Langenbeck's Archives of Surgery最新文献

{"title":"Comparative analysis of survival outcomes and prognostic factors between intrahepatic and extrahepatic cholangiocarcinoma after surgical resection: a propensity score-matched study based on the SEER database.","authors":"Jize Tian","doi":"10.1007/s00423-026-04118-y","DOIUrl":"10.1007/s00423-026-04118-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore survival outcomes and prognostic factors between intrahepatic and extrahepatic cholangiocarcinoma after surgical resection.</p><p><strong>Methods: </strong>Patients diagnosed with primary intrahepatic or extrahepatic cholangiocarcinoma between 2010 and 2018 who underwent cancer-directed surgery were identified from the SEER database. A 1:1 Propensity Score Matching was performed. Survival outcomes were analyzed via Kaplan-Meier curves and Log-rank tests. Multivariable Cox proportional hazards regression models and Fine-Gray competing risk models were constructed.</p><p><strong>Results: </strong>A total of 1,586 eligible patients were included. After matching, 478 patients (239 per group) were balanced. In the matched cohort, intrahepatic patients exhibited significantly superior Overall Survival (OS) compared to extrahepatic patients (median OS: 45 vs. 25 months; HR = 1.244, 95% CI: 1.001-1.545, P = 0.049). Conversely, a Fine-Gray competing risk analysis showed no significant difference in Cancer-Specific Survival (CSS) between the subtypes (SHR = 0.818, 95% CI: 0.641-1.043, P = 0.105). Independent risk factors for OS included advanced age, T3/T4 stage, N1/N2 stage, and tumor size ≥ 5 cm. Notably, the retrieval of 4 or more lymph nodes was associated with improved OS (HR = 0.630, 95% CI: 0.469-0.846, P = 0.002), though its association with CSS was not statistically significant in the competing risk model.</p><p><strong>Conclusions: </strong>Results from this PSM analysis suggest that intrahepatic location is associated with better OS compared to extrahepatic disease, but cancer-specific survival is similar between the subtypes after accounting for competing risks. This divergence implies that survival differences might be driven by competing risks, potentially distinct long-term surgical morbidities, rather than intrinsic biological lethality. Furthermore, adequate lymphadenectomy (≥ 4 nodes) correlated with improved overall survival and staging accuracy, highlighting its potential role as a surgical quality metric for both subtypes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339050","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":"AI-assisted digital breast tomosynthesis as a decision-support tool for post-neoadjuvant surgical planning in breast cancer.","authors":"Adnan Gündoğdu, Nur Betül Ünal Özdemir, Ceyda Sönmez Wetherilt, Merve Aktaş, Damiano Gentile, Bülent Çomçalı, Osman Cem Yılmaz","doi":"10.1007/s00423-026-04116-0","DOIUrl":"10.1007/s00423-026-04116-0","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of residual disease after neoadjuvant chemotherapy (NAC) is essential for surgical planning and prevention of incomplete excision. This study evaluated artificial intelligence (AI)-assisted digital breast tomosynthesis (DBT) as a decision-support tool for post-NAC assessment in breast cancer.</p><p><strong>Methods: </strong>This retrospective study included 151 patients treated with NAC followed by surgery. Post-NAC DBT images were analyzed using Lunit INSIGHT DBT. An AI score threshold of 70 was used to classify patients as having low (< 70) or high (≥ 70) scores. In a paired subgroup of 70 patients, pre- and post-NAC AI scores were compared. Diagnostic performance and univariable and multivariable analyses were performed.</p><p><strong>Results: </strong>The overall pathological complete response (pCR) rate was 41.1% (62/151). Patients with low AI scores had higher pCR rates than those with high scores (49.5% vs. 28.3%, p = 0.010). High AI scores were associated with persistent microcalcifications and residual ductal carcinoma in situ (p < 0.001). Overall accuracy was 58.3% and varied by molecular subtype, with higher performance in triple-negative breast cancer and limited discrimination in HR+/HER2 - tumors. In multivariable analysis, AI score showed borderline significance (p = 0.070). In the paired cohort, AI scores decreased after NAC (p < 0.001), but delta change did not differ between pCR and non-pCR groups (p = 0.877).</p><p><strong>Conclusion: </strong>AI-assisted DBT may have potential complementary value as a decision-support tool for post-NAC surgical planning, particularly in triple-negative breast cancer and in cases with residual microcalcifications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339044","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":"ERAS enables safe ≤ 100-hour discharge after pancreatoduodenectomy: a multicenter cohort study.","authors":"Yasser Debakey, Mohamed Saber Mostafa, Ahmed Refaat, Sayed Shaker Sheier, Amr Nofal","doi":"10.1007/s00423-026-04088-1","DOIUrl":"10.1007/s00423-026-04088-1","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) pathways have been increasingly adopted in gastrointestinal surgery; however, their application to pancreatoduodenectomy (PD) remains variable due to concerns regarding postoperative morbidity and safety (1-3). This study aimed to evaluate the impact of ERAS on postoperative outcomes and the feasibility of ultra-early discharge following PD.</p><p><strong>Methods: </strong>A multicenter cohort study was conducted including 180 patients undergoing PD across four tertiary hepatopancreatobiliary centers. Sixty patients were managed prospectively under a standardized ERAS protocol, while 120 patients treated prior to ERAS implementation served as controls. Postoperative outcomes, including pancreatic fistula and delayed gastric emptying defined according to established criteria, were analyzed (4,5). Multivariate logistic regression was performed to identify predictors of discharge within ≤ 100 h.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. ERAS compliance exceeded 83% across key perioperative domains. Rates of clinically relevant pancreatic fistula were similar between groups (3.3% vs. 2.5%, p > 0.05). Delayed gastric emptying was significantly reduced in the ERAS cohort (13.3% vs. 31.7%, p = 0.011). Major complications (Clavien-Dindo ≥ III) occurred in 3.3% vs. 5.8%, readmission rates were 7.0% vs. 6.0%, and 90-day mortality was 3.3% vs. 1.7% in the ERAS and control groups, respectively. Mean length of stay was significantly shorter in the ERAS group (4.48 vs 10.91 days, respectively; p < 0.001), with 81.7% of patients achieving discharge within ≤100 hours compared to none in the control group. Importantly, while the majority of ERAS patients achieved early discharge, a small subset experienced prolonged hospital stay, resulting in partial overlap with the control group. ERAS implementation was the strongest independent predictor of early discharge.  CONCLUSION: ERAS pathways in pancreatoduodenectomy are safe and reproducible, and enable substantial acceleration of postoperative recovery without increasing morbidity, supporting their integration into routine pancreatic surgical practice.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05192044.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339075","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 ERAS on morbidity and length of stay in elderly patients undergoing elective laparoscopic colorectal cancer surgery: a two-center comparative study.","authors":"Alessandro Verbo, Iacopo Verbo","doi":"10.1007/s00423-026-04120-4","DOIUrl":"10.1007/s00423-026-04120-4","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) protocols are widely implemented in colorectal surgery to improve postoperative recovery and reduce hospital stay. However, their impact on postoperative morbidity in elderly and clinically complex populations remains debated.</p><p><strong>Aim: </strong>To evaluate the impact of ERAS implementation on postoperative morbidity and hospital length of stay in an elderly and oncologically complex population undergoing elective laparoscopic colorectal cancer surgery.</p><p><strong>Methods: </strong>We conducted a retrospective comparative study including patients undergoing elective laparoscopic colorectal cancer resection. Patients treated between January 2016 and December 2018 received standard perioperative care, whereas those treated between January 2022 and December 2025 were managed according to a structured ERAS protocol. All procedures were performed laparoscopically by the same surgical team. To reduce selection bias and improve comparability between cohorts, propensity score matching was performed using age, sex, tumour location, T stage, N stage, and preoperative metastatic disease. The primary endpoint was the incidence of major postoperative complications (Clavien-Dindo grade ≥ III). Secondary endpoints included overall postoperative complications, in-hospital/30-day mortality, and length of hospital stay.</p><p><strong>Results: </strong>A total of 209 patients were included (ERAS: 83; non-ERAS: 126). Propensity score matching generated 68 matched pairs, achieving adequate covariate balance (all standardized mean differences < 0.10). In the overall cohort, major complication rates were similar between groups (22.9% vs. 23.8%, p = 1.000), as were overall complication rates (59.0% vs. 61.1%, p = 0.876). Mortality did not differ significantly (6.0% vs. 2.4%, p = 0.270). Length of hospital stay was significantly shorter in the ERAS group (6.2 ± 2.8 vs. 7.9 ± 5.7 days, p = 0.004).</p><p><strong>Conclusions: </strong>In an elderly and clinically complex population undergoing elective laparoscopic colorectal cancer surgery, ERAS implementation was associated with a significant reduction in hospital length of stay without evidence of increased major postoperative morbidity or mortality. Propensity score matching improved baseline comparability between cohorts. Given the retrospective design and non-contemporaneous study periods, these findings should be interpreted with caution but support the feasibility and safety of ERAS in real-world colorectal surgical practice.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317914","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":"Evolution of percutaneous tension band constructs: biological fixation strategies in contemporary patellar fracture management.","authors":"Wei Li, Mei Zhou, Yang Li, Hui Zhang, Quankui Zhuang","doi":"10.1007/s00423-026-04105-3","DOIUrl":"10.1007/s00423-026-04105-3","url":null,"abstract":"<p><strong>Purpose: </strong>This article aims to review the progress of minimally invasive tension band techniques in the treatment of patellar fractures, summarize the operational points, clinical outcomes, and advantages and disadvantages of various techniques, and provide a reference for clinicians.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed, Cochrane Library, and China National Knowledge Infrastructure databases up to December 2023. Search terms included \"patella fracture\" or \"patellar fracture\" combined with \"minimally invasive,\" \"percutaneous,\" \"tension band,\" or \"arthroscopic.\" Clinical studies on minimally invasive tension band treatment for patellar fractures were included.</p><p><strong>Results: </strong>Minimally invasive tension band techniques mainly include simple tension band technique, K-wire tension band technique, cannulated screw tension band technique, and non-absorbable suture technique. Based on the use of arthroscopic assistance, they can be categorized into arthroscopically assisted and non-arthroscopically assisted minimally invasive techniques. Compared with traditional open surgery, minimally invasive tension band techniques have significant advantages in operative time, hospital stay, postoperative pain, joint function recovery, and cosmesis. However, issues such as the need for secondary implant removal surgery and the controversial necessity of arthroscopic assistance remain unresolved.</p><p><strong>Conclusion: </strong>Minimally invasive tension band techniques for patellar fractures may offer potential advantages including reduced soft tissue trauma, earlier postoperative mobilization, and improved cosmetic outcomes. However, the current evidence base is limited by a predominance of small, retrospective studies with heterogeneous techniques and short-term follow-up. While these approaches represent a promising direction, high-quality comparative studies with long-term outcomes are needed to establish definitive superiority over conventional open techniques.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330592","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":"Survival benefit of surgical resection in elderly patients with extrahepatic cholangiocarcinoma: a propensity score-matched analysis.","authors":"Chaoran Chen, Xuming Zhang","doi":"10.1007/s00423-026-04112-4","DOIUrl":"10.1007/s00423-026-04112-4","url":null,"abstract":"<p><strong>Purpose: </strong>Extrahepatic cholangiocarcinoma (eCCA) predominantly affects elderly patients, yet robust evidence evaluating surgical effectiveness in this population remains limited. This study aimed to determine the independent survival benefit of surgical resection in elderly patients with eCCA using propensity score matching to minimize selection bias.</p><p><strong>Method: </strong>Patients aged ≥ 65 years with non-metastatic eCCA diagnosed between 2010 and 2017 were identified from the SEER database. One-to-one propensity score matching (caliper 0.05 SD) balanced baseline characteristics between surgical (n = 682) and non-surgical (n = 617) groups, yielding 184 matched pairs. Overall survival (OS) and cancer-specific survival (CSS) were compared using Kaplan-Meier analysis and multivariable Cox regression.</p><p><strong>Results: </strong>In the matched cohort, surgical resection was associated with significantly improved survival for both endpoints. For OS: median survival was 29 vs 8 months (HR = 0.336, 95% CI: 0.267-0.423, P < 0.001), with 5-year OS rates of 25.3% vs 4.6%. For CSS: median survival was 36 vs 8 months (HR = 0.307, 95% CI: 0.237-0.396, P < 0.001), with 5-year CSS rates of 34.5% vs 7.4%. Surgical benefit remained consistent across all age strata (65-74y: HR = 0.32; 75-84y: HR = 0.29; ≥ 85y: HR = 0.34), with no age interaction (P = 0.89). Tumor stage modified treatment effect (P = 0.012), with greater benefit in T1-2 (HR = 0.27) than T3-4 disease (HR = 0.40), though both groups benefited significantly.</p><p><strong>Conclusion: </strong>Surgical resection was associated with substantial survival benefit in elderly patients with non-metastatic, resectable eCCA, with approximately 66% reduction in mortality risk persisting across all age groups including octogenarians. Chronological age alone should not preclude surgical evaluation; decisions should incorporate comprehensive geriatric assessment and tumor biology.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317900","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":"Enhanced recovery protocols: compliance and outcome in elective vs. emergency colorectal surgery.","authors":"Andres Heigl, Chiara Paganetti, Michael D Honaker, Marionna Cathomas, Stephanie Taha-Mehlitz, Robert Rosenberg, Otto Kollmar, Anas Taha","doi":"10.1007/s00423-026-04114-2","DOIUrl":"10.1007/s00423-026-04114-2","url":null,"abstract":"<p><strong>Purpose: </strong>The feasibility and impact of Enhanced Recovery after Surgery (ERAS) protocols in emergency settings remain poorly understood due to patient instability, limited preoperative optimization, and inconsistent protocol adherence. Therefore, this study aimed to evaluate ERAS implementation in emergency colorectal surgery compared to elective cases.</p><p><strong>Methods: </strong>Using the ERAS^® Interactive Audit System (EIAS) database, a retrospective analysis was performed, encompassing all patients undergoing elective (n = 690) or urgent (n = 128) colorectal surgery between May 2016 and October 2024. Both groups were matched using 2:1 Propensity Scored Matching (PSM) and compared considering demographics, perioperative factors, and results. Postoperative complication rates, anastomotic leakage and compliance to the ERAS protocol were primary endpoints.</p><p><strong>Results: </strong>The number of elective cases was significantly higher than the number of emergency cases. Baseline characteristics and nature of the underlying disease appeared more favorable in the elective group. PSM analysis showed similar baseline characteristics between both groups. Within the emergency group the open approach was significantly higher compared to the elective group (p = 0.014). The compliance rate to ERAS was significantly lower in the emergency group compared to the elective group (71.12 ± 14.43 vs. 76.39 ± 12.59; p < 0.001). There was no significant difference in the rates of anastomotic leakage, major organ-specific complications, or mortality between both groups.</p><p><strong>Conclusion: </strong>ERAS implementation in emergency colorectal surgery is feasible despite lower compliance. Serious complications and mortality rates were similar to elective cases, highlighting the importance of developing specific ERAS protocols for emergency colorectal surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308664","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 of malignant esophageal stricture or esophageal leakage with a Niti-S™ covered anti-reflux stent is safe and efficient.","authors":"Lisa Gensthaler, Johanna Bauer, Dagmar Kollmann, Milena Bologheanu, Joy Feka, Ivan Kristo, Gerd Jomrich, Erwin Rieder, Reza Asari, Sebastian F Schoppmann","doi":"10.1007/s00423-026-04111-5","DOIUrl":"10.1007/s00423-026-04111-5","url":null,"abstract":"<p><strong>Background: </strong>Self-expanding metal stents (SEMS) are a palliative treatment option for malignant esophageal strictures causing dysphagia. Retrosternal pain, reflux-related symptoms and migration remain relevant limitations. SEMS with an anti-reflux valve (SEMS-ART; Niti-S™ esophageal covered stent, anti-reflux type, TaeWoong Medical) may reduce these limitations but clinical data remain limited. This study evaluates safety, tolerability and clinical performance of SEMS-ART in malignant esophageal stricture and leakage.</p><p><strong>Materials and methods: </strong>All patients treated with SEMS-ART for malignant esophageal stricture or leakage at the Medical University of Vienna, Department of General Surgery, between 01/2016 and 04/2021 were included into this retrospective analysis. Parameters regarding patients' safety, compliance and associated comorbidities like reflux and dysphagia were analyzed.</p><p><strong>Results: </strong>Twenty patients were included. The cohort was predominantly male (90.0%) with a mean age of 65.3 years. Advanced esophageal cancer UICC stage III-IV was present in 75.0%. Technical success was achieved in all patients (100%). Adequate stent expansion was confirmed in all patients, while correct positioning and normal contrast passage were observed in 95%. Reflux, Dysphagia and Regurgitation resolved in all cases after SEMS insertion (p < 0.001). Dislocation occurred in 15.0% (n = 3) and primarily managed endoscopically. Mean SEMS dwell time was 88.3 days. 30-day SEMS-related safety was 95.0%, and no SEMS-related mortality occurred within the observational period.</p><p><strong>Conclusion: </strong>This small case series demonstrates high technical success of SEMS-ART, supporting feasibility and an acceptable safety profile on migration and symptom relief. These findings support the use of SEMS-ART in selected patients with malignant esophageal stricture and should be considered hypothesis-generating, supporting further prospective comparative studies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302316","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":"Long-term results (> 12 years) of surgical treatment of perihilar cholangiocarcinoma: Application of a modified Nagoya approach at a western center.","authors":"İlgin Özden, Orhan Bilge, Nergiz Dağoğlu, Ayşen Yavru, Mine Güllüoğlu, Arzu Poyanlı, Yaman Tekant, Ahmet Kızir","doi":"10.1007/s00423-026-04106-2","DOIUrl":"10.1007/s00423-026-04106-2","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the results of a modified Nagoya approach in perihilar cholangiocarcinoma at a western center.</p><p><strong>Methods: </strong>The first author trained for one year at Nagoya University. The records of the 53 patients who underwent major hepatobiliary resection between 2001 and 2012 were reviewed. All fundamental principles were strictly applied with following modifications: hepatoduodenal ligament dissection limited to the level cranial to the gastroduodenal artery; 8a-p lymph nodes removed only if macroscopically positive; adjuvant radiotherapy, chemoradiotherapy (CRT) and CRT followed by chemotherapy in selected patients starting in 2007,2009 and 2011 respectively. The results were compared with the 2021 international benchmark values.</p><p><strong>Results: </strong>Twenty-seven patients were men; median (range) age was 54 (29-74). Percutaneous biliary drainage was performed in 45 patients (85%) and portal vein embolization in 8 (15%). Portal vein resection was required in 10 patients (19%). The 90-day mortality was 4% (2/53). Perihepatic fluid infection without an obvious biliary leak was the most frequent complication (42%). The frequencies of liver failure B-C and bile leak were 8% and 12% respectively. The calculated 1,3,5 and 10 -year survival rates were 87%,62%, 41% and 25% respectively. Thirteen patients (25%) survived longer than 10 years: seven had T1 and six had T2a tumors; none had a poorly differentiated tumor, positive surgical margins or lymph node metastasis.</p><p><strong>Conclusions: </strong>The modified Nagoya approach yielded outcomes similar to 25th percentile values for 90-day mortality, postoperative liver failure B-C and bile leak and benchmark values for 5-year overall survival.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295663","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":"Robotic versus laparoscopic pancreatoduodenectomy across the learning curve: a systematic review and meta-analysis.","authors":"Ahmed Abdelsamad, Khaled Mohamed, Youssef Badie, Zainab Hussein, Mennatullah Mohsen, Osama Selim, Omar Mohamed, Mohammed Khaled Mohammed, Zeyad M Wesh, Felix Nickel, Sascha Vaghiri, Florian Gebauer","doi":"10.1007/s00423-026-04108-0","DOIUrl":"10.1007/s00423-026-04108-0","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive pancreatoduodenectomy (MIPD) has a substantial learning curve. This systematic review and meta-analysis evaluated learning-phase effects in robotic (RPD) and laparoscopic pancreatoduodenectomy (LPD).</p><p><strong>Methods: </strong>The protocol was registered in PROSPERO (CRD420261283406). PubMed, Scopus, and Web of Science were searched through June 1, 2026. Studies reporting early-versus-late learning-phase outcomes or phase-specific RPD-versus-LPD comparisons were included. Random-effects models were used, and the certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Twenty-five studies were included qualitatively and 20 quantitatively, comprising 4,764 patients. The median case volume required to overcome the learning curve was similar for RPD and LPD (31.5 vs. 35 cases; p = 0.56). Late-phase MIPD was associated with significantly shorter operative time, lower estimated blood loss, lower conversion rate, shorter length of stay, and reduced rates of POPF, bile leak, and delayed gastric emptying. During the early phase, RPD had a longer operative time but a shorter length of stay and a lower CR-POPF than LPD. In the late phase, RPD showed lower conversion, while most other outcomes were comparable.</p><p><strong>Conclusion: </strong>Both RPD and LPD improve with experience. RPD may offer selected learning-phase advantages, but current evidence does not support broad superiority over LPD.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283934","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}