Digestive Surgery最新文献

{"title":"Feasibility of Telementoring during Robot-Assisted Minimally Invasive Esophagectomy.","authors":"Robin B den Boer, Cas de Jongh, Gijs I van Boxel, Philippe Rouanet, Anne Mourregot, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1159/000542035","DOIUrl":"10.1159/000542035","url":null,"abstract":"<p><strong>Introduction: </strong>Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE.</p><p><strong>Methods: </strong>The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was the impact of the technology on conveying and understanding instructions.</p><p><strong>Results: </strong>Between December 2021 and December 2022, nine RAMIE procedures were proctored using telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n = 21, 96%). Most proctor instructions were aimed at improving surgical exposure (n = 9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team.</p><p><strong>Discussion: </strong>Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496908","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}

{"title":"Retraction Statement.","authors":"","doi":"10.1159/000544961","DOIUrl":"https://doi.org/10.1159/000544961","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"42 3","pages":"154"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648820","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}

{"title":"Endoscopic Negative Pressure Therapy for Post-Sleeve Gastrectomy Proximal Staple-Line Leaks: A Single-Center Experience of 40 Patients.","authors":"Vasiliki Christogianni, Matthias Ross, Radostina Dukovska, Ashwini Rao, Martin Buesing, Markus Reiser","doi":"10.1159/000545177","DOIUrl":"10.1159/000545177","url":null,"abstract":"<p><strong>Introduction: </strong>Post-sleeve gastrectomy (SG) proximal staple-line leak is a rare yet serious complication. Endoscopic negative pressure therapy (ENPT) has emerged as a safe technique, showing promising results in treating anastomotic leakages in the upper and lower gastrointestinal tract, often in conjunction with surgical interventions. A standardized treatment algorithm has not been established. This study aimed to assess the safety and efficacy of ENPT in the multidisciplinary management of proximal staple-line leaks after SG.</p><p><strong>Methods: </strong>This is an observational study of 40 post-SG proximal staple-line leak cases treated with an ENPT-based approach. Revisional surgery was performed in addition to ENPT in critically ill patients or nondiagnostic imaging results. Success was defined as the healing of the defect and paraluminal cavity with no further need for surgical or endoscopic intervention following ENPT.</p><p><strong>Results: </strong>Thirty-three patients were successfully treated with ENPT (82.5% success rate). Additional surgical interventions were performed in 37 patients, with re-laparoscopy, lavage, and drain of the abdominal cavity being the most frequently performed procedures. The mean duration of treatment was 25.6 days, with an average of 6.4 endoscopic interventions per patient.</p><p><strong>Conclusions: </strong>ENPT is a safe and effective technique for treating proximal staple-line leaks following SG. Its application should be considered alongside other endoscopic and surgical approaches.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"97-104"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604284","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}

{"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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"116-126"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","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}

{"title":"Impact of Robotic Surgery on Postoperative Pancreatic Fistula for High-Risk Pancreaticojejunostomy after Pancreatoduodenectomy.","authors":"Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara","doi":"10.1159/000543737","DOIUrl":"10.1159/000543737","url":null,"abstract":"<p><strong>Introduction: </strong>The safety and feasibility of robotic pancreatoduodenectomy (RPD) in high-risk patients for postoperative pancreatic fistula (POPF) have rarely been investigated, although the rate of POPF is lower than in open pancreatoduodenectomy (OPD). This study aimed to examine the impact of robotic surgery on POPF in high-risk patients after pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>We performed a retrospective study of 204 patients who underwent RPD and OPD between January 2018 and June 2023. Of the 204 patients, 126 with high-risk pancreaticojejunostomies for developing POPF were included. The outcomes of RPD and OPD were compared. Multivariate analyses were conducted to identify risk factors associated with the development of clinically relevant POPF (CR-POPF) after surgery.</p><p><strong>Results: </strong>Of the 126 patients, 50 underwent RPD and 76 underwent OPD. The incidence of CR-POPF was significantly lower in the RPD group than in the OPD group (6.0% vs. 38.2%, p < 0.001). Multivariate analyses identified OPD as an independent risk factor associated with CR-POPF (odds ratio [OR]: 7.87, 95% confidence interval [CI]: 2.11-29.4, p = 0.002).</p><p><strong>Conclusion: </strong>This study demonstrated the impact of robotic surgery on POPF in high-risk patients after PD. These results suggest that RPD may be significantly associated with a decreased incidence of CR-POPF in high-risk anastomoses.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"49-58"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045822","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}

{"title":"Exploration of Risk Factors and an Identification Signature for Bacteremia in Acute Cholecystitis.","authors":"Satoshi Nishiwada, Tetsuya Tanaka, Kenji Uno, Yuki Kirihataya, Takeshi Takei, Tomomi Sadamitsu, Akihiro Kajita, Mayuko Kikuchi, Yoshiki Tamada, Masaru Enoki, Kazusuke Matsumoto, Junya Suzuki, Hazuki Horiuchi, Yasushi Okura, Teruyuki Hidaka, Masayoshi Sawai, Atsushi Yoshimura","doi":"10.1159/000545140","DOIUrl":"10.1159/000545140","url":null,"abstract":"<p><strong>Introduction: </strong>Acute cholecystitis (AC) is one of the most common abdominal emergencies worldwide. Biliary infections can easily induce bacteremia, leading to severe general conditions including systemic inflammation and blood coagulation abnormalities. However, bacteremia in AC has not been investigated so far. Herein, we analyzed the blood cultures and clinical data of patients with AC to identify the risk factors and develop a statistical identification model for bacteremia.</p><p><strong>Methods: </strong>Of 319 consecutive patients with AC at our hospital, we retrospectively investigated 176 patients who were evaluated by blood culture at diagnosis to assess risk factors and develop an identification model for bacteremia in AC.</p><p><strong>Results: </strong>Based on blood culture results, 37 (21.0%) of 176 patients were diagnosed with bacteremia. The bacteremia-positive group had a significantly worse systemic status at diagnosis than the negative group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities. Multivariate analysis revealed previous endoscopic papillary procedures, total bilirubin, and systemic inflammatory response syndrome ≥3 as significant risk factors for bacteremia. On dividing early and late cohorts according to the onset time of AC, an identification signature derived from the three risk factors robustly distinguished bacteremia in both cohorts (area under the curve, early cohort = 0.93; late cohort = 0.91).</p><p><strong>Conclusions: </strong>In this study, we identified risk factors and signatures that accurately detect bacteremia in patients with AC. This study enriches our medical knowledge of AC, helping us step toward designing individualized treatment strategies for this disease.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"84-96"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585131","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}

{"title":"Empiric Antimicrobial Treatment of Anastomotic Leakage after Esophageal Resection: The Most Commonly Used Antimicrobial Regimens in the Netherlands and an Antimicrobial Treatment Recommendation Based on a Single-Center Population.","authors":"Nicole Chatain Lorza, Esther M van Wezel, M H Edwina Doting, Jasper B van Praagh, Jan Willem Haveman","doi":"10.1159/000545046","DOIUrl":"10.1159/000545046","url":null,"abstract":"<p><strong>Introduction: </strong>The development of anastomotic leakage (AL) after esophagectomy is a severe complication, often leading to mediastinitis and systemic infections. Effective empiric antimicrobial therapy is crucial, but there is no consensus on the optimal regimen. This study aimed to document antimicrobial regimens used in the Netherlands and to evaluate culture results from AL after esophagectomy at our center.</p><p><strong>Methods: </strong>An online questionnaire about the preferred antimicrobial treatment of AL after esophagectomy was sent to all upper gastrointestinal surgeons in the Netherlands. In addition, drain culture results from patients with AL after esophagectomy in our center were retrospectively analyzed.</p><p><strong>Results: </strong>From 76 responses, 28 were included, representing 13 of the 15 esophagectomy-performing centers in the Netherlands. For treating AL after esophagectomy, respondents typically choose broad-spectrum regimens covering Gram-negative, Gram-positive, and anaerobic bacteria. The cultures of 57 patients were analyzed. Overall, 61% had positive cultures for yeast, 61% of patients for Enterobacterales, and 16% for Pseudomonas and other non-fermenters.</p><p><strong>Conclusion: </strong>Based on the studied cultures, empiric antibiotics should cover Gram-positive, Gram-negative, anaerobe bacteria and Pseudomonas. We recommend the use of empiric amoxicillin/clavulanic acid with tobramycin for patients with AL after esophagectomy, which is now protocol in our center. The addition of antifungals remains debatable. Given the high incidence of yeast-positive cultures in the studied cohort, we recommend the addition of an echinocandin in clinically unstable patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"68-76"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"127-135"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","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}

{"title":"Delayed Return of Gastrointestinal Function after Partial Hepatectomy: A Single-Center Cross-Sectional Study.","authors":"Giulia Piazza, Ismail Labgaa, Emilie Uldry, Emmanuel Melloul, Nermin Halkic, Gaëtan-Romain Joliat","doi":"10.1159/000542028","DOIUrl":"10.1159/000542028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p &lt; 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p &lt; 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p &lt; 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p &lt; 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p &lt; 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p &lt; 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p &lt; 0.001), and higher median blood loss (1,088 vs. 701 mL, p &lt; 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p &lt; 0.001) and had longer median length of stay (19 vs. 8 days, p &lt; 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p &lt; 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p &lt; 0.001) were independently associated with DRGF occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"9-16"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Intratumoral injection of holmium-166 microspheres in patients with unresectable PDAC seems feasible and safe. Research into minimally invasive image-guided application is advised.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"136-145"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","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}