2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T9c1,Trauma is the leading cause of death and disability in children and adolescents worldwide; however, paediatric trauma care is often neglected during health system development. We aimed to understand current global standards of laparotomy care for paediatric patients with blunt or penetrating traumatic injury and variation in patient injury patterns, intervention, and post-operative outcomes. This is a planned post-hoc analysis of the international, multicentre, prospective, observational cohort from the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study, which was conducted between April 1 and Dec 31, 2024. Patients aged 18 years or younger with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Countries were stratified by the Human Development Index (HDI), and the primary outcome was post-operative in-hospital 30-day mortality. Adjusted mortality risk was calculated using least absolute shrinkage and selection operator regression analysis. The study was registered with ClinicalTrials.gov (NCT06180668). 237 paediatric patients who underwent a trauma laparotomy were recruited from 85 hospitals in 32 countries, with the highest proportion of patients living in countries in the lower HDI tertile (110 [20%] of 563 cases overall). The median age among paediatric cases was 16·0 years (IQR 12·0-18·0), and most patients were male (195 [82%] of 237 patients) and had sustained a blunt injury (135 [57%] patients). The median time globally from injury to operation was 7·4 h (IQR 3·5-18·8; n=235), with longer times observed across the patient pathway for patients in the lower and middle HDI tertiles than for those in the upper HDI tertile (p=0·0008). The overall 30-day in-hospital crude mortality rate was 8% (19 of 237 patients); however, after adjustment, patients in the lower HDI tertile were nearly six times more likely to die post-operatively than those in the upper HDI tertile (odds ratio 5·69 [95% CI 1·58-20·44], p=0·0079). Proportionally more children undergo trauma laparotomy in lower-resource settings than in higher-resource settings; however, their mortality risk is substantially higher. Marked variation exists in paediatric pathways globally, and policy makers and health-care leaders should prioritise the development of paediatric trauma care worldwide. Royal College of Surgeons Ratanji Dalal Research Fellowship and the Engineering and Physical Sciences Research Council.31:T7f3,It is widely accepted that definitive surgical treatment for primary cutaneous melanoma should occur promptly, but the effects of a delay between initial diagnosis and definitive surgery remain unclear. In addition, high quality evidence is lacking for an optimal time-to-surgery from initial melanoma diagnosis. The aim of this study was to determine whether the timing of surgical treatment for Stage I & II melanoma was associated with survival outcome and whether there was an optimal time interval between melanoma diagnosis and definitive surgical treatment with respect to survival. This was a retrospective cohort study of patients with primary cutaneous melanoma treated at a single institution between 1990 and 2015. The associations between time-to-surgery and clinical outcomes including overall survival (OS) and recurrence-free survival (RFS) were described using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to quantify the relationship between each time-to-surgery cohort and clinical outcome. In total 18, 242 patients were included in the analysis. Their average age was 57.5 years and 57% were male. The majority of primary melanomas were located on the trunk (32.5%) and upper limb (24.7%). Mean Breslow thickness was 1.8 mm (range 0.1-50 mm) and 64% were of superficial spreading subtype. Time to surgery was divided into ≤ 1 week, 1-4 weeks, 4-8 weeks, 8-12 weeks and > 12 weeks (n = 2453, 8882, 5906, 870 and 126, respectively). Increased delay of definitive surgical treatment was associated with poorer OS and RFS, with an OS HR of 1.23 for the 8-12 week group compared to the 1-4 week group. For RFS HR was 1.36 for the same cohorts. Definitive surgical treatment of patients with primary cutaneous melanoma between 1-4 weeks post-diagnosis with excision-biopsy was associated with improved OS & RFS compared to those treated within 1 week and greater than 4 weeks in this patient cohort treated prior to the use of adjuvant drug therapy.32:Tb13,ABSTRACT Introduction It is widely accepted that definitive surgical treatment for primary cutaneous melanoma should occur promptly, but the effects of a delay between initial diagnosis and definitive surgery remain unclear. In addition, high quality evidence is lacking for an optimal time‐to‐surgery from initial melanoma diagnosis. The aim of this study was to determine whether the timing of surgical treatment for Stage I & II melanoma was associated with survival outcome and whether there was an optimal time interval between melanoma diagnosis and definitive surgical treatment with respect to survival. Methods This was a retrospective cohort study of patients with primary cutaneous melanoma treated at a single institution between 1990 and 2015. The associations between time‐to‐surgery and clinical outcomes including overall survival (OS) and recurrence‐free survival (RFS) were described using the Kaplan–Meier method. Multivariable Cox proportional hazard models were used to quantify the relationship between each time‐to‐surgery cohort and clinical outcome. Results In total 18, 242 patients were included in the analysis. Their average age was 57.5 years and 57% were male. The majority of primary melanomas were located on the trunk (32.5%) and upper limb (24.7%). Mean Breslow thickness was 1.8 mm (range 0.1–50 mm) and 64% were of superficial spreading subtype. Time to surgery was divided into ≤ 1 week, 1–4 weeks, 4–8 weeks, 8–12 weeks and > 12 weeks ( n = 2453, 8882, 5906, 870 and 126, respectively). Increased delay of definitive surgical treatment was associated with poorer OS and RFS, with an OS HR of 1.23 for the 8–12 week group compared to the 1–4 week group. For RFS HR was 1.36 for the same cohorts. Conclusion Definitive surgical treatment of patients with primary cutaneous melanoma between 1–4 weeks post‐diagnosis with excision‐biopsy was associated with improved OS & RFS compared to those treated within 1 week and greater than 4 weeks in this patient cohort treated prior to the use of adjuvant drug therapy. 33:T105e,Although retrospective and limited prospective observational studies have suggested a potential benefit of appendicectomy in therapy-refractory ulcerative colitis, its effectiveness compared with advanced medical therapy in active, biologic-exposed patients has not been evaluated prospectively. We evaluated the efficacy of laparoscopic appendicectomy in inducing remission, compared with JAK inhibitor therapy, in patients with active ulcerative colitis who had persistent disease activity despite previous advanced therapy exposure (a small molecule or a biologic). In this multicentre, patient-preference, interventional cohort study, conducted in five hospitals in the Netherlands, patients with a total Mayo score (TMS) of 5-12 and an endoscopic subscore of 2 or higher despite treatment with an advanced therapy were offered one of three treatments: laparoscopic appendicectomy while continuing their existing advanced therapy at a stable dose; switching their advanced therapy to a JAK inhibitor; or colectomy. This analysis focuses on patients who chose appendicectomy or to switch their advanced therapy; patients who chose colectomy were included in a non-comparative registry cohort, and outcomes in this group were recorded but not included in the comparative analyses. The primary outcome was the proportion of patients in clinical remission (TMS ≤2, no subscore >1) at 12 months without therapy failure (defined as start or restart of oral corticosteroids; switch to other advanced therapies; initiation of experimental treatment in a clinical trial; or colectomy), assessed in the modified intention-to-treat population (all patients who underwent appendicectomy or received at least one dose of the JAK inhibitor, excluding patients who had a change in disease diagnosis from ulcerative colitis to Crohn's disease). The primary endpoint was analysed by χ Between Aug 24, 2018, and Dec 15, 2023, 211 patients were screened for eligibility, of whom 125 (59%) patients were enrolled in the study; 116 patients were included in the modified intention-to-treat-analysis (67 received appendicectomy and 49 received JAK inhibitor). 22 (32·8%) of 67 patients in the appendicectomy group were in clinical remission without therapy failure at 12 months compared with six (12·2%) of 49 patients in the JAK inhibitor group (unadjusted difference of 20·6 percentage points [95% CI 6·1-35·1]; p=0·010; adjusted difference of 22·9 percentage points [95% CI 6·1-39·8]; p=0·016). At 12 months, corticosteroid-free clinical remission without therapy failure was attained in 22 (32·8%) of 67 patients in the appendicectomy group compared with six (12·2%) of 49 patients in the JAK inhibitor group (difference of 20·6 percentage points [95% CI 6·1-35·1]; p=0·010), clinical response in 49 (73·1%) of 67 patients compared with 26 (53·1%) of 49 patients (20·1 percentage points [2·5-37·6]; p=0·025), and endoscopic response in 31 (48·4%) of 64 patients compared with 11 (25·6%) of 43 patients (25·6%; 22·9 percentage points [5·0-40·7]; p=0·018). Time-to-symptomatic remission (hazard ratio 1·06 [95% CI 0·62 to 1·82]; p=0·82), therapy failure (39 [58·2%] of 67 patients vs 28 [57·1%] of 49 patients; difference of 1·1 percentage points [95% CI -17·1 to 19·3]; p=0·91) and colectomy rates (six [9·0%] of 67 patients vs four [8·2%] of 49 patients; difference of 0·8 percentage points [95% CI -9·5 to 11·1]; p=1·0) were similar between the appendicectomy and JAK inhibitor groups. Adverse events were reported in 39 (56·5%) of 69 patients in the appendicectomy group and 30 (60·0%) of 50 patients in the JAK inhibitor group (difference of 3·5 percentage points [95% CI -21·4 to 14·4]; p=0·70]). Appendicectomy-related complications occurred in three (4·3%) of 69 patients and were all Clavien-Dindo grade II or lower. Appendicectomy as an adjunct to advanced therapy in biologic-exposed patients with active ulcerative colitis was associated with higher clinical remission rates at 12 months compared with switching to a JAK inhibitor, suggesting potential effectiveness, and the procedure can be performed safely in this patient group. ZonMW.34:T88b,Risk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain. To evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer-specific mortality in female carriers of BRCA pathogenic variants. PubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined. Eligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer-specific mortality. Studies including patients with a history of breast cancer were excluded. This meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies-of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment. Overall and breast cancer-specific mortality. Six observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P < .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P < .001) analyses. Breast cancer-specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P < .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002). Risk-reducing bilateral mastectomy was associated with lower overall and breast cancer-specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women.35:T12b9, Importance Risk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain. Objective To evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer–specific mortality in female carriers of BRCA pathogenic variants. Data Sources PubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined. Study Selection Eligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer–specific mortality. Studies including patients with a history of breast cancer were excluded. Data Extraction and Synthesis This meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies—of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment. Main Outcomes and Measures Overall and breast cancer–specific mortality. Results Six observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P &lt; .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P &lt; .001) analyses. Breast cancer–specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P &lt; .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002). Conclusions and Relevance Risk-reducing bilateral mastectomy was associated with lower overall and breast cancer–specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women. 36:T654,Rectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps - rectal mobilisation, prolapse reduction, and fixation - techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy. An international 28-item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty. A total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two-thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day-case procedure. Regional and specialty-related variations were evident in approach, mesh type, and perioperative protocols. This international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision-making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery.37:T8d7,Abstract Aim Rectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps – rectal mobilisation, prolapse reduction, and fixation – techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy. Methods An international 28‐item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty. Results A total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two‐thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day‐case procedure. Regional and specialty‐related variations were evident in approach, mesh type, and perioperative protocols. Conclusion This international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision‐making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery. 38:T402,Periprosthetic fracture is a devastating complication of total hip arthroplasty that is associated with significant morbidity and mortality. Cement-in-cement revision of the femoral component is a technique that has been proposed as an efficient revision technique to treat femoral periprosthetic fractures where the femoral stem is loose, but the bone-cement interface is intact. By eliminating the need to remove the existing cement mantle, proposed advantages include shorter operative time, reduced blood loss, easy restoration of pre-fracture version and soft tissue tension, and eliminating the risk of iatrogenic damage from cement removal. However, the technique has not been widely popularised due to concerns over the fixation stability and risk of non-union from cement extrusion into the fracture site. Herein, an up-to-date review of the indications for, surgical technique of, and outcomes of cement-in-cement revision of the femoral component of a total hip arthroplasty for periprosthetic fracture is provided.39:T59e,A total of 208 patients who underwent curative-intent distal gastrectomy with D2 lymphadenectomy were included in the full analysis set, with 104 patients in each group. There was no crossover between the 2 groups. Patients in the LDG group had a mean (SD) age of 61.1 (10.0) years and included 25 female patients (24.0%). Patients in the ODG group had a mean (SD) age of 60.0 (10.7) years and included 29 female patients (27.9%). No significant differences were found between the LDG and ODG groups in 30-day morbidity and mortality, including rates of any postoperative complication (22.1% vs 21.2%; P = .87) and severe complications (2.9% vs 3.8%; P > .99). The LDG group showed nonsignificant differences regarding surgical complications (21.2% vs 16.4%; P = .37) and general complications (3.9% vs 10.6%; P = .11) compared to the ODG group. The LDG group had significantly longer mean (SD) operative time (220.0 [42.4] minutes vs 153.7 [36.7] minutes; P < .001) and higher median (IQR) blood loss (80 [50-145] mL vs 50 [30-100] mL; P = .003). There were no significant differences in terms of time to the first flatus, time to oral tolerance, length of postoperative hospital stay, and time from surgery to initiation of adjuvant chemotherapy. Comorbidity was identified as an independent risk factor for postoperative complications in multivariate analysis (odds ratio, 2.42; 95% CI, 1.11-5.30; P = .03).3a:Tb58,No prospective trial on laparoscopy has been specifically designed for clinical T4a gastric cancer (GC); evidence of the safety and efficacy of laparoscopy for T4a GC is currently insufficient. To compare the short-term surgical outcomes between laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) with D2 lymph node dissection for patients with clinical T4a GC. The UMC-UPPERGI-01 randomized clinical trial (RCT) was a single-center, open-label, noninferiority RCT conducted at a tertiary hospital in Ho Chi Minh City, Vietnam, among patients with clinical T4a GC. The study was conducted from June 2020 to April 2025. Interim and short-term results analyses were conducted in October 2023 and June 2025, respectively. Patients were randomly assigned 1:1 to undergo LDG or ODG with D2 lymph node dissection as the full analysis set of the UMC-UPPERGI-01 trial. The procedures were performed exclusively by qualified surgeons. Short-term outcomes included surgical results, pathological characteristics, 30-day postoperative morbidity and mortality (Clavien-Dindo classification), and postoperative recovery parameters. A total of 208 patients who underwent curative-intent distal gastrectomy with D2 lymphadenectomy were included in the full analysis set, with 104 patients in each group. There was no crossover between the 2 groups. Patients in the LDG group had a mean (SD) age of 61.1 (10.0) years and included 25 female patients (24.0%). Patients in the ODG group had a mean (SD) age of 60.0 (10.7) years and included 29 female patients (27.9%). No significant differences were found between the LDG and ODG groups in 30-day morbidity and mortality, including rates of any postoperative complication (22.1% vs 21.2%; P = .87) and severe complications (2.9% vs 3.8%; P > .99). The LDG group showed nonsignificant differences regarding surgical complications (21.2% vs 16.4%; P = .37) and general complications (3.9% vs 10.6%; P = .11) compared to the ODG group. The LDG group had significantly longer mean (SD) operative time (220.0 [42.4] minutes vs 153.7 [36.7] minutes; P < .001) and higher median (IQR) blood loss (80 [50-145] mL vs 50 [30-100] mL; P = .003). There were no significant differences in terms of time to the first flatus, time to oral tolerance, length of postoperative hospital stay, and time from surgery to initiation of adjuvant chemotherapy. Comorbidity was identified as an independent risk factor for postoperative complications in multivariate analysis (odds ratio, 2.42; 95% CI, 1.11-5.30; P = .03). In the UMC-UPPERGI-01 noninferiority RCT, LDG showed comparable short-term outcomes to ODG for T4a GC. The results suggest that LDG can be recommended as an alternative to ODG by qualified surgeons for clinical T4a GC; ongoing follow-up will determine long-term oncologic outcomes. ClinicalTrials.gov Identifier: NCT04384757.3b:T137e, Importance No prospective trial on laparoscopy has been specifically designed for clinical T4a gastric cancer (GC); evidence of the safety and efficacy of laparoscopy for T4a GC is currently insufficient. Objective To compare the short-term surgical outcomes between laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) with D2 lymph node dissection for patients with clinical T4a GC. Design, Setting, and Participants The UMC-UPPERGI-01 randomized clinical trial (RCT) was a single-center, open-label, noninferiority RCT conducted at a tertiary hospital in Ho Chi Minh City, Vietnam, among patients with clinical T4a GC. The study was conducted from June 2020 to April 2025. Interim and short-term results analyses were conducted in October 2023 and June 2025, respectively. Interventions Patients were randomly assigned 1:1 to undergo LDG or ODG with D2 lymph node dissection as the full analysis set of the UMC-UPPERGI-01 trial. The procedures were performed exclusively by qualified surgeons. Main Outcomes and Measures Short-term outcomes included surgical results, pathological characteristics, 30-day postoperative morbidity and mortality (Clavien-Dindo classification), and postoperative recovery parameters. Results A total of 208 patients who underwent curative-intent distal gastrectomy with D2 lymphadenectomy were included in the full analysis set, with 104 patients in each group. There was no crossover between the 2 groups. Patients in the LDG group had a mean (SD) age of 61.1 (10.0) years and included 25 female patients (24.0%). Patients in the ODG group had a mean (SD) age of 60.0 (10.7) years and included 29 female patients (27.9%). No significant differences were found between the LDG and ODG groups in 30-day morbidity and mortality, including rates of any postoperative complication (22.1% vs 21.2%; P = .87) and severe complications (2.9% vs 3.8%; P &gt; .99). The LDG group showed nonsignificant differences regarding surgical complications (21.2% vs 16.4%; P = .37) and general complications (3.9% vs 10.6%; P = .11) compared to the ODG group. The LDG group had significantly longer mean (SD) operative time (220.0 [42.4] minutes vs 153.7 [36.7] minutes; P &lt; .001) and higher median (IQR) blood loss (80 [50-145] mL vs 50 [30-100] mL; P = .003). There were no significant differences in terms of time to the first flatus, time to oral tolerance, length of postoperative hospital stay, and time from surgery to initiation of adjuvant chemotherapy. Comorbidity was identified as an independent risk factor for postoperative complications in multivariate analysis (odds ratio, 2.42; 95% CI, 1.11-5.30; P = .03). Conclusions and Relevance In the UMC-UPPERGI-01 noninferiority RCT, LDG showed comparable short-term outcomes to ODG for T4a GC. The results suggest that LDG can be recommended as an alternative to ODG by qualified surgeons for clinical T4a GC; ongoing follow-up will determine long-term oncologic outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT04384757 3c:T469,Of 1246 studies screened, 7 RCTs, including 1480 pediatric patients, met inclusion criteria. Treatment failure was significantly higher in the NOM group than in the appendectomy group at 1 year (risk ratio [RR], 4.97; 95% CI, 3.57-6.91; I2 = 0.0%). Treatment success was significantly lower in the NOM group at 1 year (RR, 0.67; 95% CI, 0.60-0.75; I2 = 31.1%). Major complications classified as Clavien-Dindo grade IIIb or worse were more frequent in the NOM group (RR, 33.37; 95% CI, 7.89-141.05; I2 = 9.5%). Appendicitis recurred at a rate of 18.47 events/100 observations (95% CI, 12.62-25.07 events/100 observations; I2 = 48.5%) among patients who received NOM. NOM, compared with appendectomy, was associated with a modestly faster return to school (mean difference, -1.36 days; 95% CI, -2.64 to -0.08 days; P = .04; I2 = 57.7%) and return to normal activities (-4.93 days; 95% CI, -8.68 to -1.19 days; P = .01; I2 = 87.2%), although this may be offset by subsequent readmissions or reintervention. Trial sequential analysis demonstrated the robustness and conclusiveness of primary outcomes.3d:Tbd8,Nonoperative management (NOM) has emerged as a potential alternative to surgery for acute uncomplicated appendicitis in children; however, while short-term outcomes are often favorable, concerns remain about treatment durability, complication rates, and long-term failure. An updated meta-analysis of randomized clinical trials (RCTs) may help clarify the comparative safety and effectiveness of NOM vs appendectomy. To evaluate the safety and effectiveness of NOM compared with appendectomy for uncomplicated appendicitis in children using the highest level of available evidence. A systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science was conducted from inception through March 2025 to identify randomized clinical trials comparing NOM with surgical management in pediatric patients. RCTs comparing NOM vs surgical management in pediatric patients younger than 18 years were included. Nonrandomized and quasi-randomized studies were excluded. Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted using random-effects models. Risk of bias was assessed independently by multiple reviewers. Trial sequential analysis was performed to determine whether the evidence was sufficiently robust and conclusive. The primary outcomes were treatment failure and treatment success in 1 year and major complications (Clavien-Dindo grade ≥IIIb). Secondary outcomes included time to return to school and time to return to normal activity. Of 1246 studies screened, 7 RCTs, including 1480 pediatric patients, met inclusion criteria. Treatment failure was significantly higher in the NOM group than in the appendectomy group at 1 year (risk ratio [RR], 4.97; 95% CI, 3.57-6.91; I2 = 0.0%). Treatment success was significantly lower in the NOM group at 1 year (RR, 0.67; 95% CI, 0.60-0.75; I2 = 31.1%). Major complications classified as Clavien-Dindo grade IIIb or worse were more frequent in the NOM group (RR, 33.37; 95% CI, 7.89-141.05; I2 = 9.5%). Appendicitis recurred at a rate of 18.47 events/100 observations (95% CI, 12.62-25.07 events/100 observations; I2 = 48.5%) among patients who received NOM. NOM, compared with appendectomy, was associated with a modestly faster return to school (mean difference, -1.36 days; 95% CI, -2.64 to -0.08 days; P = .04; I2 = 57.7%) and return to normal activities (-4.93 days; 95% CI, -8.68 to -1.19 days; P = .01; I2 = 87.2%), although this may be offset by subsequent readmissions or reintervention. Trial sequential analysis demonstrated the robustness and conclusiveness of primary outcomes. In contrast to earlier studies, this meta-analysis found significantly higher treatment failure and major complication rates within a year with NOM among children and adolescents. The meta-analysis provides pediatricians and pediatric surgeons with up-to-date data to inform shared decision-making with families and encourage individualized, patient-centered treatment.3e:T1545, Importance Nonoperative management (NOM) has emerged as a potential alternative to surgery for acute uncomplicated appendicitis in children; however, while short-term outcomes are often favorable, concerns remain about treatment durability, complication rates, and long-term failure. An updated meta-analysis of randomized clinical trials (RCTs) may help clarify the comparative safety and effectiveness of NOM vs appendectomy. Objective To evaluate the safety and effectiveness of NOM compared with appendectomy for uncomplicated appendicitis in children using the highest level of available evidence. Data Sources A systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science was conducted from inception through March 2025 to identify randomized clinical trials comparing NOM with surgical management in pediatric patients. Study Selection RCTs comparing NOM vs surgical management in pediatric patients younger than 18 years were included. Nonrandomized and quasi-randomized studies were excluded. Data Extraction and Synthesis Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted using random-effects models. Risk of bias was assessed independently by multiple reviewers. Trial sequential analysis was performed to determine whether the evidence was sufficiently robust and conclusive. Main Outcomes and Measures The primary outcomes were treatment failure and treatment success in 1 year and major complications (Clavien-Dindo grade ≥IIIb). Secondary outcomes included time to return to school and time to return to normal activity. Results Of 1246 studies screened, 7 RCTs, including 1480 pediatric patients, met inclusion criteria. Treatment failure was significantly higher in the NOM group than in the appendectomy group at 1 year (risk ratio [RR], 4.97; 95% CI, 3.57-6.91; I 2 = 0.0%). Treatment success was significantly lower in the NOM group at 1 year (RR, 0.67; 95% CI, 0.60-0.75; I 2 = 31.1%). Major complications classified as Clavien-Dindo grade IIIb or worse were more frequent in the NOM group (RR, 33.37; 95% CI, 7.89-141.05; I 2 = 9.5%). Appendicitis recurred at a rate of 18.47 events/100 observations (95% CI, 12.62-25.07 events/100 observations; I 2 = 48.5%) among patients who received NOM. NOM, compared with appendectomy, was associated with a modestly faster return to school (mean difference, –1.36 days; 95% CI, −2.64 to −0.08 days; P = .04; I 2 = 57.7%) and return to normal activities (–4.93 days; 95% CI, −8.68 to −1.19 days; P = .01; I 2 = 87.2%), although this may be offset by subsequent readmissions or reintervention. Trial sequential analysis demonstrated the robustness and conclusiveness of primary outcomes. Conclusions and Relevance In contrast to earlier studies, this meta-analysis found significantly higher treatment failure and major complication rates within a year with NOM among children and adolescents. The meta-analysis provides pediatricians and pediatric surgeons with up-to-date data to inform shared decision-making with families and encourage individualized, patient-centered treatment. 3f:T4c3,A total of 401 patients (214 [53.4%] women) with 403 non-LM/non-ALM MIS and a median (IQR) age of 52 (40-62) years were included in the analysis. MIS was frequently located on the trunk (201 lesions [49.9%]), followed by the lower extremity (99 [24.6%]), the upper extremity (71 [17.6%]), and the head and neck (32 [7.9%]). All lesions were initially treated with excisional biopsy, followed by wide excision for 372 (92.3%). There was only 1 local recurrence in a patient with involved margins at the excisional biopsy who did not undergo wide excision and developed an invasive melanoma 14 months later. Thirty lesions in 30 patients had clear excisional biopsy margins with no wide excision and had no recurrence at a median (IQR) follow-up of 8.1 (4.1-12.9) years. In 23 patients with 23 lesions that had wide excision with narrower than the standard 0.5-cm margins (mean [SD] margin size, 0.36 [0.07] cm), no recurrences were found at a median (IQR) follow-up of 4.3 (2.7-6.2) years. During follow-up, 6 patients (1.5%) developed a lesion suspicious for recurrence near the excision scar, which was excised and showed nevus or solar lentigo on histopathology. No patients had metastasis or melanoma-specific death.40:T9c8,The overdiagnosis of melanoma in situ (MIS) is well documented. There is limited evidence on the rate of local recurrence of the non-lentigo maligna (non-LM)/non-acral lentiginous melanoma (non-ALM) subtypes. To investigate local recurrence and prognosis in non-LM/non-ALM MIS, the histopathological clearance of the excisional biopsy margins, and the association with the size of wide excision margins. This retrospective cohort study included patients with non-LM/non-ALM MIS diagnosed from 1991 to 2023 who were followed up for at least 1 year at the Skin Cancer and Melanoma Unit of Andreas Sygros University Hospital in Athens, Greece. Patients with a history of invasive melanoma or a histopathological diagnosis of LM or ALM in situ were excluded. Median (IQR) follow-up was 5.2 (2.9-7.9) years. Deidentified data on patient demographics and clinical characteristics, including the histopathological clearance of margins of the initial excisional biopsy and the size of margins of the wide excision, were obtained from medical records. The primary outcomes were local recurrence, metastasis, and melanoma-specific survival. A total of 401 patients (214 [53.4%] women) with 403 non-LM/non-ALM MIS and a median (IQR) age of 52 (40-62) years were included in the analysis. MIS was frequently located on the trunk (201 lesions [49.9%]), followed by the lower extremity (99 [24.6%]), the upper extremity (71 [17.6%]), and the head and neck (32 [7.9%]). All lesions were initially treated with excisional biopsy, followed by wide excision for 372 (92.3%). There was only 1 local recurrence in a patient with involved margins at the excisional biopsy who did not undergo wide excision and developed an invasive melanoma 14 months later. Thirty lesions in 30 patients had clear excisional biopsy margins with no wide excision and had no recurrence at a median (IQR) follow-up of 8.1 (4.1-12.9) years. In 23 patients with 23 lesions that had wide excision with narrower than the standard 0.5-cm margins (mean [SD] margin size, 0.36 [0.07] cm), no recurrences were found at a median (IQR) follow-up of 4.3 (2.7-6.2) years. During follow-up, 6 patients (1.5%) developed a lesion suspicious for recurrence near the excision scar, which was excised and showed nevus or solar lentigo on histopathology. No patients had metastasis or melanoma-specific death. This cohort study found that diagnostic excisional biopsies with clear margins may be sufficient for treating MIS; however, larger studies are necessary.41:Tc23,ImportanceThe overdiagnosis of melanoma in situ (MIS) is well documented. There is limited evidence on the rate of local recurrence of the non-lentigo maligna (non-LM)/non-acral lentiginous melanoma (non-ALM) subtypes.ObjectiveTo investigate local recurrence and prognosis in non-LM/non-ALM MIS, the histopathological clearance of the excisional biopsy margins, and the association with the size of wide excision margins.Design, Setting, and ParticipantsThis retrospective cohort study included patients with non-LM/non-ALM MIS diagnosed from 1991 to 2023 who were followed up for at least 1 year at the Skin Cancer and Melanoma Unit of Andreas Sygros University Hospital in Athens, Greece. Patients with a history of invasive melanoma or a histopathological diagnosis of LM or ALM in situ were excluded. Median (IQR) follow-up was 5.2 (2.9-7.9) years. Deidentified data on patient demographics and clinical characteristics, including the histopathological clearance of margins of the initial excisional biopsy and the size of margins of the wide excision, were obtained from medical records.Main Outcomes and MeasuresThe primary outcomes were local recurrence, metastasis, and melanoma-specific survival.ResultsA total of 401 patients (214 [53.4%] women) with 403 non-LM/non-ALM MIS and a median (IQR) age of 52 (40-62) years were included in the analysis. MIS was frequently located on the trunk (201 lesions [49.9%]), followed by the lower extremity (99 [24.6%]), the upper extremity (71 [17.6%]), and the head and neck (32 [7.9%]). All lesions were initially treated with excisional biopsy, followed by wide excision for 372 (92.3%). There was only 1 local recurrence in a patient with involved margins at the excisional biopsy who did not undergo wide excision and developed an invasive melanoma 14 months later. Thirty lesions in 30 patients had clear excisional biopsy margins with no wide excision and had no recurrence at a median (IQR) follow-up of 8.1 (4.1-12.9) years. In 23 patients with 23 lesions that had wide excision with narrower than the standard 0.5-cm margins (mean [SD] margin size, 0.36 [0.07] cm), no recurrences were found at a median (IQR) follow-up of 4.3 (2.7-6.2) years. During follow-up, 6 patients (1.5%) developed a lesion suspicious for recurrence near the excision scar, which was excised and showed nevus or solar lentigo on histopathology. No patients had metastasis or melanoma-specific death.Conclusions and RelevanceThis cohort study found that diagnostic excisional biopsies with clear margins may be sufficient for treating MIS; however, larger studies are necessary.42:T9ef,Merkel cell carcinoma (MCC) is a rare cutaneous malignant neoplasm with increasing incidence and high mortality. Although it is accepted that the optimal treatment for localized tumors is surgical, the data surrounding the optimal surgical approach are mixed, and current National Comprehensive Cancer Network guidelines state that Mohs micrographic surgery (MMS) and wide local excision (WLE) can both be used. The current National Comprehensive Cancer Network guidelines do not advocate a preference for MMS or WLE and suggest that they can be used interchangeably. To evaluate the association of surgical approach with overall survival after excision of localized T1/T2 MCC. This retrospective cohort study used the National Cancer Database to assess adults with T1/T2 MCC who were diagnosed between January 1, 2004, and December 31, 2018, with pathologically confirmed, negative regional lymph nodes and treated with surgery. The National Cancer Database includes all reportable cases from Commission on Cancer-accredited facilities. Data analysis was performed from October 2022 to May 2023. Surgical approach. Overall survival. A total of 2313 patients (mean [SD] age, 71 [10.6] years; 1340 [57.9%] male) were included in the study. Excision with MMS had the best unadjusted survival, with mean (SE) survival rates of 87.4% (3.4%) at 3 years, 84.5% (3.9%) at 5 years, and 81.8% (4.6%) at 10 years vs 86.1% (0.9%) at 3 years, 76.9% (1.2%) at 5 years, and 60.9% (2.0%) at 10 years for patients treated with WLE. Patients treated with narrow-margin excision had similar survival as those treated with WLE, with mean (SE) survival rates of 84.8% (1.4%) at 3 years, 78.3% (1.7%) at 5 years, and 60.8% (3.6%) at 10 years. On multivariable survival analysis, excision with MMS was associated with significantly improved survival compared with WLE (hazard ratio, 0.59; 95% CI, 0.36-0.97; P = .04). High-volume MCC centers were significantly more likely to use MMS over WLE compared with other centers (odds ratio, 1.99; 95% CI, 1.63-2.44; P < .001). In this cohort study, the use of MMS (compared with WLE) was associated with significantly improved survival for patients with localized MCC with pathologically confirmed negative lymph nodes treated with surgery. These data suggest that Mohs surgery may provide a more effective treatment for MCC primary tumors than conventional WLE, although the lack of randomization and potential for selection bias in this study highlight the need for future prospective work evaluating this issue.43:Tce8,ImportanceMerkel cell carcinoma (MCC) is a rare cutaneous malignant neoplasm with increasing incidence and high mortality. Although it is accepted that the optimal treatment for localized tumors is surgical, the data surrounding the optimal surgical approach are mixed, and current National Comprehensive Cancer Network guidelines state that Mohs micrographic surgery (MMS) and wide local excision (WLE) can both be used. The current National Comprehensive Cancer Network guidelines do not advocate a preference for MMS or WLE and suggest that they can be used interchangeably.ObjectiveTo evaluate the association of surgical approach with overall survival after excision of localized T1/T2 MCC.Design, Setting, and ParticipantsThis retrospective cohort study used the National Cancer Database to assess adults with T1/T2 MCC who were diagnosed between January 1, 2004, and December 31, 2018, with pathologically confirmed, negative regional lymph nodes and treated with surgery. The National Cancer Database includes all reportable cases from Commission on Cancer–accredited facilities. Data analysis was performed from October 2022 to May 2023.ExposureSurgical approach.Main Outcomes and MeasuresOverall survival.ResultsA total of 2313 patients (mean [SD] age, 71 [10.6] years; 1340 [57.9%] male) were included in the study. Excision with MMS had the best unadjusted survival, with mean (SE) survival rates of 87.4% (3.4%) at 3 years, 84.5% (3.9%) at 5 years, and 81.8% (4.6%) at 10 years vs 86.1% (0.9%) at 3 years, 76.9% (1.2%) at 5 years, and 60.9% (2.0%) at 10 years for patients treated with WLE. Patients treated with narrow-margin excision had similar survival as those treated with WLE, with mean (SE) survival rates of 84.8% (1.4%) at 3 years, 78.3% (1.7%) at 5 years, and 60.8% (3.6%) at 10 years. On multivariable survival analysis, excision with MMS was associated with significantly improved survival compared with WLE (hazard ratio, 0.59; 95% CI, 0.36-0.97; P = .04). High-volume MCC centers were significantly more likely to use MMS over WLE compared with other centers (odds ratio, 1.99; 95% CI, 1.63-2.44; P &lt; .001).Conclusions and RelevanceIn this cohort study, the use of MMS (compared with WLE) was associated with significantly improved survival for patients with localized MCC with pathologically confirmed negative lymph nodes treated with surgery. These data suggest that Mohs surgery may provide a more effective treatment for MCC primary tumors than conventional WLE, although the lack of randomization and potential for selection bias in this study highlight the need for future prospective work evaluating this issue.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Surgery: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Surgery (modality). 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The RVS group (n=42) achieved 2-year DFS of 90% (95% CI, 77%–96%) with 100% laryngeal preservation in laryngeal/hypopharyngeal cancers, while the SVS group (n=5) had 2-year DFS of only 20% (95% CI, 0.8%–58%). Grade 3 AEs occurred in 16% (NAICT-related) and 15% (surgery-related); no grade 4–5 AEs were recorded.","limitations":"- Single-arm phase II design with no randomized comparator limits causal inference.\n- Small SVS subgroup (n=5) makes outcomes in poor responders highly uncertain.\n- Restricted to HPV-negative LA-HNSCC, limiting generalizability to HPV-positive disease.","practice_takeaway":"For HPV-negative LA-HNSCC patients who achieve ≥50% tumor regression after neoadjuvant immunochemotherapy, response-adapted reduced-volume surgery appears feasible and yields high laryngeal preservation rates with manageable toxicity. These results should be considered hypothesis-generating; phase III validation is needed before adopting this de-escalation approach."}},{"doi":"10.1186/s12893-026-04160-z","pmid":null,"title":"Reverse-orientation small-bowel anastomosis causing functional obstruction mimicking afferent loop syndrome after pancreaticoduodenectomy in a patient with prior right hemicolectomy: a case report","journal_title":"BMC Surgery","journal_issn":"1471-2482","published_at":"2026-08-31T00:00:00.000Z","url":"https://doi.org/10.1186/s12893-026-04160-z","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-09-06T06:23:13.258Z","updated_at":"2026-09-06T06:23:13.258Z","tags":[{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"condition","value":"Afferent Loop Syndrome","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"condition","value":"Postoperative Complication","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"condition","value":"Small Bowel Obstruction","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"modality","value":"Surgery","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"warning","value":"Full paper text was not provided — summary is based on title, journal metadata, and inferred content only; specific clinical details, patient demographics, and outcome data could not be verified.","value_numeric":null},{"paper_doi":"10.1186/s12893-026-04160-z","tag_type":"warning","value":"Study design classified as Case Report based on the title; no abstract or full text was available to confirm.","value_numeric":null}],"summaries":{"what_studied":"A case report describing a patient with a prior right hemicolectomy who developed functional obstruction mimicking afferent loop syndrome after pancreaticoduodenectomy, caused by a reverse-orientation small-bowel anastomosis.","key_result":"The reverse-orientation anastomosis created a functional obstruction that clinically resembled afferent loop syndrome; recognition of the prior surgical anatomy was key to diagnosis and management.","limitations":"Single case report with no generalizability; clinical details such as exact management steps and outcomes are not fully extractable from the abstract alone.","practice_takeaway":"In patients with prior bowel resection undergoing pancreaticoduodenectomy, carefully verify small-bowel orientation during reconstruction to avoid reverse-orientation anastomosis, which can cause functional obstruction mimicking afferent loop syndrome."}},{"doi":"10.1093/ced/llag377","pmid":"42663292","title":"Extramammary Paget Disease: A Review","journal_title":"Clinical and Experimental Dermatology","journal_issn":"0307-6938","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/ced/llag377","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-04T06:22:16.881Z","updated_at":"2026-09-04T06:22:16.881Z","tags":[{"paper_doi":"10.1093/ced/llag377","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"condition","value":"Extramammary Paget Disease","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Surgery","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Systemic Therapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"modality","value":"Topical Therapy","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"5-year survival figure is anchored to a single diagnosis cohort year (2013); more recent outcomes may differ.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"Incidence and survival data are derived exclusively from England (2013–2020) and may not reflect global epidemiology.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"No specific sample size (patient N) is provided in the abstract for the England dataset; sample_size tag was omitted.","value_numeric":null},{"paper_doi":"10.1093/ced/llag377","tag_type":"warning","value":"Sex distribution of affected patients is not reported in the abstract; sex tag was omitted.","value_numeric":null}],"summaries":{"what_studied":"This review covers extramammary Paget disease (EMPD) — a rare adenocarcinoma of apocrine gland-rich skin — including its history, classification, epidemiology, aetiology, pathogenesis, diagnosis, malignancy screening, and management strategies.","key_result":"England data (2013–2020) show a crude incidence of 0.17 per 100,000 person-years; 5-year net survival was 90.9% for cases diagnosed in 2013, comparable to melanoma (89.6%), prostate (85.8%), and breast cancer (85.9%). Recurrence rates reach up to 50% across treatment modalities.","limitations":"Epidemiological data are drawn from England only, limiting global generalizability. Survival figures reflect a single diagnosis year (2013), which may not represent current outcomes. As a narrative review, it does not perform systematic evidence synthesis or meta-analysis.","practice_takeaway":"Screen all EMPD patients for underlying visceral malignancy, as risk varies by anatomical site. Counsel patients on the high recurrence rate (up to 50%) regardless of treatment chosen, and maintain close long-term surveillance."}},{"doi":"10.3748/wjg.117897","pmid":null,"title":"Contribution of the appendix to ulcerative colitis by supplying pathogenic immunoglobulin G-producing cells","journal_title":"World Journal of Gastroenterology","journal_issn":"1007-9327","published_at":"2026-07-21T00:00:00.000Z","url":"https://doi.org/10.3748/wjg.117897","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:59.990Z","updated_at":"2026-08-19T06:28:59.990Z","tags":[{"paper_doi":"10.3748/wjg.117897","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"modality","value":"Single-Cell RNA Sequencing","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"modality","value":"Surgery","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"study_design","value":"Translational Cohort Study","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"warning","value":"Controls were colorectal cancer patients, not healthy volunteers, which may introduce immune confounding.","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"warning","value":"No sample size (N) was reported in the abstract; total patient numbers could not be extracted.","value_numeric":null},{"paper_doi":"10.3748/wjg.117897","tag_type":"warning","value":"Study design is a translational surgical cohort — not a randomized trial — so the 'practice_changing' flag reflects mechanistic novelty rather than proven clinical efficacy.","value_numeric":null}],"summaries":{"what_studied":"This study examined the role of the appendix in ulcerative colitis (UC) by analyzing appendiceal immune cells from UC patients undergoing surgery versus colorectal cancer surgery controls, using single-cell RNA sequencing, immunohistochemistry, and flow cytometry.","key_result":"IgG-expressing plasma cells were markedly increased in the appendices of UC patients. Patients with UC who had undergone prior appendectomy showed significantly lower IgG levels in the large intestine. Repertoire analysis found elevated IgG antibodies with integrin-binding motifs at antigen-recognition sites in UC patients.","limitations":"Small, single-center surgical cohort limits generalizability. Causal direction (appendix driving colitis vs. colitis affecting appendix) is not definitively established. Control appendices came from colorectal cancer patients, which may not represent healthy tissue.","practice_takeaway":"The appendix appears to be a key source of pathogenic IgG antibodies in UC, offering a mechanistic rationale for appendectomy as a therapeutic strategy. Clinicians managing refractory UC may consider this immunological basis when weighing surgical options."}},{"doi":"10.1016/j.athoracsur.2026.05.037","pmid":"42264017","title":"STAGE II NON-SMALL CELL LUNG CANCER: UPFRONT SURGERY OR NEOADJUVANT CHEMOIMMUNOTHERAPY","journal_title":"The Annals of Thoracic Surgery","journal_issn":"0003-4975","published_at":"2026-06-09T00:00:00.000Z","url":"https://doi.org/10.1016/j.athoracsur.2026.05.037","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-21T13:29:47.820Z","updated_at":"2026-06-21T13:29:47.820Z","tags":[{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"condition","value":"Stage II Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"modality","value":"Chemoimmunotherapy","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"modality","value":"Neoadjuvant Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"modality","value":"Surgery","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"sample_size","value":"n=7617","value_numeric":7617},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"study_design","value":"Individual Patient Data Meta-Analysis","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"warning","value":"IPD was reconstructed using the IPDfromKM method rather than obtained directly from trial sponsors, which may introduce statistical reconstruction error.","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"warning","value":"The divergence in OS benefit between TNM 8th and 9th edition comparisons is a key ambiguity — the study does not clearly adjudicate which edition is more appropriate for current practice.","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously: the authors themselves call for stratification tools and do not recommend an immediate practice shift.","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.05.037","tag_type":"warning","value":"The total sample size tag reflects the largest surgical comparator group (9th-edition TNM database, n=7,342) plus chemoimmunotherapy arm (n=275); the true combined analytic N varies by comparison. Exact total N is not explicitly stated for all analyses.","value_numeric":null}],"summaries":{"what_studied":"This IPD meta-analysis compared overall survival in stage-II NSCLC patients (AJCC TNM 8th ed.) receiving neoadjuvant chemoimmunotherapy (n=275, from phase-3 RCTs) versus upfront surgery (n=6,864–7,342, from pathological TNM 8th/9th-edition databases). Secondary comparisons evaluated neoadjuvant chemoimmunotherapy vs. chemotherapy alone for pathologic response, event-free survival, and surgical outcomes.","key_result":"Chemoimmunotherapy improved OS vs. upfront surgery per the 8th-edition TNM database (HR=0.68, 95%CI 0.53–0.87, p=0.002), but not per the 9th-edition (HR=0.82, 95%CI 0.64–1.1, p=0.10). Vs. chemotherapy alone, chemoimmunotherapy yielded higher pCR (RR=6.19), major pathologic response (RR=3.08), better event-free survival (HR=0.66, p<0.001), and better OS (HR=0.68, p=0.01), with no difference in surgical complication rates.","limitations":"- The chemoimmunotherapy arm is small (n=275) and extracted via the IPDfromKM method rather than directly from individual patient records, introducing reconstruction error.\n- Comparison vs. upfront surgery relied on historical TNM registry data, not a randomized control group, with potential for selection bias.\n- Results diverge depending on which TNM edition (8th vs. 9th) is used as the benchmark, limiting definitive conclusions.","practice_takeaway":"For stage-II NSCLC, neoadjuvant chemoimmunotherapy offers better pathologic responses and event-free survival than chemotherapy alone, with no added surgical risk — but its OS benefit over upfront surgery remains uncertain and depends on staging classification. Clinicians should await better patient-selection tools before broadly shifting away from upfront surgery in this stage."}},{"doi":"10.1016/s2352-4642(26)00069-6","pmid":"42107384","title":"Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: an international cohort study","journal_title":"The Lancet Child & Adolescent Health","journal_issn":"2352-4642","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1016/s2352-4642(26)00069-6","source_score":35,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-11","doi":"10.1016/s2352-4642(26)00069-6","days":"7","issn":"2352-4642","rank":"5","field":"Clinical Medicine","score":"35","category":"Pediatrics","categories":["Pediatrics"],"_categories":["Pediatrics"]},"pubmed":{"doi":"10.1016/S2352-4642(26)00069-6","title":"Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: an international cohort study.","journal":"The Lancet. 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The primary outcome was post‑operative in‑hospital 30‑day mortality, with timing from injury to operation also assessed.","key_result":"Median time from injury to operation was 7.4 h (IQR 3.5–18.8; n=235) and was longer in lower/middle vs upper HDI settings (p=0.0008). Crude 30‑day mortality was 8% (19/237), and after adjustment patients in lower‑HDI countries had higher odds of death than those in upper‑HDI countries (OR 5.69, 95% CI 1.58–20.44; p=0.0079).","limitations":"This is a planned post‑hoc analysis of a multicentre observational cohort focused on paediatric cases. Sample size was modest (n=237) and time‑to‑operation data were missing for two patients (n=235).","practice_takeaway":"Proportionally more children undergo trauma laparotomy in lower‑resource settings, yet they face much higher adjusted 30‑day mortality and longer delays to surgery. Health systems—especially in lower‑ and middle‑HDI settings—should target faster pathways to the operating room and strengthen paediatric trauma care."}},{"doi":"10.1111/ans.70490","pmid":"41532394","title":"Timing of Definitive Surgical Management of Primary Cutaneous Melanoma: Association With Survival","journal_title":"ANZ Journal of Surgery","journal_issn":"1445-1433","published_at":"2026-01-14T00:00:00.000Z","url":"https://doi.org/10.1111/ans.70490","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-15","doi":"10.1111/ans.70490","days":"7","issn":"1445-1433","rank":"10","field":"Clinical Medicine","score":"15","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1111/ans.70490","title":"Timing of Definitive Surgical Management of Primary Cutaneous Melanoma: Association With Survival.","journal":"ANZ journal of surgery","methods":"","results":"In total 18, 242 patients were included in the analysis. Their average age was 57.5 years and 57% were male. The majority of primary melanomas were located on the trunk (32.5%) and upper limb (24.7%). Mean Breslow thickness was 1.8 mm (range 0.1-50 mm) and 64% were of superficial spreading subtype. Time to surgery was divided into ≤ 1 week, 1-4 weeks, 4-8 weeks, 8-12 weeks and > 12 weeks (n = 2453, 8882, 5906, 870 and 126, respectively). Increased delay of definitive surgical treatment was associated with poorer OS and RFS, with an OS HR of 1.23 for the 8-12 week group compared to the 1-4 week group. For RFS HR was 1.36 for the same cohorts.","abstract":"$31","keywords":[],"pubmed_id":"41532394","conclusions":"Definitive surgical treatment of patients with primary cutaneous melanoma between 1-4 weeks post-diagnosis with excision-biopsy was associated with improved OS & RFS compared to those treated within 1 week and greater than 4 weeks in this patient cohort treated prior to the use of adjuvant drug therapy.","publication_date":"2026-01-14T00:00:00"},"crossref":{"DOI":"10.1111/ans.70490","URL":"https://doi.org/10.1111/ans.70490","ISSN":["1445-1433","1445-2197"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ans.70490","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ans.70490","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ans.70490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Timing of Definitive Surgical Management of Primary Cutaneous Melanoma: Association With Survival"],"author":[{"given":"Edward (Ned)","family":"Farley","sequence":"first","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"}]},{"given":"Jake","family":"Hindmarch","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"}]},{"given":"Janet","family":"McKeown","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"}]},{"given":"Serigne N.","family":"Lo","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"}]},{"given":"Sydney","family":"Ch'ng","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"},{"name":"Royal Prince Alfred Hospital Sydney Australia"},{"name":"Chris O’Brien Lifehouse Sydney Australia"},{"name":"Mater Hospital Sydney Australia"}]},{"given":"Omgo E.","family":"Nieweg","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"}]},{"given":"Thomas E.","family":"Pennington","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"},{"name":"Royal Prince Alfred Hospital Sydney Australia"},{"name":"Mater Hospital Sydney Australia"}]},{"given":"Kerwin F.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"},{"name":"Royal Prince Alfred Hospital Sydney Australia"},{"name":"Chris O’Brien Lifehouse Sydney Australia"},{"name":"Mater Hospital Sydney Australia"}]},{"given":"Andrew J.","family":"Spillane","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"},{"name":"Mater Hospital Sydney Australia"},{"name":"Royal North Shore Hospital Sydney Australia"}]},{"given":"John F.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia The University of Sydney Sydney Australia"},{"name":"Faculty of Medicine and Health The University of Sydney Sydney Australia"},{"name":"Royal Prince Alfred Hospital Sydney Australia"},{"name":"Mater Hospital Sydney Australia"},{"name":"Faculty of Health and Medical Sciences The University of Western Australia Perth Australia"}]},{"given":"Robyn P. 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Time-to-surgery groups included n=2,453 (≤1 week), 8,882 (1–4 weeks), 5,906 (4–8 weeks), 870 (8–12 weeks), and 126 (>12 weeks).","limitations":"Retrospective, single-center cohort predating adjuvant melanoma therapies; residual confounding is likely. 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The primary outcome was clinical remission without therapy failure at 12 months in a modified intention‑to‑treat population (67 vs 49 patients).","key_result":"At 12 months, 22/67 (32.8%) after appendicectomy achieved clinical remission without therapy failure versus 6/49 (12.2%) after switching to a JAK inhibitor (difference 20.6 percentage points, 95% CI 6.1–35.1; p=0.010; adjusted difference 22.9 points, 95% CI 6.1–39.8; p=0.016).","limitations":"Nonrandomized, patient‑preference design risks selection bias and confounding; the colectomy group was excluded from comparative analyses; conducted in five centres in the Netherlands with modest group sizes (67 vs 49), and endoscopic outcomes were reported for subsets (64 and 43).","practice_takeaway":"Consider discussing appendicectomy plus ongoing advanced therapy as an option after biologic exposure in active ulcerative colitis, given higher 12‑month remission without therapy failure than switching to a JAK inhibitor, similar adverse event rates (56.5% vs 60.0%), and few low‑grade surgical complications (3/69, all grade ≤II), while acknowledging the nonrandomized design."}},{"doi":"10.1001/jamasurg.2025.5929","pmid":"41499127","title":"Risk-Reducing Bilateral Mastectomy and Mortality in Carriers of\n BRCA1\n and\n BRCA2\n Variants","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-01-07T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12780977/","source_score":31,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-10","doi":"10.1001/jamasurg.2025.5929","days":"14","issn":"2168-6254","rank":"10","field":"Clinical Medicine","score":"31","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1001/jamasurg.2025.5929","title":"Risk-Reducing Bilateral Mastectomy and Mortality in Carriers of BRCA1 and BRCA2 Variants: A Systematic Review and Meta-Analysis.","journal":"JAMA surgery","methods":"","results":"Six observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. 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Use these data to support shared decision-making about surgical prevention."}},{"doi":"10.1111/codi.70355","pmid":"41486360","title":"Surgeon preferences and practice patterns in rectopexy: Results of an international survey","journal_title":"Colorectal Disease","journal_issn":"1462-8910","published_at":"2026-01-05T00:00:00.000Z","url":"https://doi.org/10.1111/codi.70355","source_score":6,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-09","doi":"10.1111/codi.70355","days":"7","issn":"1462-8910","rank":"9","field":"Clinical Medicine","score":"6","category":"Gastroenterology & Hepatology","categories":["Gastroenterology & Hepatology","Surgery"],"_categories":["Gastroenterology & Hepatology","Surgery"]},"pubmed":{"doi":"10.1111/codi.70355","title":"Surgeon preferences and practice patterns in rectopexy: Results of an international survey.","journal":"Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland","methods":"","results":"A total of 226 surgeons from 36 countries across four continents completed the survey. 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Consider these data hypothesis-generating; larger studies are needed and current standards should guide care."}},{"doi":"10.1001/jamadermatol.2023.2822","pmid":"37610773","title":"Overall Survival After Mohs Surgery for Early-Stage Merkel Cell Carcinoma","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2023-08-23T00:00:00.000Z","url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10448369","source_score":63,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2023-11-15","doi":"10.1001/jamadermatol.2023.2822","days":"30","issn":"2168-6068","rank":"4","field":"Clinical Medicine","score":"63","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2023.2822","title":"Overall Survival After Mohs Surgery for Early-Stage Merkel Cell Carcinoma.","journal":"JAMA dermatology","methods":"","results":"A total of 2313 patients (mean [SD] age, 71 [10.6] years; 1340 [57.9%] male) were included in the study. Excision with MMS had the best unadjusted survival, with mean (SE) survival rates of 87.4% (3.4%) at 3 years, 84.5% (3.9%) at 5 years, and 81.8% (4.6%) at 10 years vs 86.1% (0.9%) at 3 years, 76.9% (1.2%) at 5 years, and 60.9% (2.0%) at 10 years for patients treated with WLE. Patients treated with narrow-margin excision had similar survival as those treated with WLE, with mean (SE) survival rates of 84.8% (1.4%) at 3 years, 78.3% (1.7%) at 5 years, and 60.8% (3.6%) at 10 years. On multivariable survival analysis, excision with MMS was associated with significantly improved survival compared with WLE (hazard ratio, 0.59; 95% CI, 0.36-0.97; P = .04). High-volume MCC centers were significantly more likely to use MMS over WLE compared with other centers (odds ratio, 1.99; 95% CI, 1.63-2.44; P < .001).","abstract":"$42","keywords":[],"pubmed_id":"37610773","conclusions":"","publication_date":"2023-08-23T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2023.2822","URL":"https://doi.org/10.1001/jamadermatol.2023.2822","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2808884/jamadermatology_cheraghlou_2023_oi_230036_1697555524.75181.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"1068","type":"journal-article","issue":"10","score":1,"title":["Overall Survival After Mohs Surgery for Early-Stage Merkel Cell Carcinoma"],"author":[{"given":"Shayan","family":"Cheraghlou","sequence":"first","affiliation":[{"name":"The Ronald O. 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In multivariable analysis, MMS was associated with lower mortality than WLE (HR 0.59; 95% CI 0.36–0.97; P=0.04), narrow‑margin excision was similar to WLE, and high‑volume centers were more likely to use MMS (OR 1.99; 95% CI 1.63–2.44).","limitations":"Nonrandomized, retrospective NCDB analysis with potential selection bias. Treatment selection varied by center volume, which could confound results.","practice_takeaway":"For localized, node‑negative T1/T2 Merkel cell carcinoma, MMS was associated with better overall survival than WLE in this large cohort; consider this signal when planning surgery, while awaiting prospective confirmation."}}],"initialOffset":16,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Surgery"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Surgery"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Surgery"}}}]]

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