Background: The outcomes for patients with NASH-related HCC after curative resection have not been clarified. This study compared the overall survival (OS), time-to-tumor recurrence (TTR), and recurrence-free survival (RFS) associated with NASH-related HCC and virus-related HCC after resection. Methods: Patients with HCC who underwent curative resection were retrospectively enrolled. Baseline characteristics, including disease etiologies and clinical and tumor features, were reviewed. The primary outcomes were OS, TTR, and RFS. Results: Two hundred and six patients were enrolled (HBV: n = 121, HCV: n = 54, NASH: n = 31). Of those with virus-related HCC, 84.0% achieved viral suppression. In both the overall and propensity-score-matched cohorts, those with NASH-related HCC experienced recurrence significantly earlier than those with virus-related HCC (median TTR: 1108 days vs. non-reached; p = 0.03). Through multivariate analysis, NASH-related HCC (hazard ratio (HR), 2.27; 95% confidence interval (CI), 1.25–4.12) was independently associated with early recurrence. The unadjusted RFS rate of the NASH-related HCC group was lower than the virus-related HCC group. There was no difference in the OS between the two groups. Conclusions: NASH-related HCC was associated with earlier tumor recurrence following curative resection compared to virus-related HCC. Post-surgical surveillance is crucial for detecting early recurrence in patients with NASH-related HCC.

Background: Patients sustaining multiple rib fractures have a significant risk of developing morbidity and mortality. More evidence is emerging that the indication of surgical stabilization of rib fractures (SSRF) should expand beyond flail chest. Nevertheless, little is known about factors associated with poor outcomes after surgical fixation. We reviewed patients with rib fractures to further explore the role of SSRF; we matched two groups by propensity score (PS). Method: A comparison of patients with blunt thoracic trauma treated with SSRF between 2010 and 2020 was compared with those who received conservative treatment for rib fractures. Risk factors for poor outcomes were analyzed by multivariate regression analysis. Results: After tailored SSRF, the number of fractured ribs was not associated with longer ventilator days (p = 0.617), ICU stay (p = 0.478), hospital stay (p = 0.706), and increased nonprocedure-related pulmonary complications (NPRCs) (p = 0.226) despite having experienced much more severe trauma. In the multivariate regression models, lower GCS, delayed surgery, thoracotomy, and flail chest requiring mechanical ventilation were factors associated with prolonged ventilator days. Lower GCS, higher ISS, delayed surgery, and flail chest requiring mechanical ventilation were factors associated with longer ICU stays. Lower GCS and older age were factors associated with increased NPRCs. In the PS model, NPRCs risk was reduced by SSRF. Conclusions: The risk of NPRCs was reduced once ribs were surgically fixed through an algorithmic approach, and poor consciousness and aging were independent risk factors for NPRCs.

Thoracic injuries, especially rib fractures, carry high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) has emerged as a promising approach to reduce pulmonary complications. We aimed to analyze the benefits of SSRF beyond flail chest and make the study applicable to clinical practice. This study compared SSRF and conservative treatments at a tertiary trauma center. A time series analysis and propensity score matching were applied to evaluate the outcomes. Data from a trauma registry (January 2017 to December 2020) were used. Exclusion criteria included patients with non-salvageable injuries and those transferred after 72 h. Primary outcomes were ventilator-free days on day 28 (VFD28) and non-procedural pulmonary complications (NPRCs). Of 770 eligible patients, 692 were enrolled, with 164 undergoing SSRF. SSRF patients had significantly longer VFD28 (22.5 vs. 19.0; P = 0.042) and reduced NPRCs (8.0 % vs. 14.5 %; P = 0.086). Subgroup analysis showed that SSRF patients requiring mechanical ventilation had longer ICU-free days (IFD28) and hospital-free days (HFD90) and lower mortality rates. Those not receiving ventilation but with more than three rib fractures also benefited from SSRF in terms of reduced NPRCs. SSRF improved clinical outcomes in more than just flail chest cases, benefiting patients with multiple rib fractures, both with and without mechanical ventilation. These findings support the broader clinical application of SSRF.