. Data were extracted on study setting, training method, participant characteristics, and outcomes. Due to heterogeneity of study designs and interventions, a narrative synthesis was conducted. RESULTS: Nineteen studies were included, spanning Africa, Latin America, Asia, and the Caribbean. Training methods were diverse, encompassing low-cost simulators, telesimulation and telementoring, structured curricula, international collaborations, and virtual or remote learning. Participant groups ranged from small cohorts of residents and rural surgeons to large-scale programs training thousands of practitioners. Reported outcomes consistently demonstrated improved technical skills, increased knowledge and confidence, high participant satisfaction, and evidence of feasibility and cost-effectiveness. Longitudinal implementation studies in Ghana and Ethiopia highlighted progressive adoption of laparoscopy with increasing independence of local surgeons. Barriers identified included limited access to equipment, lack of simulation laboratories, and insufficient integration into formal curricula. CONCLUSIONS: Laparoscopic training in LMICs is feasible, effective, and increasingly diverse in delivery models. Innovative low-cost simulators, telesimulation, and structured curricula have proven particularly successful in overcoming resource constraints. Expansion of sustainable context-appropriate training programs is essential to strengthen surgical capacity in LMICs.
Ramírez-Sandoval JC, Cojuc-Konigsberg G, Canaviri-Flores VA
… +6 more, Zavala-Miranda F, Hernández-Calderón A, Anaya-Sánchez S, Perez-Soto RH, Buerba GA, Velazquez-Fernández D
World J Surg
· 2026 May · PMID 42132369
·
Publisher ↗
BACKGROUND: The utility of intraoperative parathyroid hormone (IOPTH) monitoring during subtotal parathyroidectomy to predict long-term intact PTH levels in kidney failure remains uncertain. METHODS: Diagnostic accuracy...BACKGROUND: The utility of intraoperative parathyroid hormone (IOPTH) monitoring during subtotal parathyroidectomy to predict long-term intact PTH levels in kidney failure remains uncertain. METHODS: Diagnostic accuracy study in a cohort of 46 patients with severe, uncontrolled secondary hyperparathyroidism. IOPTH was measured before incision and at 10- and 30-min post-excision. Sensitivity, specificity, and AUC-ROC were assessed for predicting surgical success-defined as iPTH < 300 pg/mL (KDOQI criterion) over 6 months. We also assessed KDIGO criterion as secondary outcome (iPTH < 9× the upper limit of normal, defined as 792 pg/mL) All patients received postoperative calcium and active vitamin D. RESULTS: Surgical success was achieved in 37 (80%) patients using the KDOQI criterion. Compared with the failure group, the KDOQI success group had lower median 10-min IOPTH (186 pg/mL vs. 495 pg/mL, p < 0.001) and 30-min IOPTH (112 pg/mL vs. 495 pg/mL, p < 0.001). The 10-min percentage decline in IOPTH was also greater in patients who experienced KDOQI success (91% vs. 85%, p = 0.008). AUCs for 10- and 30-min IOPTH in predicting KDOQI success were 0.86 (95% CI: 0.72-1.00) and 0.86 (95% CI: 0.73-1.00), respectively. AUCs for percentage decline at 10 and 30 min were 0.78 (95% CI: 0.63-0.92, p = 0.03) and 0.75 (95% CI: 0.60-0.92, p = 0.02), respectively. A 10-min IOPTH < 270.7 pg/mL yielded 89% sensitivity and 68% specificity for predicting KDOQI success. Using KDIGO criterion, 41 (89%) patients achieved surgical success, with similar trends observed. CONCLUSIONS: In severe secondary hyperparathyroidism due to kidney failure, 10-min IOPTH is a strong predictor of surgical success, with < 270 pg/mL suggesting better outcomes; percentage decline and 30-min values add little benefit.
Kawaguchi T, Watanabe F, Kaneda S
… +2 more, Ito D, Kawaguchi K
World J Surg
· 2026 Jun · PMID 42132368
·
Full text
BACKGROUND: The da Vinci SP enables single-port robot-assisted thoracoscopic surgery and this modality represents a novel approach to lung resection via the subcostal arch technique. We implemented this technique at our...BACKGROUND: The da Vinci SP enables single-port robot-assisted thoracoscopic surgery and this modality represents a novel approach to lung resection via the subcostal arch technique. We implemented this technique at our institution, performed 30 surgeries, and then compared the outcomes with those of surgeries using the da Vinci Xi system. METHODS: Thirty consecutive patients in each group with stage I-III lung cancer, who were all operated on with da Vinci SP and Xi, were compared. RESULTS: The SP group included 24 lobectomies and 6 segmentectomies. The Xi group included 16 lobectomies, 1 bilobectomy, and 13 segmentectomies. No conversion was required in either group. An additional port was needed in two cases in the SP group. There were no significant differences in the perioperative outcomes between the SP and Xi groups. Postoperative complications occurred in two patients in the SP group and nine patients in the Xi group. No complications classified as Clavien-Dindo grade ≥ 3 were observed in the SP group. CONCLUSIONS: Anatomic lung resection using the da Vinci SP system demonstrated outcomes that were comparable to those of the da Vinci Xi system. TRIAL REGISTRATION: Clinical registration number: approval number, H2025-092; date of approval, 2025.6.3, Mie university Hospital.
Camara AF, Elvam A, O'Connor JM
… +4 more, O'Connor Z, Schaeffer HD, Skavdahl DH, Tchoba S
World J Surg
· 2026 May · PMID 42132361
·
Publisher ↗
The mounting evidence for an antibiotic-only treatment approach to acute appendicitis has to some extent only added more uncertainty to the surgeon working in the low-resource setting.The mounting evidence for an antibiotic-only treatment approach to acute appendicitis has to some extent only added more uncertainty to the surgeon working in the low-resource setting.
Manasrah A, Ayyad A, Abu Suilik H
… +6 more, Zibara Z, Alalawneh A, Bataineh Z, Rjoub S, Al Akash MA, Tanashat M
World J Surg
· 2026 May · PMID 42128818
·
Publisher ↗
BACKGROUND: Surgical site infections (SSIs) are among the most frequent postoperative complications, contributing significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs. Prophylactic...BACKGROUND: Surgical site infections (SSIs) are among the most frequent postoperative complications, contributing significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs. Prophylactic negative pressure wound therapy (ciNPWT) has emerged as a potential strategy to reduce SSIs, particularly in abdominal surgery, but its effectiveness remains debated. OBJECTIVE: To evaluate the effectiveness of ciNPWT in reducing SSI rates and other surgical outcomes following abdominal surgery by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: We performed a comprehensive meta-analysis of RCTs assessing the use of ciNPWT versus standard wound care in abdominal surgeries including mixed wound contamination classes (e.g., clean-contaminated to contaminated/dirty procedures). The protocol was registered with PROSPERO (https://www.crd.york.ac.uk/prospero/Registration ID: CRD420251005562). Primary outcomes included SSI incidence, while secondary outcomes comprised mortality, hematoma, hospital readmission, reoperation, length of stay, and other incisional complications. Sensitivity analyses and trial sequential analyses were conducted to assess the robustness of findings. RESULTS: A total of 11 studies involving 2519 patients were included. NPWT significantly reduced the risk of surgical site infection compared to standard dressings (RR = 0.61 (95% CI: 0.44-0.86); p = 0.004). Substantial heterogeneity was present (I = 66%; p for heterogeneity = 0.001), which was not resolved by sensitivity analyses. No significant differences were observed in mortality (RR = 0.90 (95% CI: 0.48-1.69); p = 0.74), hematoma (RR = 0.75 (95% CI: 0.37-1.52); p = 0.42), or bleeding (RR = 0.54 (95% CI: 0.15-2.02); p = 0.36). NPWT showed no significant effects on readmission (RR = 0.65 (95% CI: 0.37-1.16); p = 0.15), reoperation (RR = 1.27 (95% CI: 0.45-3.58); p = 0.66), or length of hospital stay (MD = -0.32 (95% CI: -0.81 to 0.18); p = 0.21). Trial sequential analysis (TSA) confirmed the robustness of the primary outcome, and sensitivity analyses supported the consistency of results. CONCLUSIONS: ciNPWT appears effective in reducing SSIs in abdominal surgery, yet its broader clinical value remains uncertain due to inconsistent benefits across secondary outcomes and unresolved heterogeneity. Future studies should focus on standardizing ciNPWT protocols, identifying high-risk subgroups, and evaluating cost-effectiveness, particularly in resource-limited settings.
World J Surg
· 2026 Jun · PMID 42115755
·
Publisher ↗
BACKGROUND: Spermatic cord lipomas (SCLs) are benign adipose lesions commonly encountered during inguinal hernia evaluation or surgery. Their clinical significance lies in their frequent mimicry of inguinal hernias and o...BACKGROUND: Spermatic cord lipomas (SCLs) are benign adipose lesions commonly encountered during inguinal hernia evaluation or surgery. Their clinical significance lies in their frequent mimicry of inguinal hernias and other inguinoscrotal masses, which may lead to diagnostic confusion and inappropriate management. METHODS: A systematic review of literature from databases including PubMed, Scopus, Embase, and SpringerLink was conducted. Studies focusing on prevalence, diagnosis, management, and outcomes of SCLs were included. RESULTS: SCLs account for 30%-35% of benign spermatic cord tumors and are often confused with inguinal hernias. Imaging modalities such as ultrasound, CT, and MRI have improved diagnostic accuracy. Surgical excision remains the primary treatment, with both open and laparoscopic techniques showing high success rates. CONCLUSION: Increased awareness of SCLs among surgeons is crucial for accurate diagnosis and optimal management. Further research is needed to evaluate long-term outcomes of surgical versus conservative management.
Turyagumanawe J, Mukiibi E, Kakooza J
… +14 more, Mugenyi M, Mumbere BV, Safiriyu AA, Kazigo AK, Kabuye U, Bwaga I, Nyende L, Bukyana S, Ibudi E, Naziru R, Bitamazire D, Lewis CR, Akankwasa P, Hakizimana T
World J Surg
· 2026 Jun · PMID 42115142
·
Publisher ↗
BACKGROUND: Surgical site infections remain disproportionately common in low- and middle-income countries (LMICs). We systematically reviewed and meta-analyzed evidence comparing chlorhexidine-alcohol (CHG-ALC) and povid...BACKGROUND: Surgical site infections remain disproportionately common in low- and middle-income countries (LMICs). We systematically reviewed and meta-analyzed evidence comparing chlorhexidine-alcohol (CHG-ALC) and povidone-iodine (PI) for preoperative skin antisepsis in abdominal surgery in LMICs. METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Lens.org from January 2015 to October 2025 for randomized trials and prospective cohort studies conducted in LMICs that compared CHG-ALC with PI and reported SSI outcomes after abdominal surgery. Because some eligible studies included mixed wound classifications, we performed a primary pooled analysis across eligible abdominal procedures and a pre-specified sensitivity analysis restricted to studies limited to clean-contaminated wounds. Study-level risk ratios (RRs) were pooled using a random effects model, and heterogeneity and publication bias were assessed using I, τ, Cochran's Q statistics, Egger's regression, and funnel plot-based methods. RESULTS: Fifteen studies including 7459 patients were analyzed. Overall, CHG-ALC was associated with a lower risk of SSI than PI (RR = 0.61, 95% CI 0.46-0.80; p < 0.001; and I = 0%). This effect remained significant when the largest trial was excluded (RR = 0.58, 95% CI 0.46-0.71) and when analysis was restricted to studies enrolling only clean-contaminated wounds (RR = 0.59, 95% CI 0.45-0.77; I = 0%). Regional subgroup analysis showed consistent benefit in South Asia (RR = 0.58, 95% CI 0.46-0.71; I = 0%), whereas evidence in sub-Saharan Africa was inconclusive (RR = 0.88, 95% CI 0.35-2.21; I = 90.8%). CONCLUSION: CHG-ALC appears more effective than PI for reducing SSI after abdominal surgery in LMICs overall, with the most consistent evidence observed in South Asia. However, evidence from sub-Saharan Africa remains limited and heterogeneous. These findings support context-specific implementation and the need for additional African trials focused on abdominal procedures and clearly defined wound classes.
Miyoshi Y, Hashida S, Ohki M
… +4 more, Yamamoto S, Ikeda H, Hayashi N, Tsukuda K
World J Surg
· 2026 May · PMID 42112895
·
Publisher ↗
AIM: This study evaluated the safety and appropriateness of early laparoscopic cholecystectomy (LapC) for acute cholecystitis classified as high-risk according to the Tokyo Guidelines 2018 (TG18). METHODS: We retrospecti...AIM: This study evaluated the safety and appropriateness of early laparoscopic cholecystectomy (LapC) for acute cholecystitis classified as high-risk according to the Tokyo Guidelines 2018 (TG18). METHODS: We retrospectively analyzed 126 patients who underwent early LapC between January 2023 and August 2024. Patients were classified into high-risk (n = 67) and low-risk (n = 59) groups based on TG18 criteria. Primary endpoints were in-hospital mortality and major complications (Clavien-Dindo ≥ IIIa). RESULTS: No in-hospital mortality occurred. Major complications were observed in seven patients (5.6%) with no significant difference between groups (6.0% vs. 5.1%, p = 0.467). Grade 3 cholecystitis was independently associated with overall complications (adjusted OR 3.12, 95% CI 1.03-21.47, p = 0.046). Among Grade 1-2 cases, neither age-adjusted Charlson Comorbidity Index (AA-CCI) nor American Society of Anesthesiologists Physical Status (ASA-PS) correlated with complications, whereas higher preoperative C-reactive protein was an independent predictor (adjusted OR 1.05, 95% CI 1.00-1.10, p = 0.037). CONCLUSION: In our single-center experience, early LapC was safely performed in TG18-defined high-risk patients with Grade 1-2 cholecystitis. Traditional static risk indicators (AA-CCI, ASA-PS) showed limited predictive value in our cohort, whereas dynamic inflammatory markers such as CRP showed potential for risk assessment, though further validation is needed.
He R, Kong V, Ko J
… +7 more, Yeung W, Lee D, Babu N, Ahn J, Wain H, Laing G, Clarke D
World J Surg
· 2026 Jun · PMID 42101048
·
Full text
PURPOSE: Cervical spinal injury (CSI) following blunt trauma to the neck can have devastating consequences. There is a current controversy surrounding how CSIs are excluded in obtunded patients. This study aimed to evalu...PURPOSE: Cervical spinal injury (CSI) following blunt trauma to the neck can have devastating consequences. There is a current controversy surrounding how CSIs are excluded in obtunded patients. This study aimed to evaluate the utility of CT in cervical spine clearance in a high-volume trauma center in a developing world setting. METHODS: Longitudinal 11-year data (2012-2022) were collected from the Hybrid Electronic Medical Registry (HEMR), based at the Pietermaritzburg Metropolitan Trauma Service, to identify all obtunded patients (GCS < 15) who underwent a cervical CT scan. The accuracy of CT imaging in identifying CSI was evaluated by calculating the diagnostic sensitivity, specificity, negative predictive value, and positive predictive value against the final admission diagnosis. RESULTS: In total, 1039 obtunded blunt trauma patients underwent CT of the C-spine. 121 (12%) of these patients had a CSI demonstrated on CT or MRI. Six (5%) required surgery, and 115 (95%) were treated nonoperatively. In total, 113 (93%) of these patients had a positive CT, and 8 (7%) patients had a false-negative CT but went on to have a positive MRI for CSI; none of these patients with an injury identified on MRI required surgery. CT demonstrated a sensitivity and specificity of 93.4% and 96.2%, with a negative predictive value of 99.1% for identifying CSI. CONCLUSION: In the obtunded trauma patient, CT correctly identifies all patients with a bony fracture of the cervical spine who will require intervention. In a small subset of patients, CT will miss non-bony injuries. MRI may be necessary for further investigation in the context of persisting clinical concern for CSI (e.g., neurological deficit, polytrauma, unstable vital signs (especially hypotension), and intubation). Most of these non-bony injuries do not require surgery.
Yadav SK, S D, Sethi S
… +3 more, Azhar T, Abdurahman A, Agrawal SK
World J Surg
· 2026 Jun · PMID 42095770
·
Publisher ↗
BACKGROUND: Chest wall perforator flaps (CWPFs) offer a promising, volume-preserving reconstructive option for patients undergoing breast-conserving surgery. However, standardized data on safety, efficacy, and patient-re...BACKGROUND: Chest wall perforator flaps (CWPFs) offer a promising, volume-preserving reconstructive option for patients undergoing breast-conserving surgery. However, standardized data on safety, efficacy, and patient-reported outcomes remain limited. METHODS: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, clinical trial registries, and grey literature was performed up to April 2025. Primary outcomes were surgical complications, operative time, and validated patient satisfaction scores. Secondary outcomes included aesthetic assessments and oncologic safety. Methodological quality was assessed using the MINORS criteria. Meta-analysis was not performed due to heterogeneity. RESULTS: Fifty-two studies involving 2591 patients were included. Overall complication rates were low: seroma (5.0%), infection (∼2%), fat necrosis (1.6%), flap loss (0.7%), and wound dehiscence (1.5%). Cosmetic outcomes, when evaluated by patients or surgeons, were generally rated good to excellent. Validated PROMs were underutilized. Oncologic outcomes reported by a minority of studies suggested low locoregional (∼2%) and distant (∼4.3%) recurrence rates, with 5-year overall survival exceeding 90% in most series. CONCLUSION: CWPFs appear to provide favorable aesthetic outcomes with low short-term morbidity across heterogeneous observational cohorts. However, oncologic outcomes are sparsely reported with short and inconsistent follow-up and incomplete adjustment for tumor biology, systemic therapy, and radiotherapy. Accordingly, oncologic safety cannot be inferred from the current evidence, and the certainty of evidence for oncologic endpoints is very low. Prospective, standardized studies reporting LRR/DFS/OS at prespecified time-points and using validated PROMs are essential.
Kim Y, Oh J, Kim H
… +15 more, Yeo D, Kim HJ, Kim S, Lee H, Hwang SH, Cho J, Kim K, Lee J, Hyeon E, Yu B, Kim DW, Seok J, Kim K, Yon DK, Kang WS
World J Surg
· 2026 Jun · PMID 42095768
·
Publisher ↗
BACKGROUND: Infectious complications, such as sepsis or catheter-related infections, are common and serious sequelae after trauma. Despite their clinical significance, existing risk-prediction models are limited by relia...BACKGROUND: Infectious complications, such as sepsis or catheter-related infections, are common and serious sequelae after trauma. Despite their clinical significance, existing risk-prediction models are limited by reliance on in-hospital data that fail to capture complex physiological interactions. Thus, this study aimed to develop and validate an interpretable ensemble machine learning (ML) model integrating both prehospital and in-hospital clinical data to predict infectious complications after trauma. METHODS: We used data from the Korean Trauma Data Bank, comprising patients admitted to all 19 trauma centers from 2017 to 2022 in South Korea (discovery; n = 227,567) and from four additional centers added in 2023 for external validation (n = 8867). Trauma cases were defined utilizing S or T diagnostic codes based on the 7th Korean Standard Classification of Diseases, and infectious complications were defined as a composite outcome of pneumonia, urinary tract infection, catheter-related bloodstream infection, surgical site infection (deep, organ, and superficial), osteomyelitis, or severe sepsis. A total of 33 prehospital and in-hospital features were used in ML model training, and the top-performing models were ensembled to construct the final model. Model performance was evaluated through five-fold cross-validation, internal testing, and external validation. Shapley Additive Explanations (SHAP) were applied to assess predictor importance, and predicted risks were categorized into tertiles (T1-T3) to examine associations with in-hospital mortality and presented adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Among 88,899 eligible patients with trauma in the discovery cohort, the soft-voting ensemble model integrating logistic regression, categorical boosting, and extreme gradient boosting achieved the best discrimination, with an area under the receiver operating characteristic curve of 0.796 in the discovery cohort and 0.717 in the external validation cohort. SHAP analysis identified age, accident type, Glasgow Coma Scale verbal response, and sex as the most influential variables. Higher tertiles of predicted infection risk were strongly associated with mortality, with aORs of 2.52 (95% CI, 2.12-2.99) for T1, 4.65 (3.96-5.47) for T2, and 6.19 (5.02-7.62) for T3. CONCLUSION: This interpretable model, which integrates prehospital and in-hospital data available within the first 24 h of admission, presented robust predictive performance for post-traumatic infectious complications. The proportional association between predicted infection risk and mortality highlights its clinical relevance, as even modest increases in predicted risk may carry meaningful implications for patient outcomes and early intervention strategies.
World J Surg
· 2026 Jun · PMID 42095759
·
Publisher ↗
BACKGROUND: Somalia represents a critical data vacuum in global health. While its surgical burden of disease is presumed to be high, the absence of empirical data hinders effective policy and humanitarian aid. This study...BACKGROUND: Somalia represents a critical data vacuum in global health. While its surgical burden of disease is presumed to be high, the absence of empirical data hinders effective policy and humanitarian aid. This study provides the first large-scale, longitudinal analysis of surgical care delivery in this fragile state, offering a foundational dataset where none previously existed. METHODS: We conducted a 10-year retrospective analysis of 52,469 surgical procedures performed between January 2016 and June 2025 at Somalia's largest tertiary referral hospital. We analyzed trends in surgical volume, procedural distribution, and risk factors for 30-day postoperative mortality to characterize the disease burden and institutional capacity. RESULTS: Surgical volume increased significantly over the study period, with General Surgery (22.3%), Orthopedics (14.7%), and Urology (12.5%) being the most common specialties. The procedural mix revealed a dual burden of trauma and obstetric emergencies alongside a growing capacity for elective surgery. Notably, Caesarean section was the single most frequent procedure among the top 10 indications, accounting for 32% of these high-volume cases. The overall 30-day postoperative mortality rate was 7.2%. Multivariate analysis identified ICU admission as the strongest independent predictor of mortality (AOR 7.28; 95% CI 6.75-7.85), followed by general anesthesia (AOR 4.67; 95% CI 4.02-5.43) and operative duration exceeding 4 h (AOR 1.69; 95% CI 1.42-2.00). CONCLUSION: This foundational dataset provides the first empirical evidence of tertiary-level surgical needs in Somalia. The findings reveal the hospital's crucial role as an "island of capacity" in a fragile health system, absorbing a concentrated burden of risk from a vast, underserved region. The high volume of Caesarean sections functions as a barometer of systemic weaknesses in primary and district-level care. The identified predictors of mortality reflect a patient population with extreme clinical acuity, underscoring the urgent need for a National Surgical Plan to build a resilient referral system and address the country's immense unmet surgical needs.
Sekiguchi N, Takahashi H, Akita H
… +11 more, Sasaki K, Hasegawa S, Iwagami Y, Yamada D, Tomimaru Y, Asaoka T, Noda T, Shimizu J, Kobayashi S, Doki Y, Eguchi H
World J Surg
· 2026 Jun · PMID 42095757
·
Full text
BACKGROUND: The relationship between the radiographic portal vein-superior mesenteric vein (PV-SMV) involvement and pathological PV-SMV (pPV) invasion has been established in upfront surgery cases of pancreatic cancer (P...BACKGROUND: The relationship between the radiographic portal vein-superior mesenteric vein (PV-SMV) involvement and pathological PV-SMV (pPV) invasion has been established in upfront surgery cases of pancreatic cancer (PC); however, evidence remains limited for patients receiving neoadjuvant therapy (NAT). This study aimed to evaluate the association of radiographic findings with pPV invasion in patients treated with NAT, and to examine whether this association differs between patients treated with neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT). METHODS: We retrospectively analyzed patients with PC whose tumors contacted the PV-SMV on radiographic imaging before or after NAT. The relationship between radiographic findings and pPV invasion was evaluated in subgroups defined by pre- and post-NAT imaging findings. RESULTS: Tumor size, PV-SMV contact length, and contact angle were significantly reduced in post-NAT imaging. Radiographic PV-SMV involvement showed limited association with pPV invasion in the entire cohort. The overall pPV invasion rate was 15% and did not differ between the NAC and NACRT groups (17% vs. 13%, p = 0.790). Among patients with a pre-NAT tumor size of < 20 mm, the pPV invasion rate was significantly lower in the NACRT group than in the NAC group (29% vs. 0%, p = 0.007). This difference was not observed in patients with a pre-NAT tumor size ≥ 20 mm (12% vs. 19%, p = 0.438). Across other radiographic classifications, pPV invasion rates remained comparable between treatment groups. CONCLUSIONS: The association of radiographic findings with pPV invasion differs between patients treated with NAC and NACRT in patients with small tumors.
Naidoo N, Martin L, Conradie W
… +3 more, Heunis M, Smit CP, Edge J
World J Surg
· 2026 Jun · PMID 42095726
·
Full text
BACKGROUND: Globally, breast cancer is a sentinel health crisis, with 2.3 million new cases annually. In comparison with HICs, the stage of presentation in LMICs is higher, with a greater number of deaths occurring due t...BACKGROUND: Globally, breast cancer is a sentinel health crisis, with 2.3 million new cases annually. In comparison with HICs, the stage of presentation in LMICs is higher, with a greater number of deaths occurring due to metastatic disease. A call for action with a global strategy for breast cancer is required, with an increasing role of the multidisciplinary team meeting (MDT). Its (the MDT's) use in resource-constrained systems is not well established. This study aimed to evaluate the outcomes of MDT decisions and determine the concordance of treatment recommendations and those received by the patient. Additionally, concordance across disease stages was assessed. METHODS: Retrospective data of all adult patients newly diagnosed with breast cancer and discussed at the MDT between 01 July 2021 and 30 June 2022 were collected. Patients with recurrent breast cancer, those primarily referred for palliative care, and patients with incomplete data (treatment received "unknown") were excluded. The decision made by the MDT and the primary treatment received by the patients were assessed to determine concordance. Rates of concordance and stage of disease were calculated using contingency tables. Descriptive statistics were computed to describe continuous and categorical data. RESULTS: A total of 556 patients were included in the analyses. Most patients (88%) received primary treatment aligned with the MDT's recommendations. The highest level of concordance was seen in those with early breast cancer who were recommended to have primary surgery (94%), and the lowest in those with metastatic disease. CONCLUSIONS: Findings demonstrate that most breast cancer patients received the treatment recommended by the MDT. Reasons for discordance could be explored in future studies. We recommend that an MDT form part of breast patient care in South Africa (SA).