Gland surgery最新文献

{"title":"Fluorescent intraoperative tissue angiography during breast reduction: a single institution, single surgeon study evaluating decrease in complication rates with acquired proficiency.","authors":"Jillian A Smith, Scott Sylvester, Daniel Norez, William D Kelly, Hugues Touze, Kristina M Crawford, Brian G Celso, John D Murray","doi":"10.21037/gs-2024-532","DOIUrl":"10.21037/gs-2024-532","url":null,"abstract":"<p><strong>Background: </strong>Fluorescent intraoperative tissue angiography (FITA) provides real-time perfusion analysis that predicts which tissues will progress to postoperative ischemic necrosis. This technology helps guide the surgeon to resect the at-risk tissues preemptively. The purpose of our study was to evaluate whether clinical outcomes are affected by the level of experience with FITA for superomedial-pedicle breast reduction (SBR).</p><p><strong>Methods: </strong>A retrospective, sequential series of 50 patients who underwent single-surgeon bilateral reduction mammaplasty using FITA (SPY Elite, Stryker, Kalamazoo, MI, USA) between April 2015 and September 2020 were included in the study. Two groups from the series were formed: the first three years with 25 patients (Group A) and the last three years with 25 patients (Group B). Operative data included FITA perfusion indices (medial breast, lateral breast, and nipple-areolar complex) and resection weight. Post-operative complications such as return to operating room (RTOR), and skin or nipple loss were reported.</p><p><strong>Results: </strong>Two statistically significant changes were observed: superomedial perfusion indices increased (right breast P<0.001, left breast P=0.02) and resection weights decreased (right breast P=0.044, left breast P=0.007). While the number of observed complications (nipple sensation, minor skin loss, RTOR), decreased in Group B compared to Group A, the difference was not statistically significant (P=0.62). The rate of minor skin or nipple loss was reduced by 57% in Group B versus Group A).</p><p><strong>Conclusions: </strong>FITA may help guide the preservation of perforators in the breast reduction pedicle. Though doing so did not reveal any statistical reduction in the number of complications in our study. These findings require further investigation for definitive conclusions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"611-617"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127392","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":"Oncoplastic breast-conserving surgery: advancing oncological outcomes and aesthetic standards in breast cancer treatment.","authors":"Umar Wazir, Kefah Mokbel","doi":"10.21037/gs-2024-572","DOIUrl":"10.21037/gs-2024-572","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"797-799"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127410","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":"Erratum: Lysyl oxidase promotes anaplastic thyroid carcinoma cell proliferation and metastasis mediated via BMP1.","authors":"","doi":"10.21037/gs-2025b-1","DOIUrl":"10.21037/gs-2025b-1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/gs-21-908.].</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"800-802"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127384","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":"Should abemaciclib candidacy be an indication for ALND?-commentary on SENOMAC post-hoc analysis.","authors":"Jasmine C Walker, Amanda L Kong, Chandler S Cortina","doi":"10.21037/gs-2025-38","DOIUrl":"10.21037/gs-2025-38","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"776-780"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127535","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":"Development and validation of a multivariable risk model based on clinicopathological characteristics, mammography, and MRI imaging features for predicting axillary lymph node metastasis in patients with upgraded ductal carcinoma <i>in situ</i>.","authors":"Min-Yi Cheng, Can-Gui Wu, Ying-Yi Lin, Jia-Chen Zou, Dong-Qing Wang, Bruce G Haffty, Kun Wang","doi":"10.21037/gs-2025-89","DOIUrl":"10.21037/gs-2025-89","url":null,"abstract":"<p><strong>Background: </strong>Axillary surgical staging is required for patients with upgraded ductal carcinoma in situ (DCIS) (DCIS is diagnosed on core biopsy with invasive cancer found on pathology after complete surgical excision), which may lead to complications in axillary surgery. At present, there is no reliable and accurate method for predicting axillary lymph node metastasis (ALNM) in patients with upgraded DCIS; however, such a method could prevent unnecessary axillary surgical interventions from being performed. In this study, we aimed to construct a non-invasive model for predicting ALNM in DCIS patients based on clinicopathological characteristics, mammography (MG) features, and magnetic resonance imaging (MRI) features.</p><p><strong>Methods: </strong>Between February 2018 and June 2020, 326 patients with upgraded DCIS were enrolled in this retrospective analysis. These patients were randomly divided into the training cohort (80%) and validation cohort (20%). Univariate and multivariable regression analyses were conducted to identify the candidate pathological features, which then used to develop a clinicopathological model. The features of the 2-mm, 4-mm, and 6-mm intratumoral and peritumoral regions (T-PTR) were extracted to develop the MRI radiomics model, and two deep learning classification models were developed based on the medial-lateral oblique (MLO) and craniocaudal (CC) views of the MG. A fusion model was then established that combined these sub-models. The receiver operating characteristic (ROC) curve, area under the curve (AUC), and other indicators were used to evaluate the performance of these models.</p><p><strong>Results: </strong>The clinicopathological characteristics of the two cohorts were basically balanced. The AUC values of the clinicopathological model were 0.675 and 0.690 in the training and validation cohorts, respectively. The model based on the T-PTR of MRI showed promising predictive ability. Among the three MRI models, the T-PTR (4 mm) model showed the best predictivity both in the training (AUC =0.885) and validation cohorts (AUC =0.843). The AUC values for the deep learning models of the MG CC and MLO positions all exceeded 0.7, indicating reliable predictive performance. The fusion model that combined the three methods significantly improved the accuracy and robustness of ALNM prediction. In both the training (AUC =0.975) and validation (AUC =0.877) cohorts, the fusion model showed excellent performance.</p><p><strong>Conclusions: </strong>We developed a fusion model that combined clinicopathological characteristics, MRI T-PTR (4 mm) radiomics, and MG-based deep learning. Our combined model showed promising performance in predicting ALNM in patients with upgraded DCIS.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"738-753"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127305","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 development and validation of biomarkers-based scoring systems for predicting early recurrence in patients with borderline resectable pancreatic cancer undergoing resection after neoadjuvant therapy.","authors":"Hang He, Cai-Feng Zou, Yong-Jian Jiang, Feng Yang, Yang Di, Ji Li, Chen Jin, De-Liang Fu","doi":"10.21037/gs-2024-500","DOIUrl":"10.21037/gs-2024-500","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant therapy (NAT) is a key component of the treatment strategy for borderline resectable pancreatic cancer (BRPC). However, early recurrence (ER) frequently occurs, leading to a poor prognosis. Effective approaches for ER risk stratification in patients with BRPC undergoing NAT have not been well established currently. This study aimed to develop biomarker-based perioperative scoring systems to predict ER in patients with BRPC who underwent resection after NAT.</p><p><strong>Methods: </strong>Patients with BRPC who underwent radical resection following NAT at our institute between 2018 and 2023 were retrospectively enrolled. Serum biochemical marker tests and imaging examinations were performed to evaluate recurrence. Perioperative biochemical and clinicopathological parameters were analyzed. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for recurrence and to construct nomograms for ER prediction. Internal validation was conducted using the bootstrapping method. The accuracy in predicting ER was evaluated using receiver operating characteristic curve analysis. Survival analysis was performed using the Kaplan-Meier survival plots and log-rank test.</p><p><strong>Results: </strong>A total of 194 patients were enrolled. Recurrence occurred in 69.0% of all patients, and 61.1% of all recurrences were found within 6 months postoperatively. A preoperative scoring system was developed based on preoperative carbohydrate antigen 19-9 (CA19-9) and CA125 levels to predict ER [area under the curve (AUC), 0.700; 95% confidence interval (95% CI): 0.614-0.786] with 86.4% specificity and 48.7% sensitivity (cut-off value was 0.35886). Patients with a post-NAT prognostic score (PNPS) ≥0.35886 exhibited significantly poorer recurrence-free survival (RFS) (P<0.001) and overall survival (OS) (P<0.001) than those with a PNPS <0.35886. A postoperative scoring system based on the postoperative CA19-9 response was established to predict ER (AUC, 0.785; 95% CI: 0.705-0.866) with 65.4% specificity and 80.8% sensitivity (cut-off value was 0.43949). Patients with a postoperative prognostic score (PPS) ≥0.43949 exhibited poorer RFS (P<0.001) and OS (P<0.001) than those with a PPS <0.43949. For patients with normal CA19-9 levels after NAT, PNPS ≥0.35886 or PPS ≥0.43949 indicated a poor prognosis after surgery. For patients without normal CA19-9 levels after NAT, PNPS <0.35886 or PPS <0.43949 was associated with a favorable prognosis after surgery.</p><p><strong>Conclusions: </strong>The preoperative and postoperative scoring systems provide risk stratification for ER in patients with BRPC undergoing NAT. This may provide references to clinicians in identifying suitable candidates and optimal timing for surgery during NAT, and administering tailored adjuvant therapy (AT) after surgery.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"670-686"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127542","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 role of robot-assisted mastectomy: promise, challenges, and evidence gaps.","authors":"Mariam Rizk, Kefah Mokbel","doi":"10.21037/gs-2025-16","DOIUrl":"10.21037/gs-2025-16","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"579-583"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127544","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":"Liquid biopsy in breast cancer: a practical guide for surgeons.","authors":"Janhavi Venkataraman, Timothy Crook, Kefah Mokbel","doi":"10.21037/gs-2025-11","DOIUrl":"10.21037/gs-2025-11","url":null,"abstract":"<p><p>Breast cancer remains a global health challenge, requiring innovative strategies for early detection, diagnosis, treatment monitoring, and recurrence detection. Liquid biopsy-leveraging circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), microRNAs (miRNAs), exosomes, immune-based biomarkers, and tumor-educated platelets (TEPs)-has emerged as a promising tool to address these needs. CTCs and ctDNA provide critical insights into tumor heterogeneity, therapeutic targets, and resistance mechanisms, while miRNAs, exosomes, and other non-CTC-based markers reflect the tumor microenvironment and offer potential biomarkers for disease progression. Importantly, liquid biopsy offers distinct advantages in early detection and precise diagnosis, as well as in identifying therapeutic resistance in real time, allowing clinicians to adapt treatment strategies effectively. The non-invasive nature of liquid biopsy further enables real-time tumor monitoring, paving the way for personalized treatment approaches. However, several challenges hinder its routine clinical adoption, including technical complexity, economic constraints, and variations in detection sensitivity due to low biomarker abundance. Additionally, a lack of standardization in methodology and interpretation limits its widespread application. Rigorous standardization and clinical validation are essential to address these barriers, ensuring equitable access across diverse healthcare settings and transforming breast cancer care for millions worldwide. Future directions include integrating artificial intelligence and multi-omic approaches to enhance diagnostic accuracy and clinical utility.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"754-760"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127429","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":"Serum thyroid-stimulating hormone as a diagnostic marker for cancer in atypia of undetermined significance/follicular lesion of undetermined significance nodules.","authors":"Saad M Alqahtani, Bassam A Altalhi, Shehata F Shehata, Yousef S Alalawi, Saif S Al-Sobhi","doi":"10.21037/gs-2024-520","DOIUrl":"10.21037/gs-2024-520","url":null,"abstract":"<p><strong>Background: </strong>Several studies have assessed the efficacy of thyroid-stimulating hormone (TSH) as a diagnostic marker of thyroid cancer (TC), with inconsistent findings. However, few studies have investigated its role in indeterminate thyroid nodules (TNs), particularly in those with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). The objective of this study was to evaluate preoperative TSH levels as a diagnostic marker for cancer in AUS/FLUS nodules.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent thyroidectomy with a primary cytological diagnosis of AUS/FLUS. The association between preoperative TSH levels and the final anatomopathological diagnosis (benign <i>vs.</i> differentiated TC) was examined.</p><p><strong>Results: </strong>The analysis included 109 patients. The median TSH level was higher in patients with malignant nodules (2.32 mIU/L) than in those with benign pathology (1.60 mIU/L) (P=0.04). Receiver operating characteristic (ROC) curve analysis revealed that the TSH level was a potential indicator for the coexistence of thyroid malignancy, with a significant area under the curve of 0.61 (P=0.04). The optimal diagnostic cutoff point for TSH levels was ≥3.06 mIU/L.</p><p><strong>Conclusions: </strong>This study demonstrated that TSH levels are an acceptable and useful marker to rule in rather than rule out TC in AUS/FLUS nodules.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"618-627"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127491","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":"Recent changes in surgical outcomes and preoperative biliary drainage with the increased use of neoadjuvant chemotherapy in pancreatic cancer patients undergoing pancreatoduodenectomy: a single-center retrospective study.","authors":"Naoya Imamura, Atsushi Nanashima, Yuki Tsuchimochi, Takeomi Hamada, Hiroshi Kawakami, Masahide Hiyoshi","doi":"10.21037/gs-2024-507","DOIUrl":"10.21037/gs-2024-507","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy (NAC) has been increasingly used in recent years in patients with pancreatic ductal adenocarcinoma (PDAC). This has forced a change in the practice of preoperative biliary drainage (PBD) is performed in PDAC patients scheduled for pancreatoduodenectomy (PD). What has changed in the NAC era and what is the appropriate method of PBD? To address this question, this study retrospectively reviewed the surgical outcomes and details of PBD in NAC and upfront surgery (US) patients.</p><p><strong>Methods: </strong>The study included consecutive PDAC patients who underwent PD from 2013 to 2021 during the transition from US to NAC, when outcomes were comparable. Clinical factors such as patient background, preoperative examination, surgical procedure, and postoperative complications were compared between the NAC group (40 patients) and the US group (59 patients), and details of PBD such as PBD procedure and adverse events were compared between the NAC and US groups who received PBD (27 NAC patients, 33 US patients). In the comparison test between groups, Fisher's exact test and Mann-Whitney <i>U</i> test were mainly used. In addition, the outcomes and patency periods of each of the 128 PBD procedures were examined for the 60 patients who underwent PBD. The log-rank test was performed using the Kaplan-Meier method to compare patency period by PBD procedure.</p><p><strong>Results: </strong>There were no differences in patient background between the NAC and US groups. Compared with the US group, the NAC group had higher preoperative albumin (ALB) levels and less blood loss, but there was no difference of postoperative complications (NAC <i>vs.</i> US, 35% <i>vs.</i> 46%, respectively, P=0.29). With respect to PBD, the NAC group had more initial metallic stent (MS) placement (NAC <i>vs.</i> US, 52% <i>vs.</i> 15%, respectively, P=0.009), and fewer PBD-related adverse events (NAC <i>vs.</i> US, 33% <i>vs.</i> 61%, respectively, P=0.04). In a comparison of outcomes by drainage method, the duration of patency was significantly longer with MS placement than plastic stent (PS) placement (median days of patency, MS <i>vs.</i> PS, 68 <i>vs.</i> 15 days, respectively, P<0.001). However, MS placement and PS placement were equally likely to require a delay in the surgical schedule due to PBD-related adverse events (MS <i>vs.</i> PS, 6% <i>vs.</i> 6%, respectively, P>0.99).</p><p><strong>Conclusions: </strong>Prolonged PBD with NAC did not adversely affect surgical outcomes. MS placement provides a long patency period and is currently useful in PBD for PDAC patients undergoing PD after NAC, which requires a prolonged preoperative period. However, MS placement also has adverse events, and further studies are needed.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"714-725"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127416","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}