Langenbeck's Archives of Surgery最新文献

{"title":"Prognostic significance and risk factors of mediastinal lymph node metastasis in esophagogastric junction cancer: a single-center, retrospective study.","authors":"Yudai Higuchi, Suguru Maruyama, Katsutoshi Shoda, Yoshihiko Kawaguchi, Ryo Saito, Koichi Takiguchi, Wataru Izumo, Yuki Nakata, Kensuke Shiraishi, Shinji Furuya, Hidetake Amemiya, Hiromichi Kawaida, Daisuke Ichikawa","doi":"10.1007/s00423-024-03529-z","DOIUrl":"https://doi.org/10.1007/s00423-024-03529-z","url":null,"abstract":"<p><strong>Background: </strong>Although the optimal extent of lymph node dissection in esophagogastric junction cancer (EGJC) has been reported, the efficacy of mediastinal lymph node dissection remains unclear. We aimed to identify risk factors for mediastinal lymph node metastasis and its prognostic impact in patients with EGJC.</p><p><strong>Methods: </strong>A total of 100 consecutive patients who underwent curative surgery for EGJC were eligible. We examined the rates of metastasis, prognosis, and therapeutic value index at each mediastinal lymph node station. In addition, multivariate analyses were performed to identify risk factors for mediastinal lymph node metastasis.</p><p><strong>Results: </strong>The rates of upper, middle, and lower mediastinal lymph node metastases were 12.0%, 20.7%, and 13.2%, respectively. The 5-year overall survival rate was lower in patients with mediastinal lymph node metastasis than in those without mediastinal lymph node metastasis (11.1% vs. 59.2%, p < 0.01). The therapeutic value index was 0 in patients with upper/middle mediastinal lymph node metastasis, and mediastinal lymph node metastasis was an independent prognostic factor (hazard ratio 6.59, 95% confidence interval [CI] 2.48-17.9, p < 0.01). Additionally, the length of esophageal invasion and the presence of hiatal hernia were independent predictors of mediastinal lymph node metastasis (odds ratio 8.21, 95%CI 1.44-46.8, p = 0.02 and odds ratio 7.13, 95%CI 1.22-41.8, p = 0.03).</p><p><strong>Conclusion: </strong>No survival benefit of mediastinal lymph node dissection was observed. Intensive multidisciplinary treatment could be considered in patients with predicted mediastinal lymph node metastasis, such as those with longer esophageal invasion and those with hiatal hernia.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"346"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623274","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":"Risk factors for wound complications after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared to repeated liver resection - a propensity score matching analysis.","authors":"Elias Khajeh, Nastaran Sabetkish, Ali Ramouz, Alexander Werba, Rosa Klotz, Christoph W Michalski, Arianeb Mehrabi, Frank Pianka","doi":"10.1007/s00423-024-03540-4","DOIUrl":"10.1007/s00423-024-03540-4","url":null,"abstract":"<p><strong>Aim: </strong>Sufficient liver function is crucial in extracellular matrix growth, hemostasis, and wound healing. Repeated abdominal surgery is a known risk factor for the development of wound complications. This study aimed to evaluate this high-risk constellation in patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and repeated liver resections (RLR) in comparison to single liver resection (SLR).</p><p><strong>Method: </strong>Forty patients who underwent ALPPS between 2011 and 2020 were evenly matched with patients undergoing RLR or SLR (n = 40 per group) using propensity scores. Postoperative outcomes were compared and factors associated with wound complications were analyzed.</p><p><strong>Results: </strong>Postoperative wound complications were significantly more frequent in ALPPS group (p = 0.001). The reoperation rate was not significantly different between the three groups (p = 0.143). However, surgical reintervention due to wound complications occurred more frequently in the ALPPS group in relation to RLR and SLR (17.5% vs. 7.5% and 5% respectively). Length of stay was significantly longer in the ALPPS group (p = 0.033). ALPPS was an independent risk factor for postoperative wound complication (OR = 8.55, 95% CI:1.07-68.44, p = 0.043). Risk factor analysis identified age ≥ 60 years (OR = 27.64, 95% CI:3.09-246.75, p = 0.003), BMI ≥ 30 kg/m² (OR = 30.21, 95% CI:3.35-271.83, p = 0.002), and low postoperative albumin levels (OR = 168.41, 95% CI:7.76-3651.18, p = 0.001) as independent predictors of postoperative wound complications after major liver resection.</p><p><strong>Conclusion: </strong>Patients undergoing ALPPS and RLR are faced with a high risk of developing wound complications. Older age, obesity, a history of previous abdominal surgery, and a decreased postoperative albumin level were independent risk factors for wound complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"347"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623289","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":"Results of a German nationwide survey on perioperative cardiac management in vascular surgery.","authors":"Dmitriy I Dovzhanskiy, Moritz S Bischoff, Karola Passek, Dittmar Böckler","doi":"10.1007/s00423-024-03523-5","DOIUrl":"10.1007/s00423-024-03523-5","url":null,"abstract":"<p><p>Because of the lack of specific recommendations concerning cardiac risk stratification before vascular surgery, appropriate decisions remain individual. The aim of the present study was to evaluate the perioperative cardiac management in vascular surgery in Germany.</p><p><strong>Methods: </strong>This article is based on a survey from 2018 of heads of German vascular surgical departments or units regarding their experience with perioperative cardiac management. The questionnaire asked about the experience with preoperative cardiac evaluation and its extension, awareness of perioperative myocardial ischemia, the art of postoperative monitoring and the routine use of the best medical treatment.</p><p><strong>Results: </strong>In total, 62% of responders agreed that perioperative myocardial ischemia is a relevant postoperative problem in their clinic after open abdominal aortic surgery, while 47% stated the same after vascular surgery (VS) like carotid endarterectomy, peripheral arterial surgery or EVAR. Preoperative cardiological evaluations are performed routinely by 87% of responders before open abdominal aortic surgery and by 42% before VS. Preoperative cardiac evaluation included cardiac echography in 92% and stress diagnostics (stress echography, stress ECG) in 38%. Routine preoperative cardiac catheterisation is performed in 4% before OAS and only 0.5% before VS. In addition, 79% of participants initiate acetylsalicylic acid routinely and 68% use statins preoperatively. The serum troponin diagnostic test in asymptomatic patients was routinely applied by 19% of responders after OAS and by 6% after VS.</p><p><strong>Conclusion: </strong>Perioperative myocardial ischemia is considered a relevant problem, primarily after aortic surgery. The preoperative cardiac stress diagnostics among vascular surgeons does not seem to be sufficiently widespread. The preoperative initiation of acetylsalicylic acid and statins is not routine in 30% of hospitals.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"345"},"PeriodicalIF":2.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623286","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":"Spinal analgesia with continuous local wound infusion vs thoracic epidural analgesia after open pancreaticoduodenectomy.","authors":"Harrison Davies, Ngee-Soon Lau, Michael Wilson, Sivakumar Gananadha","doi":"10.1007/s00423-024-03534-2","DOIUrl":"10.1007/s00423-024-03534-2","url":null,"abstract":"<p><strong>Background: </strong>The current gold standard for postoperative analgesia following a pancreaticoduodenectomy (PD) is a thoracic epidural analgesia (TEA). Spinal analgesia with continuous wound infusion (CWI) of local anaesthetic is an emerging alternative modality. This non-inferiority study aimed to compare CWI with spinal analgesia to TEA and assess its impact on clinical outcomes.</p><p><strong>Methods: </strong>A retrospective observational analysis of patients undergoing open pancreatoduodenectomy through a midline laparotomy. A total of 74 patients were included in the study forming two groups: CWI (n = 33) and TEA (n = 41).</p><p><strong>Results: </strong>TEA resulted in lower median pain scores at rest (p = 0.002) and with coughing (p = 0.005) on postoperative day 2. CWI was non-inferior to TEA for all other pain outcomes measures from days 0-5. Patients in the CWI group had a shorter time to first bowel motion (p = 0.001), commencement of a liquid diet (p = 0.04), earlier removal of nasogastric tube (p = 0.005), abdominal drain (p = 0.003) and indwelling catheter (p < 0.001). Analgesic failure and postoperative nausea and vomiting were also less frequent (p = 0.001 and p < 0.001 respectively).</p><p><strong>Conclusion: </strong>Local CWI with spinal analgesia was non-inferior to TEA for pain management in open pancreaticoduodenectomy. CWI demonstrated advantages in measures associated with enhanced recovery after surgery programs without disadvantages in terms of analgesia requirements.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"344"},"PeriodicalIF":2.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621703","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":"Prognosis analysis and nomogram for predicting lateral lymph node metastasis in Medullary Thyroid Microcarcinoma.","authors":"Jinming Zhang, Dongmei Huang, Ming Gao, Xiangqian Zheng","doi":"10.1007/s00423-024-03538-y","DOIUrl":"https://doi.org/10.1007/s00423-024-03538-y","url":null,"abstract":"<p><strong>Background: </strong>Currently, the incidence rate of Medullary Thyroid Microcarcinoma (micro-MTC) has an increasing trend, but the incidence of LNM and prognosis were still ambiguous. We analyzed the status of neck LNM of micro-MTC patients and created a prognostic nomogram to predict the probability of lateral lymph node metastasis (LLNM) for clinical practice.</p><p><strong>Methods: </strong>This is a retrospective study included patients with micro-MTC from SEER database for the period from 2004 to 2017 and patients from our medical center for the period from 2011 to 2019. A nomogram was constructed and the accuracy and clinical practicability were separately tested by Harrell's C-indexes, calibration plots, Receiver operating characteristic curve (ROC) and decision curve analyses (DCA).</p><p><strong>Results: </strong>A total of 413 patients with micro-MTC from SEER database and 64 patients with micro-MTC from our department enrolled in the study. There were 16.0% and 9.4% cases in SEER database and 39.1% and 25.0% cases in our department appeared LNM and LLNM, respectively. Besides, a nomogram was constructed to assess the incidence of LLNM with good C-index, which was 0.850 in training cohort and 0.856 in validation cohort. The results of the area under the curve (AUC) were 0.830 in training cohort, 0.801 in validation cohort and 0.832 in external testing cohort, respectively.</p><p><strong>Conclusion: </strong>A relatively high rate of LLNM than expected was found, which should be emphasized. The prediction model could facilitate clinicians to assess the probability of LLNM and make a personalized treatment strategy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"343"},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623272","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":"Risk factors and predictive model development for high blood loss in minimally invasive distal pancreatectomy: a retrospective cohort study.","authors":"Cong Chen, Ronggui Lin, Xianchao Lin, Heguang Huang, Fengchun Lu","doi":"10.1007/s00423-024-03533-3","DOIUrl":"https://doi.org/10.1007/s00423-024-03533-3","url":null,"abstract":"<p><strong>Background: </strong>High blood loss is an adverse event related to increased morbidity and poorer outcomes in pancreatic surgery patients. The aim of this study was to identify risk factors and establish a predictive model for high perioperative blood loss (HPBL) in minimally invasive distal pancreatectomy (MIDP).</p><p><strong>Methods: </strong>We collected data from 353 patients who underwent MIDP at a university affiliated tertiary hospital between January 2016 and October 2023. Perioperative blood loss was calculated based on pre- and postoperative hemoglobin concentrations according to a combination of the formulas provided by Nadler and Gross. Multivariate logistic regression analyses were performed for the training cohort to identify the clinical factors independently associated with perioperative blood loss (PBL). A predictive nomogram based on these factors was established and validated.</p><p><strong>Results: </strong>Weight, imaging findings, serum albumin concentration, MIDP experience, spleen treatment, and operation time were independent predictors for HPBL. The established model for predicting HPBL showed that the area under the curve (AUC) was 0.799 (95% CI = 0.746-0.853) and 0.852 (95% CI = 0.760-0.943) for the training cohort and validation cohort, respectively. When utilized to predict blood transfusion, the AUC was 0.778 (95% CI = 0.691-0.865) in the training cohort and 0.818 (95% CI = 0.681-0.955) in the validation cohort. Patients with a high predicted risk had significantly higher incidences of postoperative pancreatic fistula, intra-abdominal infection, and longer hospital stays than patients with a low risk.</p><p><strong>Conclusions: </strong>We established and validated a model for predicting HPBL in MIDP patients. This novel model may have future utility when generating surgical strategies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"342"},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623288","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":"Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB).","authors":"Mohamed Abdul Moneim El Masry, Islam Abdul Rahman, Mohamed Fathy Mahmoud Elshal, Ahmed Maher Abdul Moneim","doi":"10.1007/s00423-024-03525-3","DOIUrl":"10.1007/s00423-024-03525-3","url":null,"abstract":"<p><strong>Purpose: </strong>Diverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.</p><p><strong>Methods: </strong>This is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients' data until 2 years of follow-up were compared.</p><p><strong>Results: </strong>This study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.</p><p><strong>Conclusion: </strong>D-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"340"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623268","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":"Ghost-ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer: results of a randomised controlled multicentre pilot trial (DRKS00013997).","authors":"Felix J Hüttner, Pascal Probst, André L Mihaljevic, Lukas D Sauer, Colette Doerr-Harim, Alexis Ulrich, Samira Stratmeyer, Rosa Klotz, Markus K Diener, Phillip Knebel","doi":"10.1007/s00423-024-03530-6","DOIUrl":"https://doi.org/10.1007/s00423-024-03530-6","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of the current pilot trial was to evaluate whether ghost ileostomy is a safe alternative to the current standard of care in terms of a conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision (LAR/TME) for rectal cancer.</p><p><strong>Methods: </strong>This randomized controlled pilot trial included patients undergoing LAR/TME, randomly assigning them to ghost ileostomy or conventional loop ileostomy intraoperatively. Follow-up spanned 6 months, evaluating the following endpoints: comprehensive complication index (CCI), postoperative morbidity, transformation of ghost ileostomy, presence of ostomy at 6 months, Wexner score, and quality of life (EORTC QLQ-C30 & CR29). Exploratory statistical analysis based on the intention-to-treat principle was conducted.</p><p><strong>Results: </strong>Recruiting 30 patients from May 2018 to September 2022, the trial was prematurely stopped due to slow recruitment. The mean CCI was comparable between groups at any point of time (at 6 months: 30.7 vs. 29.7, p = 0.889). There was no mortality and no need for creation of a terminal ostomy. Anastomotic leakage rates were similar in ghost ileostomy and loop ileostomy groups (p > 0.99). The ghost ileostomy was converted into a conventional loop ileostomy in 6 of 15 (40.0%) patients. Neither postoperative function, nor the overall quality of life showed significant differences.</p><p><strong>Conclusion: </strong>Ghost ileostomy appears as a viable and safe option for selectively deciding ileostomy creation in LAR/TME for rectal cancer. However, challenges in patient selection, excluding those at high risk for anastomotic leakage, limit widespread application and call for optimization in future research.</p><p><strong>Trial-registration: </strong>German Clinical Trials Register ( https://drks.de/ ): DRKS00013997; date of registration: April 9th 2018.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"341"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623270","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":"Ideal outcome post-pancreatoduodenectomy: a comprehensive healthcare system analysis.","authors":"Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis","doi":"10.1007/s00423-024-03532-4","DOIUrl":"https://doi.org/10.1007/s00423-024-03532-4","url":null,"abstract":"<p><strong>Introduction: </strong>Indicators, such as mortality and complications, are commonly used to measure the quality of care. However, a more comprehensive assessment of surgical quality is captured using composite outcome measures such as Textbook Outcome (TO), Optimal Pancreatic Surgery, and a newer 'Ideal Outcome' (IO) measure. We reviewed our institutional experience to assess the impact of demographics, comorbidities, and operative variables on IO after pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>A retrospective study was conducted on PD patients at Northwell Health between 2009 and 2023. IO was determined by the absence of six adverse outcomes, including in-hospital mortality, Clavien-Dindo ≥ III complications, clinically-relevant postoperative pancreatic fistula, reoperation, hospital stay > 75th percentile, and readmission within 30 days. Logistic regression analyzed the effects of various factors on achieving IO.</p><p><strong>Results: </strong>Of the 578 patients who underwent PD, 248 (42.91%) achieved the IO. On multivariable analysis, factors associated with increased odds of achieving IO included neoadjuvant chemotherapy (OR 1.30, 95% CI 1.05-1.62) and the presence of neuroendocrine tumors (OR 3.37, 95% CI 1.35-8.41). Percutaneous transhepatic biliary drainage (PTBD) (OR 0.34, 95% CI 0.14-0.80) and older age (≥ 70 years) (OR 0.48, 95% CI 0.32-0.74) were associated with decreased odds of achieving IO. Patients with IO had significantly improved survival on Kaplan-Meier log-rank test (p = 0.001) as well as adjusted Cox analysis (HR 0.62 95% CI: 0.39-0.97).</p><p><strong>Conclusion: </strong>IO may offer a comprehensive metric for assessing PD outcomes, highlighting the impact of age, chemotherapy, biliary drainage, and tumor types. These findings suggest targeted interventions and quality improvements could enhance PD outcomes by addressing modifiable factors and refining clinical strategies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"339"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623271","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":"Comparison of robot-assisted, open, and laparoscopic-assisted surgery for cholangiocarcinoma: a network meta-analysis.","authors":"Sifan Dong, An Jiang, Shiqi An, Junzhi Xiao","doi":"10.1007/s00423-024-03541-3","DOIUrl":"10.1007/s00423-024-03541-3","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to compare the efficacy of robot-assisted, laparoscopic-assisted and open surgery in the treatment of cholangiocarcinoma, and to evaluate the clinical effect of three surgical methods in the treatment of cholangiocarcinoma by network Meta-analysis.</p><p><strong>Methods: </strong>A systematical retrieval in PubMed and Web of Science was performed for relative literature on the effects of robot-assisted(RA), laparoscopy-assisted(LA), and open surgery(OA) for cholangiocarcinoma in treating cholangiocarcinoma. A literature search updated to September 1st, 2024, was performed.</p><p><strong>Results: </strong>Studies have shown that the length of R0 resection, complication rate, 30-day mortality, Transfusion rate, Lymph Node Metastasis Rate, and hospital stay in RA are superior to LA and open surgery. The relative effectiveness of the three surgical methods in terms of operation time were: open surgery, laparoscope-assisted surgery, and robot-assisted surgery, and there was no significant difference among the three groups.</p><p><strong>Conclusion: </strong>Robot-assisted surgery is safe and feasible in the treatment of cholangiocarcinoma, but more clinical evidence is needed to confirm these findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"336"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604913","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}