Langenbeck's Archives of Surgery最新文献

{"title":"Orbitozygomatic-transsylvian approach to the insula: microsurgical anatomy and endoscopic correlation using the fiber-separation technique.","authors":"Mustafa Eren Yuncu, Abdullah Bozoklar, Hayrettin Fidan, Erman Guler, Berra Bilgin, Ali Karadag, Necmettin Tanriover","doi":"10.1007/s00423-026-04183-3","DOIUrl":"10.1007/s00423-026-04183-3","url":null,"abstract":"<p><strong>Background: </strong>Insular surgery remains technically demanding because of the region's deep location and intimate relationships with the middle cerebral artery complex and surrounding white matter pathways. Safe resection requires precise understanding of vascular landmarks and subcortical functional boundaries.</p><p><strong>Methods: </strong>Eight formalin-fixed adult cadaveric heads (16 hemispheres) underwent bilateral two-piece orbitozygomatic (OZ) transsylvian (TS) dissections. Endoscopic assistance (0° and 30°) was used selectively to enhance visualization of deep and anatomically concealed regions. Following cortical exposure, approach-oriented subinsular fiber separation and dedicated hemispheric Klingler fiber dissections were performed to define operative surgical boundaries and characterize the three-dimensional organization of the peri-insular white matter.</p><p><strong>Results: </strong>The OZ-TS corridor provided wide anterior and anteroinferior exposure of the insula, allowing early identification of the M2 trunks, M3 opercular branches, and lenticulostriate arteries, thereby clarifying the medial vascular limit. Endoscopic assistance provided complementary visualization of the limen insulae, anterior perforated substance, and deep perforators while maintaining the established operative corridor. Layered subinsular dissection consistently revealed the extreme capsule, claustrum, external capsule with its uncinate fasciculus and inferior fronto-occipital fasciculus (IFOF), followed by the putamen and internal capsule. The IFOF formed a critical medial boundary in anterior resections, whereas the posterior limb of the internal capsule and optic radiation defined posteromedial and posterior functional limits.</p><p><strong>Conclusion: </strong>Endoscope-assisted OZ-TS exposure combined with a structured fiber-separation strategy provides an integrated anatomical perspective of the insular region. Early identification of vascular landmarks and systematic progression along intrinsic white matter planes facilitate anatomical definition of subcortical surgical boundaries.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017262","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":"Concordance between GPT-4 and a multidisciplinary tumor board in pancreatic cancer: A prospective pilot study.","authors":"Fiete Gehrisch, Kürsat Kirkgöz, Antonie Willner, Faik G Uzunoglu, Marianne Sinn, Jan Bardenhagen, Mara R Goetz, Andreas Brandl, Felix Nickel, Anna Nießen, Thilo Hackert, Thilo Welsch","doi":"10.1007/s00423-026-04242-9","DOIUrl":"10.1007/s00423-026-04242-9","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) such as GPT-4 are being evaluated for their use as supportive tools in oncological treatment planning. However, in pancreatic cancer, current studies are confined to predefined question-answer formats, while studies specifically investigating real-world scenarios that benchmark LLM performance against multidisciplinary tumor board (MDT) decisions are lacking.</p><p><strong>Methods: </strong>This prospective comparative analysis evaluated treatment and diagnostic recommendations for patients with newly diagnosed or suspected pancreatic cancer between an MDT and GPT-4. Using MDT referrals, clinical data were entered into a clinical data matrix and submitted to GPT-4 for therapeutic and diagnostic recommendations. Outputs were assessed before and after additional prompting with 41 high-ranking abstracts relevant to pancreatic cancer care. The primary endpoint was the concordance of recommendations between the MDT and GPT-4 before and after literature-based prompting.</p><p><strong>Results: </strong>Between September 1, 2024 and March 31, 2025, 45 patients were enrolled. The overall concordance rate between the MDT and GPT-4 was 73.3% (κ = 0.64, p < 0.0001) and did not improve following literature prompting. Discordance most often occurred in complex clinical scenarios. Concordance was highest in cases of metastatic disease (90.0%) and in neoadjuvant settings (90.0%) while it was lowest in patients requiring additional diagnostic workup (50.0%).</p><p><strong>Conclusions: </strong>GPT-4 demonstrated substantial agreement with MDT recommendations in patients with newly diagnosed or suspected pancreatic cancer. However, specific abstract prompting did not enhance the rate of concordance and GPT-4's limitations in individualized or complex contexts underscore the need for a cautious future integration into oncologic workflows.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001650","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":"Watchful waiting or dynamic reassessment? Interpreting surgical crossover in acute symptomatic hernias.","authors":"Tugberk Tok","doi":"10.1007/s00423-026-04274-1","DOIUrl":"10.1007/s00423-026-04274-1","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983110","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":"Early postoperative serum IL-6 may contribute to risk stratification for pancreas-specific complications after pancreatic resection.","authors":"Hanna Schulte-Hürmann, Faruk Koca, Julia Wicke, Elena Mazzella, Tamás Benkö, Armin Wiegering, Ekaterina Petrova","doi":"10.1007/s00423-026-04283-0","DOIUrl":"10.1007/s00423-026-04283-0","url":null,"abstract":"<p><strong>Purpose: </strong>IL-6 level in serum has been shown to have predictive value for postoperative infectious complications and prognostic value in acute pancreatitis. Evidence on its role after pancreatic resection is limited. The aim of the study was to analyse the predictive role of early postoperative serum IL-6 regarding complications after pancreatic resection.</p><p><strong>Methods: </strong>A retrospective analysis of patients with pancreatic resection at a tertiary German centre was performed. All IL-6 values per patient within 48 h after resection were delineated. Values at fixed postoperative time points were interpolated between each patient's measurements and, beyond them, predicted from a linear mixed-effects model. Receiver operating characteristic curve analysis was performed, and optimal time and cut-off points for prediction of postoperative pancreatic fistula (POPF), postpancreatectomy acute pancreatitis (PPAP) and overall complications were set out.</p><p><strong>Results: </strong>Out of 316 patients, 157 patients with more than one IL-6 value were included. IL-6 at 36 h after resection showed the best diagnostic performance for all three endpoints. For PPAP B/C, the AUC was 0.800 (95% CI 0.685-0.916) at a cut-off of 296 pg/ml (sensitivity 62%, specificity 80%, PPV 26%, NPV 95%), and for POPF B/C 0.715 (0.632-0.798) at 192 pg/ml (sensitivity 70%, specificity 59%, PPV 52%, NPV 76%). Discrimination for major complications (Clavien-Dindo ≥ 3b) was weaker, with an AUC of 0.636 (0.539-0.733) at 208 pg/ml (sensitivity 55%, specificity 62%, PPV 44%, NPV 73%).</p><p><strong>Conclusion: </strong>Serum IL-6 within 48 h after pancreatic resection could be useful in risk assessment for pancreas-specific complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977223","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":"Postoperative outcomes after inguinal hernia repair in octogenarians in Germany: an exploratory analysis of a retrospective single-centre cohort.","authors":"Hanan El Youzouri, Yvonne Beaugé, Kim L Zerr, Michel Kostantin, Safoora Cheema, Armin Wiegering, Teresa Schreckenbach","doi":"10.1007/s00423-026-04244-7","DOIUrl":"10.1007/s00423-026-04244-7","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the number of elderly patients undergoing inguinal hernia repair is increasing. Advanced age is associated with higher rates of comorbidity and frailty, which may potentially affect postoperative outcomes. This study evaluated postoperative morbidity in different age groups with a focus on octogenarians.</p><p><strong>Methods: </strong>This exploratory retrospective single-centre study included 388 patients undergoing elective inguinal hernia repair between 2014 and 2020. The patients were stratified into three groups according to age < 65 years (n = 240), 65-79 years (n = 117), and ≥ 80 years (n = 31). Open (Lichtenstein) and transabdominal preperitoneal laparoscopic techniques were analysed. The primary outcome was postoperative morbidity according to the Clavien-Dindo classification. Logistic regression analyses were performed to identify risk factors.</p><p><strong>Results: </strong>Octogenarians more frequently underwent open repair, whereas younger patients more often received laparoscopic treatment (p < 0.001). No significant differences were observed between age groups in regard to intraoperative or overall postoperative complications, including complication severity. In the multivariable analysis, age was not associated with postoperative complications (p = 0.974). Laparoscopic repair was associated with lower odds of postoperative complications (odds ratio (OR) 0.544; p = 0.031), while longer operative time was associated with increased risk of complications (OR 1.009; p = 0.022).</p><p><strong>Conclusions: </strong>Octogenarians did not show increased postoperative morbidity. Surgical decision-making should not rely on chronological age alone.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956098","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":"Outcome after renal transplantation utilizing octogenarian donors- retrospective single-center analysis within the Eurotransplant region.","authors":"Dennis Kleine-Doepke, Oliver Beetz, Christian Hinze, Ulrich Zwirner, Cornelius van Beekum, Philipp Felgendreff, Markus Quante, Ulf Kulik, Moritz Schmelzle, Gerrit Grannas","doi":"10.1007/s00423-026-04255-4","DOIUrl":"10.1007/s00423-026-04255-4","url":null,"abstract":"<p><strong>Background: </strong>A severe shortage of donors and organs remains the primary challenge in modern transplantation medicine. For kidney transplantation, prolonged time on the waiting list increases morbidity and mortality, particularly among elderly patients. Dedicated allocation initiatives, such as the Eurotransplant Senior Program (ESP), were established to shorten waiting times, and previous age limits for organ acceptance were raised to expand the donor pool for this specific patient population.</p><p><strong>Methods: </strong>This retrospective study evaluated all patients who received a kidney graft from an octogenarian donor between January 2006 and September 2023. Key outcomes assessed included patient survival, graft survival, and graft function.</p><p><strong>Results: </strong>A total of 71 kidney transplantations were included. Primary non-function occurred in five patients, and nine patients experienced delayed graft function. The 5-year recipient survival rate was 68.8%, and the 5-year death-censored graft survival rate was 65.3%. Graft function, assessed via median serum creatinine levels, remained stable throughout the follow-up period, although median creatinine values did not return to the normal range.</p><p><strong>Conclusions: </strong>Following meticulous donor selection, allocating kidney grafts from donors aged 80 years or older represents a viable strategy to expand the donor pool for ESP patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956123","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":"Does age matter? Acute appendicitis in octogenarians vs. younger patients - results of a German multicenter analysis.","authors":"Jasmin M M Schmitt, Nina Kühler, Sebastian Schaaf, Arnulf G Willms, Johan F Lock","doi":"10.1007/s00423-026-04202-3","DOIUrl":"10.1007/s00423-026-04202-3","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis is a common indication for emergency abdominal surgery. Octogenarians (≥ 80 years) are considered high risk due to comorbidities and reduced physiological reserve. This study examined age-related differences in symptoms, surgical management, and outcomes in patients undergoing surgery for acute appendicitis.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study includes 1,582 surgically treated patients from 41 German hospitals, comprising 1,533 non-octogenarians (18-79 years) and 49 octogenarians (≥ 80 years).</p><p><strong>Results: </strong>Octogenarians had higher comorbidity burden and ASA classification (both p < 0.001). Clinical presentation was largely comparable; however, octogenarians experienced lower pain intensity (p = 0.05) and had higher CRP levels (p < 0.001). Complicated appendicitis was more prevalent in octogenarians (63.3% vs. 28.1%; p < 0.001), with higher rates of perforation, peritonitis, and abscess formation (all p < 0.001). Consequently, extended resections (p = 0.01), open or converted surgery (p < 0.001), drainage (p < 0.001), and stoma formation (p = 0.01) were more common. Postoperative complications (p < 0.001), mortality (p = 0.002), ICU admission (p < 0.001), duration of antimicrobial therapy (p < 0.001), and hospital stay (p < 0.001) were all increased. Following propensity score matching, outcomes were largely comparable between octogenarians and younger patients, indicating the comorbidity spectrum of the elderly, rather than chronological age alone, as key determinants.</p><p><strong>Conclusion: </strong>Despite a similar initial presentation, octogenarians present with more advanced appendicitis and significantly worse postoperative outcomes. This emphasizes the need for age- and comorbidity-adapted diagnostic and perioperative strategies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930578","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":"Outcomes of living donor liver transplantation in elderly Egyptian patients: a retrospective study.","authors":"Ahmed Abdelrafee, Mohamed Abdelwahab, Amr Sanad, Ahmed Shehta, Mohamed Eldesoky, Mahmoud A Ali, Mohamed A Elmorshedi, Adel Ali Hassan, Waleed M R Elsarraf","doi":"10.1007/s00423-026-04166-4","DOIUrl":"10.1007/s00423-026-04166-4","url":null,"abstract":"<p><strong>Purpose: </strong>Although the results of living donor liver transplantation (LDLT) in the elderly have been reported worldwide, there is still a dearth of information on elderly patients in Egypt. The purpose of this study is to investigate the clinical outcomes of LDLT in this growing population group.</p><p><strong>Methods: </strong>This was a retrospective study that evaluated all LDLT patients at the Gastrointestinal Surgical Center, Mansoura University, from January 2009 to December 2023. Based on the recipient's age, two patient cohorts were created: younger (< 60) and elderly (≥ 60). Demographics, liver disease etiology, MELD score, surgical duration, blood loss, and early and late post-transplant outcomes (complications, graft survival, and patient survival) were compared between the two groups. Propensity score matching (PSM) was done to improve the baseline covariates imbalance.</p><p><strong>Results: </strong>Among 967 LDLT operations, 110 patients were classified in the elderly group (≥ 60 years). Hepatocellular carcinoma (HCC) was markedly more prevalent in the elderly group (44.6% vs. 30.5%, p = 0.002). After PSM analysis, the occurrence of early post-transplant problems was greater in the elderly group (65.5% vs. 51.9%, p = 0.033). Major complications were comparable between both groups (p = 0.763). Importantly, there was no statistically significant difference in 90-day mortality (p = 0.697) or in the 1, 3, and 5-year survival rates (p = 0.660) between the two matched groups.</p><p><strong>Conclusion: </strong>Living donor liver transplantation for carefully selected elderly recipients yields comparable early survival outcomes to younger recipients. However, the elderly cohort faces a significantly higher risk of early morbidity and not statistically significant lower graft survival. Rigorous selection and targeted perioperative care are therefore essential.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891882","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":"An inflammation-nutrition composite index and its dynamic change for predicting postoperative wound complications.","authors":"Mehmet Emin Gönüllü, Mehmet Fuat Çetin, Fatih Gürsoy, Erman Yekenkurul","doi":"10.1007/s00423-026-04209-w","DOIUrl":"https://doi.org/10.1007/s00423-026-04209-w","url":null,"abstract":"<p><strong>Background: </strong>Postoperative wound complications are an important cause of morbidity, and routinely available inflammatory markers may assist with early risk assessment. This study evaluated a newly proposed exploratory composite index, the Wound Inflammation-Nutrition Index (WINA), and its change between postoperative day 1 and postoperative day 3 (ΔWINA) in relation to postoperative wound complications.</p><p><strong>Methods: </strong>This retrospective observational study included 86 patients who underwent general surgical procedures between January 2020 and December 2025. WINA was calculated by multiplying the C-reactive protein-to-albumin ratio by the neutrophil-to-lymphocyte ratio at postoperative days 1 and 3. ΔWINA was calculated as the POD3 value minus the POD1 value. Logistic regression, receiver operating characteristic analysis, model comparison, bootstrap internal validation, and sensitivity analyses were performed.</p><p><strong>Results: </strong>Postoperative wound complications occurred in 24 patients (27.9%). WINA values at POD1 and POD3 and ΔWINA were higher in patients with wound complications (all p < 0.001). In the parsimonious multivariable model, ΔWINA per 100-unit increase was associated with wound complications (adjusted OR: 2.12, 95% CI: 1.44-3.13, p = 0.001), together with diabetes mellitus (adjusted OR: 2.89, 95% CI: 1.01-8.29, p = 0.048) and operative time per 30-minute increase (adjusted OR: 1.67, 95% CI: 1.08-2.58, p = 0.021). ΔWINA had an AUC of 0.872 (95% CI: 0.789-0.941), with 83.3% sensitivity, 80.6% specificity, 62.5% positive predictive value, and 92.6% negative predictive value at a cut-off of 245.0. Its discrimination did not differ significantly from WINA at POD3. Adding ΔWINA to the clinical model increased the AUC from 0.772 to 0.903 (ΔAUC: 0.131, p = 0.003). The association remained after excluding complications diagnosed on or before POD3.</p><p><strong>Conclusion: </strong>ΔWINA was associated with postoperative wound complications and improved the performance of a parsimonious clinical model. However, it did not outperform WINA measured at POD3, and the derived cut-off requires external validation before clinical use.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111424","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":"Indocyanine green (ICG) guided thyroidectomy versus conventional thyroidectomy and the impact on parathyroid function preservation: an updated GRADE-assessed systematic review and meta-analysis.","authors":"Ahmed Wael Moftah, Abdo Mohamed Abdalhy, Hammam Majed Alsousi, Abdalrahman Salah Shehata, Mahmoud Ashraf Hussein, Yasser Ashraf Gamal, Myame Ayman, Israa A Solah, Hebatalla Aly","doi":"10.1007/s00423-026-04210-3","DOIUrl":"https://doi.org/10.1007/s00423-026-04210-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thyroidectomy carries a significant risk of parathyroid gland injury, with transient hypoparathyroidism occurring in 15-50% of cases and permanent hypoparathyroidism in up to 5%, resulting in lifelong morbidity. Near-infrared (NIR) autofluorescence imaging combined with indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative adjunct for parathyroid identification and perfusion assessment, but its comparative efficacy over conventional white-light surgery remains to be comprehensively quantified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search across five databases through January 2026 identified randomized controlled trials and observational studies comparing NIR autofluorescence with ICG imaging versus conventional thyroidectomy without fluorescence guidance. Outcomes included inadvertent parathyroid removal, permanent and transient hypoparathyroidism, permanent and transient hypocalcemia, postoperative parathyroid hormone (PTH) levels, postoperative serum calcium levels, and operative time. Meta-analysis utilized a random-effects model to calculate pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven studies encompassing 2,203 patients (ICG: n = 897; Control: n = 1,306) were included. ICG-guided NIR imaging significantly reduced inadvertent parathyroid removal (RR 0.43, 95% CI 0.30-0.61, p = 0.002; I²=0%) and permanent hypocalcemia (RR 0.25, 95% CI 0.17-0.37, p = 0.004; I²=0%). A non-significant trend toward reduced permanent hypoparathyroidism was observed under our pre-specified random-effects model (RR 0.45, 95% CI 0.20-1.02, p = 0.054). A post-hoc sensitivity analysis using a fixed-effect model yielded a statistically significant result (RR 0.50, 95% CI 0.36-0.71, p &lt; 0.001); however, this finding should be interpreted with caution, as it did not correspond to our primary pre-specified analytical approach. ICG guidance was associated with significantly higher postoperative PTH levels (MD 5.45 pg/mol, 95% CI 0.26-10.64, p = 0.042) and serum calcium levels (MD 0.06 mmol/L, 95% CI 0.01-0.11, p = 0.033). No significant differences were noted in transient hypoparathyroidism (RR 0.56, 95% CI 0.21-1.53, p = 0.185) or transient hypocalcemia (RR 0.67, 95% CI 0.33-1.34, p = 0.182), both characterized by substantial heterogeneity (I²=78.4% and 75.4%, respectively). Operative time was comparable between groups (MD 0.08 min, 95% CI - 18.25 to 18.42, p = 0.989).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;NIR autofluorescence with ICG imaging is associated with a reduction in inadvertent parathyroid removal and permanent hypocalcemia, supported by high and moderate certainty evidence respectively, along with improvements in postoperative PTH and calcium levels (moderate certainty). Evidence for benefit in permanent hypoparathyroidism was directionally favorable but of","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111504","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}