tbuckley/cabot-search huggingface dataset:
Comparison of the efficacy of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: meta-analysis of randomized controlled trials
Authors: De-Xing Zeng, Ruo-Nan Liu, Xian-Kun Ren, Peng Zhang, Ling-Han Tang, Ling Tan, Rehman Zia Ur, Mao-Ru Zhao, Peng Guo, Pan Zhang, Jun Du, Xian Qin, Shi-Yan Wan, Lu-Qian Deng, Ya-Jun Luo, Zi-Lin Liu, Jiang-Wei Xiao
Journal: International Journal of Surgery (2025)

Background: Preoperative neoadjuvant chemoradiotherapy (nCRT) is considered to be the standard treatment strategy for locally advanced rectal cancer (LARC); however, the risk of adverse events and postoperative recurrence remains significant. This study aimed to evaluate the non-inferiority of neoadjuvant chemotherapy (nCT) compared with nCRT in patients with LARC and to assess the possibility of eliminating radiotherapy on the basis of guaranteed efficacy. Materials and methods: We searched the PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing the efficacy of nCRT and nCT for LARC. The study protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO). Results: A total of 2706 patients from 7 studies were included in the meta-analysis. There was no significant difference in overall survival (OS) or disease-free survival (DFS) between the nCT and nCRT groups. This study demonstrated a lower rate of infection (OR = 0.53, 95% CI = 0.34–0.82; P = 0.005), anastomotic leak (OR = 0.55, 95% CI = 0.34–0.87; P = 0.01), tumor regression grade (TRG) 0-1 (OR = 0.50, 95% CI = 0.36–0.69; P &lt; 0.0001), preventive diverting ileostomy (OR = 0.41, 95% CI = 0.17–1.02; P = 0.05) and leukopenia (OR = 0.50, 95% CI = 0.25–1.01; P = 0.05) in the nCT group. However, there was no significant difference in the other toxic events, such as intestinal obstruction, urinary complications, diarrhoea, and surgical or pathological outcomes, such as clinical fistula, sphincter preservation, postoperative mortality (≤ 60 d), R0 resection, ypStage 0-I, positive circumferential resection margin (CRM +) or pathological complete response (pCR) between the two groups. Conclusion: This study indicated that OS and DFS were not lower in the nCT group than in the nCRT group. In addition, the nCT group had fewer complications. Preoperative nCT is expected to become a standard treatment option for most patients with stage II-III LARC. It is worth noting that radiotherapy can not be ignored for some patients who need to ensure the conversion effect of neoadjuvant therapy and strongly request to preserve organ function.
Prediction Model of the T Cell-mediated Rejection After Liver Transplantation in Children and Adults: a Case-controlled Study
Authors: Chengbo Ai, Jiulin Song, Chi Yuan, Gang Xu, Jian Yang, Tao Lv, Shuguang Jin, Hong Wu, Bo Xiang, Jiayin Yang
Journal: International Journal of Surgery (2025)

Objective: T cell-mediated rejection (TCMR) is a major concern following liver transplantation (LT), and identifying its predictors could help improve post-transplant prognosis. This study aimed to develop a model to predict the risk of TCMR in children and adults after LT. Method: Pre-transplant demographic characteristics, intraoperative parameters, and especially early post-transplant laboratory data for 1,221 LT recipients (1,096 adults and 125 children) were obtained from Hospital, University, between 1 January 2015, and 1 January 2022. These data were analyzed to develop the prediction model. Result: The incidence of TCMR was higher in pediatric LT recipients than in adults (17.6% vs. 6.4%, p &lt; 0.001). In adult recipients, seven predictors were identified: donor sex, recipient age, recipient height, and post-transplant levels of serum direct bilirubin, urea, platelets, and neutrophil-to-lymphocyte ratio. In pediatric recipients, four predictors were identified: post-transplant levels of serum monocyte percentage, direct bilirubin, albumin, and gamma-glutamyl transferase. The area under the model’s curve incorporating these variables for predicting TCMR after LT was 0.713 (95% CI: 0.655-0.770) in adults and 0.786 (95% CI: 0.675-0.896) in children. Decision curve analyses demonstrated the clinical significance of the model. Conclusion: This study developed a prediction model that may be useful in identifying high-TCMR-risk populations in both adult and pediatric LT recipients.
Construction of an Artificially Intelligent Model for Accurate Detection of HCC by Integrating Clinical, Radiological, and Peripheral Immunological Features
Authors: Yangyang Wang, Shengqiang Chi, Yu Tian, Xueyao Li, Hang Zhang, Yiting Xu, Chao Huang, Yiwei Gao, Gaowei Jin, Qihan Fu, Wanyue Cao, Cao Chen, Haonan Ding, Yuquan Zhang, Yupeng Hong, Junjian Li, Xu Sun, Enliang Li, Yuhua Zhang, Weiyun Yao, Runtian Liu, Yongfei Hua, Haifeng Huang, Minghui Xu, Bo Zhang, Weifeng Tao, Tianxing Yang, Yuming Gao, Xiaoguang Wang, Cheng Lin, Jingsong Li, Qi Zhang, Tingbo Liang
Journal: International Journal of Surgery (2025)

Background: Integrating comprehensive information on hepatocellular carcinoma (HCC) is essential to improve its early detection. We aimed to develop a model with multi-modal features (MMF) using artificial intelligence (AI) approaches to enhance the performance of HCC detection. Materials and methods: A total of 1,092 participants were enrolled from 16 centers. These participants were allocated into the training, internal validation, and external validation cohorts. Peripheral blood specimens were collected prospectively and subjected to mass cytometry analysis. Clinical and radiological data were obtained from electrical medical records. Various AI methods were employed to identify pertinent features and construct single-modal models with optimal performance. The XGBoost algorithm was utilized to amalgamate these models, integrating multi-modal information and facilitating the development of a fusion model. Model evaluation and interpretability were demonstrated using the SHapley Additive exPlanations method. Results: We constructed the electronic health record, BioScore, RadiomicScore, and DLScore models based on clinical, radiological, and peripheral immunological features, respectively. Subsequently, these single-modal models were amalgamated to develop an all-in-one MMF model. The MMF model exhibited enhanced performance compared to models comprising only single-modal features in detecting HCC. This superiority in performance was confirmed through the internal and external validation cohorts, yielding area under the curve (AUC) values of 0.985 and 0.915, respectively. Additionally, the MMF model improved the detection ability in subpopulations of HCCs that were negative for alpha-fetoprotein and those with small size, with AUC values of 0.974 and 0.996, respectively. Conclusions: Integrating multi-modal features improved the performance of the model for HCC detection.
Incidence and treatment of anastomotic leakage after esophagectomy in German acute care hospitals: a retrospective cohort study
Authors: Marie-Christin Weber, Nicolas Jorek, Philipp-Alexander Neumann, Jeannine Bachmann, Rebekka Dimpel, Marc Martignoni, Marcus Feith, Helmut Friess, Alexander Novotny, Maximilian Berlet, Daniel Reim
Journal: International Journal of Surgery (2025)

Background: Anastomotic leakage (AL) is a major concern following esophagectomy due to the associated morbidity and mortality. The impact of hospital volume on postoperative outcomes after esophagectomy has previously been reported. The aim of this study was to analyze the current trends in postoperative anastomotic leakage and associated failure-to-rescue after esophagectomy in relation to hospital volume in German acute care hospitals using real-world data from the German Diagnosis-Related Groups (G-DRG) database. Materials and methods: A retrospective secondary data analysis of the G-DRG database was performed for all in-hospital cases of patients undergoing esophagectomy from 2013 to 2021. AL and in-house mortality rates were assessed in relation to hospital case volume and endoscopic treatment modalities. Results: The study included 32 335 cases. The mean reported AL rate was 17.1% with a mean failure-to-rescue rate of 18.9%. AL rates did not differ between hospitals with an annual case-volume ≤ 25 procedures/year vs. &gt;25 procedures/year (16.8% vs. 17.6%, OR 1.06, P = 0.07). However, in high-volume centers (&gt; 25 procedures/year), in-hospital mortality for cases with AL (failure-to-rescue) was lower compared to medium-volume (10-25 cases/year) and low-volume (1-9 cases/year) centers (14.2% vs. 21.5% vs. 25.1%). The use of EVT increased over time, reaching 58.1% of AL cases in 2021 compared to 14.2% in 2013, while the use of self-expanding metal stents (SEMS) decreased from 37.0% in 2013 to 9.3% in 2021. Conclusions: AL rates after esophagectomy remain high. In-house mortality is significantly lower in high-volume hospitals highlighting the importance to consider improvements in centralization of procedures. Further efforts are needed to reduce AL rates and improve outcomes after esophagectomy.
Global, Regional, and National Burden of Hepatoblastoma, 1990-2021: a Systematic Analysis of the Global Burden of Disease Study 2021
Authors: Lang Yang, Zi-Qing Yu, Yi-Zhou Zhang, Yi-Qiao Deng, Xiao Chen, Hua-Yuan Liu, kXiao-Yin Bai, Hong Zhao
Journal: International Journal of Surgery (2025)

Yang, Lang; Yu, Zi-Qing; Zhang, Yi-Zhou; Deng, Yi-Qiao; Chen, Xiao; Liu, Hua-Yuan; Bai, kXiao-Yin; Zhao, Hong Author Information
Incidence, risk factors and endoscopic retrieval of proximally migrated pancreatic stents: 25 years of experience in a high-volume center – a case controlled study
Authors: Yi-Li Cai, Fan Wang, Jie Zhang, Miao Liu, Rui-Xi Guo, Ting Yang, Zhao-Shen Li, Liang-Hao Hu
Journal: International Journal of Surgery (2025)

Background and aim: Proximal migration is one of the complications after pancreatic stenting. This study aims to determine the incidence, risk factors and endoscopic treatment of proximally migrated pancreatic stents. Methods: A retrospective search of all the endoscopic retrograde cholangiopancreatography (ERCP) records was conducted from 1997 to 2022 in our tertiary center. Proximal migration of the pancreatic stent was defined as when the stent shifted completely into the pancreatic duct and the distal end of the stent was no longer visible at the duodenal papilla. Results: A total of 9017 pancreatic duct stentings of 6083 patients were performed. The proximal migration rate was 0.2% (17/9017). Three predictive factors for proximal migration were identified: pancreatic duct stones (OR, 0.107), residual pancreatic duct stones (OR, 8.290) and straight-shape stent (OR, 4.725). After including 19 patients transferred from other hospitals, 46 ERCPs were performed to retrieve the proximally migrated stents in 36 patients. The success rate of endoscopic removal was 80.6% (29/36). 1 (2.8%) patient was referred to surgery, and 6 patients had new pancreatic stents placed for conservative treatment. 21.7% (10/46) cases developed post-ERCP pancreatitis and 2.2% (1/46) developed infection. Conclusions: Proximal migration of pancreatic stents is less common, but deserves more attention. Endoscopy is efficient in retrieving proximally migrated stents. In patients with residual pancreatic duct stones and straight stent, the risk of proximal migration is significantly increased.
Performance of sentinel lymph node biopsy after neoadjuvant chemotherapy in clinically node positive breast cancer patients: systematic review and meta-analysis
Authors: Mariam Zahwe, Abir Ghzaiel, Ahmad Najia, Lara Soueid, Khalil El Asmar, Malak Ghezzawi, Sarah El Iskandarani, Marwa Diab, Miryam El Jibbawi, Reem Hoteit, Eman Sbaity
Journal: International Journal of Surgery (2025)

Background: The reliability of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) in patients with initially node-positive breast cancer is still controversial. This meta-analysis is conducted to investigate the feasibility and accuracy of SLNB after NACT in patients with initially positive axillary nodes. Methods: We conducted a literature search using Medline, PubMed, Embase, Central, and SCOPUS up until April 2021 for studies on the performance of SLNB following NACT. We included prospective studies including breast cancer patients with positive lymph nodes at diagnosis and received NACT before undergoing SLNB irrespective of their molecular subtypes or stage. Our main outcomes of interest were the identification rate (IR) and the false negative rate (FNR) of SLNB. Results: We included an aggregate of 33 studies in this meta-analysis enrolling 4,624 patients. The reported IR ranged from a minimum of 77.6% to a maximum of 100% and resulted in a pooled IR of 88% (95%CI: 86-90, I 2 :80.9%). The FNR reported in the studies ranged from a minimum of 5.1% to a maximum of 43% and showed a pooled FNR of 13% (95% CI: 11-15, I 2 : 72.31%). The subgroup analysis demonstrated that the usage of dual mapping technique could decrease the FNR and increase the IR. Moreover, the number of lymph nodes retrieved inversely correlated with FNR (p&lt;0.01). Conclusion: Our findings support the feasibility and accuracy of SLNB after NACT in initially node-positive breast cancer patients, that converted to clinically node negative when performed in properly selected cases. SLNB offers a less invasive approach in selected patients sparing them the morbidity associated with ALND. This approach aligns with efforts to de-escalate surgical management in breast cancer and reinforces that SLNB post-NACT should be incorporated into clinical practice, provided that stringent patient selection and procedural standards are maintained.
Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis
Authors: Qing Lu, Xiu-He Lv, Li Tang, Hai-Lin Yan, Bi-Han Xia, Zhu Wang, Jin-Lin Yang
Journal: International Journal of Surgery (2025)

Background: This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago. Methods: A comprehensive search was conducted on June 3rd, 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs). Results: We retrieved a total of 15,417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I 2 = 94%) and 23.5 (95% CI 9.0-61.3; I 2 = 100%) per 10,000 colonoscopies, respectively. The “ &gt; 80 years” group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I 2 = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I 2 = 0%) compared to the “65-80 years” group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I 2 = 0%) and 27 (95%CI 9.0-81.0; I 2 = 99%) per 10,000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I 2 = 1%) and 16 (95% CI 8.1-31.3; I 2 = 98%) per 10,000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10,000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10,000 colonoscopies). The prevalence of cardiopulmonary AEs in elderly population is relatively high, although the definition used vary across different studies. Conclusions: We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AEs rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.
Utilizing explainable machine learning for progression-free survival prediction in high-grade serous ovarian cancer: insights from a prospective cohort study
Authors: Zhuo Chen, Hui Ouyang, Botao Sun, Jiashan Ding, Yu Zhang, Xinying Li
Journal: International Journal of Surgery (2025)

Background: High-grade serous ovarian cancer (HGSOC) remains one of the most challenging gynecological malignancies, with over 70% of ovarian cancer patients ultimately experiencing disease progression. The current prognostic tools for progression-free survival (PFS) in HGSOC patients have limitations. This study aims to develop an explainable machine learning (ML) model for predicting PFS in HGSOC patients. Methods: Nine ML algorithms for PFS prediction were developed using a prospective cohort of 310 HGSOC patients consecutively enrolled from a large Chinese tertiary hospital between January 2017 and December 2020. The optimal model was internally validated using the 1000 bootstrap method. The SHapley Additive exPlanations (SHAP) method was employed to interpret the model in terms of feature importance and feature effects. The final model, constructed with the optimal feature subset, was deployed as an interactive web-based Shiny app. Results: The random survival forest (RSF) model demonstrated superior predictive performance compared to other ML models, the RFS model constructed with an optimal feature subset in the optimal imputed dataset achieved a superior 1000 bootstrap C-index of 0.755 (95% CI: 0.750–0.780) and a Brier score of 0.183 (95% CI: 0.175–0.190). SHAP analysis identified tumor residual, HE4, FIGO stage, T stage, CA125, age, ascites volume, platelet counts, and BMI as the top nine contributing factors. It also revealed potential nonlinear relationships and important thresholds between HE4, CA125, age, ascites volume, platelet counts, the body mass index, and PFS risk. Additionally, interaction effects were found between tumor residual and age, HE4, and CA125. Finally, an interactive web-based Shiny app for the model was developed and accessible at https://rsfmodels.shinyapps.io/ocRSF/. Conclusion: An explainable ML model for PFS prediction in HGSOC patients was developed with superior results. The publicly accessible web tool based on the optimized model facilitates its utility in clinical settings, potentially improving individualized patient management and treatment decision-making in HGSOC.
Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial
Authors: Weibo Cao, Fan Ren, Tong Li, Fei Ma, Yuan Shi, Xuanguang Li, Cancan Cao, Ning Zhou, Hanyi Li, Haochuan Yu, Fuling Mao, Gang Chen, Lingling Zu, Li Wei, Qing Li, Yuanyuan Zhang, Lin Su, Wei Cui, Li Wu, Yuxin Zheng, Jing Li, Chunyan Wang, Renhua Ju, Chongliang Fang, Ling Yin, Yi Lu, Qiang Zhang, Song Xu
Journal: International Journal of Surgery (2025)

The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference, −0.889; 95% CI, −1.464 to −0.314; P &lt; 0.001), 2 (mean difference, −0.631; 95% CI, −1.211 to −0.051; P = 0.014), and 3 (mean difference, −0.798; 95% CI, −1.345 to −0.251; P &lt; 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.
Evaluation of the comparative efficacy and safety of surgical strategies for long bone defects: a network meta-analysis
Authors: Yuanli Shen, Qihong Yang, Hui Cheng, Yitian Feng, Yuan Liu, Jun Hu
Journal: International Journal of Surgery (2025)

Abstract To evaluate the safety and efficacy of various surgical treatments for long bone defects. Despite numerous observational studies, randomized controlled trials (RCTs), and meta-analyses, the optimal surgical treatment for long bone defects remains undetermined. Methods: A network meta-analysis (NMA) was conducted. PubMed, Embase, and the Cochrane Library were searched for articles published between 1 January 2000, and 12 January 2023, on surgical treatments for long bone defects. RCTs and observational studies comparing five surgical treatments were selected: the Masquelet technique (MT), bone transport (BT), vascularized bone graft (VBG), non-VBG (NVBG), and bone tissue engineering (BTE). Data were extracted by two independent reviewers. The NMA aggregated direct and indirect evidence. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA) scores. Data are presented as mean differences and 95% confidence intervals. The primary outcomes were the postoperative healing rate, with subgroup analysis based on defect size (4–8 cm and &gt;8 cm). The secondary outcomes included postoperative complications. Results: This NMA included 23 studies (3 RCTs and 20 observational studies) with 930 participants (median age, 35 years). There were no significant differences in clinical outcomes among the treatments. VBG (SUCRA, 75.1%) was rated as optimal for healing, and BTE (SUCRA, 28.5%) was the least effective. BTE had the highest complication rate (SUCRA, 90.9%), whereas NVBG had the lowest complication rate (SUCRA, 27.6%). Subgroup analysis showed reduced heterogeneity: for 4–8 cm defects, VBG (SUCRA, 80.4%) was optimal, and for &gt;8 cm defects, BT (SUCRA, 76.2%) was optimal. Conclusions: VBG and BT may offer superior clinical outcomes for long bone defects compared to MT, NVBG, and BTE. However, BTE is associated with a high risk of complications. Further high-quality, large-sample RCTs are required to confirm these findings.