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: Pulmonary resection is the best therapeutic option for lung metastases from colorectal cancer (CRC) today. However, recurrences are frequent following pulmonary resection. We aimed to evaluate the recurrence pattern and treatment of initial pulmonary resection for metastases from CRC. Data from 76 patients with recurrence after curative resection of primary CRC and lung metastases were reviewed. The primary outcome measure was overall survival (OS), defined as the interval between the date of recurrence after pulmonary resection and the date of death or last follow-up. Cox regression analyses were performed to identify the factors associated with OS. Recurrence sites after initial pulmonary resection were lung (n = 37), liver (n = 12), others (n = 11), and multiple (n = 16). Treatments for recurrence included surgery (n = 35), chemotherapy (n = 37), and palliative care (n = 4). Of 35 patients who underwent surgery, 22 had pulmonary resection, and 11 had hepatic resection, and 2 had other resection. The 3-year OS was 84.1 % for surgery, 38.9 % for chemotherapy, and 0 % for palliative care, respectively (p < 0.001). In the surgery group, there was no difference in survival between surgical treatments for pulmonary and hepatic recurrences (p = 0.503). Cox regression analyses identified three factors: disease-free interval (DFI) (HR 1.99, 95 % CI 1.03-3.83), surgery (HR 0.30, 95 % CI 0.12-0.72), and recurrence site (lung: HR 0.10, 95 % CI 0.04-0.28, liver: HR 0.08, 95 % CI 0.02-0.31). The most common recurrence site after resection of lung metastases was the lung. Although the relapse rate is high, surgery for isolated recurrences is a promising strategy, especially for patients with long DFI.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Poorly designed experiments and popular media have led to multiple myths about wound ballistics. Some of these myths have been incorporated into the trauma literature as fact and are included in Advanced Trauma Life Support (ATLS). We hypothesized that these erroneous beliefs would be prevalent, even among those providing care for patients with gunshot wounds (GSWs), but could be addressed through education. ATLS course content was reviewed. Several myths involving wound ballistics were identified. Clinically relevant myths were chosen including wounding mechanism, lead poisoning, debridement, and antibiotic use. Subsequently, surgery and emergency medicine services at three different trauma centers were studied. All three sites were busy, urban trauma centers with a significant amount of penetrating trauma. A pre-test was administered prior to a lecture on wound ballistics followed by a post-test. Pre- and post-test scores were compared and correlated with demographic data including ATLS course completion, firearm/ballistics experience, and years of post-graduate medical experience (PGME). One-hundred and fifteen clinicians participated in the study. A mean pre-test score of 34 % improved to 78 % on the post-test with associated improvements in all areas of knowledge (p < 0.001). Years of PGME correlated with higher pre-test score (p = 0.021); however, ATLS status did not (p = 0.774). Erroneous beliefs involving wound ballistics are prevalent even among clinicians who frequently treat victims of GSWs and could lead to inappropriate treatment. Focused education markedly improved knowledge. The ATLS course and manual promulgate some of these myths and should be revised.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Precise preoperative localization is essential for focussed parathyroidectomy. The imaging standard consists of cervical ultrasonography (cUS) and (99m)Tc-MIBI-SPECT (MIBI-SPECT). (11)C-methionine positron emission tomography/computed tomography (Met-PET/CT) is a promising method for localizing parathyroid adenomas. The objective of our study was to elucidate whether additional Met-PET/CT increases the rate of focussed parathyroidectomy. Fourteen patients with primary hyperparathyroidism (HPT) and three patients with tertiary HPT underwent cUS and MIBI-SPECT. Met-PET/CT was carried out in patients with negative MIBI results. Subsequent surgical strategy was adapted according to imaging results. cUS localized a single parathyroid adenoma in 10/17 patients (59 %), while MIBI-SPECT/CT identified 11/17 single adenomas (65 %). In the remaining six patients, Met-PET/CT identified five single adenomas. This step-up approach correctly identified single adenomas in 16/17 patients (94 %). Met-PET/CT raises the rate of correctly localized single parathyroid adenomas in patients with negative cUS and MIBI-SPECT/CT and increases the number of focussed surgical approaches.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Standardized reporting of intraoperative adverse events is important to enhance transparency. To the best of our knowledge, there is no validated definition and classification of intraoperative complications. We conducted a two-round Delphi study to develop a definition and classification of intraoperative complications. Experts were contacted by email and sent a link to the online questionnaire. In a pilot study, two independent raters applied the definition and classification in a sample of 60 surgical interventions of low, intermediate, and high complexity and evaluated practicability. Interrater agreement of the classification was determined (raw categorical agreement, weighted kappa, and intraclass correlation). In the Delphi study, 40 of 52 experts (77 % return rate) from 14 countries took part in each round. The Delphi study resulted in a comprehensive definition of intraoperative complications as any deviation from the ideal intraoperative course occurring between skin incision and skin closure. The classification foresees four grades depending on the need for treatment (no need, grade I; need for treatment, grade II) and the severity of the complication (life-threatening/permanent disability, grade III; death, grade IV). The pilot study showed good practicability (6 on a 7-point scale) and a high raw agreement of 87 %, a weighted kappa of 0.83 [95 % confidence interval (CI) 0.73-0.94] and an intraclass correlation coefficient of 0.83 (95 % CI 0.73-0.90). While the Delphi process enabled to develop definitions and classification of intraoperative complications by severity, further research including a multicentre international full-scale validation needs to be conducted with the ultimate goal to contribute to standardized reporting in surgical practice and research.
    World Journal of Surgery 02/2015;
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    ABSTRACT: South Africa has a low incidence of acute appendicitis, but poor outcomes. However, South African studies on appendicitis focus solely on public hospitals, neglecting those who utilize private facilities. This study aims to compare appendicitis characteristics and outcomes in public and private hospitals in South Africa. A prospective cohort study was conducted among two public and three private hospitals in the Cape Town metropole, from September 2013 to March 2014. Hospital records, operative notes, and histology results were reviewed for patients undergoing appendectomy for acute appendicitis. Patients were interviewed during their hospitalization and followed up at monthly intervals until normal function was attained. A total of 134 patients were enrolled, with 73 in the public and 61 in the private sector. Education and employment were higher among private sector patients. Public sector patients had a higher rupture rate (30.6 vs 13.2 %, p = 0.023). Times to presentation were not statistically different between the two cohorts. Public sector patients had longer hospital stays (5.3 vs 2.9 days, p = 0.036) and longer return to work times (23.0 vs 12.1 days, p < 0.0001). Although complication rates were similar, complications in public hospitals were more severe. Public sector patients in South Africa with appendicitis have higher rupture rates, worse complications, longer hospital stays, and longer recoveries than private sector patients. Patients with perforation had longer delays in presentation than patients without perforation.
    World Journal of Surgery 02/2015;
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    ABSTRACT: The postoperative installation of isotonic saline in the abdomen has been suggested as a method to reduce the effect of local toxins, thereby reducing postoperative pain in patients undergoing laparoscopic surgery. The aim of this randomized prospective double-blind trial was to assess whether installation of isotonic saline can reduce postoperative pain and nausea following laparoscopic cholecystectomy (LC). Altogether 71 LC patients were randomized to either intra-abdominal instillation of isotonic saline group (S) (n = 36) or no saline (NS) group (n = 35) at the end of surgery. Data were collected by means of questionnaires. The postoperative recovery profile questionnaire was answered prior to surgery and 1 week postoperatively, SF-36 prior to surgery and at 1 month postoperatively, and a pain diary recording a Visual Analogue Scale score each day during the first week. The overall response rate was 94 %. No significant differences were seen between the groups regarding abdominal and shoulder pain. However, the NS group reported more pain (NS = 53 %, S = 29 %) and fatigue (NS = 50 %, S = 35 %) than the S group postoperative day 7. Moreover, the most frequently reported problem in both groups 7 days after surgery was getting back to normal life (60 %). Females reported a slower recovery profile than males and also more postoperative symptoms day 7. HRQoL results were similar between the groups. Instillation of isotonic saline does not improve recovery after laparoscopic cholecystectomy. Postoperative pain was more often reported in the NS group than in the S group, though the difference was not significant.
    World Journal of Surgery 02/2015;
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    ABSTRACT: To compare outcomes of laparoscopic versus open hepatic resection (OHR) exclusively for hepatocellular carcinoma in terms of morbidity and cost. Laparoscopic hepatic resection (LHR) has become more prevalent with recent improvements in instrumentation and surgeon experience. A review of multicenter, prospectively collected hepatobiliary databases from three institutions was performed from 12/1990 to 12/2009. Prospective evaluation of all patients undergoing hepatectomy for hepatocellular cancer was performed. A total of 354 patients who had resections for Hepatocellular carcinoma (HCC) were analyzed, 100 were performed laparoscopically. The two groups were similar in terms of demographics and comorbidities. Evaluation of outcomes showed significantly higher intraoperative estimated blood loss although postoperative transfusion rates were similar. The incidence of any complication (44 vs 44 %, p = 0.23) and 90-day mortality (6 vs 6 %, p = 0.8) were similar between the two groups, with a similar reoperation rate (4.0 vs. 2.4 %; p = 0.9). Using Cox regression analysis, the laparoscopic approach had no effect on disease-free interval (OR 1.4, CI 0.31-6.3, p = 0.66) or overall survival (HR 1.2, CI 0.59-2.5 p = 0.6). Length of stay was significantly shorter in the laparoscopic group 6.2 vs. 9.3 days (p = 0.001). Adjusted operative charges ($41 vs. $39 k, p = 0.601) and adjusted total hospital charges ($71 vs. $82 k, p = 0.368) were similar in LHR versus OHR. Our study confirms previous literature showing comparable perioperative outcomes and recurrence. We further show comparable cost with laparoscopic versus open liver resection for HCC.
    World Journal of Surgery 02/2015;
  • World Journal of Surgery 02/2015;
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    ABSTRACT: This retrospective study was designed to assess the feasibility of laparoscopic total gastrectomy (LTG) in clinical stage I gastric cancer patients, and validate the appropriateness of the widespread adoption of LTG for experienced open surgeons. Eighty-eight patients with clinical stage I gastric cancer underwent LTG in our hospitals (n = 55) and affiliated hospitals (n = 33). Esophagojejunostomy was performed intracoporeally using a circular stapler with an incision in the left upper abdomen. We investigated the patients' clinicopathologic factor, and evaluated the effect of hospital volume on short-term outcomes. Fixed insertion of the anvil head was successfully achieved in all patients (lift-up method in 58 patients and transoral method in 28 patients), although 2 patients were converted to open surgery. The approach using a circular stapler through a small incision from the upper left quadrant of the abdomen facilitated a good laparoscopic visual field for the plane of the esophagojejunostomy. Fourteen patients developed Clavien-Dindo classification grade II or more postoperative complications, and the overall operative morbidity rate was 15.9 %. No anastomotic leakage was encountered in this series. No significant difference was observed in clinical outcomes between patients in the high- and low-volume hospital groups. Laparoscopic total gastrectomy can be performed safely on clinical stage I gastric cancer patients by surgeons with sufficient experience in open gastrectomy and therefore represents a feasible procedure that is not clinically impacted by hospital volume.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Nutritional support influences the outcome of gastroenterological surgery, and enteral nutrition effectively mitigates postoperative complications in highly invasive surgery such as resection of esophageal cancer. However, feeding via jejunostomy can cause complications including mechanical obstruction, which could be life threatening. From 2009, we began enteral feeding via duodenostomy to reduce the likelihood of complications. In this study, we compared duodenostomy with the conventional jejunostomy feeding, mainly looking at the catheter-related complications. The database records of 378 patients with esophageal cancer who underwent radical esophagectomy with retrosternal or posterior mediastinal gastric tube reconstruction in our department from January 1998 to December 2012 were examined. Of the 378 patients, 111 underwent feeding via duodenostomy (FD) and 267 underwent feeding via jejunostomy (FJ), and their records were reviewed for the following catheter-related complications: site infection, dislodgement, peritonitis, and mechanical obstruction. Mechanical obstruction occurred in 12 patients in the FJ group but none in the FD group (4.5 % vs. 0 %, P = 0.023). Of the 12 cases, 7 (58.3 %) required surgery of which 2 had bowel resection due to strangulated mechanical obstruction. Catheter site infection was seen in 14 cases in the FJ group, of which 2 (14.2 %) had peritonitis following catheter dislocation, while only one case of site infection was seen in the FD group (5.2 % vs. 0.9 %, P = 0.078). Feeding via duodenectomy could be the procedure of choice since neither mechanical obstruction nor relaparotomy was seen during enteral feeding through this technique.
    World Journal of Surgery 02/2015;
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    ABSTRACT: There are no conclusive cost-effectiveness studies measuring the efficacy of salvage LT after liver resection (LR) and radiofrequency ablation (RFA) in patients with early hepatocellular carcinoma (HCC) and compensated cirrhosis. The aim of the present study is to compare liver transplantation (LT) versus locoregional therapy plus salvage LT (to treat tumor recurrence) in patients with early HCC and compensated cirrhosis. Reference case: 55-year old male with HCC within Milan criteria and Child-Pugh A cirrhosis. The analysis was performed in two geographical cost settings: USA and Italy. Survival benefit measured in quality-adjusted life years (QALYs), costs (C) in US$, incremental cost-effectiveness, willingness to pay, and net health benefit (NHB). In the base-case analysis, NHB of LT vs. LR and RFA was -1.7 and -1.3 years for single tumor ≤3 cm, -1.2 and -0.7 for single nodules measuring 3.1-5 cm and -0.7 and -0.7 for multi-nodular tumor ≤3 cm in Italy. In USA, NHB of LT versus LR and RFA were -1.2 and -0.8 years for single tumor ≤3 cm, -0.9 and -0.5 for single nodules measuring 3.1-5 cm, and -0.5 and -0.4 for multi-nodular tumor ≤ 3 cm. On the Monte Carlo simulation, only young patients with multi-nodular HCC and short waiting list time had a positive NHB. Salvage LT proved to be an ineffective cost strategy after RFA or LR. In patients with HCC within Milan criteria and Child-Pugh A cirrhosis, LR and RFA were more cost-effective than LT. Salvage LT was not cost-effective.
    World Journal of Surgery 02/2015;
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    ABSTRACT: There is evidence of increased mortality and reduced efficiency in hospitals due to the annual changeover of junior doctors. This paper describes a framework to develop an intensive simulated week that will recreate experiences and situations that junixor surgical interns will likely face in their first weeks after graduation. To provide evidence-based recommendations, a systematic review of published literature using the keywords 'surg*', 'boot', 'camp' was performed. Reports of the development, implementation or evaluation of a simulated skills course or 'boot camp' to prepare incoming surgical interns were analysed. Eighteen relevant articles were identified. Subjects on internship preparation courses have identified 'hands-on' training sessions to be very useful. In particular, mock pages have been identified as being valuable and didactic lectures have been identified as the weakest parts of the course. We first consider the end-users of the course and their associated learning needs. We subsequently discuss resources required and propose a strategy for the organisation of a course and selection of teaching faculty. Finally, we consider the costs involved in running a course. This paper proposes a framework for the development, organisation and implementation of an intensive simulation course to prepare graduating medical students for their role as junior surgical intern. Facilitating the step change in responsibility from student to surgical intern may improve patient safety in addition to reducing the associated anxiety for the clinician.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Hepatocellular carcinoma (HCC) larger than ten cm belonging to Barcelona Clinic Liver Cancer (BCLC) stage B and C may benefit from hepatic resection (HR), compared to presently recommended management by transarterial chemoembolization and sorafenib, respectively. This study reviews survival outcomes in such patients treated at a tertiary level hospital in Taiwan, and compares survival advantage of surgical resection over embolization therapy using a statistically valid propensity scores matching model. 192 patients newly diagnosed with HCC ≥ 10 cm between 2005 and 2010, who had HR (n = 104) and transarterial embolization (TAE) (n = 88), were retrospectively studied. Thirty-two patients in each group were selected by propensity scores matching model for comparison. Survival rates at 1, 3, and 5 years of patients in BCLC stage B who had HR and TAE were 78.5, 61.4, 54.2 % and 30, 12.9, 12.9 %, (p < 0.001), respectively. For stage C, survival rates were 77.8, 56.4, and 47 % at 1, 3, 5 years in HR group, while it was 12.7 % at 1 year in TAE group, (p < 0.001). Propensity score-based analysis showed estimated 1-, 3-, and 5-year survival rates of patients receiving HR and TAE were 90.2 versus 26.4 %, 64.3 versus 3.3 %, and 51.5 versus 3.3 %, respectively (p < 0.001). HR had significantly better 5 year survival than TAE for patients with HCC ≥ 10 cm in the propensity score model. Overall survival of BCLC stage B may be improved by considering HR as first treatment option for resectable large HCCs, provided patient is fit for surgery with good liver remnant.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Growing attention is being focused on global surgical issues, with an increasing evidence base being generated in both the surgical and global health literatures. A component of this research includes assessments of the capacity to deliver surgical care in individual hospitals and across networks of hospitals in many low- and middle-income countries. These articles have addressed human resources (skills, training, staffing), physical resources (equipment, supplies), and infrastructure. The article by Lucas et al. summarizes this literature to date [1]. After an extensive search, the authors document a total of 28 studies from 17 countries that use a variety of inter-related tools to evaluate such surgical capacity. The authors restrict their search to articles on surgical capacity in general and allude to, but do not summarize, data from studies on pediatric surgery, trauma care, or other sub-components of overall surgical capacity.The literature on surgical capacity has been robust an ...
    World Journal of Surgery 02/2015;
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    ABSTRACT: Prophylactic combined extrahepatic bile duct resection remains controversial for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion. The aim of this study is to resolve this issue and establish an appropriate surgery for locally advanced gallbladder carcinoma. A total of 52 patients underwent surgical resection combined with extrahepatic bile duct resection for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion, and their medical records were retrospectively reviewed for microvessel invasion (MVI), including lymphatic, venous, and/or perineural invasions, around the extrahepatic bile duct. Of the 52 patients, 8 (15 %) had MVI around the extrahepatic bile duct. All of the 8 patients had Stage IV disease. According to a survival analysis of the 50 patients who tolerated surgery, MVIs around the extrahepatic bile duct and distant metastasis were identified as independent prognostic factors. Survival for patients with MVI around the extrahepatic bile duct was dismal, with a lack of 2-year survivors. MVI around the extrahepatic bile duct is a sign of extremely locally advanced gallbladder carcinoma; therefore, prophylactic combined bile duct resection has no survival impact for patients without extrahepatic bile duct invasion.
    World Journal of Surgery 02/2015;
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    ABSTRACT: Ultrasound-guided fine-needle aspiration (FNA) is the most valuable procedure in the diagnosis of thyroid nodules. One possible result of FNA of thyroid nodules, however, is "nondiagnostic" cytology. In these cases, consensus guidelines suggest repeating FNA with ultrasound guidance, but the results obtained may continue to be nondiagnostic. These results cause confusion due to the fact that there exist conflicting potential treatment modalities, such as performing diagnostic surgery or recommending follow-up. Hence, the present study aimed to establish a protocol for performing diagnostic operations for thyroid nodules with repeat nondiagnostic cytology. This study was performed on patients who underwent ultrasound-guided FNA and molecular testing for BRAF gene mutation. Out of 1,203 patients, 84 had nondiagnostic cytology and were BRAF negative, and ultrasound-guided FNA was repeated on these patients. Out of this group, 54 patients once again had nondiagnostic cytology, and 51 of these underwent diagnostic surgery. We analyzed the characteristics and ultrasonographic findings of the group of patients with repeat nondiagnostic cytology. On the initial ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 6.98 %, and on repeat ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 67.5 %. The majority of these patients underwent diagnostic surgery, and 36 (70.6 %) patients were diagnosed as having a malignant thyroid nodule, while15 (29.4 %) patients were diagnosed with a benign nodule. Univariate analysis showed a significant difference in the size of the nodule, hypoechogenicity, and microcalcification in the ultrasonography findings. Multivariate analysis revealed only hypoechogenicity as a factor that showed a significant difference (p value 0.017, 95 % confidence interval 1.494-62.426).The diagnostic accuracy of the ultrasonography was 76.5 %. Hypoechogenicity on ultrasonography represents an excellent parameter for the selection of those who should be referred for diagnostic operation among patients with thyroid nodules and repeat nondiagnostic cytology.
    World Journal of Surgery 02/2015;