{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:43:23Z","timestamp":1777448603255,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to evaluate the impact of postoperative complications on early recurrence (ER) after pancreaticoduodenectomy (PD) for biliary tract cancer (BTC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients who underwent PD for BTC between 2009 and 2022 were enrolled in this study. Postoperative complications were assessed using the comprehensive complication index (CCI), calculated by summing all the complications. The optimal CCI cutoff value for predicting ER was selected based on the minimum\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value from the chi-square test. ER was defined as recurrence within 12\u00a0months of resection. Risk factors for ER were identified using multivariate analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 118 patients were analyzed. ER was observed in 34 (28.8 %) patients, indicating a significantly poorer prognosis than those without ER (log-rank,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). No significant differences were observed in the primary tumor site or pathological features between the low CCI (&lt;42.6) and high CCI (\u226542.6) groups. The incidence of ER was significantly higher in the high CCI group than in the low CCI group (50.0% vs 24.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .015). Multivariate analysis revealed that high CCI (odds ratio [OR] 4.43, 95% confidence interval [CI] 1.41-13.97,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .011) and R1 resection (OR 4.88, 95% CI 1.43-16.70,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .012) were independent risk factors for ER.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Postoperative complications after PD for BTC were found to be independent risk factors for ER.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251368282","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T15:10:10Z","timestamp":1754665810000},"page":"386-392","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Postoperative Complications Assessed by the Comprehensive Complication Index (CCI) and Early Recurrence after Pancreaticoduodenectomy for Biliary Tract Cancer"],"prefix":"10.1177","volume":"92","author":[{"given":"Yuki","family":"Okazoe","sequence":"first","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6493-4732","authenticated-orcid":false,"given":"Hiroaki","family":"Yanagimoto","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Tsugawa","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Akita","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michihiko","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryunosuke","family":"Konaka","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihide","family":"Nanno","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Urade","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohei","family":"Komatsu","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadaki","family":"Asari","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Kido","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takumi","family":"Fukumoto","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.1170"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9752"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.08.011"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10296"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-023-06974-x"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001011"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-022-02513-9"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI67484"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2000.103498"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-020-05859-7"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002477"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2020.09.002"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001849"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318296c732"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004465"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-021-09811-4"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2023.07.008"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrac115"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-019-01880-z"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-018-4530-0"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251368282","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251368282","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251368282","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:21Z","timestamp":1777379901000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251368282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/00031348251368282"],"URL":"https:\/\/doi.org\/10.1177\/00031348251368282","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,8]]}}}