Gland surgery最新文献

{"title":"Core needle biopsy washout biomarkers combined with ultrasound for preoperative axillary risk stratification in breast cancer: a retrospective nomogram study with temporal validation.","authors":"Jiang Xue, Pengling Ma, Chengyu Guo, Zhiqiang Zhang","doi":"10.21037/gs-2026-0280","DOIUrl":"https://doi.org/10.21037/gs-2026-0280","url":null,"abstract":"<p><strong>Background: </strong>Preoperative assessment of axillary lymph node (ALN) involvement informs breast cancer surgical planning. Axillary ultrasound (US) is routine but may miss occult disease. We evaluated whether vascular endothelial growth factor-C (VEGF-C) and cytokeratin 19 (CK19) in primary-tumor core needle biopsy (CNB) washout fluid improved US-based risk assessment.</p><p><strong>Methods: </strong>This single-center retrospective temporal-validation study screened 493 women with primary breast cancer who underwent preoperative axillary US, primary-lesion CNB, and postoperative nodal pathology from June 2023 to July 2025. Eligible cases were split by calendar time into development and temporal-validation cohorts. CNB washout VEGF-C and CK19 were measured by enzyme-linked immunosorbent assay (ELISA). A four-variable logistic model was fitted in development and applied unchanged to temporal validation.</p><p><strong>Results: </strong>The eligible analysis set included 380 patients: 278 in development and 102 in temporal validation. Pathological ALN metastasis was present in 114 (41.0%) and 42 (41.2%) patients, respectively. The model included tumor size, positive axillary US status, log₂(VEGF-C+1), and log₂(CK19+1). Development-cohort area under the receiver operating characteristic curve (AUC) was 0.861 [95% confidence interval (CI): 0.813-0.905], and temporal-validation AUC was 0.799 (95% CI: 0.706-0.880). Temporal-validation calibration intercept and slope were 0.183 and 0.869. At the development-derived Youden cutoff of 0.445, temporal-validation sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 64.3%, 86.7%, 77.1%, and 77.6%.</p><p><strong>Conclusions: </strong>CNB washout VEGF-C and CK19 complemented axillary US and tumor size for preoperative ALN risk stratification and retained moderate discrimination in later same-center patients. Multicenter external validation is required before clinical use.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"252"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181362","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":"Synchronous medullary and papillary thyroid carcinoma with mixed-component lateral cervical lymph node metastases: a case report.","authors":"Yifan He, Cheng Fu, Yawen Bai, Jianfeng Sheng","doi":"10.21037/gs-2026-0288","DOIUrl":"https://doi.org/10.21037/gs-2026-0288","url":null,"abstract":"<p><strong>Background: </strong>Synchronous medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are uncommon thyroid malignancies, whereas mixed-component cervical lymph node metastases containing both tumor components within the same metastatic deposit are exceptionally rare. This case highlights the diagnostic value of integrating discordant site-specific fine-needle aspiration (FNA) findings with serum biomarkers for preoperative recognition of this unusual presentation.</p><p><strong>Case description: </strong>A 65-year-old man presented with a progressively enlarging right-sided neck mass accompanied by ipsilateral cervical lymphadenopathy for more than two months. Ultrasonography demonstrated a 4.28 cm × 2.28 cm × 2.54 cm Thyroid Imaging Reporting and Data System (TI-RADS) 5 thyroid nodule with multiple enlarged right cervical lymph nodes. Serum calcitonin (Ctn) (1,796.38 ng/L), carcinoembryonic antigen (CEA) (81.69 μg/L), and thyroglobulin (Tg) (163.65 μg/L) levels were markedly elevated. FNA of the thyroid nodule supported MTC, whereas FNA of a metastatic cervical lymph node demonstrated PTC, providing discordant cytological evidence that raised preoperative suspicion of synchronous thyroid malignancies. Total thyroidectomy with bilateral neck dissection revealed multifocal MTC and microscopic contralateral PTC with mixed-component metastases involving 10 cervical lymph nodes. No postoperative complications such as recurrent laryngeal nerve injury or permanent hypoparathyroidism occurred. Serum parathyroid hormone (PTH) levels recovered to 40.85 ng/L at 12 months. Serum Ctn, CEA, and Tg levels remained persistently low (57.29 ng/L, 3.96 μg/L, and 0.39 μg/L, respectively), and follow-up neck CT scans over the 12 months showed no signs of lymphadenopathy.</p><p><strong>Conclusions: </strong>This case demonstrates that discordant FNA results between primary thyroid lesions and metastatic lymph nodes, accompanied by dual-marker elevation (Ctn, CEA and Tg), strongly indicate synchronous MTC and PTC. A comprehensive radical surgical approach and rigorous dual-biomarker longitudinal surveillance are key to achieving optimal oncological control and preventing diagnostic omissions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"269"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181334","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":"Prognostic factors in thyroid cancer with lung-only metastasis: SEER-based retrospective study.","authors":"Wei-Hu Xia, Yan Su, Qin-Yang Wang, Wei Wan, Ya-Min Zhang, Jin-Peng Liu","doi":"10.21037/gs-2026-0333","DOIUrl":"https://doi.org/10.21037/gs-2026-0333","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lung-only metastasis in thyroid cancer is uncommon, and its prognostic determinants remain poorly defined. This study aimed to investigate the clinicopathological features and prognostic factors associated with survival in patients with primary thyroid cancer with lung-only metastases (PTCSLMs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients diagnosed with PTCSLMs from 2010 to 2015 were screened from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria comprised histologically confirmed thyroid cancer, first primary malignancy, and lung‑only metastasis at initial diagnosis, while patients with bone/liver/brain metastases, unknown race, unknown T stage/T&lt;sub&gt;0&lt;/sub&gt;, or missing survival data were excluded. Variables analyzed included demographics (age, sex, marital status, race), clinicopathological features (histological subtype, T stage, N stage, grade stage), and treatment modalities {surgery, radiotherapy [external beam radiation therapy (EBRT)/radioactive iodine (RAI)/others], and chemotherapy}. Overall survival (OS) was defined as time from diagnosis to death from any cause, and cancer-specific survival (CSS) as time to thyroid cancer‑specific death. Univariate and multivariate Cox proportional hazards model were used to identify prognostic factors of PTCSLMs. The Kaplan-Meier method was used to generate survival curves, and the difference was compared using the log-rank test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 592 patients diagnosed with PTCSLMs from 2010 to 2015 were extracted from the SEER database based on the specified criteria for inclusion and exclusion. Univariate analysis demonstrated statistically significant associations between OS and age at diagnosis, marital status, histologic subtype, T stage, N stage, grade stage, surgery, radiotherapy and chemotherapy (P&lt;i&gt;&lt;&lt;/i&gt;0.001). The results of multivariate survival analyses showed that age at diagnosis [43-80 &lt;i&gt;vs.&lt;/i&gt; 6-42 years, hazard ratio (HR) =5.044, 95% confidence interval (CI): 2.290-11.111, P&lt;i&gt;&lt;&lt;/i&gt;0.001; 81-99 &lt;i&gt;vs.&lt;/i&gt; 6-42 years, HR =7.769, 95% CI: 3.296-18.312, P&lt;i&gt;&lt;&lt;/i&gt;0.001], histologic subtype [others &lt;i&gt;vs.&lt;/i&gt; papillary adenocarcinoma (PA), HR =1.786, 95% CI: 1.323-2.411, P&lt;i&gt;&lt;&lt;/i&gt;0.001], T stage (T&lt;sub&gt;2&lt;/sub&gt; &lt;i&gt;vs.&lt;/i&gt; T&lt;sub&gt;X&lt;/sub&gt;, HR =0.480, 95% CI: 0.247-0.935, P&lt;i&gt;=&lt;/i&gt;0.03), grade stage (poorly differentiated &lt;i&gt;vs.&lt;/i&gt; well differentiated, HR =1.976, 95% CI: 1.123-3.476, P&lt;i&gt;=&lt;/i&gt;0.02; undifferentiated &lt;i&gt;vs.&lt;/i&gt; well differentiated, HR =2.531, 95% CI: 1.417-4.521, P&lt;i&gt;=&lt;/i&gt;0.002), surgery (total thyroidectomy &lt;i&gt;vs.&lt;/i&gt; refuse/none, HR =0.387, 95% CI: 0.278-0.538, P&lt;i&gt;&lt;&lt;/i&gt;0.001; others &lt;i&gt;vs.&lt;/i&gt; refuse/none, HR =0.663, 95% CI: 0.455-0.967, P&lt;i&gt;=&lt;/i&gt;0.03), radiotherapy (EBRT &lt;i&gt;vs.&lt;/i&gt; refuse/none/unknown, HR =0.734, 95% CI: 0.564-0.955, P&lt;i&gt;=&lt;/i&gt;0.02; RAI &lt;i&gt;vs.&lt;/i&gt; refuse/none/unknown, HR =0.481, 95% CI: 0.336-0.688, P&lt;i&gt;&lt;&lt;/i&gt;0.001; others &lt;i&gt;vs.&lt;/i&gt; refuse/n","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"248"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181369","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":"Channel attention of the image for distinguishing ductal carcinoma <i>in situ</i> from benign mimics based on ultrasound images.","authors":"Yu Yan, Yifei Qian, Yichen Xu, Lizhi Cao, Jingwu Ma, Runqiu Cai, Xiaowei Cai, Yi Zhang, Linjing Shi, Zhennan Lu, Yiyun Wu","doi":"10.21037/gs-2026-0391","DOIUrl":"https://doi.org/10.21037/gs-2026-0391","url":null,"abstract":"<p><strong>Background: </strong>Ductal carcinoma in situ (DCIS) is widely recognized as a precursor to invasive breast cancer, with an estimated 20-50% of cases progressing to invasive disease. The early detection of DCIS could save doctors and patients more time to deal with the breast cancer, which has posed a great threat to the life safety of women worldwide. This study aimed to develop a deep learning algorithm based on the image-level attention to distinguish DCIS from the benign mimics on ultrasound images, assisting doctors in screening for benign breast lesions.</p><p><strong>Methods: </strong>By screening the biopsy results of 3,327 patients, the ultrasound images of 612 patients were retrospectively collected, including DCIS and benign mimics. The dataset was randomly split at the patient level into training (70%, n=430) and test (30%, n=182) sets. Using ResNet18 as the backbone architecture, we compared and developed models with image-level attention mechanisms. Model performance was evaluated on the test set using the area under the curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. To assess the statistical significance of performance differences between models, the Holm-Bonferroni correction was employed to account for multiple comparisons.</p><p><strong>Results: </strong>Through quantitative comparison with 6 shallow benchmark algorithms such as AlexNet, VGG16, GoogleNet, ResNet18, CoAtNet and Swin Transformer, the effectiveness of our method was demonstrated, which achieved the best performance with AUC, accuracy, sensitivity, specificity, precision and F1-score of 0.868±0.009, 0.835±0.016, 0.767±0.056, 0.916±0.057, 0.916±0.059, 0.835±0.04, respectively. After Holm-Bonferroni correction, these improvements were statistically significant (corrected P<0.05) compared to all other models. The effect size of AUC, specificity, precision, F1-score were 0.69, 0.68, 0.89, 0.58, respectively, revealing large practical improvement. Furthermore, Gradient-weighted Class Activation Mapping (GradCAM) visualization confirmed that our model focused more accurately on lesion regions, providing interpretability for its superior feature extraction.</p><p><strong>Conclusions: </strong>In this paper, we proposed the ResNet18-CA for the classification of DCIS and confused cases, which was good at learning the ultrasound image features. The proposed network achieved higher accuracy than the other methods being compared.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"254"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181388","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":"Operative management of abdominal bulge following deep inferior epigastric perforator flap breast reconstruction: a systematic review of repair strategies and outcomes.","authors":"Raj Saini, Akshay Soni, Felicity Huang, Ishith Seth, Warren M Rozen","doi":"10.21037/gs-2026-0316","DOIUrl":"https://doi.org/10.21037/gs-2026-0316","url":null,"abstract":"<p><strong>Background: </strong>Abdominal bulge after deep inferior epigastric perforator (DIEP) flap breast reconstruction is an uncommon but clinically meaningful donor-site complication. Although several operative repair strategies have been described, evidence guiding management remains limited. This systematic review aimed to synthesize the evidence on operative management of established abdominal bulge after DIEP flap breast reconstruction, including repair techniques, outcomes, and persistent or recurrent deformity.</p><p><strong>Methods: </strong>This review was prospectively registered (PROSPERO CRD420261368586). MEDLINE, Scopus, and Web of Science were searched from inception to August 2026 for studies reporting abdominal wall morbidity after DIEP flap breast reconstruction and describing management of an established complication with extractable outcomes. Quality was appraised with Joanna Briggs Institute tools and certainty of evidence with GRADE. Heterogeneity in design, definitions, techniques, and outcome reporting precluded meta-analysis, so findings were synthesized narratively.</p><p><strong>Results: </strong>Six studies were included: five retrospective single-arm series and one case report, with no randomized, prospective comparative or controlled study identified. Clinically relevant bulge or hernia occurred in 3.6% to 4.8% of patients in cohorts reporting denominators. Repair outcomes were extractable for 34 patients across five studies, spanning DIEP-specific and mixed abdominal free-flap populations. Reported techniques were open fascial plication with onlay mesh, laparoscopic underlay, robotic retromuscular, and enhanced-view totally extraperitoneal repair. Persistent or recurrent deformity followed both open and minimally invasive approaches. Certainty was very low for every outcome assessed, and no study used a validated post-repair patient-reported outcome measure, objective abdominal wall function testing, or imaging-confirmed durability assessment.</p><p><strong>Conclusions: </strong>Operative management of post-DIEP abdominal bulge is poorly standardized, and very low certainty evidence does not establish superiority of any technique, mesh type, or mesh plane. We propose a phenotype-based classification, a structured assessment pathway, and a minimum reporting dataset for secondary repair, offered as expert interpretation requiring prospective validation rather than as guidance. Future studies should use standardized phenotyping, repair-specific follow-up, cross-sectional or dynamic imaging, objective function testing, and validated patient-reported outcomes.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"264"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181398","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":"The use of intraoperative parathyroid hormone assay in predicting the success and reduce morbidity of targeted minimal invasive parathyroidectomy for primary hyperparathyroidism.","authors":"Františka Hanzalová, Jiří Hložek, Jan Rotnágl, Richard Holý, Jiří Soukup, Adéla Rozehnalová, Michal Pancák, Jaromír Astl","doi":"10.21037/gs-2026-0312","DOIUrl":"https://doi.org/10.21037/gs-2026-0312","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary hyperparathyroidism (PHPT) is caused by overproduction of parathyroid hormone (PTH) by a hyperfunctioning parathyroid gland (most commonly a parathyroid adenoma, PTA) or glands. Historically, the most commonly described surgical approach has been bilateral neck exploration (BNE). This study focuses on the outcomes of targeted minimally invasive parathyroidectomy [unilateral neck exploration (UNE), focused exploration (FE)-including endoscope and/or exoscope-assisted parathyroidectomy]. Intraoperative measurement of parathyroid hormone levels (ioPTH) is generally considered confirmation of complete removal of all hyperfunctioning parathyroid tissue. Intraoperative surgical success is evaluated using the modified Miami criteria, with a reported sensitivity of 97%. The aim of this study is to determine the safety FE (targeted/focused procedure), sensitivity, specificity and accuracy of ioPTH measurement, based on samples collected at 5, and 15 minutes after removal of pathological tissue. The study further aims to identify the most appropriate evaluation criteria supported the Miami criteria with the high sensitivity and predictive value supported for surgical success of focused/targeted) parathyroidectomy (morbidity including). Study design is a retrospective analysis of minimally invasive parathyroidectomy (MIPT) procedures indicated for primary PHPT performed between 2020 and 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The analyzed cohort included 92 evaluated patients. The analyzed data included preoperative PTH levels, ioPTH levels measured at 5, 10 and 15 minutes and PTH levels on the third postoperative day. The analyze used statistic: sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were evaluated for the various ioPTH criteria. Confidence intervals were calculated using a confusion matrix. We used the Chi-squared test, F-test to compare the time-intervals and box graphs used for presentation. We used the MedCalc software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For data analysis, six criteria for evaluating the intraoperative decline in PTH levels were defined. The criterion with the high sensitivity (99%) was assessment of PTH levels 10 minutes after resection of the PTA, combined with evaluation of the decrease in PTH levels between 5 and 15 minutes after resection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The focused (targeted) lateral (back door) approach parathyroidectomy is the safe and effective therapy of primary PHPT based on the results of very low incidence of RLN palsy (0.0%) in presented cohort. We would like present an additional sensitive criterium for assessment of the procedure function effect supporting Miami criteria's using ioPTH measurement: (I) 0-10: a ≥50% decrease in PTH or a decrease to within the normal range; (II) 5-15: a ≥50% decrease in PTH or a decrease to within the normal range. This both parameters predict surgical success with a sensitivity of ","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"261"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181352","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":"Treatment strategies for unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis: a narrative review.","authors":"Yi Yang, Yuhan Jiang, Tianyuchen Jiang, Hanyun Tu, Anping Su","doi":"10.21037/gs-2026-0281","DOIUrl":"https://doi.org/10.21037/gs-2026-0281","url":null,"abstract":"<p><strong>Background and objective: </strong>Unilateral papillary thyroid carcinoma (PTC) with ipsilateral cervical lymph-node metastasis carries intermediate-to-high recurrence risk. Although total thyroidectomy is conventionally recommended by multiple clinical guidelines, accumulating real‑world evidence has triggered ongoing debates regarding surgical extent, neck dissection scope, adjuvant radioactive iodine administration and molecular‑guided risk stratification. This narrative review intends to synthesize contemporary clinical evidence and provide references for individualized therapeutic decision‑making for this specific patient population.</p><p><strong>Methods: </strong>Literature was retrieved from PubMed, Embase, and Web of Science up to January 2026. English articles were screened by two reviewers through consensus. This is a narrative review without formal systematic-review procedures.</p><p><strong>Key content and findings: </strong>For properly-selected patients, lobectomy provides similar oncological outcomes as total thyroidectomy with fewer complications. Unilateral central neck dissection plus selective lateral neck dissection balances tumour control and surgical morbidity. Aggressive pathological variants and concurrent B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E/telomerase reverse transcriptase (TERT) promoter dual mutations indicate elevated recurrence and mortality risk. Radioactive iodine (RAI) ablation ought to be determined by integrated risk assessment rather than routine application. Lymph‑node yield and lymph‑node ratio serve as key prognostic markers reflecting dissection quality and recurrence likelihood. Serum thyroglobulin, interfered by thyroglobulin antibodies, remains the core surveillance biomarker.</p><p><strong>Conclusions: </strong>Risk‑stratified individualized management is strongly recommended for unilateral PTC patients with ipsilateral cervical lymph‑node metastasis. This review may facilitate clinical practice. Nevertheless, most available evidence comes from retrospective studies; further high‑quality prospective investigations are required to refine treatment strategies.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"263"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180810","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":"A new path to shorter drain duration?-a quick look at inactivated <i>Pseudomonas</i> preparation in nipple-sparing mastectomy with immediate prosthetic reconstruction.","authors":"Juan C Torres, Robert K Sigal, Oscar J Manrique","doi":"10.21037/gs-2026-0462","DOIUrl":"https://doi.org/10.21037/gs-2026-0462","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"246"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181166","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":"Preventive strategies for postoperative hypocalcemia and hungry bone syndrome following parathyroidectomy: a systematic review and pairwise meta-analysis.","authors":"Kun Hu, Min Zhang, Mao Ye","doi":"10.21037/gs-2026-0314","DOIUrl":"https://doi.org/10.21037/gs-2026-0314","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative hypocalcemia and hungry bone syndrome (HBS) remain clinically important after parathyroidectomy, particularly in renal hyperparathyroidism. Preventive drug regimens, calcium-infusion protocols, dialysis-related measures, and bundled pathways are used, but direct head-to-head comparisons between active strategies are largely absent. We therefore mapped the available strategies and determined which clinically comparable direct comparisons could support pairwise meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The review was registered in PROSPERO (CRD420261373430). PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane CENTRAL, and Wanfang Data were searched from January 1990 through 21 April 2026. Comparative studies of adults undergoing parathyroidectomy were selected using prespecified population, intervention, comparator, outcome, and study-design criteria. Strict HBS, biochemical hypocalcemia, early serum calcium, and postoperative intravenous-calcium requirement were analyzed as distinct outcomes. Studies reporting random allocation were assessed with Risk of Bias 2 (RoB 2) and non-randomized studies with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Clinically compatible direct comparisons were synthesized using random-effects restricted maximum likelihood models, and certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Network meta-analysis was not performed because transitivity was not defensible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The searches yielded 10,640 records; 15 studies with 1,322 participants were included. These evaluated vitamin D (3 studies), intravenous bisphosphonates (3 studies), cinacalcet (4 studies), preventive intravenous calcium (2 studies), active vitamin D (1 study), high-calcium dialysate (1 study), and an enhanced-recovery bundle (1 study). All 3 studies reporting random allocation had some concerns under RoB 2, and all 12 non-randomized studies had serious ROBINS-I risk. In 2 non-randomized secondary-hyperparathyroidism studies (396 participants), preventive intravenous calcium was associated with less severe postoperative hypocalcemia [adjusted odds ratio (OR) 0.12, 95% confidence interval (CI): 0.06-0.22; I&lt;sup&gt;2&lt;/sup&gt;=0%]. Four non-randomized studies (325 participants) did not show that preoperative cinacalcet reduced postoperative intravenous-calcium requirement [risk ratio (RR) 1.08, 95% CI: 0.48-2.41; I&lt;sup&gt;2&lt;/sup&gt;=64.2%]. Strict HBS data were not poolable; certainty was very low.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preventive intravenous calcium may reduce short-term biochemical hypocalcemia in selected secondary-hyperparathyroidism pathways, but serious confounding prevents a causal claim and the result does not establish prevention of strict HBS. Evidence did not support a clear benefit of cinacalcet or any comparative treatment ranking. Standardized randomized studies are needed.&lt;/p","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"256"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181366","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":"Repeat breast-conserving surgery for ipsilateral breast tumour recurrence: towards a paradigm shift-a narrative review.","authors":"Janhavi Venkataraman, Anas Mustafa Massad, Kefah Mokbel","doi":"10.21037/gs-2026-0338","DOIUrl":"https://doi.org/10.21037/gs-2026-0338","url":null,"abstract":"<p><strong>Background and objective: </strong>Ipsilateral breast tumour recurrence (IBTR) following breast-conserving therapy (BCT) has traditionally been managed with salvage mastectomy because of concerns regarding oncological safety and toxicity associated with repeat breast conservation and re-irradiation. However, accumulating evidence from retrospective series, meta-analyses, prospective cohort studies, and phase II trials has challenged this longstanding paradigm. This narrative review evaluates the evidence supporting repeat breast-conserving treatment (rBCT) as an alternative to salvage mastectomy in selected patients with IBTR.</p><p><strong>Methods: </strong>A targeted narrative review of published literature was conducted, encompassing meta-analyses, prospective cohort studies, population-based analyses, phase II trials, and relevant international clinical practice guidelines addressing the management of IBTR following BCT. Studies were selected on the basis of clinical relevance, methodological quality, and influence on contemporary practice.</p><p><strong>Key content and findings: </strong>Two independent meta-analyses, multicentre cohort data from the GEC-ESTRO study, and two landmark phase II trials (NRG Oncology/RTOG 1014 and RE-IORT) collectively demonstrate that rBCT-defined as repeat breast-conserving surgery (rBCS) combined with adjuvant partial breast re-irradiation-achieves local control and overall survival (OS) comparable to salvage mastectomy in carefully selected patients. Re-irradiation is an oncological prerequisite; its omission is associated with a two- to four-fold increase in second local recurrence. Axillary management is evolving towards de-escalation via repeat sentinel lymph node biopsy (rSLNB) and targeted axillary dissection (TAD). Patient selection, tumour biology, and multidisciplinary planning are central to safe implementation.</p><p><strong>Conclusions: </strong>rBCT represents a clinically valid alternative to salvage mastectomy in carefully selected patients with IBTR, supported by consistent evidence across meta-analyses and prospective trials. Randomised controlled trial data are lacking; ongoing trials (BREAST, REPEAT, and BRASIL) are expected to provide the level I evidence required to inform formal guideline revision. rBCT should be routinely offered and discussed at multidisciplinary team (MDT) level in eligible patients.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"266"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181392","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}