World Journal of Surgery (WORLD J SURG)

Publisher: International Society of Surgery, Springer Verlag

Journal description

World Journal of Surgery publishes original articles that offer significant contributions to knowledge in the broad fields of clinical surgery, experimental surgery and related sciences, surgical education and history, and the socioeconomic aspects of surgical care. The Journal has an international circulation and is designed to serve as a medium for rapid dissemination of new and important information about the science and art of surgery throughout the world. In the interests of a wide international readership, use of the English language is required. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.

Current impact factor: 2.35

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.348
2012 Impact Factor 2.228
2011 Impact Factor 2.362
2010 Impact Factor 2.693
2009 Impact Factor 2.696
2008 Impact Factor 2.641
2007 Impact Factor 1.778
2006 Impact Factor 1.765
2005 Impact Factor 1.601
2004 Impact Factor 1.952
2003 Impact Factor 1.909
2002 Impact Factor 1.777
2001 Impact Factor 1.644
2000 Impact Factor 2.02
1999 Impact Factor 2.025
1998 Impact Factor 2.271
1997 Impact Factor 2.077
1996 Impact Factor 1.809
1995 Impact Factor 1.262
1994 Impact Factor 1.507
1993 Impact Factor 1.171
1992 Impact Factor 1.364

Impact factor over time

Impact factor

Additional details

5-year impact 2.75
Cited half-life 6.80
Immediacy index 0.48
Eigenfactor 0.03
Article influence 0.84
Website World Journal of Surgery website
Other titles World journal of surgery (Online), World j. surg
ISSN 0364-2313
OCLC 43477365
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's pre-print on pre-print servers such as
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Tumor size plays a significant part in the decision making of the management of HCC patients. For those with isolated lesions 1]. In the present issue of World Journal of Surgery, three articles, however, bring new insights regarding the underestimated oncologic risk of isolated small lesions which should lead to reconsider the curative management of these patients. First, the study of Zhong et al. [2] reports often underestimated rates of microvascular invasion and intrahepatic micrometastases of 16.2 and 13.4 %, respectively, in single HCCs
    World Journal of Surgery 05/2015; 39(5). DOI:10.1007/s00268-014-2848-9
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    ABSTRACT: Introduction: Differentiating inflammatory from malignant head mass in the background of chronic calcific pancreatitis(CCP) is difficult, and there is no investigation which can reliably solve this dilemma. An accurate diagnosis is crucial as the treatment is different for the two cases and a failure to identify malignancy before surgery can be disastrous. We aimed to assess the accuracy of platelet-lymphocyte ratio (PLR) and to compare it with CA19.9 in determining the nature of PHM. Materials and Methods: Eighty three patients who presented with CCP and PHM between 2005 and 2011,were included in the study. Patients identified to have malignancy underwent Pancreaticoduodenectomy,while those deemed to have a benign lesion underwent Frey’s procedure.Clinical features of both the groups were compared. CA 19-9 and PLR individually and in combination were compared in both groups. Receiver operating characteristic curves (ROC) were used to analyse the predictive values of CA19-9 and PLR individually and together. Results: Histologically, 66.3% had an inflammatory head mass and 33.7% had a malignant head mass.Significant clinical features which predicted a malignancy included the presence of a head mass in CCP of tropics, older age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss. Sensitivity and Specificity of CA 19-9 and PLR in diagnosing malignancy were similar(85.5 vs 81.2% & 96.4 vs 92.8% respectively),on combining CA 19-9 & PLR there was an improvement in sensitivity(94.5 %). Conclusion:PLR is atleast as good as CA 19-9 as a diagnostic marker to differentiate between malignant and inflammatory head mass in CCP. When used together, PLR improves the predictive value of serum CA19-9.
    World Journal of Surgery 03/2015; DOI:10.1007/s00268-015-3087-4
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    ABSTRACT: Inguinal hernia repair is the most common elective procedure in general surgery. Therefore, the number of patients having complications related to inguinal hernia surgery is relatively large. The aim of this study was to compare complication profiles of inguinal open mesh (OM) hernioplasties with open non-mesh (OS) repairs and laparoscopic (LAP) repairs using retrospective nationwide registry data. The database of the Finnish Patient Insurance Centre (FPIC) was searched for complications of inguinal and femoral hernia repairs during 2002-2010. Complications of OM repairs were compared to complications of OS repairs and LAP repairs. Over 75 % of all inguinal hernia procedures during the study period in Finland were OM hernioplasties. FPIC received 245 complication reports after OM repairs, 40 after OS repairs, and 50 after LAP repairs. Reported complications were significantly more severe after LAP and OS repairs than OM surgery (p < 0.001). Visceral complications (p < 0.001), deep infections (p < 0.001), and deep hemorrhagic complications (p < 0.001) were overrepresented in the LAP group. In the OS group, visceral complications (p < 0.001), recurrences (p < 0.001), and severe neuropathic pain (p < 0.001) predominated. LAP and OS repairs of inguinal hernia were associated with more severe complications than open surgery with mesh in this study.
    World Journal of Surgery 03/2015; DOI:10.1007/s00268-015-3028-2
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    ABSTRACT: Diffuse sclerosing variant (DSV) of papillary thyroid carcinoma (PTC) is a rare variant more common among younger patients. Excluding patients with microcarcinoma, 5848 patients with PTC underwent initial surgery between 1995 and 2011. Twenty-two patients (0.4 %) were histologically diagnosed with DSV, of whom 20 (91 %) were <45 years old. We compared clinicopathologic characteristics and outcomes between patients with DSV and those with classical PTC <45 years old. Univariate analysis by the Kaplan-Meier method in relation to cause-specific survival (CSS) and disease-free survival (DFS) rates was performed with regard to the following variables: sex; anti-thyroglobulin antibody (TgAb) positivity; presence of distant metastasis; pathological lymph node metastasis; extra-thyroidal invasion; and pathological variant (classical vs. The 20 patients with DSV <45 years old comprised 18 females and 2 males. Frequencies of TgAb, pN1b, and local recurrence were higher in the DSV group than in the classical PTC group. Ten-year CSS and DFS rates for PTC patients <45 years old were 99.7 and 88.6 % in the classical PTC group and 100 and 60.5 % in the DSV group. CSS rate did not differ between groups, but DFS rate was significantly lower in the DSV group than in the classical PTC group (p < 0.0001, log-rank test). Multivariate analysis identified DSV group and pN1b as prognostic factors for recurrence in young PTC patients. Most DSV patients were young and had a background of chronic thyroiditis. Outcomes for DSV were very good, but recurrence was more common than in classical PTC.
    World Journal of Surgery 03/2015; 39(7). DOI:10.1007/s00268-015-3021-9
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    ABSTRACT: The surgical extent and indication for treatment in patients with papillary thyroid microcarcinoma (PTMC) remain a controversial issue. The aim of this study was to investigate the predictive factor for contralateral occult carcinoma in patients with unilateral PTMC by preoperative ultrasonographic and pathological features. Of the total patients who underwent thyroidectomy, 455 patients with PTMC confined to one unilateral lobe as diagnosed using preoperative ultrasonography (US) were enrolled in the study. Occult contralateral carcinoma was defined as tumor foci in the contralateral lobe that was not detected preoperatively, but was detected pathologically. All patients underwent preoperative US review to investigate the US features of PTMC such as laterality, location, size, internal component, echogenicity, margin, calcification shape, multifocality, bilaterality, extrathyroidal extension, and location with respect to the trachea. Clinicopathological data were also analyzed. Of the total of 455 patients who underwent total thyroidectomy for preoperatively detected unilateral PTMC, 71 patients (15.6 %) had contralateral occult carcinoma. Clinicopathological characteristics did not significantly differ between patients with and without contralateral occult carcinoma. Multivariate analysis showed that the absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US images. We demonstrated that an absence of a well-defined margin and the presence of a probably benign nodule in the contralateral lobe were independent predictive factors for contralateral occult carcinoma in patients with unilateral PTMC in preoperative US. The prediction of contralateral occult carcinoma in unilateral PTMC using preoperative US features could be useful for determining the optical extent of surgery.
    World Journal of Surgery 03/2015; 39(7). DOI:10.1007/s00268-015-3024-6
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    ABSTRACT: The impact of postoperative complications (POCs) on long-term survival outcomes following hepatic resection for colorectal liver metastasis (CRLM) is in controversy. The aim of the present meta-analysis was to systematically evaluate the POC effect on overall survival (OS) and disease-free survival (DFS) in patients undergoing hepatic resection for CRLM. We conducted a systematic review and meta-analysis of all observational studies to evaluate the POC effect on OS and DFS in patients undergoing hepatic resection for CRLM. A search for all major databases and relevant journals from inception to January 2014 without restriction on languages or regions was performed. POCs were extracted and graded according to a validated system of classification. Outcome measures were postoperative 1-, 2-, 3-, and 10-year OSs and DFSs. Both random-effects and fixed-effect models were used to pool the hazard ratios (HRs) of the survival outcomes. Test of heterogeneity was performed with the Q statistic. A total of 2370 patients were included in the meta-analysis. Both 5- and 10-year postoperative OSs showed significant decreases in patients with POCs (HR = 1.52; 95 % CI 1.27-1.83; P < 0.001 and HR = 1.36; 95 % CI 1.18-1.58; P < 0.001, respectively). Similar outcomes were also observed in terms of DFSs, with the 5- and 10-year HRs found to be 1.37 (95 % CI 1.23-1.53; P < 0.001) and 1.34 (95 % CI 1.17-1.53; P < 0.001), respectively, compared to no POC group. POCs are strongly related to long-term oncologic outcomes following hepatic resection for CRLM. Further efforts to refine surgical technique and postoperative management to avoid complications may improve the long-term oncological outcomes of the selected patients.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-3019-3
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    ABSTRACT: Achieving the critical view of safety (CVS) before transection of the cystic artery and duct is important to reduce biliary duct injury in laparoscopic cholecystectomy. To gain more insight into complications after laparoscopic cholecystectomy, we investigated whether the criteria for CVS were met during surgery by analyzing videos of operations performed at our institution. All consecutive patients who underwent a completed laparoscopic cholecystectomy between 2009 and 2011 were included. The videos of the operations of patients with complications were independently reviewed and rated by two investigators with a third consulted in the event of a disagreement. The reviewers answered consecutive questions about whether the CVS criteria were met. Patients who underwent an elective laparoscopic cholecystectomy and had no complications were used as a control group for comparison. Of the 1108 consecutive patients who had undergone a laparoscopic cholecystectomy during the study period, 8.8 % developed complications (average age 51 years) and 1.7 % had bile duct injuries [six patients (0.6 %) had a major bile duct injury, type B, D, or E injury]. In the 65 surgical videos available for analysis, CVS was reached in 80 % of cases according to the operative notes. However, the reviewers found that CVS was reached in only 10.8 % of the cases. Only in 18.7 % of the cases the operative notes and video agreed about CVS being reached. CVS was not reached in any of the patients who had biliary injuries. In the control group, CVS was reached significantly more often in 72 %. In our institutional series of laparoscopic cholecystectomies with postoperative complications, CVS was reached in only a few cases. Evaluating surgical videos of laparoscopic cholecystectomy cases are important and we recommend its use to improve surgical technique and decrease the number of biliary injuries.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-2993-9
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    ABSTRACT: Recent studies have shown that Ku80 expression was implicated in development and progression of malignant tumors. In the present study, we analyzed for the first time the expression of Ku80 in locally advanced esophageal squamous cell carcinoma (ESCC) and its correlation with clinicopathologic features and patient survival. The expression profile of Ku80 was analyzed in 126 cases of locally advanced ESCC and 79 cases of normal subjects as control using immunohistochemistry and Western blot. The associations of Ku80 expression with clinicopathological features were estimated by χ (2) test. We further performed univariate and multivariate analyses to identify prognostic factors for overall survival (OS) of patients. Immunohistochemistry and Western blot analyses both showed the Ku80 protein expression was significantly higher in ESCC than normal esophageal mucosa and corresponding healthy esophageal mucosa. Statistical analysis suggested a significant correlation of Ku80 overexpression with the tumor size (p = 0.037), differentiation degree (p = 0.018), depth of invasion (p = 0.020), lymph node metastasis (p = 0.045), clinicopathological staging (p = 0.001), and tumor recurrence (p = 0.011) in locally advanced ESCC patients. Moreover, overexpression of Ku80 was associated with reduced OS of patients after surgery (p = 0.001). Multivariate analysis with a Cox proportional hazards model further suggested that Ku80 expression was an independent prognostic indicator for patients' OS (p = 0.029). Ku80 was a predictor of tumor's progression and prognosis of locally advanced ESCC patients. All of these results indicate that assessment of Ku80 level could improve stratification of locally advanced ESCC patients.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-3023-7
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    ABSTRACT: The stapling technique was recommended in a recent Cochrane analysis based on relatively small randomized trials between 1970 and 2009. Data from a large Swedish population-based quality register were analyzed in order to compare the leakage frequency between stapled and hand-sewn ileocolic anastomoses in colon cancer surgery. Three-thousand four-hundred and twenty-eight patients with an ileocolic anastomosis were entered in a Swedish regional quality register for colon cancer, including the type of anastomosis used. The patients were analyzed by logistic regression regarding risk for leakage, and Cox proportional hazard regression for survival associated with the technique used for anastomosis. Analyses were made for gender, age, elective or emergency surgery, duration of surgery, bleeding, cancer stage, and local radicality. Most anastomoses were hand sewn (1,908 of 3,428, 55.7 %, p < 0.001), whereas stapling was more common among emergency cases (342 of 618, 55.3 %, p < 0.001). Clinically relevant leakage appeared in 58 patients (1.7 %), of whom 51 (87.9 %) were re-operated. Leakage was found to be more frequent after stapled anastomosis (2.4 vs. 1.2 %, p = 0.006), and in multivariate analysis, stapled anastomosis was the only risk factor (OR = 2.04 95 % CI 1.19-3.50). There was no difference in overall survival related to the technique. Hand-sewn anastomosis is not associated with a higher leakage rate when comparing to a stapling procedure and is recommended for routine and emergency right-sided colon cancer surgery. This recommendation is based on what appears to be a lower leakage rate, similar survival and lower material cost.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-2996-6
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    ABSTRACT: Appreciating the luxury of our modern operating rooms and arsenal of surgical instruments never seemed easier than when forced to operate in a very low-resource setting. As we have both experienced during short-term humanitarian surgical mission trips to Africa, performing specialized endocrine surgical procedures in resource-limited settings can make technically difficult cases seem all the more challenging. The article by O Donohoe et al. highlights a collection of key points regarding endocrine surgery in Sub-Saharan Africa [1].First and foremost, continued development of the surgical workforce in Sub-Saharan Africa is of paramount importance. Local surgeons are often required to perform procedures that are frequently funneled to fellowship-trained subspecialists in developed countries. Mission surgical specialists can provide invaluable onsite, personalized, one-on-one committed teaching and consultation to these surgeons. The experienced, sage surgeon comfortable with complex endo ...
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-2999-3
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    ABSTRACT: Achalasia is a disease for which treatments are palliative in nature. Success of therapy is judged by a number of metrics, the most important being relief of symptoms, such as dysphagia and regurgitation. Patients often compensate for symptoms though a variety of dietary and lifestyle modifications, making symptomatic assessment of therapeutic outcome unreliable. Given this fact, and the progressive nature of the condition if left inadequately treated, patients not infrequently present with the disabling manifestations of end-stage disease for which esophagectomy is the best option. In appropriately selected patients, and when performed in experienced centers, esophagectomy with foregut reconstruction can be undertaken successfully with acceptable rates of morbidity and mortality, as well as a good long-term symptomatic outcome, in cases of end-stage achalasia.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-3012-x
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    ABSTRACT: The presence of a replaced or accessory right hepatic artery (R/A RHA) originating from the superior mesenteric artery represents one of the most common anatomical vascular variants of the hepatic artery and comprises the most frequently injured vessels during liver harvesting. Vascular arterial injuries following liver procurement are associated with decreased patient and graft survival and higher retransplantation rates. We describe an alternative technique for harvesting marginal liver grafts with replaced or accessory right hepatic arteries in the absence of pancreatic procurement. The entire procedure is divided and schematically described in six steps for didactical purposes. This technique has been used in 72 liver harvests over a three-year period with no R/A RHA injury. The technical advantages and limitations of this alternative method are discussed.
    World Journal of Surgery 02/2015; 39(7). DOI:10.1007/s00268-015-3018-4
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    ABSTRACT: Total superficial vein reflux eradication in the treatment of venous ulcer. Our initial experience with groin-knee vein stripping resulted in recurrent or unhealed venous ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active venous ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active venous ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p < 0.0001 and 1.0, 0.7, p = 0.035 for VCSS and VDS, respectively). Recurrent ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous ulcer could be satisfactory treated by the total removal of the peri-ulcer reflux.
    World Journal of Surgery 02/2015; 39(5). DOI:10.1007/s00268-014-2935-y
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    ABSTRACT: Hepatectomy is the most effective treatment for patients with colorectal liver metastasis (CRLM). However, the procedure is also associated with a high risk of recurrence, and adjuvant chemotherapy for postoperative recurrence remains controversial. We investigated the efficacy of adjuvant chemotherapy for CRLM with the clinical risk score (CRS) proposed by Fong et al. Patients with CRLM who were treated, without preoperative chemotherapy, between 1992 and 2012 were classified as having low CRS (score of 0-1), intermediate CRS (2-3), or high CRS (4-5). The efficacy of adjuvant chemotherapy was retrospectively analyzed for each CRS subgroup. Of the 161 patients who underwent hepatectomy, 100 received adjuvant chemotherapy (group A) and 61 did not (group N). For intermediate CRS, 5-year disease free survival (DFS) was significant different between the groups (group A: n = 61; 33.9 % vs. group N: n = 39; 23.2 %, P = 0.008) and 5-year overall survival (OS) of group A was higher than group N (53.5 vs. 36.5 %, P = 0.048), respectively. For both low CRS and high CRS, 5-year DFS and OS were similar between the groups. Multivariate analysis of DFS identified prognostic factors as major resection for low CRS (P = 0.02) and adjuvant chemotherapy for intermediate CRS (P = 0.015). Similarly, multivariate analysis of OS identified major resection for low CRS (P = 0.05) and adjuvant chemotherapy for intermediate CRS (P = 0.05). High CRS was not identified prognostic factor. Adjuvant chemotherapy for CRLM was effective in intermediate CRS patients. In low CRS patients, adjuvant chemotherapy may not be necessary, but adequate surgical resection is important.
    World Journal of Surgery 02/2015; 39(6). DOI:10.1007/s00268-015-2980-1
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    ABSTRACT: A recent study of focused minimally invasive parathyroidectomy (FPTX) in sporadic primary hyperparathyroidism (pHPT) using intraoperative parathyroid hormone (ioPTH) measurements shows that inadequate ioPTH drop and multiglandular disease are more commonly found when a first gland <200 mg is resected. Our aim was to study if a resected gland that weighed <200 mg was associated with an increased persistence rate after FPTX. This is a cohort study of FPTX for pHPT performed in the period 1998-2013. FPTX was performed in patients with pHPT where Sestamibi and Ultrasound imaging localized single-gland disease, only one gland was excised and the weight recorded. IoPTH was not used routinely. Two groups were composed according to the weight of the resected gland: Group A <200 mg and Group B ≥200 mg. Persistent or recurrent disease was defined if it occurred within, or after 6 months. The primary outcome measure was the rate of persisting pHPT. A total of 3,511 parathyroidectomies were performed, and a total 1,745 FPTX (1,347 female) met inclusion criteria. There were 245 and 1,500 patients in groups A and B, respectively. The rate of persistent pHPT was higher in Group A, 6.1 versus 2.0 % (p < 0.001). Findings at re-operative surgery showed that the ipsilateral gland was diseased in 47 % (7/15) of persistent cases in group A. The risk of persistent disease after MIP was higher if the resected gland weighed ≤200 mg, and this corroborates the findings of a recent study. A heightened awareness of the possibility of multigland disease should be raised, and ioPTH monitoring, identification of the ipsilateral gland or bilateral exploration may be advisable in such cases.
    World Journal of Surgery 02/2015; DOI:10.1007/s00268-015-3017-5
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    ABSTRACT: This month’s issue of the World Journal of Surgery presents a meta-analysis and systemic review of laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease [1]. The authors’ aim was to answer the above (very important) question, which is asked of an upper gastrointestinal surgeon countless times by his/her patients. However, although the authors have prepared a comprehensive and thorough review, their study design has not answered this question. By not addressing the anatomical differences between varying degrees of fundoplication, misleading outcomes might have been generated that will not influence current surgical practice. Why is the design of this study problematic? Similar to a meta-analysis published in Annals of Surgery in 2011 [2] by a group from the Netherlands, the authors of the current study have grouped together 90°, 120°, and 180° wraps into an ‘anterior’ group, and 270° and 360° wraps into a ‘posterior’ group. The decision to combine t ...
    World Journal of Surgery 02/2015; 39(4). DOI:10.1007/s00268-015-3015-7