BackgroundAccess to health care facilities presents an obstacle to receiving appropriate cancer treatment. This retrospective cohort study analyzes how access to care by geographic distance and patient demographics affect receipt of chemotherapy in colon cancer patients requiring resection.Methods342,779 patients with stages 2-4 colon cancer requiring surgery who were recommended to receive either neoadjuvant or adjuvant chemotherapy were analyzed using the NCDB from 2012 to 2021. Patients who refused chemotherapy were excluded. A logistic regression evaluated demographic and cancer-related factors.ResultsPatients who were non-Hispanic Black (RR = 0.83, P < 0.001), unknown or other race (RR = 0.78, P < 0.001), uninsured (RR = 0.45, P < 0.001), Medicaid (RR = 0.67, P < 0.001), unknown insurance (RR = 0.22, P < 0.001), living in a metropolitan area (RR = 0.74, P < 0.001), and with lower high school education rates (RR = 0.61, P < 0.001) were less likely to receive chemotherapy especially at closer distances to their facility. Patients who lived closest to the diagnostic facility (<10 miles) were less likely to receive chemotherapy when compared to patients living 10-20 (RR = 1.33, P < 0.001), 20-50 (RR = 1.77, P < 0.001), 50-100 (RR = 1.56, P < 0.001) or 100-250 miles (RR = 1.31, P = 0.010).ConclusionsRace, insurance, and education disparities associated with non-receipt of chemotherapy were greatest when <10 miles from reporting facility.
BackgroundDifficult laparoscopic cholecystectomy (LC) remains a major contributor to bile duct injury, bailout procedures, and conversion to open surgery. Although numerous preoperative prediction models have been developed, their ability to meaningfully support operative decision-making and safe bailout strategies remains uncertain. This systematic review aimed to evaluate current preoperative risk prediction models for difficult LC, with particular emphasis on their clinical applicability, integration into surgical decision-making, and relevance to contemporary safe cholecystectomy concepts.MethodsA systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from inception to March 2026 for studies evaluating preoperative prediction models for difficult LC, including both traditional clinical scoring systems and machine learning-based approaches. Data regarding study design, predictors, model performance, validation strategies, and clinical applicability were extracted. Artificial intelligence applications related to intraoperative guidance and operative workflow were analyzed separately. Because variance measures were inconsistently reported across studies, a formal meta-analysis was not feasible.ResultsFourteen studies were included in the qualitative synthesis, comprising nine studies on preoperative prediction models and five studies on artificial intelligence applications in LC. Most studies were retrospective, single-center, and methodologically heterogeneous. Traditional clinical and radiological models demonstrated moderate discriminatory performance, whereas external validation was uncommon. Across five studies with extractable AUC data involving 1738 patients, reported AUC values ranged from 0.735 to 0.960, with substantial variability and limited generalizability. Most artificial intelligence studies focused on intraoperative image analysis and critical view of safety assessment rather than actionable preoperative risk stratification. Importantly, current prediction systems remain insufficiently integrated into real-world operative decision-making and safe bailout strategy selection.ConclusionCurrent evidence suggests that preoperative prediction models may assist in risk stratification and operative planning; however, their real-world clinical applicability remains limited. At present, no model has demonstrated sufficient external validation or integration into surgical workflow to support routine standalone use. Future research should move beyond predictive accuracy alone toward clinically integrated decision-support systems that combine preoperative risk stratification, intraoperative grading frameworks, and AI-assisted guidance to support safe operative strategy selection, bailout planning, and intraoperative risk management.
IntroductionContemporary trauma guidelines support higher initial enoxaparin dosing for adult trauma patients, as standard dosing (30 mg twice daily [BID]) frequently fails to achieve target anticoagulant activity. While anti-factor Xa (anti-Xa) monitoring guides dose adjustments, real-world implementation of follow-up monitoring remains variable. This study evaluated anti-Xa target attainment, dose escalation practices, and completion of follow-up monitoring in high-risk trauma patients.MethodsThis retrospective cohort study at a Level I trauma center included adult trauma patients (April 2022-October 2023) receiving enoxaparin venous thromboembolism prophylaxis who underwent at least one anti-Xa measurement. Demographics, Injury Severity Score (ISS), dosing changes, and repeat monitoring frequencies were analyzed. This study evaluated real-world clinical practice and was not designed to compare dosing strategies or assess a protocolized intervention.ResultsAmong 244 patients (median ISS 22; 43% with BMI >40 kg/m2), 80% initially received standard dosing (30 mg BID). Only 42% achieved target prophylactic anti-Xa levels (0.2-<0.5 IU/mL). Of those on standard dosing, 34% required escalation, with the mean adjusted dose approaching 40 mg BID. While 68% of patients who underwent repeat testing after dose escalation successfully achieved target levels, repeat monitoring was completed in only 22% of all adjusted patients. Venous thromboembolism occurred in 5%, and bleeding in 7%.ConclusionStandard enoxaparin dosing frequently fails high-risk trauma patients, supporting contemporary higher-dose guidelines. However, a critical implementation gap persists; while clinicians recognize subtherapeutic levels and escalate doses, follow-up anti-Xa monitoring is inconsistently performed. Standardized tracking protocols and automated electronic triggers are required to close the loop in anti-Xa pathways.
Language barriers may influence trauma care and outcomes. This study evaluated the impact of primary language on clinical care factors and outcomes in adult trauma patients via retrospective review from 2019 to 2023. Patients were stratified as English primary language (EPL) or non-English primary language (NEPL). Among 9,528 patients, 9% were NEPL. Non-English primary language patients were younger, more often male, self-pay, and injured at work, with fewer comorbidities. After multivariable adjustment, NEPL patients had significantly lower odds of non-home discharge (OR 0.76, 95% CI: 0.59-0.98, P = 0.034). Primary language was not independently associated with hospital LOS (IRR 1.01, 95% CI: 0.94-1.09, P = 0.715). Non-English primary language patients were more likely to be discharged home after adjustment, which may reflect limited access to post-acute care, rather than better recovery. High uninsured rates among NEPL patients may drive reduced access, highlighting a gap in care transitions for NEPL trauma population.
BackgroundBronchobiliary fistula (BBF) is a rare but significant complication of hepatic ablation, particularly in tumors adjacent to the diaphragm. With increasing use of thermal ablation, a growing literature has emerged characterizing its presentation and management.MethodsWe present a representative case of recurrent BBF after radiofrequency ablation for hepatocellular carcinoma, successfully managed with a multimodal interventional radiology approach. Following PRISMA guidelines, we conducted a systematic review of the literature on BBF after hepatic ablative therapy published between March 2005 and February 2026, identifying 20 eligible articles encompassing 39 cases.ResultsThe pooled analysis revealed a distinct clinical syndrome: subphrenic tumor location (89.7%), delayed presentation at a median of 4-8 weeks post-ablation, and bilioptysis as the hallmark symptom (92.3%). Diagnostic strategies included CT, bronchoscopy, and cholangiography, often used in combination. Multimodal minimally invasive approaches, including percutaneous, endoscopic, and bronchoscopic techniques, account for 87.2% of current management. While interventional radiology-guided embolization achieved overall success in 66.7% of cases in this pooled series, it often required multiple sessions, reflecting the challenging nature of this complication. Based on these findings, we propose a practical treatment algorithm.ConclusionBBF after hepatic ablation follows a recognizable pattern that should prompt early diagnosis. A persistent, multimodal minimally invasive approach can achieve definitive closure in many cases and should generally be considered before proceeding to surgical intervention. The available evidence, however, remains limited to case reports and small series, and recommendations for specific embolization strategies should be interpreted with this in mind.
Rectal neuroendocrine tumors (NETs) are rare, typically indolent neoplasms arising from enterochromaffin cells that may recur locally or distantly after long disease-free intervals. We report a case of robotic partial hepatectomy for delayed hepatic metastasis from a rectal NET. Methods: A 68-year-old woman was referred for evaluation of a liver lesion suspicious for metastatic rectal NET. Ten years earlier, a 4 mm rectal NET had been identified on screening colonoscopy and treated with endoscopic mucosal resection, with no residual malignancy. Surveillance endoscopy showed no recurrence. Ten years after diagnosis, CT imaging for an unrelated issue revealed a 4.8 × 4.3 cm lesion in segment III of the liver. MRI demonstrated a 5.2 × 5.5 cm mildly T2 hyperintense mass with heterogeneous low-level enhancement and marked restricted diffusion, concerning for metastasis. After discussion, the patient underwent robotic partial hepatectomy without complication and was discharged on postoperative day one. Pathology revealed a 6.2 cm metastatic carcinoid tumor with negative margins and lymphovascular invasion. Mitotic index was 3 per 10 high-power fields and Ki-67 was 4%, consistent with an intermediate-grade tumor. At 16 months postoperatively, she remains disease-free. Conclusion: Isolated hepatic recurrence of rectal NET after a prolonged disease-free interval is uncommon. Although international societies provide surveillance recommendations after rectal NET resection, there remains no clear consensus on the optimal duration of surveillance for patients at higher risk of recurrence or with incomplete initial pathologic data. A personalized, multidisciplinary surveillance strategy should therefore be considered in such patient.
Surgical training has long valued decisiveness, technical excellence, and confidence. However, complex patient care also exposes surgeons and trainees to cognitive traps such as anchoring, confirmation bias, overconfidence, premature closure, and diagnosis momentum. This editorial argues that intellectual humility is not only an educational virtue but also a psychological precondition for debiasing. It situates intellectual humility within the broader literature on cognitive bias and debiasing, and then proposes a practical reflection scaffold organized around claims, warrants, disconfirming evidence, and revision conditions. This approach aligns with cognitive forcing strategies, diagnostic time outs, structured reflection, simulation-based metacognition training, debriefing, and checklist-based interventions. Cultivating intellectual humility through teaching, Morbidity and Mortality conferences, and attending role modeling may strengthen revisable judgment and support safer surgical care.
BackgroundMesenteric hematoma (MH) after blunt abdominal trauma may obscure underlying bowel injury, creating a diagnostic gray zone. We evaluated whether MH identifies patients at higher risk for delayed bowel injury and worse outcomes, informing risk-stratified observation.MethodsAdult blunt trauma patients (≥18 years) admitted between January 2018 and August 2025 with MH on initial CT imaging of the abdomen and pelvis and no definitive bowel perforation were retrospectively reviewed (n = 56). Patients were matched 1:1 with trauma patients without MH or bowel injury (N-MH, n = 56) by age, sex, injury mechanism, Injury Severity Score (ISS), and abdominal Abbreviated Injury Scale (AIS). Outcomes, imaging findings, and admission lactic acid were analyzed. Conditional logistic regression identified factors associated with missed bowel injury within 24 h.ResultsFifty-six patients with mesenteric hematoma and no definitive CT evidence of bowel perforation were identified. Patients with mesenteric hematoma demonstrated higher admission lactate levels compared with controls. Delayed bowel injury was diagnosed in 7 patients (12.5%) within the first 24 h of hospitalization despite initially inconclusive imaging. Admission lactic acid was independently associated with missed bowel injury (OR 1.10 per mmol/L; 95% CI: 1.01-1.21; P = 0.02).ConclusionsMesenteric hematoma on CT imaging may identify a subgroup of trauma patients at increased risk for delayed bowel injury. These findings suggest that patients with mesenteric hematoma may benefit from heightened surveillance, including serial clinical examinations, physiologic monitoring, and consideration of repeating imaging during the early post-injury period.
BackgroundSuperior mesenteric artery syndrome (SMAS) is a rare cause of duodenum obstruction, which affects the quality of life. Laparoscopic duodenal de-rotation has demonstrated short-term efficacy in case report. However, the characterization of intermediate-term outcomes remains limited.ObjectiveEvaluate the intermediate-term efficacy of laparoscopic duodenal de-rotation by assessing symptom resolution.MethodBetween January 2016 and February 2025, patients diagnosed with SMAS who underwent laparoscopic duodenal de-rotation at the department of pediatric surgery at 2 tertiary children's referral centers were reviewed. From 2016 to 2022, patient records were reviewed retrospectively, while patient data were collected prospectively starting in 2023. The symptoms, complications and Body mass index (BMI) were recorded.ResultsThe study group included 7 boys (47%) and 8 girls (53%). Age ranged from 5 to 16 years (median, 13.3 years). All patients received conservative treatment, which lasted a median of 1 year. Patients underwent laparoscopic duodenal de-rotation without conversion. Patients were started on a clear liquid diet 2 days postoperatively, and mean length of hospital stay was 5.3 ± 1.9 days. With median follow-up time of 35 months, obstructive symptoms were complete relief in 5 patients (33%), and 9 patients (60%) showed improvement in their symptoms. BMI increased from median of 15.1 kg/m2 (IQR 13.5-16.0) to 17.1 kg/m2 (IQR 15.6-18.3) at the time of last follow-up. One required reoperation due to gastrointestinal dysmotility.ConclusionThe laparoscopic duodenal de-rotation provides durable symptom improvement in most patients while avoiding the risk of anastomotic leakage.
Recurrent subphrenic abscess from retained radiolucent gallstones is a difficult problem: the stones are often difficult to localize due to its radiolucency, the operative field is confined and distorted due to its inflammation, and dissection lies close to the heart, pleura, and kidney. We report the case of a 77-year-old man with recurrent subphrenic abscesses, in whom these challenges were resolved with a robotic approach using a miniature drop-in ultrasound probe (FUJIFILM L51 K). The probe confirmed that a trans-diaphragmatic abscess and its contained stone lay deeper than the dissection plane suggested, defined a safe plane for de-roofing within 1 cm of the right atrium and pleura, and directed dissection of a second posterior collection between the inferior vena cava, pleura, and right kidney. All stones were retrieved without complication. The patient was discharged on day 5 and remained well at 20 months. This case illustrates the expanding role of advanced real-time imaging technologies in enhancing safety and precision in modern minimally invasive surgery.
Artificial intelligence (AI) is being integrated into clinical practice at a pace that has outstripped clinicians' ability to critically evaluate it. While 2 in 3 physicians now report using AI in some capacity in their practice, most trainees receive no formal education in AI. The result is not a deficit in intelligence or curiosity, but, at least in part, a lack of shared vocabulary that limits clinicians' ability to interpret AI claims and participate in governance decisions. This paper presents a practical clinical framework for interrogating AI claims, organized around five core questions: What is it? Does it work? Will it work here? What does it do? Is it real? These domains provide a structured approach applicable across clinical encounters, including literature appraisal, vendor evaluation, and point-of-care use. To support this framework, we define 6 vocabulary clusters commonly encountered in clinical AI discourse and introduce a translation layer that maps AI terminology to familiar traditional clinical and biological concepts. Finally, we illustrate the framework through representative real-world scenarios. This approach enables clinicians to critically evaluate AI tools, engage meaningfully in institutional decision-making, and apply consistent standards of evidence to emerging technologies.
Surgical complications often persist in a patient's memory long after physical recovery has been achieved. This reflective narrative describes the case of a woman who presented 5 years after excision of a benign posterior mediastinal mass. Although re-exploration undertaken for postoperative drain bleeding revealed no active source of bleeding, and she went on to recover completely, she continued to identify herself as "the re-exploration case." Her experience illustrates how clinical language, conversations among staff, and perioperative uncertainty may shape a patient's self-perception and recollection more powerfully than a favorable clinical outcome. Complications are also known to affect surgeons, giving rise to distress, guilt, and self-doubt. Surgical care must, therefore, incorporate respectful communication, compassionate support, and due attention to the enduring emotional consequences of adverse perioperative events.
BackgroundPostoperative pulmonary complications (PPCs) remain a major cause of adverse recovery after lung resection in elderly patients with early-stage non-small cell lung cancer (NSCLC). This study evaluated the predictive value of preoperative chest computed tomography (CT)-measured diaphragm thickness combined with pulmonary function for PPCs after anatomic lung resection.MethodsIn this single-center retrospective study, 248 patients aged 65 years or older with clinical stage I NSCLC who underwent lobectomy or segmentectomy between January 1, 2020 and December 31, 2025 were included. Preoperative CT-measured diaphragm thickness, pulmonary function indices, perioperative variables, and PPCs occurring within 30 days after surgery or during hospitalization were analyzed. Multivariable logistic regression and receiver operating characteristic analyses were performed.ResultsPPCs occurred in 54 of 248 patients (21.8%). Multivariable analysis showed that chronic obstructive pulmonary disease (odds ratio [OR], 2.29; 95% CI, 1.12-4.69; P = .023) and longer operative time (OR per 10-min increase, 1.13; 95% CI, 1.04-1.23; P = .004) were associated with increased PPC risk, whereas greater mean bilateral diaphragm thickness (OR per 0.1-mm increase, 0.88; 95% CI, 0.81-0.96; P = .004) and higher FEV1%pred (OR, 0.96; 95% CI, 0.93-0.99; P = .009) were protective. The area under the curve was 0.791 for mean bilateral diaphragm thickness, 0.752 for FEV1%pred, and 0.842 for the combined model; the bootstrap-corrected AUC was 0.829.ConclusionPreoperative CT-measured mean bilateral diaphragm thickness and FEV1%pred independently predicted PPCs after anatomic lung resection in elderly patients with clinical stage I NSCLC. Their combination provided improved predictive performance for preoperative risk stratification.
Presented herein is a novel concept of a chest wall injury service to manage surgical stabilization of rib fractures (SSRF). This chest wall injury service encompasses the strength of two respective surgical services, trauma and orthopedics, into a structured clinical pathway emphasizing early identification, multidisciplinary decision-making, and coordinated operative care. At our site, patients with rib fractures undergo standardized physiologic assessment using Pain, Inspiratory volume, and Cough (PIC) score along with radiographic evaluation. The model involves the team, consisting of both trauma and orthopedic surgeons, performing joint evaluation and determination of candidacy for SSRF as well as operative and postoperative management. Since implementation in June 2024, the pathway has managed 35 patients undergoing SSRF, demonstrating successful integration of multidisciplinary evaluation, protocolized triage, and joint operative workflow. The model aligns with emerging literature and provides a reproducible framework for standardizing care delivery in patients with complex chest wall injury.
BackgroundRubber band ligation (RBL) is a widely accepted treatment for Grade II-III internal hemorrhoids. However, postoperative bleeding, particularly delayed massive bleeding (DMB), remains a serious complication. This study aims to compare the outcomes of RBL alone vs RBL combined with absorbable suture ligation (RBL-SL), with a primary focus on postoperative DMB events.MethodsWe retrospectively enrolled patients with grade II/III internal hemorrhoids who were treated with RBL from May 2024 to December 2024 and RBL combined with suture ligation from January 2025 to July 2025 at the General Hospital of Central Theater Command. The incidence of DMB and hemorrhoids recurrence were evaluated as the primary outcomes. The secondary outcomes assessed were the degree of postoperative pain, anal edema, and sensation of prolapse. The Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale for HD (SHS-HD) were documented during long-term follow-up.ResultsA total of 530 patients were enrolled, including 263 patients received RBL combined with suture ligation and 267 patients underwent RBL alone. There was no statistically significant difference in most baseline characteristics except age and body mass index (BMI) between the two groups (P > 0.05). Compared with one patient who underwent DMB in the RBL-SL group, seven cases of DMB were observed in the RBL group. The difference was statistically significant (P < 0.05). Although the number of hemorrhoid recurrence cases in the RBL-SL group was lower than the RBL group, there was no statistically significant difference in the recurrence rate between the two groups (8.0% vs 12.7%, P > 0.05). On the third and seventh days after surgery, there were no statistically significant differences in minor complications (pain score, anal edema, and prolapse sensation) between the two groups(P > 0.05). There were also no significant differences in HDSS and SHS scores between the two groups after surgery (P > 0.05).ConclusionIn this single-center, nonrandomized study, adjunctive absorbable suture ligation was associated with a signal toward reduced DMB after RBL for internal hemorrhoids. However, due to the small number of events, wide confidence intervals, and potential for bias from sequential allocation, these findings are hypothesis-generating only. Further prospective, randomized evaluation is required before considering this technique as a new standard of care.
Pediatric e-scooter injuries have risen rapidly, yet single-center data describing injury severity, admission patterns, and helmet use within high-acuity trauma populations remain limited. We describe a single-center retrospective series of 31 National Trauma Data Bank (NTDB)-eligible pediatric patients treated for e-scooter-related injuries at a level-one pediatric trauma center from January 2022 to December 2024. The cohort was predominantly male (26 of 31, 83.9%). Twenty-three patients (74.2%) were admitted-substantially higher than the 5% to 15% reported in broader national cohorts and consistent with NTDB selection for significant trauma. Injuries were minor (ISS 1-9) in 23 patients (74.2%) and moderate or greater (ISS ≥10) in 8 (25.8%); all moderate-or-greater injuries were admitted, and every PICU and operative admission occurred within these higher-severity groups, although the difference from minor injuries did not reach statistical significance (Fisher exact P = 0.08). Notably, no patient was documented as wearing a helmet at the time of injury (unhelmeted 64.5%, unknown 35.5%). Within this NTDB-eligible, level-one cohort, pediatric e-scooter trauma was characterized by a high admission rate and near-absent documented helmet use, reinforcing the importance of helmet promotion and targeted injury-prevention efforts.
BackgroundEmergency department (ED) length of stay (LOS) is commonly used as a trauma-system performance measure, but in trauma it may reflect triage priority and disposition workflow rather than clinical risk. We evaluated whether trauma activation was associated with ED LOS and whether ED LOS independently predicted adverse outcomes.MethodsWe performed a retrospective cohort study of adult trauma encounters at an ACS-verified Level I trauma center from January 2018 through January 2020. Higher activation (partial/full) was compared with lower activation (consult/no activation). Outcomes were ED LOS, a nonmortality performance-improvement (PI)-listed adverse-event composite, in-hospital mortality, and 30-day readmission. Multivariable logistic regression adjusted for age, sex, Injury Severity Score, transfer status, activation group, and mechanism.ResultsAmong 5055 encounters, 2889 (57.2%) had higher activation and 2166 (42.8%) lower activation. Median ED LOS was shorter with higher activation (148 vs 323 minutes; P < 0.001). Unadjusted mortality (5.8% vs 1.6%; P < 0.001) and adverse events (10.1% vs 4.5%; P < 0.001) were higher, while readmission was similar (2.7% vs 2.2%; P = 0.301). Adjusted ED LOS was not associated with the nonmortality PI composite (OR/h, 1.00; 95% CI, 0.95-1.06; P = 0.908) but was inversely associated with mortality (OR/h, 0.82; 95% CI, 0.72-0.94; P = 0.005); this association did not persist after excluding deaths before inpatient admission.ConclusionsHigher activation was associated with shorter ED LOS despite greater injury severity. ED LOS was not independently associated with the nonmortality PI-listed adverse-event composite and should be interpreted as a marker of triage priority, workflow, and disposition rather than as an isolated outcome endpoint.
Background Inflammatory bowel disease (IBD), affecting over 2 million individuals in the United States, is associated with substantial morbidity, recurrent hospitalizations, and need for long-term immunosuppressive therapy. Although biologic therapies have been associated with declining operative rates in IBD, a clinically significant subset of patients continues to progress to surgery despite biologic exposure. Methods This retrospective cohort study evaluated surgical intervention rates among patients with Crohn’s disease (CD) and ulcerative colitis (UC) across two biologic treatment eras using the TriNetX Research Network, a multi-institutional database of de-identified electronic health records. Adult patients (ages 18-90) receiving biologic therapy were divided into two cohorts: 2004-2014 and 2014-2024. Surgical intervention following biologic initiation was used as a surrogate for treatment failure, and propensity score matching was performed to reduce confounding. Results After matching, 9822 patients remained in each cohort. Surgical intervention occurred in 8.4% of patients in the earlier cohort compared with 5.9% in the contemporary cohort, corresponding to a 29.8% relative reduction in operative intervention (RR 1.426, 95% CI 1.285-1.583; P < 0.001). Patients in the earlier cohort also demonstrated significantly higher risk of surgery within 1 year of biologic initiation. Within the contemporary cohort, CD patients continued to demonstrate higher operative risk compared with UC. Discussion Contemporary biologic therapy was associated with reduced operative intervention over time; however, persistent operative burden remains despite biologic exposure, particularly among patients with CD and nutritional compromise.
Hepatic artery infusion pump (HAIP) therapy has re-emerged as an important liver-directed treatment for colorectal liver metastases (CRLM), yet its integration into contemporary surgical workflows, including minimally invasive and combined procedures, remains incompletely characterized. We performed a retrospective analysis of patients undergoing HAIP placement between 2022 and 2024 at a multi-hospital academic health system. Nine patients were identified, including four who underwent synchronous colectomy. Operative time and length of stay were longer in synchronous cases (10h51min vs 8h56min; 7.0 vs 3.5 days), while a minimally invasive approach was utilized in 78% of cases and hepatectomy in two-thirds. No 30-day mortality or infectious complications were observed, and one Clavien-Dindo grade III complication occurred.This early implementation-focused experience demonstrates how HAIP therapy can be operationalized within a contemporary multi-hospital system through multidisciplinary patient selection, integration with minimally invasive surgery, and coordination of combined colorectal and liver procedures. These findings provide practical insights for centers seeking to develop similar HAIP programs.
