Gland surgery最新文献

{"title":"Integrating multimodal ultrasound imaging for improved radiomics sentinel lymph node assessment in breast cancer.","authors":"Zhe-Qin Yang, Yuan Zhang, Feng Lu, Tian Yang, Jun Shan, Quan Jiang, Geok Hoon Lim, François Bertucci, Hongbo Du, Yi-Cheng Zhu","doi":"10.21037/gs-2025-223","DOIUrl":"10.21037/gs-2025-223","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative assessment of sentinel lymph node (SLN) is critical for treatment planning in breast cancer (BC). While SLN biopsy (SLNB) remains the gold standard, it is invasive and may be unnecessary for all patients, particularly those with clinically node-negative disease. Combining conventional B-mode ultrasound (BMUS) and color Doppler ultrasound (CDUS) with new techniques like radiomics and deep learning may improve SLN prediction, but this approach has not been widely studied yet. This retrospective study aims to develop and validate a deep learning radiomics model that combining BMUS and CDUS imaging to noninvasively predict SLN metastasis in patients with BC.</p><p><strong>Methods: </strong>A total of 450 women with invasive BC who were treated at 2 hospitals between October 2021 and March 2025 were retrospectively analyzed. Patients were divided into training (n=276), external validation (n=105), and testing (n=69) sets. Handcrafted features were extracted from the breast lesion areas and its surrounding areas in BMUS images. Deep learning-based features were derived by applying a fine-tuned dual-stream MobileNetV2-based model, ultrasound and color doppler network, to both BMUS and CDUS images. The extracted deep features were then subjected to dimensionality reduction using principal component analysis. Following this, both handcrafted and deep learning features underwent further feature selection and dimensionality reduction process via application of inter- and intraclass correlation coefficient filtering, Pearson correlation analysis, and least absolute shrinkage and selection operator (LASSO) regression. Three models were constructed: only handcrafted features (ONLY_HF), only deep-learning features (ONLY_DF), and combined features (COMB). Each model's performance was evaluated using the area under the curve (AUC).</p><p><strong>Results: </strong>The COMB model integrated ten features (six handcrafted and four deep learning) following LASSO regression. In predicting SLN metastasis between N0 and N≥1, COMB achieved a higher AUC (0.888, 0.861, and 0.837 in the training, validation, and testing sets, respectively) compared to ONLY_HF (0.792, 0.765, and 0.739) and ONLY_DF (0.781, 0.748, and 0.717). The negative prediction value of COMB was the highest (88.89%, 76.60%, and 71.23%), followed by ONLY_HF (83.33%, 72.00%, and 43.10%), and ONLY_DF (78.38%, 67.57%, and 52.69%).</p><p><strong>Conclusions: </strong>By integrating BMUS and CDUS imaging with advanced deep learning techniques, the COMB model achieved a high negative predictive value, which could guide axillary treatment decisions and reducing unnecessary invasive procedures. These findings highlight the potential of multimodal imaging and machine learning strategies to serve as noninvasive, supplementary tools for personalized BC management.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 7","pages":"1348-1365"},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794276","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 prediction model for lymph node metastasis in thyroid cancer: integrating deep learning and radiomics features from intra- and peri-tumoral regions.","authors":"Lichang Zhong, Lin Shi, Xinpeng Liu, Yanna Zhao, Liping Gu, Wenkun Bai, Yuanyi Zheng","doi":"10.21037/gs-2025-50","DOIUrl":"10.21037/gs-2025-50","url":null,"abstract":"<p><strong>Background: </strong>Current preoperative imaging methods, such as ultrasound, are limited by operator dependency and suboptimal sensitivity for detecting central lymph node metastasis (CLNM). This study aimed to propose a method that integrates deep learning and radiomics to accurately predict lymph node metastasis in thyroid cancer by analyzing intra- and peri-tumoral imaging features, thereby improving the preoperative prediction accuracy.</p><p><strong>Methods: </strong>From July 2020 to June 2022, 405 patients diagnosed with PTC were enrolled from two centers: Center 1 (Shanghai Sixth People's Hospital) with 294 patients divided into a training set (n=294) and an internal validation set, and Center 2 (Tongji Hospital Affiliated to Tongji University) with 111 patients as the external test set. Postoperative pathological confirmation served as the reference standard for CLNM diagnosis. A total of 1,561 radiomics features and 2,048 deep learning features were extracted from intra- and peri-tumoral regions of each ultrasound image. Feature selection was performed using analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO), resulting in the selection of relevant features for constructing support vector machine (SVM) models. Additionally, radiomics-deep learning fusion models were developed by combining selected radiomics and deep learning features.</p><p><strong>Results: </strong>Among 405 patients (mean age: 46.59±12.74 years; 68.6% female), 171 exhibited CLNM, highlighting the clinical urgency for accurate prediction. Among the 405 patients, 171 exhibited CLNM. The radiomics models demonstrated area under the curve (AUC) values of 0.760 in internal validation and 0.748 in the external test cohort. The deep learning models demonstrated improved performance with AUCs of 0.794 and 0.756 in the internal and external test sets. Notably, the highest AUC values of 0.897 (internal validation) and 0.881 (external test set) were obtained by the radiomics-deep learning fusion SVM model incorporating both intra- and peri-tumoral regions. DeLong's test confirmed statistically significant improvements (P<0.05) of the fusion model over the intra-tumoral radiomics model (P=0.008), intra-tumoral deep learning model (P=0.005), and combined intra-tumoral radiomics-deep learning model (P=0.01). However, no significant differences were observed compared to the combined intra- and peri-tumoral deep learning model (P=0.17). Decision curve analysis indicated that the fusion model offers greater clinical utility in predicting CLNM.</p><p><strong>Conclusions: </strong>The integration of radiomics and deep learning features significantly enhances the diagnostic performance for predicting CLNM in papillary thyroid carcinoma (PTC). The radiomics-deep learning fusion SVM model outperforms individual radiomics and deep learning models, demonstrating substantial potential for clinical application in improving surgical decision-mak","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 7","pages":"1272-1282"},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794272","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 convenient model based on mammography and magnetic resonance imaging for preoperative differentiation of breast phyllodes tumors and fibroadenomas.","authors":"Xiaowen Ma, Jinhui Li, Feixiang Hu, Yan Huang, Qin Xiao, Weijun Peng, Yajia Gu","doi":"10.21037/gs-2025-145","DOIUrl":"10.21037/gs-2025-145","url":null,"abstract":"<p><strong>Background: </strong>Differentiation between breast phyllodes tumors (PTs) and fibroadenomas (FAs) remains a key clinical challenge, which is critical for formulating clinical treatment strategies. This study aimed to establish a fusion model based on mammography (MG) and magnetic resonance imaging (MRI) for the preoperative differentiation of PTs and FAs.</p><p><strong>Methods: </strong>The clinical data, MG images, and magnetic resonance (MR) images of patients with breast FAs treated in Fudan University Shanghai Cancer Center from October 2019 to December 2020, as well as patients with PTs treated from January 2011 to December 2020, were retrospectively collected. Univariate and multivariate logistic regression analyses were conducted to select independent factors and to construct a diagnostic model to differentiate PTs and FAs. The diagnostic performance of the model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>A total of 147 patients with FAs and 138 patients with PTs were included in this study. Patient age, maximum diameter of mass, density on MG images, lobulation on MR images, and time-intensity curve (TIC) were independent factors contributing to the differential diagnosis. Finally, the fusion model showed satisfactory discrimination [area under the curve (AUC) 0.90, 95% confidence interval (CI): 0.86-0.94] and calibration. DCA indicated good clinical benefit, as indicated by most values being within threshold probabilities.</p><p><strong>Conclusions: </strong>Breast MG and MRI findings help differentiate between FAs and PTs preoperatively. The multimodal fusion model was clinically efficacious and thus useful for accurate clinical diagnosis and treatment.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 7","pages":"1306-1317"},"PeriodicalIF":1.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794266","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":"Individualized survival prediction and risk stratification using machine learning for patients with malignant struma ovarii: a population-based study with external validation.","authors":"Shangcheng Yan, Zhen Cao, Qiyao Zhang, Bingrong Chen, Hao Wu, Hongtao Cao, Xiaobin Li, Yaqi Wang, Yalei Wang, Yonghui Chen, Ziwen Liu","doi":"10.21037/gs-2025-35","DOIUrl":"10.21037/gs-2025-35","url":null,"abstract":"<p><strong>Background: </strong>Malignant struma ovarii (MSO) is a rare thyroid-type cancer originating in ovarian teratoma. Prognosis of MSO is less studied without unanimous staging or stratification system. This study aimed to developed and validated a machine learning (ML)-based model to predict overall survival (OS) for patients with MSO and to risk-stratify them.</p><p><strong>Methods: </strong>Patients with histologically confirmed MSO diagnosed in 1975-2021 from the Surveillance, Epidemiology, and End Results (SEER) program were identified as the training cohort. Patients in a systematic literature review were collected as the testing cohort. OS was selected as the outcome, while demographic, clinicopathological and therapeutic information were used as features. Following data encoding, imputing and scaling, univariate feature selection was performed. Cox proportional hazard (CoxPH), Cox with elastic net penalty (CoxNet), random survival forest (RSF), gradient boosting machine (GBM), and survival tree (ST) models were trained and tuned. Each model was evaluated on its c-index, time-dependent area under the curve (AUC), time-dependent Brier score (BS) and stratification ability in the training and the testing cohort respectively. The algorithm that performed the best in the testing cohort was finally chosen for SHapley Additive exPlanations (SHAP) interpretation and Streamlit web application deployment.</p><p><strong>Results: </strong>The study included 120 and 194 patients in the training and testing cohort respectively. At the end of follow-up (median time 115.5 and 32.5 months respectively), 101 (84.2%) and 181 patients (93.3%) survived respectively. RSF had the best performance in the testing cohort, possessing the highest c-index (0.841, 95% confidence interval: 0.732-0.916), the highest mean AUC (0.852), the lowest integrated BS (0.042), and the smallest P value (<0.001) on log-rank test comparing the stratified groups. According to SHAP, older age, hysterectomy, larger tumor size and more advanced American Joint Committee on Cancer stage had the strongest predictive power for worse OS among all 13 features. An interactive application (https://mso-surv.streamlit.app/) was then implemented which can display the predicted Kaplan-Meier curve, survival probability, risk stratification and the contributions of features for the output.</p><p><strong>Conclusions: </strong>We reported the first externally tested time-to-event prognostic prediction model for MSO. ML algorithms enabled precise individual-patient prediction and stratification, and can potentially assist patient counselling and decision-making for treatment and surveillance.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1052-1065"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649241","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":"Thyroid tuberculosis misdiagnosed as papillary thyroid carcinoma under ultrasound-guided fine-needle aspiration cytology: a case report and literature review.","authors":"Lu Gan, Li Sun, Junzhi Zhao, Qiang Feng, Jiahua Li, Qinyun Wan, Qiannan Meng, Jianxue Liu","doi":"10.21037/gs-2025-19","DOIUrl":"10.21037/gs-2025-19","url":null,"abstract":"<p><strong>Background: </strong>Thyroid tuberculosis is very rare, making diagnosis challenging without fine-needle aspiration cytology (FNAC) because of its atypical features. We report a case of thyroid tuberculosis that was misdiagnosed as papillary thyroid carcinoma (PTC).</p><p><strong>Case description: </strong>A 68-year-old woman visited Baoji Central Hospital following ultrasound (US) performed at another hospital indicated a suspicious malignant nodule in her thyroid. Physical examination and thyroid US revealed a hard mass and irregular hypoechoic area in the right lobe, suggesting a possible malignant lesion. Ultrasound-guided FNAC (US-FNAC) was suspicious for PTC. The patient subsequently underwent right thyroid lobectomy and isthmusectomy, and postoperative histopathology revealed an epithelioid granulomatous lesion without tumor tissue. Meanwhile, postoperative serum testing revealed elevated TB-γ interferon concentration, and a specific T lymphocyte testing was positive, indicating a tuberculosis infection. Primary thyroid tuberculosis was ultimately confirmed. Postoperatively, the patient recovered well after surgery and received anti-tuberculosis therapy in a tuberculosis hospital for 1 year.</p><p><strong>Conclusions: </strong>This case reminds us that although thyroid tuberculosis is very rare, especially when imaging features and FNAC results resemble those of PTC, the diagnosis of primary thyroid tuberculosis should still be considered, and serum TB-related indicator testing can aid in diagnosis.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1154-1160"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649326","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":"Ultrasound-guided fine-needle aspiration biopsy of parathyroid adenomas in patients undergoing parathyroidectomy does not lead to clinically significant fibrosis.","authors":"Shahzad Ahmad, Evren Lilla, Dylan V Miller, Kallin Austin, Matt Hazel, Ismail Ansari, Berkeley Sheppard, Allison M Butler, Jules Aljammal","doi":"10.21037/gs-2025-26","DOIUrl":"10.21037/gs-2025-26","url":null,"abstract":"<p><strong>Background: </strong>Preoperative localization of parathyroid adenomas (PAs) with ultrasound-guided fine-needle aspiration (USG-FNA) is a controversial subject due to concerns about fibrosis. This paper attempts to evaluate the impact of fine-needle aspiration (FNA) on PA fibrosis in patients with primary hyperparathyroidism (PHPT) undergoing surgical resection.</p><p><strong>Methods: </strong>This retrospective review analyzed 70 patients who underwent parathyroidectomy for PHPT. Forty patients with unequivocal parathyroid lesions underwent USG-FNA using 25- or 27-gauge needles. Postoperatively, an independent pathologist assessed fibrosis in biopsied adenomas in a blinded fashion. Patients undergoing parathyroidectomy without biopsy served as controls. Surgical outcomes and fibrosis scores were compared between the two groups studied.</p><p><strong>Results: </strong>No significant difference in fibrosis scores was observed between biopsied and non-biopsied adenomas by an independent pathologist in cytopathology evaluation (P=0.99). However, ultrasound (US) demonstrated superior localization accuracy (95.8%), in comparison to Single-Photon Emission Computed Tomography-Sestamibi (SPECT-Sestamibi) study (50%). Patients with positive FNA parathyroid hormone (PTH) washout had a higher cure rate (95%) compared to those without biopsy proven localization (67%).</p><p><strong>Conclusions: </strong>Parathyroid FNA biopsy washout with 25- or 27-gauge needles does not cause clinically significant fibrosis. Preoperative localization with positive PTH washout using FNA improves surgical success rates in patients with PHPT.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"974-982"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649327","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":"Symphony of rebirth: a retrospective comparative cohort study on heterologous breast reconstruction after radiotherapy.","authors":"Gianluca Marcaccini, Simone Miccoli, Benedetta Daicampi, Roberto Cuomo, Luca Grimaldi, Bryan Lim, Ishith Seth, Warren Matthew Rozen, Leonardo Barellini","doi":"10.21037/gs-2024-552","DOIUrl":"10.21037/gs-2024-552","url":null,"abstract":"<p><strong>Background: </strong>While radiotherapy is a fundamental component of breast-conserving therapy for early breast cancer, it can complicate subsequent reconstructive procedures due to its impact on tissue quality. Despite the growing use of implant-based reconstruction, limited data are available on its safety and aesthetic outcomes in patients previously treated with radiotherapy. This study aims to evaluate the effectiveness and safety of heterologous breast reconstruction using tissue expanders and implants in irradiated patients compared to non-irradiated controls.</p><p><strong>Methods: </strong>This retrospective comparative cohort study included patients who underwent mastectomy with heterologous reconstruction between January 2020 and December 2023. Patients were divided into two groups: those with prior radiotherapy following breast-conserving surgery for local recurrence (PRS group) and those without prior radiotherapy (NPRS group). All irradiated patients received a standardized regimen of 50 Gy in 25 fractions. Reconstructions were performed using either prepectoral or subpectoral techniques, with Ti-Loop^® mesh used in all prepectoral cases. Only patients who completed the reconstructive process were included. Follow-up focused on early postoperative outcomes within 120 days. Complications and aesthetic results were evaluated, with the latter assessed by an independent plastic surgeon.</p><p><strong>Results: </strong>A total of 175 patients were included: 15 in the PRS group and 160 in the NPRS group. No statistically significant differences were found in postoperative complication rates, including hematoma (13% PRS <i>vs</i>. 5.6% NPRS, P=0.28), infection (6.6% <i>vs</i>. 5.6%, P>0.99), and wound dehiscence (6.6% <i>vs</i>. 5.6%, P>0.99). Most patients were discharged on the first postoperative day in both groups (80% PRS <i>vs</i>. 81.9% NPRS). Aesthetic scores ≥4 were achieved in 86.7% of PRS and 88% of NPRS patients.</p><p><strong>Conclusions: </strong>Implant-based breast reconstruction appears to be a viable option for patients with prior radiotherapy when performed with careful planning and standardized protocols. However, due to the small sample size of the irradiated group and limited follow-up duration, larger and longer-term studies are needed to validate these findings and assess long-term complications.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1024-1032"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649323","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":"Risk factors for postoperative outcomes in laparoscopic pancreaticoduodenectomy: a retrospective cohort study from 2015 to 2023.","authors":"Shubin Zhang, Zhongqiang Xing, Weihong Zhao, Haibo Wu, Xinda Yang, Jianhua Liu","doi":"10.21037/gs-2025-63","DOIUrl":"10.21037/gs-2025-63","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic pancreaticoduodenectomy (LPD) is being increasingly performed for pancreatic tumors, offering advantages such as reduced recovery time and trauma. However, currently there is a knowledge gap in risk factors of postoperative complications, intensive care unit (ICU) admission, and prolonged hospital stays. Identifying for these outcomes is essential for improving patient management and surgical results. This retrospective cohort study aimed to explore the important risk factors for postoperative outcomes in LPD.</p><p><strong>Methods: </strong>This retrospective cohort study included 199 patients who underwent LPD between 2015 and 2023 at a single center. Patients aged 18-85 years with pancreatic tumors were eligible, while those with distant metastases, American Society of Anesthesiologists (ASA) scores >3, or participation in other trials within 6 months prior to the current study were excluded. Data were collected on demographics, preoperative comorbidities, intraoperative variables (e.g., blood loss, transfusion, and revascularization), and postoperative outcomes, including complications, ICU admission, and length of hospital stay. The primary outcomes were postoperative complications and ICU admission, while the secondary outcomes were those factors influencing hospital stay duration. Postoperative complications, such as pancreatic fistula, biliary fistula, abdominal infection, and lung infection were documented as yes or no based on the hospital medical record system or follow-up visits. Besides, pancreatic fistula was further labeled as Grade A, B or C according to the standard of International Study Group on Pancreatic Surgery (ISGPS). The time of measurement was 90 days.</p><p><strong>Results: </strong>The cohort consisted of 101 males (50.8%) and 98 females (49.2%), with a mean age of 60.3 years [standard deviation (SD) 9.8]. Common complications included delayed gastric emptying (8.54%), biliary fistula (5.03%), and pancreatic fistula (4.52%). At total of 58 (29.15%) patients were admitted to the ICU admission, the median length of hospital stay after surgery is 15 days. Risk factors for complications and ICU admission included a lower preoperative bilirubin level, higher intraoperative blood loss, blood transfusion, revascularization, and chronic pancreatitis. Longer hospital stays were significantly correlated with intraoperative factors such as surgery duration blood transfusion volume, and blood loss (P<0.05).</p><p><strong>Conclusions: </strong>This study identified several key factors associated with postoperative complications and ICU admission after LPD. Blood loss, blood transfusions, and revascularization were significant predictors of longer hospital stays. Our findings highlight the importance of managing intraoperative variables, and their clinical implications include reducing complications, improving recovery, and refining patient management strategies following LPD for pancreat","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1128-1139"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649244","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":"Gastrointestinal perforation caused by a pancreaticojejunal anastomotic stent: a postoperative case report following pancreaticoduodenectomy.","authors":"Jiayue Zou, Daobin Wang, Danyang Shen, Yizhang Zhu, Weigang Zhang, Lei Qin, Xiaofeng Xue","doi":"10.21037/gs-2025-51","DOIUrl":"10.21037/gs-2025-51","url":null,"abstract":"<p><strong>Background: </strong>Placement of a support tube during pancreaticojejunal anastomosis has been shown to reduce the incidence of postoperative pancreatic fistula in patients with a non-dilated pancreatic duct. However, increasing reports of long-term complications, such as the presence of an indwelling support tube in the anastomosis, have raised concerns. Despite this, short-term complications, such as gastrointestinal perforation in the absence of tube displacement, remain relatively rare.</p><p><strong>Case description: </strong>This report describes a 59-year-old female patient who underwent radical pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (T2N0M0). On the 8th postoperative day, she developed back pain, followed by a sudden increase in body temperature, elevated inflammatory markers, and a significant increase in amylase levels in the drainage fluid. Enhanced abdominal computed tomography revealed that one side of the pancreatic duct support tube had penetrated the abdominal cavity, resulting in posterior peritoneal effusion. Emergency removal of the support tube and repair of the intestinal perforation were performed. The patient had an uneventful recovery after surgery and was discharged on day 20 following the second operation.</p><p><strong>Conclusions: </strong>In cases of postoperative abdominal or low back pain accompanied by signs of infection, complications related to the support tube should be considered. Further studies are needed to evaluate the necessity of placing a pancreatic duct support tube, as well as the timing for its removal after the completion of the anastomosis.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1161-1167"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649239","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":"Impact of intraoperative radiotherapy <i>vs.</i> whole-breast external beam radiotherapy for early breast cancer: a propensity score matching study based on SEER database.","authors":"Lin Ding, Huaqian Mo, Yaping Yang, Qingjian Li, Zhuofei Bi","doi":"10.21037/gs-2025-52","DOIUrl":"10.21037/gs-2025-52","url":null,"abstract":"<p><strong>Background: </strong>Breast-conserving surgery (BCS) followed by adjuvant whole-breast external beam radiotherapy (WBRT) is a standard treatment for early-stage breast cancer, effectively reducing local recurrence and improving survival. However, WBRT involves a prolonged treatment schedule and may lead to adverse effects and reduced patient compliance. Intraoperative radiotherapy (IORT), as a form of accelerated partial breast irradiation (APBI), offers a shorter treatment course by delivering a single dose of radiation during surgery. Although randomized controlled trials suggest comparable survival outcomes between IORT and WBRT in selected patients, real-world evidence is limited. This study aimed to compare the effects of IORT and WBRT on survival outcomes in early-stage breast cancer patients who underwent BCS, using a population-based dataset.</p><p><strong>Methods: </strong>Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. Patients who received either IORT or WBRT after BCS were included. Overall survival (OS) and cancer-specific survival (CSS) were assessed using Kaplan-Meier methods. Cox proportional hazards regression was performed to identify independent prognostic factors.</p><p><strong>Results: </strong>There was no statistically significant difference in OS and CSS between the IORT and WBRT groups. Factors associated with worse survival included older age, T2 stage, and higher tumor grade (all P<0.01). Positive estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were significantly associated with improved survival (all P<0.01).</p><p><strong>Conclusions: </strong>IORT is an effective alternative to WBRT with equivalent long-term survival. IORT may be considered for eligible patients based on age, tumor size, receptor status, and grade. Prospective studies are warranted to optimize the selection criteria.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 6","pages":"1012-1023"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649240","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}