Langenbeck's Archives of Surgery最新文献

{"title":"Larger size of Conn's adenoma is associated with lower cure rates post adrenalectomy.","authors":"Oliver Huang XinYao, Eugene Kwong Fei Leong, Wei Ting Chan, James Wai Kit Lee, Diluka Pinto, Ngiam Kee Yuan, Rajeev Parameswaran","doi":"10.1007/s00423-024-03553-z","DOIUrl":"https://doi.org/10.1007/s00423-024-03553-z","url":null,"abstract":"<p><strong>Background: </strong>The cure for patients with primary hyperaldosteronism (PHA) secondary to solitary adrenal adenoma is adrenalectomy. We investigated the impact of size of Conns' tumour on hypertension resolution in a multi-ethnic South East Asian Cohort.</p><p><strong>Methods: </strong>Retrospective cohort study of patients who underwent surgery for PHA between January 2010 to December 2022 was performed. Clinicopathological parameters that included tumour size, blood pressure parameters, class and dosage of drugs, biochemical indices and details of surgery were collected. Cure of hypertension was defined as normal blood pressure post-adrenalectomy. Statistical significance was defined as a P value of < 0.05.</p><p><strong>Results: </strong>94 patients (40 female:54 male; 102 women; age 49.3 ± 11.8 years) with PHA were operated on laparoscopically (79 trans-abdominal and 15 retroperitoneal approach). Tumour size ranged from 0.4 to 4.6 cm (mean 1.5 ± 0.6 cm). Hypertension Grades were Grade 1 in 38 (40%), Grade 2 in 45 (48%) and Grade 3 in 11 (12%) patients. Patients were on a mean of 3 classes of drugs prior to surgery and this decreased to mean of 1 class of drug post adrenalectomy. All patients were rendered normokalaemic and overall cure of the patients from hypertension was 82.0%. Large adenoma (defined as greater than 1.5 cm) resulting in a greater decrease in blood pressure (mean decrease of 32mmHg systolic, 15mmHg diastolic and MAP 20mmHg) in comparison to smaller adenomas (p = 0.003), but with lower cure rates of hypertension (p = 0.038).</p><p><strong>Conclusions: </strong>Large Conn's adenomas result in a greater reduction in blood pressure post-adrenalectomy but with decreased cure rates of hypertension compared to the small adenomas.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"360"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of positive resection margin in perihilar cholangiocarcinoma, ductal margin vs radial margin.","authors":"Poowanai Sarkhampee, Weeris Ouransatien, Nithi Lertsawatvicha, Satsawat Chansitthichock, Paiwan Wattanarath","doi":"10.1007/s00423-024-03547-x","DOIUrl":"https://doi.org/10.1007/s00423-024-03547-x","url":null,"abstract":"<p><strong>Introduction: </strong>Resection margin status is the important prognostic factor in resected perihilar cholangiocarcinoma (pCCA). Although the impact of ductal margin (DM) was reported in many studies, the influence of radial margin (RM) is unclear. This study aims to investigate the effect of positive RM on survival.</p><p><strong>Methods: </strong>Patients with pCCA underwent curative resection between 2013 and 2018 were retrospectively reviewed. Resection margin status was divided into negative resection margin (R0) and positive resection margin (R1); positive RM alone (RM+) and positive DM with or without positive RM (DM+).</p><p><strong>Results: </strong>Of the 167 pCCA patients, 62 (37.1%) had R1 margin. Among 62 R1 patients; 17 (27.4%) had positive DM alone, 20 (32.3%) had positive RM alone and 25 (40.3%) had both positive DM and RM. The R1 patients had a significantly greater number of lymph node metastasis (LNM) and advanced tumor staging than R0 patients, however there was no difference between the RM + and DM + patients. The median survival time of patients with RM + was significantly poorer than R0 patients (13.8 vs. 24.5 months; p < 0.001, respectively) and similar to the DM + patients (9.1 months, p = 0.556). However, in patients with LNM, those who underwent R0 resection had no statistically significant difference in survival outcomes compared to those with R1 resection.</p><p><strong>Conclusion: </strong>Positive resection margin remains the important prognostic factor, and positive RM is common in these patients. Positive RM also had a comparable effect on survival as positive DM. As a result, in pCCA, surgical resection should target both RM and DM.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"359"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences and outcomes of inverted kidney transplantation from a single Vietnamese institute.","authors":"Hung Duong Duc, Khai Ninh Viet, Dang Do Hai, Tuan Hoang, Ngoc Ninh Bao, Son Do Ngoc","doi":"10.1007/s00423-024-03544-0","DOIUrl":"10.1007/s00423-024-03544-0","url":null,"abstract":"<p><strong>Background: </strong>Inverted kidney transplant (KT) has been applied in many transplant centers, but the experiences and outcomes of this technique was limited.</p><p><strong>Aim: </strong>To describe the technical characteristics, indications and evaluate the outcomes of inverted kidney transplantation.</p><p><strong>Methods: </strong>Retrospective study from January 2016 to December 2023, included 74 patients who underwent inverted kidney transplantation with 72 cases of right kidney transplant into the right iliac fossa and 2 cases of left kidney transplant into the left iliac fossa performed in Viet Duc University Hospital.</p><p><strong>Results: </strong>63 cases in stage 1 (ipsilateral kidney transplant), all kidney graft were transplanted on the same side and 11 cases in stage 2 in which the kidney transplant was performed in some special cases such as recipients with severe atherosclerotic iliac arteries or incompatibility between the arteries and venous. The operation time was significantly higher (192.8 vs. 173.7 min, p = 0.037). However, the kidney function showed no difference when being discharged and remained stable until the latest follow-up. 3-year graft survival was 98.3%. There was 1 case of graft loss due to chronic graft rejection- immunosuppression incompliance requiring retransplantation after 2 years. Main complications included acute pancreatitis (2.7%), and ureteral stenosis at the ureter-bladder junction (6.8%), not significantly different compared to conventional KT.</p><p><strong>Conclusion: </strong>Inverted kidney transplantation is a simple, safe and effective technique and could be a feasible solution for some specific circumstances.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"358"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival after resection of invasive pancreatic intraductal papillary mucinous neoplasm.","authors":"Pietro Addeo, Giulia Canali, Chloe Paul, Pierre de Mathelin, Gerlinde Averous, Philippe Bachellier","doi":"10.1007/s00423-024-03550-2","DOIUrl":"https://doi.org/10.1007/s00423-024-03550-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to report the long-term outcomes after surgical resection for invasive (I) intraductal papillary mucinous neoplasm (IPMN) and to define prognostic factors for survival.</p><p><strong>Methods: </strong>We retrospectively evaluated all consecutive pancreatic resections performed IPMN between January 1, 2007, and December 31, 2022. Multivariate Cox analysis identified risk factors for survival.</p><p><strong>Results: </strong>Surgery for IPMN was performed in 125 patients including 78 I-IPMN (62%). Ninety-day mortality rates was 1.6% (n = 2) with an overall morbidity rate of 44.4%. I-IPMN showed higher serum CA 19 - 9 serum values (p < 0.0001), more frequently jaundice (p = 0.008), more high-risk stigmata (p = 0.002) and diffuse IPMN form (p = 0.005) compared with non-invasive IPMN. The median overall survival for I-IPMN was 178.36 months (95% confidence interval [CI]: 87.01-NR) with overall survival rates at one, three, five, and 10 years of 91%, 75%, 72%, and 62%, respectively. Jaundice (hazard ratio [HR]: 4.23; 95% CI: 1.48-12.07; p = 0.006), T3 lesions (HR: 3.24; 95% CI: 1.65-6.39; p = 0.006), absence of lymph node involvement (HR: 0.15; 95% CI: 0.04-0.60; p = 0.0007), R1 margin status (HR: 2.96;95%CI:1.08-8:15;p = 0.03) and need for venous resection (HR: 4.30; 95% CI: 1.26-14.6; p = 0.006) were identified as independent risk factors for survival.</p><p><strong>Conclusions: </strong>Long-term survival and cure can be observed after surgical resection of pancreatic adenocarcinomas originating from I-IPMN when resected at early stage (Tis, T1, T2). I-IPMN spreading beyond pancreatic ducts (jaundice, T3 lesions, lymph nodes, Veins) have limited long-term survival.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"361"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer.","authors":"Fuminori Teraishi, Yusuke Yoshida, Ryohei Shoji, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Shunsuke Kagawa, Rie Tamura, Yoshikazu Matsuoka, Hiroshi Morimatsu, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara","doi":"10.1007/s00423-024-03548-w","DOIUrl":"10.1007/s00423-024-03548-w","url":null,"abstract":"<p><strong>Purpose: </strong>Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older.</p><p><strong>Methods: </strong>This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined.</p><p><strong>Results: </strong>The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m². Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15).</p><p><strong>Conclusion: </strong>The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"356"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710463","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":"Multidimensional assessment of the learning curve of intracorporeal anastomosis during laparoscopic right colectomy.","authors":"Javier Vela, Christophe Riquoir, Felipe Silva, Cristián Jarry, Gonzalo Urrejola, María Elena Molina, Rodrigo Miguieles, Felipe Bellolio, José Tomás Larach","doi":"10.1007/s00423-024-03551-1","DOIUrl":"https://doi.org/10.1007/s00423-024-03551-1","url":null,"abstract":"<p><strong>Purpose: </strong>After resection during a laparoscopic right colectomy (LRC), reconstruction can be conducted with an intracorporeal (IA) or extracorporeal anastomosis. Although IA benefits are well documented, its implementation has been slow due to a steep learning curve (LC) mainly associated with intracorporeal suturing. The aim of this study is to assess the LC of IA in LRC.</p><p><strong>Methods: </strong>Consecutive patients undergoing a LRC with IA between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. 'Surgical success' as a composite outcome was also analysed by performing a CUSUM plot. Completion LC case number was determined based on these analyses. Pre-LC and post-LC perioperative outcomes were compared.</p><p><strong>Results: </strong>Two-hundred-and-ninety patients underwent a LRC during the study period. Sixty-seven met inclusion criteria. Correlation analysis identified a significant operating time reduction with increasing case numbers (p = 0.034). Total complications during implementation period were 25,3%, with 6% of severe complications. Operative time CUSUM analysis identified a consistent downwards trend after case 36 and surgical success CUSUM analysis after case 37. Two phases were established: pre-LC (case 0-37th) and post-LC (38th-67). Pre-LC and post-LC revealed a significant decrease in operative time (187vs177.8 min;p = 0.016), and length of stay (4vs3 days;p < 0.001). No difference between overall complications, severe complication, or reoperation rates were detected.</p><p><strong>Conclusion: </strong>The LC of laparoscopic IA can be achieved after 37 cases in centres with experience in advanced laparoscopic surgery. Further studies will be required to confirm these results.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"357"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis.","authors":"Theodoros Thomopoulos, Styliani Mantziari, Gaëtan-Romain Joliat","doi":"10.1007/s00423-024-03557-9","DOIUrl":"10.1007/s00423-024-03557-9","url":null,"abstract":"<p><strong>Purpose: </strong>Revisional bariatric surgery (RBS) has flourished during the last decades in many countries, due to suboptimal weight loss or long-term complications of primary bariatric surgery. Restrictive procedures, and in particular sleeve gastrectomy (SG), although widely performed as primary bariatric surgery, seems particularly prone to need surgical revision for the above-mentioned reasons during long-term follow-up. The aim of this systematic review was to compare the long-term (5-year) safety and efficacy between Roux-en-Y gastric bypass (RYGB) and single anastomosis duodeno-ileal bypass (SADI) after 'failed' SG.</p><p><strong>Methods: </strong>A systematic review was performed from 2007 to September 2024. Articles were included if SADI or RYGB were performed as RBS after 'failed SG' with follow-up at least 5 years. Pooled analysis was performed to summarize the data.</p><p><strong>Results: </strong>Among the seven studies eligible and included in this review, the SADI procedure showed comparable results to RYGB in terms of weight loss, nutritional deficiencies, and resolution of comorbidities during the long-term follow-up. However, RYGB proved superior in terms of remission of reflux disease and other functional problems after SG.</p><p><strong>Conclusions: </strong>The present review found that SADI seems to be a promising and suitable method for suboptimal weight loss after SG, with comparable or even better results to RYGB after 5-year follow-up.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"354"},"PeriodicalIF":2.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695496","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":"Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.","authors":"Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser Khakpour, Sina Seyedipour","doi":"10.1007/s00423-024-03484-9","DOIUrl":"10.1007/s00423-024-03484-9","url":null,"abstract":"<p><strong>Background: </strong>Anal fissures, tears in the epithelium of the anal canal that cause pain and bleeding, have a lifetime prevalence of 11%. While surgical treatments, such as lateral internal sphincterotomy are traditional, they pose postoperative complications. Recent studies investigated less invasive options involving botulinum toxin injection, showing promise with fewer adverse effects. The aim of this study is to compare the outcomes of botulinum toxin injection to lateral internal sphincterotomy for chronic anal fissures.</p><p><strong>Method: </strong>Up to October 2023, an extensive literature search was conducted in PubMed, Scopus, and Google Scholar to identify relevant papers. This systematic review and meta-analysis examined the comparative effectiveness of lateral internal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissures. The methodology adheres to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, and the study protocol has been registered with the Open Science Framework (OSF).</p><p><strong>Results: </strong>A total of 1,839 patients from 18 trials were included in the meta-analysis. Patients undergoing lateral internal sphincterotomy had higher healing compared to botulinum toxin injection (pooled effect = 0.77; 95% CI= [0.69- 0.83]; I² = 90.95%; P = 0.00).</p><p><strong>Conclusion: </strong>Our study revealed the efficacy of lateral internal sphincterotomy over botulinum toxin injection in promoting healing for chronic anal fissures. These findings emphasize the clinical advantage of traditional surgical interventions in the management of this condition. However, further studies with long-term follow-up are required to confirm our observations.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"355"},"PeriodicalIF":2.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic versus laparoscopic approaches for rectal cancer: a systematic review and meta-analysis of postoperative complications, anastomotic leak, and mortality.","authors":"Mellisa Lisset Villafane Asmat, José Caballero-Alvarado, Katherine Lozano-Peralta, Hugo Valencia Mariñas, Carlos Zavaleta-Corvera","doi":"10.1007/s00423-024-03545-z","DOIUrl":"10.1007/s00423-024-03545-z","url":null,"abstract":"<p><strong>Objective: </strong>Compare the efficacy and safety of robotic versus laparoscopic approach for rectal cancer treatment, addressing the ongoing debate within the medical community regarding the optimal surgical approach.</p><p><strong>Background: </strong>Traditionally, surgery has been the cornerstone of rectal cancer treatment, aimed at tumor removal and intestinal function preservation. Recent advancements have introduced laparoscopic and robotic surgeries as minimally invasive alternatives to conventional methods. However, it faces limitations in instrument mobility and dexterity. Robotic approach, on the other hand, enhances these aspects by providing surgeons with advanced precision, a three-dimensional high-definition view, and superior tissue manipulation capabilities, making it an increasingly preferred option for rectal cancer treatment.</p><p><strong>Methods: </strong>This systematic review and meta-analysis following PRISMA-2020 guidelines was carried out. This study analyzed phase 2 and 3 randomized controlled trials assessing the efficacy and safety of robotic versus laparoscopic approach in treating rectal cancer. Only studies meeting specific criteria were included, with congress abstracts, narrative reviews, case reports, and letters to the editor excluded.</p><p><strong>Results: </strong>We identified 350 studies, 8 met the inclusion criteria, encompassing 2525 patients from diverse geographical locations. The main outcomes analyzed were regional recurrence, anastomotic leak, postoperative complications, and mortality. The findings indicated no significant differences between robotic and laparoscopic surgeries in terms of Grade III Clavien-Dindo complications, mortality, and anastomotic leakage. The diverse geographical origin of the studies suggests the applicability of the results across different health care settings, although system-specific considerations are essential.</p><p><strong>Conclusion: </strong>Robotic approach does not show significant advantages over laparoscopic approach in terms of major complications and mortality rates in rectal cancer treatment, indicating that both surgical approaches are viable options with their specific benefits and limitations.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"353"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies.","authors":"Mojtaba Niknami, Hamed Tahmasbi, Shahryar Rajai Firouzabadi, Ida Mohammadi, Seyed Ali Mofidi, Mohammadreza Alinejadfard, Aryan Aarabi, Samin Sadraei","doi":"10.1007/s00423-024-03537-z","DOIUrl":"10.1007/s00423-024-03537-z","url":null,"abstract":"<p><strong>Background: </strong>Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model.</p><p><strong>Results: </strong>Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates.</p><p><strong>Conclusion: </strong>This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"352"},"PeriodicalIF":2.1,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}