Gland surgery最新文献

{"title":"Development and validation of an explainable web-based machine learning model for predicting early postoperative hypocalcemia in patients with differentiated thyroid cancer.","authors":"Jiaqi Ye, Yuanyuan Wang","doi":"10.21037/gs-2026-0211","DOIUrl":"10.21037/gs-2026-0211","url":null,"abstract":"<p><strong>Background: </strong>Early postoperative hypocalcemia is one of the most common complications after surgery for differentiated thyroid cancer (DTC) and may lead to prolonged hospitalization and impaired postoperative recovery. Most existing prediction tools are based on conventional regression methods and may be insufficient to capture complex interactions among clinical variables. This study aimed to develop and validate an interpretable machine learning model and a web-based calculator for early prediction of postoperative hypocalcemia in patients with DTC.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,222 patients with DTC who underwent surgery at a tertiary hospital between February 2021 and October 2025. Candidate predictors were screened using a combined feature selection strategy incorporating least absolute shrinkage and selection operator (LASSO) regression and the Boruta algorithm. Eight machine learning algorithms were developed and compared. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration metrics. Model interpretability was assessed using SHapley Additive exPlanations (SHAP), and the optimal model was deployed as a web-based calculator.</p><p><strong>Results: </strong>Seven consensus variables were selected for final model construction. Among the eight algorithms, the light gradient boosting machine (LGBM) achieved the best overall performance in the testing cohort, with an AUC of 0.875 [95% confidence interval (CI): 0.838-0.912] and a Brier score of 0.132, indicating good discrimination and calibration. SHAP analysis showed that bilateral central lymph node dissection (CLND), severe preoperative vitamin D deficiency, and thyroid capsular invasion were the most influential predictors of postoperative hypocalcemia. The final model was implemented as a freely accessible web-based clinical tool.</p><p><strong>Conclusions: </strong>We developed an explainable web-based LGBM model that showed good predictive performance for early postoperative hypocalcemia in patients with DTC. By combining accurate risk estimation with transparent interpretation, this tool may help clinicians identify high-risk patients and support individualized perioperative management.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"193"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721561","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 frontier trends of pancreaticojejunostomy over the past 26 years: bibliometric and visual analysis.","authors":"Xiao Cui, Piao Wang, Xiao-Zhong Jiang, Wen-Hao Zhou, Chang-Song Wang, Yu Yu, Song Su, Bin Huang","doi":"10.21037/gs-2026-0195","DOIUrl":"10.21037/gs-2026-0195","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite continuous advancements in pancreaticojejunostomy (PJ) techniques, there remains a lack of unified clinical guidelines for anastomosis selection. To date, bibliometric analysis has not yet been applied to systematically characterize the global development of PJ research. Accordingly, this study aimed to perform comprehensive bibliometric and visual analysis to clarify the developmental trajectory, research hotspots and emerging frontiers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted in the Web of Science Core Collection (WoSCC) for English-language original research and reviews on PJ published from January 1, 2000, to May 1, 2026. Bibliometric and visual analyses were performed using CiteSpace 6.4 R1, VOSviewer 1.6.20, Bibliometrix 4.1, and Scimago Graphica to characterize publication trends, research collaboration networks (country, institution, author), journal distribution, keyword co-occurrence, clustering, and citation burst characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3,329 eligible studies were included. PJ-related publications showed a continuous upward trend with a marked surge over the past 26 years. Japan, the United States and China were the most prolific countries. The United States, Italy, and Germany exhibited stronger international collaboration and higher citation impact. Zhejiang University, Sichuan University, and the University of Verona were the leading contributing institutions, with the University of Pennsylvania, the University of Pittsburgh, and Mayo Clinic emerging as core nodes in the global collaboration network. The largest author collaboration cluster was led by Claudio Bassi, Roberto Salvia, and Giovanni Marchegiani (University of Verona). &lt;i&gt;Journal of Gastrointestinal Surgery, Hepato-Gastroenterology&lt;/i&gt;, and &lt;i&gt;HPB&lt;/i&gt; were the primary journals for knowledge dissemination, and interdisciplinary integration with molecular biology, genetics, and computational science was increasingly prominent. Pancreatic fistula was the most frequent and core keyword, and citation burst and trend analysis revealed that current and future research hotspots focus on international standardized definitions, risk stratification tools, and clinical application of robot-assisted technology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PJ research has experienced progressive development from technical exploration to standardized norms and further to precision innovation over the past 26 years, with postoperative pancreatic fistula (POPF) prevention and management as the enduring core theme. International cooperation, technological innovation, and interdisciplinary integration are the key driving forces for PJ development. Future PJ research should focus on strengthening international multicenter collaboration, developing personalized risk assessment strategies, advancing robot-assisted anastomotic techniques, and promoting the popularization of advanced PJ techn","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"196"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723917","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":"Multidisciplinary minimally invasive planning for synchronous breast cancer and thymoma: a scarless single-stage surgical strategy-a case report and literature review.","authors":"Fabio Pelle, Cecilia Barbaria, Sonia Cappelli, Maddalena Barba, Gianluigi Ferretti, Filippo Tommaso Gallina, Marcello Pozzi, Franco Facciolo, Enrico Melis, Edoardo Mercadante, Claudio Botti","doi":"10.21037/gs-2026-1-0053","DOIUrl":"10.21037/gs-2026-1-0053","url":null,"abstract":"<p><strong>Background: </strong>Synchronous breast cancer and thymoma are uncommon clinical scenarios and are traditionally treated with phased surgery, often requiring separate operative sessions and potentially delaying comprehensive oncologic management. Although minimally invasive surgery enables single-stage approaches, the role of surgical planning in coordinating multidisciplinary procedures remains underreported.</p><p><strong>Case description: </strong>We report the case of a 40-year-old woman who had synchronous thymoma and HER2-positive breast cancer. After multidisciplinary evaluation, a single-stage surgical strategy was planned, combining robotic extended thymectomy, bilateral nipple-sparing mastectomy, axillary lymph node dissection and immediate reconstruction. The novelty of this report lies in the planning-driven strategy that guided procedural sequencing, access selection, and incision placement, with the explicit aim of preserving oncologic radicality while minimizing surgical footprint. Robotic thymectomy was performed first through a left-sided approach, with subxiphoid specimen extraction to avoid interference with breast incisions. Breast surgery and reconstruction were then carried out using scar-sparing approaches. Postoperative recovery was uneventful, with complete pathological response of breast cancer, R0 thymoma resection, and excellent aesthetic outcome.</p><p><strong>Conclusions: </strong>This case demonstrates that combined chest surgery should be considered primarily a planning challenge rather than only a technical challenge. Careful preoperative coordination among thoracic surgeons, breast surgeons and reconstructive teams plays a key role in defining operative priorities, minimizing surgical conflict, and achieving optimal oncologic and aesthetic outcomes. This experience supports the feasibility of a personalized single-stage approach in selected patients undergoing simultaneous treatment of thoracic and breast malignancies.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"206"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722783","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 hybrid implant-flap breast reconstruction-pearls and pitfalls: a narrative review.","authors":"Paulo P Piccolo, Maurice Y Nahabedian, Lisa Coleman, Mark Venturi, Alex Mesbahi, Silviu Diaconu","doi":"10.21037/gs-2025-399","DOIUrl":"10.21037/gs-2025-399","url":null,"abstract":"<p><strong>Background and objective: </strong>Autologous free tissue transfer is considered to be the gold-standard for breast reconstruction. The abdomen, thighs, buttocks and other donor sites have been well described in the literature. In slender patients with larger breasts who desire autologous reconstruction, breast asymmetry or insufficient volume may compromise the aesthetic or desired outcome. In these situations, hybrid reconstruction, in which the flap is combined with an implant, can provide desirable outcomes. The aim of this study to review of the available evidence and help guide clinical decision-making and optimization of outcomes.</p><p><strong>Methods: </strong>A review of the literature using keywords was performed by query of MEDLINE (PubMed), Embase, Cochrane Library. Inclusion criteria included retrospective and prospective studies that used free flaps for breast reconstruction (abdominal and other sources), studies that categorized their data into immediate and staged placement of implant, case series, case reports and review of literature. Studies from the last 30 years were included [1995-2025]. Studies that did not analyzed the use of free flaps combined with implants for breast reconstruction were not included.</p><p><strong>Key content and findings: </strong>Seventeen studies were identified. Of these 13 reported on patients who had free flaps augmented with an implant for breast reconstruction. Key findings included: A total of 359 patients and 598 breasts were reviewed. The majority of the of the free flaps (590) were abdominally based. The timing for implant placement was roughly evenly split between delayed (52%, 300 breasts) and immediate (48%, 298 breasts). Tissue expanders were used with the flap prior to the silicone implant in a minority of cases-11% of cases. Silicone implants were used 92% of cases. Mesh support (acellular dermal matrix or synthetic) was used in approximately 57% of cases.</p><p><strong>Conclusions: </strong>Performing hybrid flap-implant breast reconstruction has been established as a safe and reliable approach on patients with larger breasts who desire autologous reconstruction and have paucity of autologous donor tissue.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"204"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725048","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 randomized controlled trial: application of inactivated <i>Pseudomonas aeruginosa</i> preparation in nipple-sparing mastectomy with immediate prosthetic reconstruction for breast cancer.","authors":"Mingda Zhao, Tianming Fang, Haonan Jiang, Jianyi Li","doi":"10.21037/gs-2026-1-0135","DOIUrl":"10.21037/gs-2026-1-0135","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is one of the most commonly diagnosed malignancies worldwide. For patients undergoing nipple-sparing mastectomy with immediate prosthetic reconstruction (NSM-IPR), optimizing postoperative recovery and reducing complications are critical. Prolonged postoperative drainage is a common issue that increases infection risk and prolongs hospital stay. This study aimed to evaluate the effect of an inactivated <i>Pseudomonas aeruginosa</i> preparation (PAP) on postoperative drainage and cosmetic outcomes in this patient population.</p><p><strong>Methods: </strong>This was a single-center, prospective, four-arm parallel-group randomized controlled trial. A total of 100 patients were randomly assigned in a 1:1:1:1 ratio to receive either low-, medium-, or high-concentration inactivated PAP immersion, or povidone-iodine alone (control). Outcome assessors were blinded. Therapeutic efficacy was assessed, including total drainage volume, drainage duration, complications, and cosmetic outcomes at 3 months postoperatively.</p><p><strong>Results: </strong>Total drainage volume was significantly lower in all PAP groups compared with the control group (low-concentration: 578.4±39.34 mL, medium-concentration: 477.8±35.53 mL, high-concentration: 444.8±34.26 mL <i>vs</i>. control: 733.0±99.43 mL; all P<0.001). Drainage duration was also significantly shorter (low: 13.4±1.98 d, medium: 10.76±2.17 d, high: 10.76±1.88 d <i>vs</i>. control: 15.92±2.58 d; all P<0.001).</p><p><strong>Conclusions: </strong>The combination of inactivated PAP and povidone-iodine reduces postoperative drainage volume, shortens drainage time, and may improve cosmetic outcomes in patients undergoing NSM-IPR.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT07460297.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"189"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724632","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":"Endoscopic and Da Vinci robotic-assisted surgery in breast cancer: a narrative review of current evidence, technical advances, and future perspectives.","authors":"Jingjing Yin, Zhaoyang Sun, Chenyu Wang, Qian Wang, Jian Cui","doi":"10.21037/gs-2026-0218","DOIUrl":"10.21037/gs-2026-0218","url":null,"abstract":"<p><strong>Background and objective: </strong>Minimally invasive surgery (MIS) has been increasingly adopted in breast cancer management. Endoscopic breast surgery (EBS) and Da Vinci robotic-assisted breast surgery have emerged as the two principal MIS modalities, with the potential to combine adequate oncological safety with improved aesthetic outcomes. This review summarises the technical evolution, surgical and oncological outcomes, and learning curves of EBS and Da Vinci robotic-assisted breast surgery, and discusses cost considerations and future perspectives.</p><p><strong>Methods: </strong>We performed a structured search on PubMed, Web of Science, Scopus, and the Cochrane Library from database inception to 31 March 2026, with a supplementary literature update conducted to include relevant studies published through 1 May 2026. We included studies comparing endoscopic or robotic-assisted techniques with conventional approaches for breast-conserving surgery (BCS), nipple-sparing mastectomy (NSM), axillary lymph-node dissection (ALND), and breast reconstruction. Randomised controlled trials, prospective and retrospective cohort studies, case series, systematic reviews, and meta-analyses were eligible.</p><p><strong>Key content and findings: </strong>EBS, first developed in East Asian centres, can provide superior cosmetic outcomes in patients with early-stage breast cancer compared with conventional open surgery while maintaining acceptable short-term oncological results. Robotic-assisted NSM (RNSM) with the Da Vinci system provides three-dimensional high-definition visualisation, articulated EndoWrist instruments, and tremor filtering. Pooled data indicate that RNSM is associated with lower rates of skin-flap and nipple-areola complex (NAC) necrosis than conventional open NSM, with comparable short-term oncological outcomes; operative time and procedural costs remain higher. The learning curve for RNSM stabilises after approximately 20-50 cases. The latest development is the Da Vinci single-port (SP) system, which achieves a true single-incision mastectomy via a concealed axillary approach.</p><p><strong>Conclusions: </strong>Endoscopic and Da Vinci robotic-assisted surgery may be considered as minimally-invasive treatments for breast cancer surgery. Available data suggest short- to medium-term oncological equivalence with conventional surgery and favourable patient-reported outcomes, but long-term follow-up beyond 5 years remains scarce. Prospective randomised controlled trials with prolonged follow-up, formal cost-effectiveness analyses, and standardised training programmes are required before these techniques can be recommended for routine clinical use.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"202"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725145","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 great masquerader: a case report of intrathyroidal hypofunctional normocalcemic parathyroid carcinoma mimicking a benign thyroid nodule.","authors":"Jialin Pan, Bowen Tan, Xueyun Zhang","doi":"10.21037/gs-2026-1-0110","DOIUrl":"10.21037/gs-2026-1-0110","url":null,"abstract":"<p><strong>Background: </strong>Intrathyroidal hypofunctional normocalcemic parathyroid carcinoma (IHNPC) is a rare and aggressive malignancy; while only a small number of well-documented cases have been reported in the literature, multiple case series have described similar presentations of intrathyroidal parathyroid carcinomas (PCs) presenting as thyroid nodules without hypercalcemia. This entity accounts for an extremely small fraction of parathyroid neoplasms, with only sporadic case reports documented globally. Characterized by minimal secretion of parathyroid hormone (PTH) resulting in mild PTH elevation without corresponding hypercalcemia and normal serum calcium concentration, this neoplasm poses a distinct diagnostic challenge by virtue of its intrathyroidal location, where its clinical and radiological features closely mimic those of a common thyroid nodule, often resulting in substantial diagnostic delays.</p><p><strong>Case description: </strong>A 51-year-old woman presented with a solitary thyroid nodule that had been incidentally discovered two years earlier and monitored conservatively, and an isolated mild elevation of PTH. Imaging studies revealed a solid nodule with ill-defined margins within the right thyroid lobe. Initially misdiagnosed with a benign thyroid lesion by preoperative fine-needle aspiration cytology, she underwent right thyroid lobectomy. Intraoperative suspicion and subsequent definitive histopathology confirmed the diagnosis of PC. The patient recovered uneventfully, and at six-month follow-up, serum PTH and calcium levels had normalized with no evidence of recurrence.</p><p><strong>Conclusions: </strong>Clinicians should consider IHNPC in the differential diagnosis of any thyroid nodule, especially those with ill-defined borders or abnormal PTH levels, even in the absence of hypercalcemia. Routine measurement of serum PTH and 25-hydroxyvitamin D in patients with thyroid nodules, along with multimodal imaging and intraoperative frozen section when indicated, is essential to unmask this diagnostic masquerader and guide appropriate management.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"205"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722426","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 30-year institutional experience of insulinoma management at a tertiary care center: a case series.","authors":"Mustapha El Lakis, Nour Bakhos, Mohamad Shbaro, Mustafa Natout, Sali Sarkis, Mikel Madi, Nijad Zeineddine, Farah Bindakji, Hadi Chebaro, Riwa Deghaim, Mahmoud Choucair, Mohamad Khalifeh","doi":"10.21037/gs-2026-1-0048","DOIUrl":"10.21037/gs-2026-1-0048","url":null,"abstract":"<p><strong>Background: </strong>Insulinomas are rare functional pancreatic neuroendocrine tumors in which accurate preoperative localization is critical yet challenging, particularly in the setting of discordant imaging or atypical pathologies such as islet cell hyperplasia. This study highlights the diagnostic and operative implications of these challenges across three decades of institutional experience.</p><p><strong>Case description: </strong>We conducted a retrospective review of all patients who underwent surgical resection of biochemically proven insulinomas at our tertiary care center between 1994 and 2024. We included surgical patients with documented hypoglycemia in the presence of inappropriate endogenous hyperinsulinemia. Collected variables included demographics, symptoms, biochemical markers (glucose, insulin, C-peptide, proinsulin), imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), fluorodeoxyglucose-positron emission tomography (FDG-PET), and 68Ga-DOTATOC PET/CT], operative details, and postoperative course. Eight patients with a median age of 45 years (range 38-74) underwent surgical treatment for insulinoma. Six were women and six had an American Society of Anesthesiologists (ASA) score of 2. All patients presented with neuroglycopenic symptoms, with four also exhibiting adrenergic symptoms. Diagnosis was achieved biochemically. Preoperative localization demonstrated variable concordance with intraoperative findings, with at least one imaging modality accurately localizing the lesion in five patients. Enucleation was performed in five patients, while three required more extensive resection based on tumor location and proximity to the pancreatic duct. Two patients were found to have islet cell hyperplasia, resulting in persistent hypoglycemia in one case requiring ongoing medical therapy. Median follow-up was 164 days, during which seven out of eight patients achieved biochemical resolution.</p><p><strong>Conclusions: </strong>Insulinoma localization remains challenging despite modern imaging, with discrepancies across modalities impacting surgical planning. 68Ga-DOTATOC PET/CT may offer added value in selected cases. Recognition of atypical pathologies such as islet cell hyperplasia is essential, as it may alter management and outcomes. Surgical strategy should be individualized based on tumor localization and its relationship to the pancreatic duct.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"199"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725580","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":"Papillary thyroid carcinoma with fibromatosis/fasciitis-like stromal component is a rare subtype of papillary carcinoma with moderate aggressiveness: a single-center retrospective cross-sectional study of 725 patients.","authors":"Zuhao Yang, Shanshan Zhang, Donglai Fan, Chen Qian, Yingjie Xu, Chengguang Yang, Weiqi Kong","doi":"10.21037/gs-2026-0190","DOIUrl":"10.21037/gs-2026-0190","url":null,"abstract":"<p><strong>Background: </strong>Papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma (PTC/WF/FLS) is a rare subtype with poorly defined clinical and biological behavior. We observed an increasing number of cases and a relatively high rate of capsular invasion, suggesting potential local recurrence and postoperative relapse, which warrant further investigation. The objective of this study is to delineate the invasive and metastatic capabilities of this subtype through the investigation of its clinicobiological parameters.</p><p><strong>Methods: </strong>According to the 2022 World Health Organization (WHO) Classification of Thyroid Tumors, 725 patients with thyroid cancer collected between 2017 and 2021 were classified into a PTC/WF/FLS observation group, high-risk group (HRG), and low-risk group (LRG). Age, sex, tumor location, lesion number, tumor size, family history of cancer, genetic mutations, and tumor microenvironment were compared among the three groups, and their effects on lymph node metastasis and local invasion of the capsule, blood vessels, and nerves were analyzed.</p><p><strong>Results: </strong>The PTC/WF/FLS, HRG, and LRG showed no significant differences in age, sex, tumor location, lesion number, genetic mutations, or tumor microenvironment. In early-stage disease (T1), the PTC/WF/FLS group had the highest capsular invasion rate compared with the HRG and LRG (16.28%, 5.53%, and 7.51%, respectively; P=0.003). The association with a family history of cancer was also higher in the PTC/WF/FLS group than in the HRG and LRG (9.24%, 4.91%, and 3.44%, respectively; P=0.04). Propensity-matched and stratified analyses showed that the VI-region lymph node metastasis rate in the PTC/WF/FLS group was intermediate between those in the HRG and LRG, although the between-group differences were not significant (P=0.10 and P=0.97, respectively).</p><p><strong>Conclusions: </strong>PTC/WF/FLS is a rare, moderately aggressive subtype of papillary carcinoma. It shows a strong tendency toward capsular invasion and lymphatic metastasis, even at an early stage (T1), which may increase the risk of early local recurrence and postoperative relapse.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"191"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721310","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":"Low prealbumin predicts early recurrence after pancreatic cancer surgery: a retrospective cohort study.","authors":"Myeong Hun Oh, Hyung Il Seo, Young Mok Park, Byeong Gwan Noh, Sang Jin Lee, Suk Kim, Nam Kyung Lee, Seung Baek Hong, Seong Yong Han, Jong Hyun Lee, Dong Wook Kim, Byung Soo Park","doi":"10.21037/gs-2026-0156","DOIUrl":"10.21037/gs-2026-0156","url":null,"abstract":"<p><strong>Background: </strong>Early recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC) is linked to poor survival, but the prognostic role of host nutritional status is uncertain. We sought to identify independent predictors of early recurrence after surgery.</p><p><strong>Methods: </strong>Fifty-seven patients who underwent pancreaticoduodenectomy or radical antegrade modular pancreaticosplenectomy for PDAC between March 2021 and December 2023 were retrospectively reviewed. Early recurrence was defined as recurrence within 1 year after surgery, whereas the non-early recurrence group included patients with recurrence after 1 year and those without recurrence during follow-up. Clinicopathologic and nutritional variables were analyzed using univariable and multivariable Cox proportional hazards models. Clinical differences between early-recurrence and non-early-recurrence groups were also assessed.</p><p><strong>Results: </strong>In the univariable analysis, N2 stage [hazard ratio (HR) 3.43, P=0.03], resection margin <1 mm \u2028(HR 2.78, P=0.02), and prealbumin <20 mg/dL (HR 3.31, P=0.02) were significantly associated with early recurrence. In multivariable analysis, low prealbumin remained independently associated with early recurrence (HR 4.82, P=0.005). Group comparison further demonstrated higher frequencies of margin <1 mm (55.0% <i>vs.</i> 21.6%, P=0.01) and prealbumin <20 mg/dL (68.4% <i>vs.</i> 31.3%, P=0.01) in the early recurrence group. Other variables were not significantly different.</p><p><strong>Conclusions: </strong>Low preoperative prealbumin level remained consistently associated with early recurrence after curative PDAC resection. Margin status and nodal burden were associated with recurrence but lacked independent significance. Incorporating nutritional assessment into perioperative management may improve risk stratification and guide personalized postoperative surveillance.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"183"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724605","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}