Ejso最新文献

{"title":"Comparing 2 cm vs. 1 cm surgical margins in acral melanoma of the sole with Breslow thickness greater than 2 mm: A multicenter retrospective study of 336 Japanese patients","authors":"Shigeru Koizumi ,&nbsp;Naoya Yamazaki ,&nbsp;Yuki Ichigozaki ,&nbsp;Hiroshi Kitagawa ,&nbsp;Yukiko Kiniwa ,&nbsp;Sayuri Sato ,&nbsp;Toshihiro Takai ,&nbsp;Reiichi Doi ,&nbsp;Takamichi Ito ,&nbsp;Masahito Yasuda ,&nbsp;Yutaka Kuwatsuka ,&nbsp;Takeo Maekawa ,&nbsp;Jun Asai ,&nbsp;Takuya Miyagawa ,&nbsp;Shigeto Matsushita ,&nbsp;Takeru Funakoshi ,&nbsp;Yosuke Yamamoto ,&nbsp;Takashi Inozume ,&nbsp;Akiko Kishi ,&nbsp;Tatsuya Takenouchi ,&nbsp;Yasuhiro Nakamura","doi":"10.1016/j.ejso.2025.110264","DOIUrl":"10.1016/j.ejso.2025.110264","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple randomized trials comparing wide local excision (WLE) with different peripheral margins have established recommended peripheral margins according to Breslow thickness (BT) in the National Comprehensive Cancer Network (NCCN) Guidelines. However, these clinical trials included only a small number of patients with acral melanoma (AM). Therefore, we aimed to compare the prognosis of different WLE peripheral margin cohorts with invasive sole AM.</div></div><div><h3>Materials and methods</h3><div>We conducted a multi-institutional retrospective study of patients with sole AM and a BT greater than 2 mm. Survival outcomes were compared between two groups: those excised with a peripheral margin of 2 cm, as recommended by the NCCN Guidelines, and those excised with a peripheral margin of 1 cm.</div></div><div><h3>Results</h3><div>This study included 336 patients (2 cm margin: n = 226; 1 cm margin, n = 110) with a median follow-up period of 43.1 months. In multivariate analyses, a peripheral margin of 1 cm did not negatively affect survival (local recurrence-free survival [LRFS]: hazard ratio [HR] 1.19, <em>P</em> = 0.38; disease-free survival [DFS]: HR 1.05, <em>P</em> = 0.75). Survival after propensity score matching showed no significant differences between the matched groups (each group: n = 103; 5-year LRFS: 70.6 % vs. 59.3 %, <em>P</em> = 0.13; 5-year DFS: 47.4 % vs. 54.0 %, <em>P</em> = 0.63).</div></div><div><h3>Conclusion</h3><div>A peripheral margin of 1 cm did not negatively influence the prognosis of patients with a sole AM and a BT greater than 2 mm. Narrower surgical margins may be acceptable to minimize morbidity without compromising survival.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110264"},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted single-port and multi-port surgical staging in early-stage endometrial cancer: a propensity matched comparison","authors":"Enrico Vizza ,&nbsp;Andrea Giannini ,&nbsp;Valentina Bruno ,&nbsp;Ermelinda Baiocco ,&nbsp;Emanuela Mancini ,&nbsp;Riccardo Vizza ,&nbsp;Stefano Uccella ,&nbsp;Francesco Raspagliesi ,&nbsp;Giorgio Bogani","doi":"10.1016/j.ejso.2025.110269","DOIUrl":"10.1016/j.ejso.2025.110269","url":null,"abstract":"<div><h3>Introduction</h3><div>Robotic-assisted surgery has emerged as an effective method for managing endometrial cancer. Recently, the new Da Vinci Single-Port (SP) was developed with the aim of minimizing surgery-related morbidity, using a single-port approach. The present research evaluated outcomes of apparent early-stage endometrial cancer patients undergoing single- and multi-port robotic-assisted surgery.</div></div><div><h3>Material and methods</h3><div>This is a retrospective study. Data of consecutive patients affected by early-stage endometrial cancer who had robotic-assisted staging (including hysterectomy, bilateral salpingo-oophorectomy and nodal staging) with Da Vinci SP were matched 1:1 with a cohort of patients undergoing robotic-assisted surgery with the multi-port Da Vinci Xi. The matching was conducted by a propensity-score comparison.</div></div><div><h3>Results</h3><div>Fifty patient pairs (50 undergoing single-port surgical staging vs. 50 undergoing multiple-port surgical staging) were included. Demographic and baseline characteristics were balanced between groups. Median (skin to skin) operative time (minutes) was similar between groups (120 (range, 70–229) in the single-port vs. 115 (range, 60–205) in the multi-port group; p = 0.367). Estimated blood loss was comparable between groups (p = 0.317). No intra-operative complications or intra-operative blood transfusions were recorded. The median length of hospital stay was similar between groups (p = 0.269). Overall, 10 (10 %) patients developed 90-day surgery-related complications: six (12 %) and four (8 %) in the single- and multi-port group, respectively (p = 0.740). One (2 %) and two (4 %) patients experienced severe (grade 3 or more) 90-day complications after single- and multi-port robotic-assisted staging (p = 1.00).</div></div><div><h3>Conclusions</h3><div>Introducing Da Vinci SP appears to be safe and feasible. The single-port approach does not increase operative time and complication rates in comparison to the multi-port robotic-assisted system.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110269"},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of previous abdominal surgery on minimally invasive radical resection of colorectal cancer: A meta-analysis","authors":"Wenjun Liu ,&nbsp;Fan He ,&nbsp;Defei Chen ,&nbsp;Xiuping Zhang","doi":"10.1016/j.ejso.2025.110259","DOIUrl":"10.1016/j.ejso.2025.110259","url":null,"abstract":"<div><div>The suitability of minimally invasive surgery (MIS) for colorectal cancer (CRC) in patients who have undergone previous abdominal surgery (PAS) is controversial. This study aimed to analyse the effect of PAS on MIS in patients with CRC. We performed a meta-analysis by searching the Web of Science, MEDLINE, Embase, and Cochrane Library databases from their inception until March 2024. All published studies exploring the effects of PAS on laparoscopic or robot-assisted radical resection for CRC were included. In total, 1271 studies were retrieved, of which 12 were included in the meta-analysis, including 11,528 patients with CRC. The results showed that the conversion of minimally invasive procedures to open surgery was more common in patients with PAS (odds ratio [OR] = 1.57, p &lt; 0.0001), and most of them were due to abdominal adhesions (OR = 5.01, p &lt; 0.0001). The time to the first flatus was prolonged (weighted mean difference = 0.24, p = 0.008), and patients with PAS were more likely to develop ileus (OR = 1.40, p = 0.03) after surgery. The operative time, intraoperative blood loss, lymph node harvest, overall and major postoperative complications, reoperation, and mortality did not increase significantly. In addition, subgroup analysis revealed that major PAS increased the incidence of overall postoperative complications in patients with CRC (OR = 2.61, p = 0.003), whereas minor PAS was comparable to the postoperative clinical outcomes in patients without PAS. Generally, MIS is safe and effective for patients with CRC and PAS. Surgeons should not discourage patients with PAS from undergoing MIS while improving their experience with laparoscopic or robotic surgery.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"Article 110259"},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on “Open versus laparoscopic radical cholecystectomy for incidental and non-incidental gallbladder cancer”","authors":"Mesut Tez","doi":"10.1016/j.ejso.2025.110254","DOIUrl":"10.1016/j.ejso.2025.110254","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 8","pages":"Article 110254"},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and outcomes of local re-recurrence in rectal cancer: a multicentre observational cohort","authors":"D.M.J. Creemers ,&nbsp;D.M. Mens ,&nbsp;S. Nordkamp ,&nbsp;F. Piqeur ,&nbsp;E. Banken ,&nbsp;S.H.J. Ketelaers ,&nbsp;P.W. Harmsen ,&nbsp;J.L. Tolenaar ,&nbsp;I.E.G. van Hellemond ,&nbsp;G.M. Creemers ,&nbsp;H.M.W. Verheul ,&nbsp;G.A.P. Nieuwenhuijzen ,&nbsp;J.G. Bloemen ,&nbsp;J. Nederend ,&nbsp;A.E. Verrijssen ,&nbsp;H.M.U. Peulen ,&nbsp;J. Rothbarth ,&nbsp;R.R.J. Coebergh-van den Braak ,&nbsp;H.J.T. Rutten ,&nbsp;C. Verhoef ,&nbsp;J.W.A. Burger","doi":"10.1016/j.ejso.2025.110261","DOIUrl":"10.1016/j.ejso.2025.110261","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess patient, tumour and treatment characteristics in locally re-recurrent rectal cancer (LrRRC), and relate these to long-term oncological outcomes since limited literature on this topic is available.</div></div><div><h3>Methods</h3><div>A retrospective study of locally recurrent rectal cancer (LRRC) patients treated with curative intent between 1994 and 2022 in two tertiary centres in the Netherlands. Data on patient, tumour and treatment characteristics were collected. Oncological outcomes of patients treated with curative and palliative intent were displayed.</div></div><div><h3>Results</h3><div>Of 852 curatively treated LRRC patients, 277 (33 %) developed LrRRC. The median survival of this LrRRC group was 23 months (95 % CI 20–26). Treatment with curative intent was offered to 92/277 (33 %) patients, resulting in surgical resection in 81/277 (29 %) patients. Complete oncological clearance (R0) was achieved in 50/81 cases (62 %). Surgical resection resulted in a median survival of 35 months (95 % CI 27–43). Palliative treatment resulted in a median survival of 16 months (95 % CI 11–21). Median progression free survival (PFS) in patients treated with curative intent was 16 months (95 % CI 12–20). Median local re-re-recurrence free survival (LrrRFS) in patients who underwent surgery was 11 months (95 % CI 8–16).</div></div><div><h3>Conclusion</h3><div>The median OS in 277 LrRRC patients was 23 months. Aggressive treatment in selected patients resulted in a median OS of 35 months. Furthermore, locoregional control was achieved for 11 months in patients undergoing surgery. These findings underscore the need for meticulous patient selection and tailored treatment strategies to improve survival while minimising unnecessary morbidity.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110261"},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a deep learning-based surgical-skill assessment model focused on instrument handling in laparoscopic colorectal surgery","authors":"Kei Nakajima ,&nbsp;Shin Takenaka ,&nbsp;Daichi Kitaguchi ,&nbsp;Atsuki Tanaka ,&nbsp;Kyoko Ryu ,&nbsp;Nobuyoshi Takeshita ,&nbsp;Yusuke Kinugasa ,&nbsp;Masaaki Ito","doi":"10.1016/j.ejso.2025.110260","DOIUrl":"10.1016/j.ejso.2025.110260","url":null,"abstract":"<div><h3>Introduction</h3><div>Poor instrument handling, such as \"repeatedly makes tentative or awkward moves\" and \"grasper (frequently) slip,\" is associated with poor surgical skills. We constructed and applied an automated recognition model of tissue grasping during laparoscopic surgery using computer vision technology to clarify whether automated surgical-skill assessment using the number of tissue grasps could be feasible.</div></div><div><h3>Methods</h3><div>The number of tissue grasps and classification of success/failure were manually and automatically counted. Intraoperative videos of three groups with obviously different surgical levels (the high-, intermediate-, and low-skill groups) were prepared; an automated distinction between these groups was attempted using the models.</div></div><div><h3>Results</h3><div>The number of manually counted tissue grasps was significantly higher in the low-skill group than in the other groups, while the number of failed tissue grasps was significantly lower in the high-skill group than in the other groups. The number of automatically counted tissue grasps showed strong correlations with the manually counted ones, whereas the other parameters showed only moderate correlations. The number of automatically counted tissue grasps was significantly higher in the low-skill group than in the other groups, similar to that noted with manual counting. The other automatic parameters showed no results similar to the manual ones.</div></div><div><h3>Conclusion</h3><div>We successfully constructed automated recognition models of tissue grasping during laparoscopic surgery and found that automated surgical-skill assessment based on the number of tissue grasps could be feasible. However, the results were insufficient for automatically distinguishing between successful/failed tissue grasps. Further improvements in recognition accuracy are required for this model.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110260"},"PeriodicalIF":3.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal aortic balloon occluding in the pelvic and sacral tumor resection: An expert-based Delphi consensus","authors":"Zhiqing Zhao ,&nbsp;Wei Wang ,&nbsp;Bing Wang,&nbsp;Yunfei Lin,&nbsp;Taiqiang Yan","doi":"10.1016/j.ejso.2025.110251","DOIUrl":"10.1016/j.ejso.2025.110251","url":null,"abstract":"<div><h3>Background</h3><div>Massive bleeding remains a critical challenge during pelvic and sacral tumor resection. Over recent decades, abdominal aortic balloon occluding (AABO) has been increasingly utilized to control intraoperative bleeding. However, standardized protocols for its application in pelvic and sacral tumor resection remain lacking. This Delphi consensus aims to establish guidelines for AABO in this field based on the existing evidence and expertise.</div></div><div><h3>Methods</h3><div>A three-round Delphi process was conduct following a comprehensive literature review. Consensus was predefined as ≥85 % agreement among respondents. Forty-three experts from 19 regions of Chinese participated, including orthopedic surgeons, vascular surgeons, and anesthesiologists.</div></div><div><h3>Results</h3><div>Consensus was achieved on eleven key variables: indications/contraindications, safety in elderly patients, preoperative preparation, balloon placement position, procedures of AABO, occlusion duration, measures to reduce complications related to AABO, acute femoral thrombosis management, intraoperative anesthesia monitoring indicators, and postoperative monitoring.</div></div><div><h3>Conclusions</h3><div>This expert-based Delphi consensus provides a framework for standardizing AABO application, enhancing surgical safety, and guiding future research.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110251"},"PeriodicalIF":3.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online risk scores for pre- and postoperative prediction of early recurrence in hepatocellular carcinoma patients undergoing conversion liver resection after tyrosine kinase inhibitors and immune checkpoint inhibitors therapy","authors":"Kong-Ying Lin ,&nbsp;Hong-Zhi Liu ,&nbsp;Jian-Wei Liu ,&nbsp;Xiao-Dong Zhu ,&nbsp;Yang-Xun Pan ,&nbsp;Shun-Li Shen ,&nbsp;Wei Zhang ,&nbsp;Ren-An Jin ,&nbsp;Chuang-Ye Han ,&nbsp;Jie Chen ,&nbsp;Xiao-Yun Zhang ,&nbsp;Bin-Yong Liang ,&nbsp;Yao-Dong Zhang ,&nbsp;Jian Ma ,&nbsp;Nan-Ya Wang ,&nbsp;Dong-Xiao Li ,&nbsp;Rui Xiong ,&nbsp;Zhong-Chao Li ,&nbsp;Jing-Dong Li ,&nbsp;Zhi-Bo Zhang ,&nbsp;Yong-Yi Zeng","doi":"10.1016/j.ejso.2025.110220","DOIUrl":"10.1016/j.ejso.2025.110220","url":null,"abstract":"<div><h3>Background</h3><div>Conversion therapy with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) offers the potential for curative resection in unresectable hepatocellular carcinoma (HCC). However, early recurrence (≤2 years) after conversion liver resection remains a major concern. This study aimed to develop and validate online preoperative and postoperative risk scores to predict early recurrence in patients undergoing conversion liver resection.</div></div><div><h3>Methods</h3><div>A total of 203 patients with initially unresectable HCC who underwent conversion liver resection following TKI and ICI therapy across 28 academic centers were analyzed. Independent predictors of early recurrence were identified using Cox proportional hazards analyses, and risk scores were developed and validated using the C-index, time-dependent AUC (tdAUC), and calibration curves.</div></div><div><h3>Results</h3><div>Preoperative risk score model included the neutrophil-to-lymphocyte ratio (NLR) ≥ 1.39, multiple tumors, absence of radiographic response, and no alpha-fetoprotein (AFP) response. Postoperative risk score model included NLR ≥1.39, multiple tumors, no AFP response, active macrovascular invasion, and incomplete pathological response. The preoperative risk score had a C-index of 0.699 (training) and 0.681 (validation), while the postoperative risk score had a C-index of 0.739 (training) and 0.706 (validation). Both models demonstrated good predictive accuracy through tdAUC and calibration curves. Decision tree analysis stratified patients into distinct risk categories with significant differences in 2-year recurrence rates. All risk score models are available online for clinical use.</div></div><div><h3>Conclusion</h3><div>Online preoperative and postoperative risk scores provide valuable tools for predicting early recurrence in HCC patients after conversion liver resection, aiding in surgical decision-making and postoperative management.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110220"},"PeriodicalIF":3.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of preoperative TACE in hepatocellular carcinoma beyond Milan criteria: A propensity score matching analysis","authors":"Runhu Lan ,&nbsp;Zhengwei He ,&nbsp;Chengxian Wu ,&nbsp;Xiaoyin Yuan ,&nbsp;Awang Danzeng ,&nbsp;Pingcuo Ciren ,&nbsp;Binhao Zhang","doi":"10.1016/j.ejso.2025.110248","DOIUrl":"10.1016/j.ejso.2025.110248","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the impact of preoperative transarterial chemoembolization (TACE) on patients diagnosed with hepatocellular carcinoma (HCC) beyond the Milan criteria, and investigate the prognostic factors associated with long-term outcomes.</div></div><div><h3>Materials &amp; methods</h3><div>From January 2013 to March 2018, 675 patients diagnosed with HCC beyond the Milan criteria, which were classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B, were enrolled. Patients were assigned to two groups as follows: the surgery-alone group and the TACE + surgery group, to compare perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) following propensity score matching (PSM), a statistical method used to reduce selection bias. Univariable and multivariable Cox regression analyses were performed to identify the factors associated with OS and RFS.</div></div><div><h3>Results</h3><div>After PSM, 118 pairs of matched patients were selected. The postoperative 30-day morbidity (29.7 % vs. 27.1 %, <em>p</em> = 0.67) and length of hospital stay (12.0 days vs. 12.0 days, <em>p</em> = 0.90) were comparable between the two groups of patients. Patients in the TACE + surgery group demonstrated significantly improved median overall survival (median OS: 46.0 months vs. 29.5 months, <em>p</em> &lt; 0.001) and median recurrence-free survival (median RFS: 24.0 months vs. 12.5 months, <em>p</em> &lt; 0.001) compared with patients in the surgery-alone group. Multivariate Cox regression analysis revealed that preoperative TACE was an independent predictor of better overall survival (risk ratio [HR] 0.62, 95 % confidence interval [CI]: 0.47–0.82, <em>p</em> &lt; 0.001) and recurrence-free survival (HR 0.47, 95 % CI: 0.36–0.61, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study suggests that preoperative TACE is a safe procedure associated with improved OS and RFS for patients with HCC beyond the Milan criteria classified as BCLC stage A or B.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 9","pages":"Article 110248"},"PeriodicalIF":3.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain management after minimally invasive gastrectomy: do we need epidural analgesia?","authors":"E. Azizi ,&nbsp;Y. Okumura ,&nbsp;B. Sunde ,&nbsp;M. Lindblad ,&nbsp;M. Nilsson ,&nbsp;I. Rouvelas ,&nbsp;J. Grip ,&nbsp;F. Klevebro","doi":"10.1016/j.ejso.2025.110232","DOIUrl":"10.1016/j.ejso.2025.110232","url":null,"abstract":"<div><h3>Introduction</h3><div>Epidural analgesia (EDA) has been the gold standard postoperative pain management in gastric cancer surgery for many years. As minimally invasive techniques have reduced surgical trauma, the necessity of EDA is being questioned. This study aimed to evaluate if minimally invasive gastrectomy without EDA was associated with shorter hospital stay and fewer complications compared to operations with EDA.</div></div><div><h3>Methods</h3><div>All patients undergoing minimally invasive gastrectomy for cancer at Karolinska University Hospital (Jan 2015–Aug 2023) were included and divided into groups operated with and without EDA. Data were collected prospectively in an institutional database and retrospectively from medical records. The primary outcome was the length of hospital stay.</div></div><div><h3>Results</h3><div>Among 211 patients, 43 (20.4 %) had EDA, and 168 (79.6 %) did not, with 12 (7 %) of the latter requiring EDA postoperatively. The median hospital stay was one day longer in group with EDA (median days 7 vs 6 p &lt; 0.001), supported by multivariable adjusted analysis with a coefficient of −1.76 days (95 % CI: −9.01, −2.26 p = 0.003). Patients with EDA had lower pain scores (NRS 0–24h, 0 vs 2 p &lt; 0.001) but required longer postoperative norepinephrine infusion (11.5h vs 0h p &lt; 0.001) and one day longer stay in the high-dependency care unit (p &lt; 0.001). Overall (55.8 % vs 39.9 %, p = 0.060) and severe surgical complications (20.9 % vs 9.5 %, p = 0.039) were more common in the EDA group.</div></div><div><h3>Conclusions</h3><div>Minimally invasive gastrectomy without EDA can be associated with improved outcomes including shorter hospital stays, fewer postoperative complications, reduced postoperative norepinephrine use, and decreased high-dependency care duration.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 10","pages":"Article 110232"},"PeriodicalIF":3.5,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}