Digestive Surgery最新文献

Long-Term Outcomes of Zenker's Diverticula Treatment: Invasive Procedures Ensure Sustained Quality of Life Despite Higher Short-Term Morbidity. Zenker憩室治疗的长期结果：尽管短期发病率较高，但侵入性手术可确保持续的生活质量。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-06-06 DOI: 10.1159/000546619

Ulrich Nitsche, Marie Seitz, Helmut Friess, Hubertus Feussner, Norbert Hüser, Alissa Jell

{"title":"Long-Term Outcomes of Zenker's Diverticula Treatment: Invasive Procedures Ensure Sustained Quality of Life Despite Higher Short-Term Morbidity.","authors":"Ulrich Nitsche, Marie Seitz, Helmut Friess, Hubertus Feussner, Norbert Hüser, Alissa Jell","doi":"10.1159/000546619","DOIUrl":"https://doi.org/10.1159/000546619","url":null,"abstract":"Introduction There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker's diverticulum. This study evaluates not only short-term outcomes of different treatment approaches but also identifies prognostic factors for long-term recurrence-free survival and quality-of-life. Methods We retrospectively analyzed all patients diagnosed with Zenker's diverticulum at our center between 2001 and 2021. Long-term follow-up data, including validated quality-of-life scores (EAT-10 and GIQLI), were evaluated. Results Overall, 97 patients underwent open surgery (OS), 37 received endoscopic surgery (ES), and 17 patients were treated conservatively. Treatment-related morbidity was 25% for OS, 5% for ES, and nil for conservative management (p=0.004). After a median follow-up of 107 months, patients treated with OS or ES experienced less dysphagia (p<0.001) and regurgitation (p<0.001) compared to initial presentation. ES patients had a more favorable quality-of-life score than those treated conservatively (GIQLI: 125 vs. 106; p=0.010 but not EAT-10: 2 vs. 6; p=0.207). Recurrence rates were 28% for OS, 62% for ES, and 65% for conservative treatment (p<0.001). OS was identified as an independent prognostic factor for improved recurrence-free survival. Conclusion Despite higher short-term morbidity, OS was associated with the best recurrence-free survival. Long-term symptoms and quality-of-life outcomes were favorable and comparable between OS and ES.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-18"},"PeriodicalIF":1.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robot-Assisted Minimally Invasive Esophagectomy: Current Best Practice. 机器人辅助微创食管切除术：目前的最佳实践。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-06-05 DOI: 10.1159/000546749

Cezanne D Kooij, Lucas Goense, B Feike Kingma, Richard van Hillegersberg, Jelle P Ruurda

{"title":"Robot-Assisted Minimally Invasive Esophagectomy: Current Best Practice.","authors":"Cezanne D Kooij, Lucas Goense, B Feike Kingma, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1159/000546749","DOIUrl":"https://doi.org/10.1159/000546749","url":null,"abstract":"Background: Esophagectomy, the cornerstone in the multimodal treatment of esophageal cancer, has evolved from open surgery to minimally invasive esophagectomy (MIE) in recent decades. MIE reduces complications, facilitates faster recovery, and provides comparable or superior oncologic outcomes and survival rates compared to open surgery.Summary: Since the early 2000s, robot-assisted minimally invasive esophagectomy (RAMIE) has emerged, offering enhanced precision over MIE through features such as three-dimensional visualization, improved instrument dexterity, tremor filtration, and motion scaling. These innovations help overcome the challenges of MIE, particularly in the thoracic phase, where limited access and reduced instrument dexterity hamper the procedure. RAMIE is associated with lower complication rates, particularly pulmonary complications, improved recovery, and comparable oncological outcomes. Despite higher initial costs, its potential to reduce complications makes it financially comparable to other approaches. Moreover, mastering RAMIE requires navigating a significant learning curve, making collaboration and training vital. The integration of artificial intelligence and advancements in robotic platforms, including single-port systems, will broaden patient eligibility and improve outcomes.Key messages: RAMIE has established itself as an integral part of modern surgical practice and will continue to evolve, driving further innovation. Collaboration and training are essential for refining techniques and ensuring safe and effective implementation.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-17"},"PeriodicalIF":1.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Routine Endoscopic evaluation of colorectal anastomoses for early detection of Anastomotic Leakage (REAL study): protocol for a multicenter prospective study. 常规内镜评估结直肠吻合器早期发现吻合口漏（REAL研究）：一项多中心前瞻性研究方案。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-05-20 DOI: 10.1159/000546041

David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espin-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes

{"title":"Routine Endoscopic evaluation of colorectal anastomoses for early detection of Anastomotic Leakage (REAL study): protocol for a multicenter prospective study.","authors":"David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espin-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes","doi":"10.1159/000546041","DOIUrl":"https://doi.org/10.1159/000546041","url":null,"abstract":"Introduction: Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.Methods: This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at one year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.Conclusion: The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The association between number of retrieved lymph nodes and survival in gastric cancer surgery: a Dutch population-based study. 胃癌手术中淋巴结数量与生存率的关系：一项基于荷兰人群的研究。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-05-19 DOI: 10.1159/000546436

Weikeat K Ooi, Sander J M van Hootegem, Low Kuan Yean, Leonie R van der Werf, Pieter Christiaan van der Sluis, S M Lagarde, Bas P L Wijnhoven

{"title":"The association between number of retrieved lymph nodes and survival in gastric cancer surgery: a Dutch population-based study.","authors":"Weikeat K Ooi, Sander J M van Hootegem, Low Kuan Yean, Leonie R van der Werf, Pieter Christiaan van der Sluis, S M Lagarde, Bas P L Wijnhoven","doi":"10.1159/000546436","DOIUrl":"https://doi.org/10.1159/000546436","url":null,"abstract":"Background: This study aimed to evaluate whether the retrieval of 15 or more lymph nodes (LN) during gastrectomy for cancer is associated with better survival and more accurate pathological staging.Methods: Patients that underwent gastrectomy between 2011 and 2016 were reviewed from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 and ≥15 LN retrieved were compared after propensity-score matching based on patient and tumor characteristics. The primary endpoint was 3-year overall survival.Results: A total of 2047 patients were included in the study. After propensity score matching, 522 patients with ≥15 LNs were matched to 522 patients with <15 LNs. There was no statistically significant difference in overall survival between both groups, with 3-year survival rates of 56% versus 59%, respectively. Patients with ≥15 LNs had a more advanced pN-category. While median survival was higher for patients with ≥15 LNs versus <15 LNs in the subgroups pN2, pN3a, and pN3b, no statistically significant differences were found. Similar results were found in the propensity score matched cohort using 23 LNs as cut-off.Conclusions: ≥15 LNs retrieved during gastrectomy for cancer was associated with higher pN-stage, likely as a result of stage migration. Three-year overall survival was comparable for patients with ≥15 LNs and patients with <15 LNs retrieved.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-20"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Total Pancreatectomy with "Superior Mesenteric Artery-First Approach". “SMA-First入路”全胰切除术。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-05-10 DOI: 10.1159/000546363

Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

{"title":"Total Pancreatectomy with \"Superior Mesenteric Artery-First Approach\".","authors":"Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara","doi":"10.1159/000546363","DOIUrl":"10.1159/000546363","url":null,"abstract":"Introduction: Total pancreatectomy (TP) is a technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) have been reported in pancreatic surgery, few studies have demonstrated surgical techniques of SMA-first approach in TP.Methods: This report presents our novel SMA-first approach for PC in TP, including six steps. First, the resectability was confirmed (step 1). Next, SMA approach was applied (step 2). In this step, the anterior and left sides of the SMA were dissected, and the left renal vein was confirmed. Following retroperitoneal dissection (step 3), the pancreatic body and tail were completely mobilized (step 4). Subsequently, Whipple procedure was performed with lymphadenectomy around the right side of the SMA (step 5). Finally, hepaticojejunostomy and gastrojejunostomy were performed (step 6). Using SMA-first approach, en bloc resection with adequate lymphadenectomy around the SMA and retroperitoneal dissection was performed.Conclusion: The present study presents surgical techniques of TP using the SMA-first approach for PC. This unique approach may be useful to perform TP for PC to obtain negative resection margins.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is the Risk of Developing a Crohn's Disease Increased after Appendectomy? A Systematic Review of the Literature and Meta-Analysis. 阑尾切除术后患克罗恩病的风险增加了吗？对文献和荟萃分析进行系统回顾。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-04-22 DOI: 10.1159/000545339

Isabelle Uhe, Eleftherios Gialamas, Christophe Combescure, Christian Toso, Emilie Liot, Guillaume Meurette, Frederic Ris, Jeremy Meyer

{"title":"Is the Risk of Developing a Crohn's Disease Increased after Appendectomy? A Systematic Review of the Literature and Meta-Analysis.","authors":"Isabelle Uhe, Eleftherios Gialamas, Christophe Combescure, Christian Toso, Emilie Liot, Guillaume Meurette, Frederic Ris, Jeremy Meyer","doi":"10.1159/000545339","DOIUrl":"10.1159/000545339","url":null,"abstract":"Introduction: The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not.Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality.Results: Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%).Conclusion: Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-12"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PhotoNodes Protocol: A Multicenter Prospective Study for the Assessment of Proper Lymphadenectomy in Minimally Invasive Gastric Cancer Surgery Using Intraoperative Photographs. PhotoNodes方案：一项使用术中照片评估微创胃癌手术中适当淋巴结切除术的多中心前瞻性研究。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-04-22 DOI: 10.1159/000545846

Federico Marchesi, Marina Valente, Simone Giacopuzzi, Gian Luca Baiocchi, Paolo Morgagni, Lorena Torroni, Giorgio Dalmonte

{"title":"PhotoNodes Protocol: A Multicenter Prospective Study for the Assessment of Proper Lymphadenectomy in Minimally Invasive Gastric Cancer Surgery Using Intraoperative Photographs.","authors":"Federico Marchesi, Marina Valente, Simone Giacopuzzi, Gian Luca Baiocchi, Paolo Morgagni, Lorena Torroni, Giorgio Dalmonte","doi":"10.1159/000545846","DOIUrl":"10.1159/000545846","url":null,"abstract":"Introduction: In gastric cancer surgery, an adequate D2 lymphadenectomy is associated with improved cancer-specific survival. The aim of this study was to test the reliability of a new score (PhotoNodes Score [PNS]) conceived to rate the quality of lymphadenectomy in minimally invasive gastrectomy. The primary outcome of the study was to assess the inter-observer agreement among the reviewers assigning the score. The secondary outcome was the association between PNS and survival.Methods: This is a multicentric observational prospective study enrolling patients undergoing minimally invasive gastrectomy for gastric cancer with D2 lymphadenectomy. A set of laparoscopic/robotic images will be collected from each patient. Based on each set of images, the quality of lymphadenectomy performed will be rated with the new PNS by three surgeons. Fleiss' Kappa measure of agreement will be used to study the rating agreement among examining surgeons. The PNS score will correlate with disease-free and overall survival.Conclusion: The spread of minimally invasive approaches in oncologic gastric surgery made the collection of intraoperative images easier; for this reason, we believe that PNS could represent a new and efficient tool to assess the quality of D2 lymphadenectomy in clinical practice. The PhotoNodes study was registered at <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> #NCT06466902.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current Practice in the Treatment of Colorectal Liver Metastases by Irreversible Electroporation: An International Questionnaire Survey (LIVERMET-IRE-Q). 不可逆电穿孔治疗结直肠肝转移的当前实践：一项国际问卷调查（LIVERMET-IRE-Q）。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-04-16 DOI: 10.1159/000543634

Harry V M Spiers, Saurabh Jamdar, Santhalingam Jegatheeswaran, Nicola De Liguori Carino, Panagiotis Stathakis, Vinotha Nadarajah, Krishna V Menon, Sanjay Pandanaboyana, Adam E Frampton, Tze Min Wah, Shahid Farid, Hassan Z Malik, Robert P Jones, Jonathan Evans, Ajith K Siriwardena

{"title":"Current Practice in the Treatment of Colorectal Liver Metastases by Irreversible Electroporation: An International Questionnaire Survey (LIVERMET-IRE-Q).","authors":"Harry V M Spiers, Saurabh Jamdar, Santhalingam Jegatheeswaran, Nicola De Liguori Carino, Panagiotis Stathakis, Vinotha Nadarajah, Krishna V Menon, Sanjay Pandanaboyana, Adam E Frampton, Tze Min Wah, Shahid Farid, Hassan Z Malik, Robert P Jones, Jonathan Evans, Ajith K Siriwardena","doi":"10.1159/000543634","DOIUrl":"10.1159/000543634","url":null,"abstract":"Introduction: Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high-voltage electric current between electrodes. Although IRE has been demonstrated to achieve tumor necrosis, its role in the treatment of colorectal hepatic metastases is unestablished. This study is an international questionnaire survey on the use of IRE for patients with colorectal hepatic metastases.Methods: A questionnaire addressing views on the use of IRE for colorectal liver metastases was circulated to clinicians with an interest and/or expertise in this technique. The questionnaire addressed indications for the use of IRE in a range of scenarios: methods of use, assessment of treatment response, and outcome.Results: 64 clinicians from 17 different countries replied to the questionnaire. The preferred mode of delivery of IRE was percutaneous treatment under computed tomographic guidance. Thirty-three (70% of 47 respondents) used IRE exclusively for lesions in proximity to inflow or outflow structures. Twenty (43% respondents) used IRE as their sole ablative treatment, while 19 (40% of 47 respondents) used IRE in combination with thermal ablation. The maximum number of lesions that could be treated by IRE was two and the preferred size of lesion was <3 cm.Conclusion: Respondents to this international questionnaire survey indicate that IRE is an acceptable ablative option for small colorectal liver metastases (<3 m in diameter) close to inflow/outflow structures.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intratumoral Holmium-166 Microsphere Injection in Patients with Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Center, Single-Arm, Open-Label Feasibility and Safety Study. 肿瘤内注射钬-166微球治疗不可切除的胰腺导管腺癌：单中心、单组、开放标签的可行性和安全性研究

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-04-14 DOI: 10.1159/000545246

C Ysbrand Willink, Sjoerd F M Jenniskens, Martijn W J Stommel, Marcel J R Janssen, John J Hermans, Harm Westdorp, Cornelis J H M van Laarhoven, Jurgen J Fütterer, J Frank W Nijsen

{"title":"Intratumoral Holmium-166 Microsphere Injection in Patients with Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Center, Single-Arm, Open-Label Feasibility and Safety Study.","authors":"C Ysbrand Willink, Sjoerd F M Jenniskens, Martijn W J Stommel, Marcel J R Janssen, John J Hermans, Harm Westdorp, Cornelis J H M van Laarhoven, Jurgen J Fütterer, J Frank W Nijsen","doi":"10.1159/000545246","DOIUrl":"10.1159/000545246","url":null,"abstract":"Introduction: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and lacks local treatment options. This study aimed to assess the feasibility and safety of the first-in-human intraoperative ultrasound-guided intratumoral injection of radioactive holmium-166 microsphere in patients with PDAC.Methods: Patients with proven PDAC eligible for open surgical resection were included. If resection was abandoned during exploration, study intervention was performed. Feasibility was defined by injection success and on-/off-target radiation. Safety was based on adverse event (AE) monitoring for 12 weeks categorized by severity grade and study attribution.Results: Three of the thirteen included patients received study intervention. Injection was successful in all 3 patients. Mean tumor doses of 5.0, 17.0, and 39.0 Gy and maximum tumor doses of 25.0, 41.0 and 256.0 Gy were achieved. Off-target radiation was found once in the lungs and once in the colon with a mean dose <1.0 Gy. There were no AEs with high study attribution, 16, 14, and 19 AEs with low study attribution, including 3, 2, and 4 AEs with grade ≥3. Holmium-166 microspheres appeared hyperdense on CT.Conclusion: Intratumoral injection of holmium-166 microspheres in patients with unresectable PDAC seems feasible and safe. Research into minimally invasive image-guided application is advised.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm. 影响裂孔疝修补手术技术的患者因素：寻找外科医生的隐算法。

IF 1.8 3区医学

Digestive Surgery Pub Date : 2025-04-08 DOI: 10.1159/000545340

Berdel Akmaz, Amber Hameleers, Sander M J van Kuijk, Jan Willem M Greve, Roy F A Vliegen, Evert-Jan G Boerma, Berry Meesters, Jan H M B Stoot

{"title":"Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm.","authors":"Berdel Akmaz, Amber Hameleers, Sander M J van Kuijk, Jan Willem M Greve, Roy F A Vliegen, Evert-Jan G Boerma, Berry Meesters, Jan H M B Stoot","doi":"10.1159/000545340","DOIUrl":"10.1159/000545340","url":null,"abstract":"Introduction: Laparoscopic fundoplication is the current standard for HH repair. HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS), or mesh placement. We analyzed the influence of patient factors on the surgical technique for laparoscopic repair in a teaching hospital.Methods: Between 2012 and 2019, all patients who underwent repair of HH were assessed in this retrospective cohort study. HH was measured on CT scans and baseline patient characteristics and surgical details were collected.Results: In total, 307 patients were included. A total of 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients, and mesh in 17 patients. The use of anterior sutures was significantly associated with female gender, higher type of HH, and higher age. The use of VMS during surgery was significantly associated with higher type of HH, higher age, and larger transverse diameter of the HH. The use of mesh during surgery was significantly associated with higher type of HH and larger transverse diameter of the HH.Conclusion: In this retrospective study, the reinforcement techniques used during surgery were significantly associated with patient factors such as gender, body length and weight, type of HH, and transverse diameter. An unexpected patient-associated factor was age.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0