World J Surg [JOURNAL]
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200 papers
Enhanced Recovery After Surgery (ERAS) in Latin America and the Caribbean: A Scoping Review of Implementation Strategies, Clinical Outcomes, and Health System Impact.
Pereira LFG, Guimarães Pereira JE, Quintão VC … +4 more , Fernando Dos Reis Falcão L, Borges BA, Biccard B, Alves Bersot CD
World J Surg · 2026 Apr · PMID 41840304 · Full text
BACKGROUND: Enhanced Recovery After Surgery (ERAS) programs are increasingly recognized as effective pathways to improve perioperative outcomes, yet their implementation across Latin America and the Caribbean remains poo...
BACKGROUND: Enhanced Recovery After Surgery (ERAS) programs are increasingly recognized as effective pathways to improve perioperative outcomes, yet their implementation across Latin America and the Caribbean remains poorly mapped. Understanding current strategies, clinical results, and economic implications is essential to identify regional gaps and guide evidence-based surgical improvement. METHODS: This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR reporting guidelines. Searches were conducted in MEDLINE/PubMed, Web of Science, LILACS, and CENTRAL, complemented by gray literature and reference screening. Eligible studies were investigations evaluating perioperative optimization interventions in any surgical population within Latin America and the Caribbean. Data extraction included study characteristics, ERAS components, implementation strategies, clinical outcomes, and economic impact. RESULTS: Forty-five studies published between 2006 and 2025 were included, predominantly from Brazil (n = 28), Mexico (n = 9), Argentina (n = 4), and Chile (n = 3). Most studies implemented multimodal perioperative pathways, with the most frequent ERAS strategies being preoperative fasting abbreviation (n = 26), early refeeding (n = 22), early mobilization (n = 22), opioid-sparing anesthesia (n = 19), preoperative education (n = 16), and restrictive intravenous fluids (n = 16). Clinical outcomes consistently demonstrated reductions in postoperative length of stay and complications. Only five studies reported economic data, all focused on hospital-level costs, showing decreased expenditures primarily driven by shorter hospitalization. CONCLUSIONS: ERAS initiatives are increasing across Latin America and the Caribbean, with evidence suggesting reductions in hospital stay and costs. Nevertheless, adoption remains uneven and concentrated in a few countries. Expanding implementation will require addressing structural disparities and generating stronger economic and implementation-focused evidence to support broader regional uptake.
Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study.
van Kempen LV, Schouten R, Smeets SJM
World J Surg · 2026 Apr · PMID 41834241 · Publisher ↗
BACKGROUND: Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD), yet its efficacy in recurrent disease remains undefined. This study compared lon...
BACKGROUND: Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD), yet its efficacy in recurrent disease remains undefined. This study compared long-term outcomes following SiLaC in primary versus recurrent SPSD, hypothesizing that recurrent disease would predict inferior results. METHODS: This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53). The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis; secondary outcomes included healing rates, healing time, and complications. Univariable risk factor analysis was performed. Follow-up through telephone interviews and review of medical records achieved a 90.3% completion rate at a median of 4.0 years (IQR: 3.6-5.0 years). RESULTS: Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively. At the final follow-up, the recurrence rate was 34.6% for primary disease and 60.8% for recurrent disease. The time to recurrence was accelerated in recurrent cases (median, 11.4 vs. 14.0 months, p < 0.05). Despite comparable initial healing rates (75.4% primary, 68.0% recurrent), recurrent disease required 10 additional days for complete healing (56 vs. 46 days, p < 0.001). Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%). Three factors predicted recurrence: recurrent disease status in all patients; within recurrent cases, symptom duration greater than 38 weeks (RR 2.14) and four or more medial openings (RR 2.07); all p < 0.05. CONCLUSION: SiLaC demonstrated acceptable recurrence rates for primary SPSD comparable to other minimally invasive techniques at long-term follow-up, but significantly poorer outcomes in recurrent disease. Therefore, SiLaC may be considered a feasible first-line option for primary SPSD, while recurrent cases require careful patient selection and consideration of alternative treatments.
The Mismatch Point: A Modified Technique to Prevent and Overcome Duct-Enterotomy Discrepancy in High-Risk Pancreaticojejunostomy.
Marcucci F, Fassari A, Amariutei A … +1 more , Rosso E
World J Surg · 2026 Apr · PMID 41834237 · Publisher ↗
Anastomotic failure remains the leading source of morbidity after pancreatoduodenectomy, particularly in patients with a soft pancreas and a small main pancreatic duct. In this high-risk setting, reconstruction is freque...
Anastomotic failure remains the leading source of morbidity after pancreatoduodenectomy, particularly in patients with a soft pancreas and a small main pancreatic duct. In this high-risk setting, reconstruction is frequently compromised by geometric mismatch between the duct and an oversized jejunal enterotomy, as well as by eccentric duct anatomy that limits safe circumferential suturing. Conventional duct-to-mucosa techniques rely on tissue traction and precise stitch placement, which may be mechanically unstable in fragile glands. We developed a Seldinger-inspired, stent-centered pancreaticojejunostomy designed to address these limitations through geometry preservation and structural stabilization. Instead of cutting the jejunum, the enterotomy is created by controlled puncture and sequential dilation. A biodegradable intraductal stent is introduced over a guidewire, establishing duct-jejunal coaxial alignment. External stabilization is achieved using Blumgart-based fixation and serosal-capsular closure, avoiding ductal traction and circumferential duct-to-mucosa suturing. This technique was applied in a consecutive feasibility series of 15 high-risk patients (soft pancreas and main duct ≤ 3 mm) undergoing minimally invasive pancreatoduodenectomy. The procedure was completed robotically in 14 cases and laparoscopically in one, with no conversions or intraoperative complications. Biochemical pancreatic fistula occurred in 3 patients (20%), with no clinically relevant fistulas. No major complications (Clavien-Dindo ≥ III) or 90-day mortality were observed. By transforming a fragile duct-bowel interface into a geometry- and structure-supported reconstruction, this approach appears technically feasible and associated with encouraging short-term safety signals in a highly selected high-risk cohort. These findings should be interpreted as preliminary feasibility data and require validation in larger, multi-operator series.
Artificial Intelligence May Not Be a Panacea for Global Surgery-But It Could Help Democratize It.
Sharma D, Mayol J
World J Surg · 2026 Apr · PMID 41834231 · Publisher ↗
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Emergency Laparotomy, Team Performance, and the Architecture of Recovery.
Ripollés-Melchor J, Abad-Motos A
World J Surg · 2026 Apr · PMID 41831205 · Publisher ↗
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The Time Course of Perforation and Abscess Formation in Appendicitis.
Andresson G, Kristínardóttir ÁS
World J Surg · 2026 Apr · PMID 41831204 · Publisher ↗
BACKGROUND: Many studies have supported delayed appendectomy because the risk of perforation does not appear to increase until beyond 24-48 h of hospitalization. This study aimed to examine the natural time progression o...
BACKGROUND: Many studies have supported delayed appendectomy because the risk of perforation does not appear to increase until beyond 24-48 h of hospitalization. This study aimed to examine the natural time progression of perforation in acute appendicitis to find if it complements studies that recommend delayed appendectomy. METHODS: Between first of January 2018 and 30th of March 2020, 1274 patients, 40 years or younger, were suspected of appendicitis at the National University Hospital of Iceland. N = 658 of these had appendicitis of which 105 did perforate. The patients' medical records were examined for duration of symptoms and length of hospital stay, whereas perforation and abscess formation were assessed from CT, ultrasounds, surgical reports, and histopathology reports. Duration of symptoms and hospital stay were categorized, and their relationship with the other variables, primarily perforation, was analyzed with chi square, Spearman's correlation, and t-test statistics. RESULTS: Few perforations occurred during the first 24 h of symptoms (2.4%) and few abscesses before 48 h (1.7%). Thereafter, the rate of perforations relative to the rate at 0-24 h were 6.4, 14.7, 20.2, and 27.1 for 24-48, 48-72, 72-96, and 96+ hours respectively, (χ = 120 and p < 0.001). Furthermore, there was a significant correlation between increased duration of symptoms and prolonged hospital stay in patients with appendicitis (rho = 0.36 and p < 0.001). CONCLUSIONS: There was a clear correlation between the duration of symptoms and the incidence of perforated appendicitis. However, there was not a sharp increase in perforation and abscess formation until after 24 and 48 h of symptoms, respectively. Our study indicates that delayed appendectomy needs more careful evaluation after this time window has elapsed, focusing exclusively on the time since hospitalization would be insufficient.
Enhanced Recovery After Surgery Versus Conventional Care in Simultaneous Colorectal Resection and Hepatectomy for Synchronous Colorectal Liver Metastases.
Lohsiriwat V, Kaenla E, Ovartchaiyapong P
World J Surg · 2026 Apr · PMID 41831191 · Publisher ↗
BACKGROUND: Evidence regarding the feasibility and outcomes of enhanced recovery after surgery (ERAS) programs in patients undergoing simultaneous colorectal resection and hepatectomy remains limited. This study aimed to...
BACKGROUND: Evidence regarding the feasibility and outcomes of enhanced recovery after surgery (ERAS) programs in patients undergoing simultaneous colorectal resection and hepatectomy remains limited. This study aimed to evaluate the impact of ERAS implementation on perioperative and oncologic outcomes in patients undergoing simultaneous colorectal resection and hepatectomy for synchronous colorectal liver metastases. METHODS: A single-center retrospective cohort study was conducted involving 100 consecutive patients who underwent elective simultaneous colorectal resection and hepatectomy before (n = 50) and after (n = 50) ERAS implementation. Outcomes included postoperative complications, length of stay, hospital cost, disease-free survival, and overall survival. RESULTS: The mean age was 63 years, and 55% were male. Rectal cancer was the primary tumor in 38 patients, and 18 patients required major hepatectomy. Baseline characteristics and operative details were comparable between the ERAS and conventional care groups. ERAS implementation significantly reduced postoperative complications (22% vs. 42% and p = 0.032) and time to tolerate a solid diet (3 vs. 5 days and p = 0.001). Median postoperative length of stay was shorter in the ERAS group (6 days [IQR 5-9] vs. 8 days [IQR 6-16] and p = 0.005). Average hospital cost was slightly lower with ERAS (4815 USD vs. 5298 USD and p = 0.446). Five-year overall and disease-free survival rates were similar between groups (86.7% vs. 88.9%; p = 0.583 and 44.4% vs. 48.9%; p = 0.724, respectively). CONCLUSIONS: ERAS implementation in simultaneous colorectal resection and hepatectomy resulted in shorter hospitalization, faster bowel recovery, and a modest reduction in cost, while maintaining comparable long-term oncologic outcomes.
Significance of a Minimally Invasive Approach in Reducing Surgical Risks Throughout the Clinical Course of Patients Undergoing Hepatectomy.
Shindoh J, Kobayashi Y, Nishioka Y … +7 more , Kiya Y, Kojima K, Kobayashi M, Murakami H, Okada T, Okubo S, Matsumura M
World J Surg · 2026 Apr · PMID 41821108 · Publisher ↗
BACKGROUND: Although minimally invasive surgery (MIS) is thought to reduce the surgical risks in both initial and repeat hepatectomy patients, the actual clinical impact of the MIS-oriented surgical approach on their cli...
BACKGROUND: Although minimally invasive surgery (MIS) is thought to reduce the surgical risks in both initial and repeat hepatectomy patients, the actual clinical impact of the MIS-oriented surgical approach on their clinical course is not fully understood. METHOD: The clinical records of 1138 consecutive patients who had undergone hepatectomy were retrospectively reviewed, and the clinical significance of an MIS-oriented approach was analyzed. RESULTS: The analysis of the records of the 752 patients who had undergone an initial hepatectomy showed that MIS was associated with a lower risk of postoperative morbidity and that it was also correlated with a milder grade of adhesions observed during the next surgery. The severity of adhesions was scored according to the TORAD v2.0, and an analysis of the records of 386 repeat hepatectomy patients revealed that both the grade of adhesion and MIS were associated with a risk of postoperative morbidity at the time of the repeat hepatectomy (odds ratio, 1.60 per +1 point of the TORAD v2.0; and odds ratio, 0.09 for MIS). CONCLUSION: MIS is associated with a lower surgical risk in both initial and repeat hepatectomy patients because of its less invasiveness and lower probability of being followed by severe adhesion formation.
Impact of Borderline Resectable Criteria on Hepatocellular Carcinoma Treatment From the Perspective of Tumor Burden.
Komatsu S, Tada T, Ishihara N … +14 more , Omori M, Matsuura T, Ueshima E, Sofue K, Fujishima Y, Ishida J, Kido M, Gon H, Fukushima K, Urade T, Nanno Y, Yanagimoto H, Kodama Y, Fukumoto T
World J Surg · 2026 Apr · PMID 41814915 · Publisher ↗
BACKGROUND: The classification of oncological resectability for hepatocellular carcinoma (HCC) has been established, requiring validation of treatment outcomes for hepatectomy and systemic chemotherapy. METHODS: The stud...
BACKGROUND: The classification of oncological resectability for hepatocellular carcinoma (HCC) has been established, requiring validation of treatment outcomes for hepatectomy and systemic chemotherapy. METHODS: The study evaluated treatment outcomes in 978 patients who underwent hepatectomy and 222 patients with HCC who received first-line systemic chemotherapy (atezolizumab plus bevacizumab, lenvatinib, or durvalumab plus tremelimumab). RESULTS: Among three factors defining patients with borderline resectable 1 (BR1) and 2 (BR2), macrovascular invasion factor was associated with significantly worse prognosis in a hepatectomy group (BR1: 34.2 vs. 63.4 months, p = 0.04; BR2: 14.4 vs. 20.9 months, p = 0.004). In contrast, in the systemic chemotherapy group, none of the three factors affected prognosis in either BR1 or BR2 patients. In BR2 patients undergoing hepatectomy, those with a single risk factor had significantly better outcomes than those with 2-3 factors (20.1 vs. 12.6 months, p < 0.001). Similarly, in the entire systemic chemotherapy cohort, patients with a single risk factor had better outcomes than those with 2-3 (22.6 vs. 11.9 months, p = 0.001). However, among chemotherapy responders (per modified Response Evaluation Criteria in Solid Tumors), prognosis did not significantly differ between those with one factor and those with 2-3 factors (25.4 vs. 24.5 months, p = 0.502). CONCLUSION: Macrovascular invasion significantly impacted prognosis in patients undergoing hepatectomy, for both BR1 and BR2, whereas any of the tumor factors did not affect the prognosis of patients receiving systemic chemotherapy. Tumor burden correlated with prognosis in the entire cohort but not in chemotherapy responders, suggesting effective treatment may overcome poor prognostic indicators.
Improving Surgical Innovation: A Cross-Sectional Survey of Perceived Facilitators and Barriers.
Baker CR, Appelt J, Villafranca AA … +2 more , Eckert CM, Sexton KW
World J Surg · 2026 Apr · PMID 41806314 · Full text
New technologies, processes, or care models that substantially change practice are critical for surgical progress, patient care, and organizational efficiency.
New technologies, processes, or care models that substantially change practice are critical for surgical progress, patient care, and organizational efficiency.
Mapping of Preoperative Screening Tools Reveals Urgent Need for Standardization in Gastrointestinal Cancer Surgery: A Scoping Review.
Petridis AP, Reeves J, Koh C … +15 more , Solomon M, Karunaratne S, Alexander K, Hirst N, Pillinger N, Denehy L, Riedel B, Gillis C, Carey S, McBride K, White K, Dhillon HM, Campbell P, Biswas RK, Steffens D
World J Surg · 2026 Apr · PMID 41806273 · Full text
BACKGROUND: Gastrointestinal (GI) cancers are a major global health challenge due to their high incidence, mortality, and surgical complication rates. Preoperative physical, nutritional, and psychological vulnerabilities...
BACKGROUND: Gastrointestinal (GI) cancers are a major global health challenge due to their high incidence, mortality, and surgical complication rates. Preoperative physical, nutritional, and psychological vulnerabilities increase the risk of adverse surgical outcomes. Despite this, there is currently no validated, self-report screening tool integrating assessment across all three domains. This scoping review aims to identify and describe existing preoperative screening tools used to assess modifiable physical, nutritional, and psychological domains in adult patients undergoing elective GI cancer surgery. METHODS: We conducted this scoping review in accordance with Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches were performed across MEDLINE, EMBASE, CINAHL, EBM, and PsycINFO date limited from January 2000 to March 2025. Studies were included if they evaluated preoperative screening tools for physical, nutritional, and/or psychological assessment in adult patients undergoing GI cancer surgery. Data on tool characteristics, domains assessed, administration time, and psychometric properties were extracted and synthesized descriptively. RESULTS: From 2825 initial records, 121 studies were included, encompassing 77 unique screening tools. These were categorized as physical (n = 21), nutritional (n = 16), and psychological (n = 40) tools. Most tools were brief (1-15 items). CONCLUSIONS: Although most screening tools are brief, feasible for self-administration, and freely accessible, none integrated all three domains. Substantial heterogeneity in tools highlights the need for a comprehensive, validated multidomain preoperative screening tool for this population.
Clinical Characteristics and Outcomes in Severely Injured Older Adults: Comparison Between the United States and Japan.
Takahashi K, Yamakawa K, Tanaka Y … +4 more , Katsura M, Yamaguchi K, Nakagawa Y, Matsushima K
World J Surg · 2026 Apr · PMID 41795691 · Publisher ↗
BACKGROUND: Various differences in the healthcare system have been described between the United States (US) and Japan; however, the impact on clinical outcomes, particularly in severely injured older trauma patients, is...
BACKGROUND: Various differences in the healthcare system have been described between the United States (US) and Japan; however, the impact on clinical outcomes, particularly in severely injured older trauma patients, is not fully understood. We aimed to compare clinical outcomes of severely injured older trauma patients between the US and Japan using a nationwide trauma database in each country. METHODS: This is a retrospective study using the National Trauma Data Bank (NTDB) and Japan Trauma Data Bank (JTDB) from 2017 to 2021. The two datasets were queried for patients aged ≥ 60 years with severe injuries (injury severity score > 15). We excluded patients who were dead on arrival (DOA) and had missing outcome data. The primary outcome was in-hospital mortality, and the secondary outcomes were hospital length of stay (HLOS) and disposition after hospital discharge. RESULTS: A total of 268,013 NTDB and 29,998 JTDB patients were included for the analysis. The overall in-hospital mortality rate in the NTDB was significantly higher compared to the JTDB (14.4% vs. 10.5% p < 0.001). The median hospital length of stay was significantly longer in the JTDB than the NTDB (22 vs. 7 days, p < 0.001). The rate of prolonged hospital stay, exceeding 50 days, was significantly higher in the JTDB (16.5% vs. 1.2%, p < 0.001). In the 60-69 age group, there was a significant difference in the proportion of patients that were discharged home between the JTDB and NTDB (36.0% vs. 46.7%, p < 0.001). In both datasets, the proportions of patients discharged to home in the 80-89 age group were significantly lower compared to those in younger age groups (p < 0.001, respectively) with more patients transferred to another hospital in the JTDB and more discharged to hospice or other facilities in the NTDB. CONCLUSIONS: The results in this study suggest that there are significant outcome differences in severely injured older trauma patients between the US and Japan. Future research is warranted to identify underlying mechanisms of the outcome differences.
Fibrosis-Driven Surgical Risk After Thyroid Nodule Ablation: Quantitative Clinicopathological Determinants of Complications in Post-Ablative Thyroidectomy-A Retrospective Cohort Study.
Zhang D, Boero A, Gazzano G … +5 more , Satta A, Fugazzola L, Colombo C, Brucchi F, Dionigi G
World J Surg · 2026 Apr · PMID 41795686 · Full text
BACKGROUND: Thermal ablation is increasingly used for selected benign and low-risk thyroid nodules, yet some patients still require thyroidectomy for regrowth, persistent symptoms, or new oncologic concern. The surgical...
BACKGROUND: Thermal ablation is increasingly used for selected benign and low-risk thyroid nodules, yet some patients still require thyroidectomy for regrowth, persistent symptoms, or new oncologic concern. The surgical and pathological impact of ablation-induced remodeling remains incompletely defined. We aimed to characterize postablation thyroidectomy outcomes and identify histological correlates of perioperative morbidity. METHODS: We conducted a single-center retrospective cohort study of patients undergoing thyroidectomy after radiofrequency or ethanol ablation (2021-2025). Clinical and ablation-related variables were collected, and intraoperative neuromonitoring was routinely used. Primary outcomes were recurrent laryngeal nerve (RLN) palsy, reoperative hematoma, and hypoparathyroidism. Surgical specimens underwent blinded dual-pathologist assessment with semiquantitative scoring of sclerosis, necrosis, and residual viability, from which a maturation index was derived. Associations with complications were analyzed using nonparametric methods. Outcomes were descriptively compared with a contemporaneous nonablated cohort for contextual purposes. RESULTS: Thirty-one patients were included. Postoperative complications occurred in 22.6% of ablated cases. Histological analysis demonstrated moderate sclerosis (19.2%), necrosis (14.6%), and high residual viability (66.1%), with frequent pericapsular inflammatory changes and preserved capsule integrity. Sclerosis was the only parameter significantly associated with postoperative complications (30.0% vs. 16.9% and p = 0.008), whereas nodule size, ablation-to-surgery interval, and incidental carcinoma were not predictive. The maturation index increased with time after ablation but did not discriminate complication risk. Exploratory fibrosis-weighted metrics suggested potential risk thresholds, although these findings remain hypothesis-generating given the limited sample size. CONCLUSIONS: Thyroidectomy after prior ablation is feasible in experienced centers but may be technically demanding and associated with modestly increased procedural complexity. Mature sclerosis represents the principal histological correlate of perioperative morbidity, linking fibrotic remodeling to operative risk. These findings support centralization of postablation thyroid surgery in high-volume units with routine neuromonitoring and specialized pathology and highlight the need for larger prospective studies to validate fibrosis-based risk stratification tools.
Asian Breast Surgery Forum: Advancing Collaborative Learning Across Borders.
Yap WL, See MH, Ng JH … +22 more , Goh JL, Abd Haleem NN, Khairul Anuar LA, Doon YK, Md Arfizal MI, Lohsiriwat V, Mok CW, Lee J, Sobri FB, Kuo WL, Huang JJ, Fukuma E, Zaha H, Phuong TVT, Zhao J, Sujarittanakarn S, Park HY, Park HS, Jamaris S, Khoo KS, Mosiun JA, Lai LL
World J Surg · 2026 Apr · PMID 41793034 · Publisher ↗
BACKGROUND: The Asian Breast Surgery Forum (ABSF) is a training and knowledge-sharing platform that advocates for multidisciplinary collaborations among participants. Based on the Extension for Community Healthcare Outco...
BACKGROUND: The Asian Breast Surgery Forum (ABSF) is a training and knowledge-sharing platform that advocates for multidisciplinary collaborations among participants. Based on the Extension for Community Healthcare Outcomes (ECHO) model, the forum aims to foster virtual case-based learning and skill-building to democratize access to specialty care. METHODS: With Malaysia as its hub, the ABSF has engaged medical experts from Thailand, Japan, South Korea, Taiwan, Singapore, China, Vietnam and India. The paired samples t-test was used to determine if there were significant differences (p < 0.05) in participants' engagement and learning outcomes. The Chi-square test (goodness-of-fit and test of independence) was used to determine significant differences in post-session survey questions. RESULTS: Between 2023 and 2025, ABSF had conducted 15 sessions, connecting 400 participants from 61 cities in 24 countries. The paired samples t-test found significant difference in the level of comfort/preparedness in using the knowledge gained (p < 0.001). Goodness-of-fit analysis highlighted meaningful differences in participants' perceptions across key aspects. In the test of independence, fulfillment of learning objectives was closely aligned with pre-session expectations [χ(4) = 17.20, p = 0.002], indicating that the likelihood of fulfillment was significantly varied between objective categories. Overall feedback achieved a 100% satisfaction rate and a net promoter score (NPS) of 68. CONCLUSION: Most participants found the sessions to be highly relevant, with nearly all agreeing that the balance between lectures and interactivity was optimal. Through feedback and integration of cutting-edge techniques, the forum could continue leveraging digital platforms to enhance healthcare outcomes.
Clinicopathological Landscape and Survival Outcomes of HER2-Low Breast Cancer in a Large Arab Cohort.
Siraj AK, Parvathareddy SK, Bu R … +7 more , Annaiyappanaidu P, Al-Rasheed M, Azam S, Ajarim D, Tulbah A, Al-Dayel F, Al-Kuraya KS
World J Surg · 2026 Apr · PMID 41792988 · Publisher ↗
BACKGROUND: HER2-low breast cancer (BC) has recently emerged as a therapeutically targetable entity, yet its biological and clinical relevance remains debatable. Limited data are available about HER2-low from non-Western...
BACKGROUND: HER2-low breast cancer (BC) has recently emerged as a therapeutically targetable entity, yet its biological and clinical relevance remains debatable. Limited data are available about HER2-low from non-Western populations, particularly the Middle East, where distinct tumor biology may influence phenotype and treatment response. METHODS: We retrospectively analyzed 1097 Saudi breast cancer patients for HER2 status by immunohistochemistry (IHC), classifying tumors as HER2-zero (IHC 0) or HER2-low (IHC 1+/2+ and FISH-negative). Clinicopathological characteristics, biomarker profiles (ER, PR, Ki-67), molecular alterations (PIK3CA, TP53, BRCA) and survival outcomes (overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and distant disease-free survival (DDFS)) were compared. RESULTS: HER2-low tumors comprised 34.5% (n = 378) of the cohort and were significantly associated with ER (p < 0.0001) and PR (p = 0.0226) positivity, lower triple-negative phenotype (p < 0.0001), and reduced Ki-67 proliferation index (p = 0.0136) compared to HER2-zero tumors. Trends toward higher PIK3CA mutation (p = 0.0875) and lower BRCA mutation (p = 0.0892) rates were observed in HER2-low tumors, though not statistically significant. Despite these favorable biological features, survival analyses revealed no significant differences between HER2-low and HER2-zero subtypes with regards to OS, CSS, DFS, and DDFS. CONCLUSION: In this large, ethnically homogenous Saudi cohort, HER2-low breast cancer represents a distinct molecular and clinicopathological subtype with luminal like features, yet no prognostic advantage. These findings reinforce the therapeutic, rather than prognostic, significance of HER2-low status, highlighting its relevance in targeted antibody-drug conjugate-based therapies rather than influencing baseline risk stratification.
Trends and Burden of Inguinal, Femoral, and Abdominal Hernia From 1990 to 2023 in the Gulf Cooperation Council.
Al-Shammari YM, Al-Awadhi MA, Mandani HA … +7 more , AlDorai MJ, Alsubaiei A, Mohammad MS, AlDorai AJ, Aldhafiri GA, Alkhalfan DA, Almazeedi S
World J Surg · 2026 Apr · PMID 41792050 · Publisher ↗
BACKGROUND: Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recur...
BACKGROUND: Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recurrence and chronic pain and to optimize population health impact. This study aims to assess the burden and trends of hernia in Arabian Gulf Region from 1990 to 2023. METHODS: A comparative, multi-country analysis was conducted for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates using Global Burden of Disease (GBD) 2023 estimates. Outcomes included age-standardized incidence (ASIR), prevalence (ASPR), years lived with disability (YLDs), and disability-adjusted life years (DALYs), reported per 100,000 by year (1990-2023), sex, and age. Temporal trends were evaluated with Joinpoint regression to derive average annual percent change (AAPC). Forecasts to 2033 applied linear regression, Exponential Smoothing (ETS), ARIMA, and Neural Network Autoregression (NNAR) models; the best model for each indicator-country-sex combination was selected using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE), with 95% prediction intervals. Analyses were performed in R (forecast package) and the NCI Joinpoint program. RESULTS: In 2023, the Gulf Cooperation Council (GCC) recorded approximately 1.1 million prevalent hernia cases. While absolute counts rose 12.4% since 1990, attributable to population aging, age-standardized metrics declined across countries and sexes. YLDs comprised 75%-80% of DALYs, confirming a predominantly non-fatal burden. Male prevalence exceeded female prevalence in all states; Qatar and Bahrain formed a higher-burden cluster, whereas the United Arab Emirates and Saudi Arabia exhibited lower rates. Age-specific analyses showed marked improvements at 60-79 years but persistent or paradoxical increases in ≥ 85 years. Forecasts indicated continued declines in ASIR/ASPR to 2033, with vigilance warranted for very-elderly cohorts. CONCLUSION: The GCC experienced sustained reductions in age-standardized hernia burden since 1990 despite rising absolute numbers from demographic change. Findings support guideline-concordant expansion of elective repair, registry-based quality measurement, and targeted capacity for the oldest adults to further compress disability.
Can Desmoplastic Stromal Reaction Guide the Extent of Lymph Node Surgery in Sporadic Medullary Thyroid Carcinoma?
Matlim Ozel T, Aydin H, Akbulut S … +11 more , Celik A, Yildiz G, Aylaz G, Sahin MY, Guzey D, Karatay H, Sahbaz NA, Toprak S, Agcaoglu O, Dural AC, Sari S
World J Surg · 2026 Mar · PMID 41781807 · Publisher ↗
BACKGROUND: Medullary thyroid carcinoma (MTC) frequently presents with lymph node metastases (LNMs), and the extent of lymph node (LN) surgery remains controversial. The desmoplastic stromal reaction (DSR) has emerged as...
BACKGROUND: Medullary thyroid carcinoma (MTC) frequently presents with lymph node metastases (LNMs), and the extent of lymph node (LN) surgery remains controversial. The desmoplastic stromal reaction (DSR) has emerged as a potential histopathological predictor of metastatic spread. METHODS: We retrospectively analyzed 63 patients with sporadic MTC treated between 2016 and 2025 at four tertiary centers. Histopathological specimens were re-evaluated for DSR, which was graded as absent, low, moderate, or high. Clinicopathological features, biochemical markers, and oncologic outcomes were compared across groups. RESULTS: DSR was absent in 27.0% and present in 73% tumors. DSR positivity was significantly associated with higher calcitonin (Ctn) and carcinoembryonic antigen (CEA) levels, increased LNM (87% vs. 0%), lymphovascular invasion, advanced nodal stage, and stage IV disease. Biochemical cure was achieved in 94.1% of DSR-negative patients compared with 56.5% of DSR-positive patients. The extent of tumor desmoplasia levels correlated with higher metastatic burden. CONCLUSION: DSR negativity reliably identifies an indolent subgroup with negligible metastatic risk, whereas increasing desmoplasia stratifies patients into higher-risk categories. The incorporation of DSR alongside established biomarkers such as Ctn may refine surgical decision-making and may help tailor the extent of LN dissection in sporadic MTC.
Incidence and Risk Factors of Postoperative Urinary Retention After Thyroidectomy: A Retrospective Cohort Study.
Chang JI, Tang MH, Oh MY … +6 more , Han M, Lee JM, Yu HW, Kim SJ, Chai YJ, Choi JY
World J Surg · 2026 Apr · PMID 41781792 · Full text
BACKGROUND: Postoperative urinary retention (POUR) is a common complication, but its incidence and risk factors after thyroidectomy are not well-defined. We investigated the incidence of POUR after thyroidectomy and its...
BACKGROUND: Postoperative urinary retention (POUR) is a common complication, but its incidence and risk factors after thyroidectomy are not well-defined. We investigated the incidence of POUR after thyroidectomy and its risk factors. METHODS: We conducted a retrospective review of 511 consecutive patients who underwent thyroidectomy by a single surgeon. POUR was defined as the inability to void within 6 h of the last preoperative void performed immediately prior to transfer to the operating room, with bladder volume > 500 mL requiring catheterization. Univariable and multivariable logistic regressions were performed separately for male and female. RESULTS: Among 511 patients (368 females, 143 males; mean age 49.6 years), 412 (80.6%) underwent lobectomy, 71 (13.9%) total thyroidectomy without lateral neck dissection, and 28 (5.5%) total thyroidectomy with lateral neck dissection. Surgical access was open in 333 (65.2%), transoral robotic in 158 (30.9%), and transoral endoscopic in 20 (3.9%). Overall, 68 patients (13.3%) developed POUR. In males, independent predictors were benign prostatic hyperplasia (BPH) (adjusted odds ratio [aOR] 7.890; 95% confidence interval [CI], 1.814-34.318; p = 0.006) and body mass index (BMI) < 25 kg/m (≥ 25 kg/m aOR 0.245; 95% CI, 0.066-0.909; p = 0.036; reference < 25 kg/m), BMI < 25 kg/m (≥ 25 kg/m aOR 0.465; 95% CI, 0.228-0.947; p = 0.035; reference < 25 kg/m), and operative time ≥ 60 min (aOR 1.939; 95% CI, 1.014-3.709; p = 0.045). Surgical approach, extent of surgery, pathology, and postoperative opioid use were not independently associated with POUR in either sex. CONCLUSIONS: POUR occurred in 13.3% of thyroidectomy patients. Sex-stratified analysis showed BPH and lower BMI as key risks in males, whereas older age, lower BMI, and longer operative time were significant in females. Recognizing these factors may support targeted perioperative screening and postoperative monitoring to reduce retention-related delays and complications.
Beyond Immunosuppression: Defining Perioperative Risk in Transplant Patients Undergoing Colorectal and Small Bowel Surgery.
Meister P, Vestweber S, Neuhaus J … +3 more , Reschke MA, Neumann U, Rink AD
World J Surg · 2026 Apr · PMID 41781372 · Full text
BACKGROUND: Colorectal and small bowel surgery in transplant (TX) recipients presents unique perioperative challenges due to immunosuppression and comorbidities, with poorly defined risks. METHODS: A retrospective analys...
BACKGROUND: Colorectal and small bowel surgery in transplant (TX) recipients presents unique perioperative challenges due to immunosuppression and comorbidities, with poorly defined risks. METHODS: A retrospective analysis was conducted on 237 TX recipients who underwent colorectal or small bowel surgery at a specialized center between 2008 and 2024. Patient characteristics (transplant type, time since TX, immunosuppression, Charlson Comorbidity Index) and surgical details were analyzed in relation to postoperative outcomes (ICU stay, in-hospital mortality, length of stay, major morbidity [Dindo-Clavien ≥ 3]). RESULTS: Most patients had prior kidney (45.6%) or liver TX (28.3%). The incidence of all adverse endpoints was significantly higher in emergencies as compared to elective surgery (mortality 25.6% vs. 6.2%, morbidity 52.3% vs. 35.4%, LOS 24.9d vs. 15.7d, ICU stay 10.7d vs. 2.9d; all p ≤ 0.001). 14.8% had surgical site infections, 9.7% cardiopulmonary complications. Primary anastomosis was not correlated with worse outcome. Multivariate regression showed emergency surgery (OR 8.48 (2.68-26.8) p = 0.001), colorectal surgery (OR 3.26 (1.54-6.90) p = 0.002) and heart TX (OR 4.35 (1.10-17.23) p = 0.036) as independent risk factors, patients receiving prednisolone had reduced risk (OR 0.28 (0.13-0.60) p = 0.001). Heart TX and emergency surgery correlated with longer ICU stay, hematopoetic stem cell transplantation with longer LOS. CONCLUSIONS: TX recipients undergoing colorectal or small bowel surgery face considerable perioperative risks, especially in emergency situations and after heart transplantation. The feasibility of primary anastomosis in selected patients suggests that surgical strategies should be tailored, emphasizing the need for specialized, multidisciplinary care to optimize outcomes in this vulnerable population.
ERAS-Based Surgical Bundles and Anastomotic Leakage: Which Components Drive the Effect?
Ardila CM, González-Arroyave D
World J Surg · 2026 Apr · PMID 41775674 · Publisher ↗
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