Langenbeck's Archives of Surgery最新文献

{"title":"Clinical pathways of hospitalized extremity soft-tissue infections: a retrospective study.","authors":"Jonas Roos, Antonia Krause, Christian Prangenberg, Alberto Alfieri Zellner, Franziska Kappenberg, Matthias Schmid, Kristian Welle, Thorsten Hornung","doi":"10.1007/s00423-026-04287-w","DOIUrl":"https://doi.org/10.1007/s00423-026-04287-w","url":null,"abstract":"<p><strong>Background: </strong>Bacterial infections of the skin and soft tissues (SSTIs) are common and should be considered a key differential diagnosis in patients presenting with redness and swelling in these areas. They range from mild superficial cases to severe, complicated forms requiring prompt antimicrobial therapy and, often, surgical intervention. We aimed to describe clinical pathways, diagnostic evolution, treatment strategies, and outcomes in a hospitalized orthopedic/trauma surgery cohort.</p><p><strong>Methods: </strong>We performed a retrospective single-center analysis of all inpatients treated for extremity SSTIs between January 2020 and December 2023. Extracted variables included demographics, admission and discharge diagnoses, inflammatory markers, imaging, microbiology, surgical procedures, antibiotic regimens and duration, intensive care unit (ICU) utilization, and in-hospital outcomes.</p><p><strong>Results: </strong>A total of 242 patients were included (mean age 55.7 ± 20.3 years; 40.1% female), with a median length of stay of 7.5 days. ICU care was required in 25/242 10.3%; in-hospital mortality was 7/242 2.9%. Surgical management was required in 134/242 patients (55.4%). Comorbidity burden was substantial (ASA III-IV: 41.3%), and sepsis was documented in 32/242 (13.2%). Diagnostic classification changed between admission and discharge in 80/242 cases (33.1%) of cases. Inflammatory markers declined markedly from admission to discharge (CRP 43.0 [Range: 0.6-640.2, IQR: 13.2-107.5] to CRP: 13.1 [Range: 0.4-541.0, IQR: 4.6-35.2]; leukocytes 11.9 ± 6.09 10/L to 7.68 ± 4.25 10⁹/L). The hand, lower leg and foot were the most frequent sites. CT was performed in 111/242 (45.9%) and ultrasound in 65/242 (26.9%), with heterogeneous imaging strategies (CT only 87/242 (36.0%), US only 41/242 (16.9%), both 24/242 (9.9%), none 90/242 (37.2%)). CT use clustered with higher admission CRP and higher operative burden, including more re-interventions among operated patients. Cultures were frequently negative; when positive, staphylococci and streptococci predominated. Ampicillin/sulbactam and amoxicillin/clavulanate were the most common antibiotics, with frequent IV combination therapy.</p><p><strong>Conclusions: </strong>Hospitalized extremity SSTIs were characterized by frequent diagnostic reclassification, heterogeneous documentation and imaging pathways, and a high rate of operative management despite overall favorable outcomes. CT was more frequently used in patients with higher inflammatory activity and greater procedural burden. This descriptive association may, at least in part, reflect differences in clinical severity and selection for imaging. The findings support structured reassessment and targeted imaging when anatomical clarification is likely to alter management.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111458","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":"Machine learning for operative time prediction in robotic ventral hernia repair patients: Perspective on predictive model development and validation.","authors":"Rizaev Jasur, Amir Miraza Molai-Rad, Dilnoza Khasanova, Arvin Bahreini, Sherzod Niyazov, Najmiddin Jumakulov, Dilbar Najmutdinova, Fotima Alimova","doi":"10.1007/s00423-026-04321-x","DOIUrl":"https://doi.org/10.1007/s00423-026-04321-x","url":null,"abstract":"<p><p>Machine learning (ML) is increasingly applied to predict operative time in surgery, yet its role in robotic ventral hernia repair (VHR) remains unexplored. Brucchi and colleagues recently developed ML models, Random Forest, Gradient Boosting, and Ridge Regression, to predict operative time in 208 patients undergoing elective robotic VHR, achieving modest performance with Random Forest (R² = 0.22, MAE = 38 min). While this proof‑of‑concept study represents a novel application, several methodological considerations warrant attention before clinical translation. These include the absence of comparison with traditional statistical methods, the omission of surgeon‑level temporal data and learning curve dynamics, the lack of external validation, and the gap between SHAP‑based interpretability and actionable clinical utility. This Matters Arising offers a perspective on these considerations and proposes directions for future refinement, including incorporation of surgeon‑specific metrics, benchmarking against conventional regression models, external validation, and integration into clinical workflows, to enhance the predictive accuracy and clinical applicability of ML‑based operative time prediction in abdominal wall surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111562","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":"Clinical outcomes of early versus standard liver transplantation in patients with alcohol-related liver disease: a meta-analysis.","authors":"Solonas Symeou, Kevin Lee Boon Chun, Emmanouil Sinakos, Georgios Tsoulfas, Austin D Schenk","doi":"10.1007/s00423-026-04310-0","DOIUrl":"10.1007/s00423-026-04310-0","url":null,"abstract":"<p><strong>Background: </strong>A 6-month abstinence period before listing patients with alcohol-related liver disease (ALD) for liver transplantation (LT) is the current standard practice at many transplant centers worldwide. Its prognostic validity is, however, debated because it has not been prospectively validated, and because many ALD patients do not survive long enough to make it onto the waitlist.</p><p><strong>Methods: </strong>A meta-analysis was conducted in accordance with the guidelines put forth by Cochrane and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (PubMed/Medline, Scopus and Cochrane Library) were searched to identify studies comparing early (eLT) and standard LT (sLT).</p><p><strong>Results: </strong>Twelve studies comparing eLT and sLT for ALD were included, encompassing 2323 patients with ALD. Mortality [Risk ratio (RR) = 0.94, 95% Confidence Interval (CI): 0.73-1.22] and patient survival [Hazard Ratio (HR) = 1.10, 95% CI: 0.83-1.45] did not differ significantly between eLT and sLT. Any alcohol relapse was more frequent following eLT but did not reach significance in the primary analysis (RR = 1.37, 95%CI: 0.95-2.00). This association became statistically significant on leave-one-out and subgroup analyses. Early LT patients had a higher risk of acute graft rejection (RR = 1.22, 95% CI: 0.98-1.52) but comparable graft loss (RR = 0.97, 95% CI: 0.74-1.27). Post-operative risk of infection did not differ significantly (RR = 1.19, 95% CI: 0.80-1.77), but eLT was associated with longer hospitalization [Mean Difference (MD) = 5.24 days, 95% CI: 0.15-10.33].</p><p><strong>Conclusions: </strong>Early LT offers survival similar to sLT and is a reasonable option when medical therapy fails. However, the equivocal evidence of higher morbidity and alcohol relapse, and the longer hospitalization, support careful multidisciplinary selection and close post-transplant surveillance, particularly among recipients with alcohol-related hepatitis.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127985","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":"Geriatric co-managed prehabilitation before esophagectomy in patients aged ≥ 65 years with esophageal cancer: a prospective feasibility study with matched historical controls.","authors":"Linus Alexander Völker, Emily Haak, Hans Schlößer, Christiane J Bruns, Pauline Schumacher, Wolfgang Schröder, Paul Thomas Brinkkoetter","doi":"10.1007/s00423-026-04285-y","DOIUrl":"10.1007/s00423-026-04285-y","url":null,"abstract":"<p><strong>Purpose: </strong>Older patients undergoing esophagectomy remain at high risk for perioperative morbidity. This study evaluated the feasibility, safety and adherence of a multimodal prehabilitation program integrated with geriatric co-management in patients aged ≥ 65 years scheduled for transthoracic esophagectomy and explored perioperative outcomes.</p><p><strong>Methods: </strong>In this single-center prospective feasibility study, patients aged ≥ 65 years scheduled for transthoracic esophagectomy completed a 4-week home-based program of endurance, respiratory, resistance and balance training combined with comprehensive geriatric assessment and medication optimization. Feasibility outcomes were retention, adherence and data completeness. Perioperative outcomes were compared with a 2:1 matched historical control cohort using cluster-robust linear regression for continuous outcomes and Firth penalized logistic regression for binary outcomes.</p><p><strong>Results: </strong>Twenty-six patients were enrolled; 22 completed the intervention and were matched to 42 control records. At the first check-in 61.5% reported complete and 84.6% complete or mostly complete adherence; documentation was missing for 69.2% at the second. Despite matching, controls had more favorable performance status (p = 0.023) and comorbidity burden (p = 0.014). Postoperative complications, anastomotic leakage, hospital mortality and length of stay did not differ significantly. Intensive care unit (ICU) readmission was lower after prehabilitation (4.5% vs. 26.2%; odds ratio 0.19, 95% confidence interval 0.02-0.90; p = 0.035), but not after adjustment for surgical approach (adjusted odds ratio 0.30; p = 0.172).</p><p><strong>Conclusion: </strong>Multimodal prehabilitation with geriatric co-management was feasible and safe in this population. Overall postoperative morbidity was unchanged. The lower ICU readmission rate did not withstand adjustment and is hypothesis-generating requiring an adequately powered randomized trial. Future programs need more robust adherence monitoring.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05167682, registered 9 December 2021, retrospectively registered.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081396","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":"Biophysical rationale and emerging clinical perspectives of surfactants in thoracic surgery: a translational review.","authors":"Xiayimaierdan Yibulayin, Ehsan Arkin, Guangmin Yang, Sebastian Kalverkamp, Jan W Spillner, Johannes Greven","doi":"10.1007/s00423-026-04265-2","DOIUrl":"10.1007/s00423-026-04265-2","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary surfactants are essential for alveolar stability and gas exchange. While their clinical use is well established in neonatal care, their potential in thoracic surgery remains underexplored.</p><p><strong>Objective: </strong>To review the current and emerging applications of surfactants in thoracic surgical practice, and to assess their role in perioperative lung protection.</p><p><strong>Methods: </strong>We reviewed recent literature on surfactant biology, perioperative administration strategies, and novel formulations, including bio-derived and responsive surfactants.</p><p><strong>Results: </strong>Exogenous surfactants may improve lung compliance, preventing atelectasis, and mitigating postoperative respiratory complications. In thoracic surgery, surfactants may also serve as drug delivery vehicles or anti-inflammatory agents. However, clinical use remains limited, and further studies are needed to define optimal dosing, timing, and patient selection.</p><p><strong>Conclusions: </strong>Surfactants represent a versatile and evolving tool in thoracic surgery. With continued innovation and clinical validation, they may become an effective adjunct for enhancing perioperative respiratory outcomes.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081418","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":"Cadaveric training of total hepatic vascular exclusion for juxtahepatic venous injury: a technical study.","authors":"Tuna Aras, Julia Khabyuk, Nele Bunsen, Tobias Hilje, Janina Fischer-Mertens, Frank Eifinger, Rabi Raj Datta, Payman Majd, Martin Dübbers, Margarethe Draga, Martin Scaal, Michael Thomas, Stefan Saad, Reza Vahdad, Grigore Cernaianu","doi":"10.1007/s00423-026-04288-9","DOIUrl":"10.1007/s00423-026-04288-9","url":null,"abstract":"<p><strong>Purpose: </strong>Retrohepatic inferior vena cava (IVC) injury is a rare but frequently fatal challenge in trauma surgery. This study describes a structured cadaveric training sequence for total hepatic vascular exclusion (THVE), including transdiaphragmatic intrapericardial IVC exposure as an alternative escalation route for suprahepatic venous control.</p><p><strong>Methods: </strong>A structured cadaveric dissection study was performed on nine adult cadavers by a multidisciplinary team of vascular and pediatric surgeons. The motivation was derived from an index pediatric blunt trauma case involving life-threatening retrohepatic caval bleeding. Five anatomical exposure steps relevant to THVE were rehearsed sequentially: hepatoduodenal ligament control, infrahepatic IVC exposure above the renal veins, access to the suprahepatic IVC via infradiaphragmatic and transdiaphragmatic intrapericardial IVC exposure and optional supracoeliac aortic exposure. The exposure steps were performed in a fixed sequence that was identical in all nine donors; the sequence was not randomized. After each dissection, procedural difficulty for each anatomical landmark was graded using a five-point scale: 1 = very easy, 2 = easy, 3 = moderate, 4 = difficult, and 5 = very difficult.</p><p><strong>Results: </strong>Hepatoduodenal ligament control received the lowest difficulty ratings. Perceived difficulty of infrahepatic IVC and supracoeliac aortic exposure decreased after repeated dissections. Infradiaphragmatic suprahepatic IVC exposure remained technically demanding, whereas transdiaphragmatic intrapericardial IVC exposure received significantly lower ratings of perceived difficulty (p = .004), with lower ratings after the initial dissections.</p><p><strong>Conclusion: </strong>In this cadaveric training model, transdiaphragmatic intrapericardial IVC exposure received significantly lower ratings of perceived difficulty than infradiaphragmatic suprahepatic IVC exposure. Because the order of the two approaches was fixed and difficulty was assessed by team consensus, this finding does not establish that the transdiaphragmatic route is objectively easier, safer, or clinically superior.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075191","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":"Applicability and results of the consensus definition of delayed gastric conduit emptying after esophagectomy.","authors":"Petro Zgurskyi, Alex Ruiz Janje, Sophia Spiewok, Marius Kemper, Anas Preuschkas, Jakob Izbicki, Matthias Reeh, Felix Nickel, Thilo Hackert, Thilo Welsch","doi":"10.1007/s00423-026-04222-z","DOIUrl":"10.1007/s00423-026-04222-z","url":null,"abstract":"<p><strong>Purpose: </strong>Delayed gastric conduit emptying (DGCE) affects 15%-60% of patients after esophagectomy, depending on the definition used. This study evaluated DGCE incidence using the new consensus criteria and explored its clinical and scientific relevance. It also analyzed nasogastric tube (NGT) output to estimate a safe removal threshold.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included patients who underwent elective Ivor Lewis esophagectomy (2020-2024).</p><p><strong>Results: </strong>A total of 160 patients were included. The majority of patients underwent robot-assisted esophagectomy (n = 65 [40.6%]), whereas open esophagectomy was performed in 38 patients (23.7%). Early DGCE was identified in 40.6% of patients, predominantly via NGT output (95.4%), with few cases diagnosed radiologically (4.6%). DGCE was associated with longer hospital stays (24 vs. 18 days, p = 0.034) and higher NGT reinsertion rates (47.0% vs. 28.7%, p = 0.02), but not with differences in surgical approach or major complications (Clavien-Dindo Classification > IIIa: 18.2% vs. 13.8%, p = 0.72). Late DGCE was diagnosed in only 8 patients (5.0%), mainly because of the low use of routine radiological imaging. In the cohort of patients who did not require NGT reinsertion, the median of the average nasogastric tube output for the 2 days before removal was 200 mL per day.</p><p><strong>Conclusions: </strong>The consensus definition of DGCE is applicable and identifies a clinically relevant incidence of over 40%. An average daily NGT output of 200 mL appears to reliably predict safe tube removal.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081335","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":"Preparing surgery for Generation Z - Motivation and protective factors for pursuing a surgical career among medical students and early-career physicians: a cross-sectional study.","authors":"Runa Kinitz, Kim Klepka, Carolina Vogel","doi":"10.1007/s00423-026-04296-9","DOIUrl":"10.1007/s00423-026-04296-9","url":null,"abstract":"<p><strong>Background: </strong>Surgery is facing a substantial shortage of young professionals. In particular, it has become increasingly difficult to attract medical students, especially women, to pursue a surgical career, although women currently represent the majority of medical students. The specialty is often associated with a high workload, hierarchical leadership structures, and limited compatibility between professional and private life. Against this background, the aim of this study was to identify the factors that motivate medical students, early-career physicians and board-certified surgeons to pursue a career in surgery despite these challenges.</p><p><strong>Methods: </strong>An anonymous online survey was conducted between October and December 2025. The questionnaire comprised 18 items addressing motivations as well as encouraging and discouraging factors influencing the decision to pursue a surgical career. Responses were recorded using a five-point Likert scale ranging from 1 to 5.</p><p><strong>Results: </strong>A total of 179 individuals participated in the survey (11.7% male [n = 21], 88.3% female [n = 158]; mean age 31 ± 6.3 years), including 28.5% medical students, 48.0% residents, and 23.5% board-certified surgeons. Overall, 68.7% reported having decided on a surgical career during medical school. Notably, 87.2% of respondents stated that they had been discouraged in relation to their career choice, with discouraging feedback predominantly coming from men and from individuals working in surgical specialties. Women had 6.5-fold higher adjusted odds of reporting that they had been discouraged from pursuing a surgical career compared with men (p < 0.001). The most frequently reported motivating factors were the operative nature of the work (97.8%), working in a supportive and appreciative team environment (60.9%), and the opportunity to make a meaningful contribution to patient care (60.9%).</p><p><strong>Conclusions: </strong>The potential future surgical workforce is predominantly female and largely belongs to Generation Z. Overall, participants emphasize the importance of high-quality and structured training, a respectful working environment, predictable career pathways, and working conditions that allow for a sustainable balance between professional and private life. Addressing these factors should be considered a strategic priority for professional societies, training supervisors, and clinical leaders to attract and sustainably retain qualified surgical trainees.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025301","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":"Upfront surgery vs. neoadjuvant therapy in pancreatic cancer with venous involvement: a multicenter retrospective analysis.","authors":"Asif Halimi, Eline S Zwart, Bengi S Yilmaz, Benediktas Kurlinkus, Reea Ahola, Marco Del Chiaro, Ernesto Sparrelid, Elena Rangelova, Laura Maggino, Giuseppe Malleo, Gabriella Lionetto, Roberto Salvia, Keith J Roberts, Francesco Giovinazzo, Massimo Falconi, Stefano Crippa, Giulio Belfiori, Geert Kazemier, Patrick Maisonneuve, Johanna Laukkarinen, Güralp O Ceyhan","doi":"10.1007/s00423-026-04291-0","DOIUrl":"10.1007/s00423-026-04291-0","url":null,"abstract":"<p><strong>Introduction: </strong>The benefits of neoadjuvant therapy (NAT) for pancreatic cancer (PC) with portal venous involvement remain debated. This study aimed to compare the short- and long-term outcomes of surgery with or without NAT in patients with PC with suspected venous involvement.</p><p><strong>Methods: </strong>A multicentre retrospective cohort study compared patients who underwent upfront surgery (US) or surgery following NAT for PC with suspicion of venous involvement between 2007 and 2017. The primary endpoints were short-term morbidity and mortality, overall survival and disease-free survival.</p><p><strong>Results: </strong>We included 361 patients who received NAT and 690 patients who underwent US at nine centres. NAT patients had greater suspicion of venous involvement (96.9% vs. 83.6%, p<0.001), but underwent fewer venous resections (53.7% vs. 79.3%, p<0.001), and had less venous infiltration (52.3% vs 65.9%, p<0.001), perineural invasion (75.2% vs. 90.1%, p<0.001), angioinvasion (59.9% vs. 76.7%, p<0.001), lymph node involvement (60.6% vs. 83.6%, p<0.001) and R1 resections (44.7% vs. 67.2%, p<0.001) than patients who underwent US. Among patients undergoing venous resection, major postoperative complications were similar between the groups. However, without venous resection, NAT patients had significantly fewer (Clavien-Dindo ≥IIIb) postoperative complications (10.8% vs. 24.4%, p=0.02), fewer reoperations (3.0% vs. 11.2%, p=0.006), and lower 90-day mortality (2.4% vs. 7.7%, p=0.03). NAT patients showed improved survival (27.3 vs. 21.2 months, p=0.003).</p><p><strong>Conclusions: </strong>NAT maybe beneficial for patients with PC with venous involvement, as it might allow better patient selection for surgery and is associated with fewer major postoperative complications and better overall survival.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025365","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":"Correction to: 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/s00423-026-04289-8","DOIUrl":"10.1007/s00423-026-04289-8","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017265","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}