Langenbeck's Archives of Surgery最新文献

{"title":"Colorectal surgeons' perspectives on the efficacy of intraoperative bowel perfusion technology with a focus on indocyanine green fluorescence angiography.","authors":"Ashokkumar Singaravelu, Philip D Mc Entee, Patrick A Boland, Alice Moynihan, Cathleen McCarrick, Alexander L Vahrmeijer, Alberto Arezzo, Luigi Boni, Roel Hompes, Ronan A Cahill","doi":"10.1007/s00423-025-03640-9","DOIUrl":"10.1007/s00423-025-03640-9","url":null,"abstract":"<p><strong>Background: </strong>Level one evidence supports indocyanine green fluorescence angiography (ICGFA) use reducing anastomotic leak rates in colorectal surgery. We surveyed surgeons exploring perceptions and factors affecting its use in daily practice and adoption as routine standard of care.</p><p><strong>Methods: </strong>Validated electronic survey distributed via the Irish Association of Coloproctology, Royal College of Surgeons in Ireland, European Society of Surgical Oncology, European Association for Endoscopic Surgery, Milan Colorectal Congress and social media.</p><p><strong>Results: </strong>200 colorectal surgeons (143 consultants) responded. 147 (73.5%) surgeons already use ICGFA, with 90 (61.2%) using it routinely and 69 (46.9%) having a concomitant research interest. Strong clinical evidence base (83.5%) and protocol standardisation (78%) were overall rated most important for bowel perfusion technology with a majority of surgeons rating lack of standardisation and inter-user variability as challenges (similar between consultants and non-consultants). Lack of training and staff, reliability concerns and data security were perceived as significant barriers by selective users compared to non-users, and cost and operating time were perceived as significant barriers by selective users compared to routine users. Most surgeons (41.5%) ideated a number needed to treat (NNT) between 20 and 40 acceptable to advocate routine ICGFA use with 28% requiring a NNT < 20. Most surgeons (38.5%) indicate a per case cost savings of €250-500 supports routine use with 17% advocating it > €750.</p><p><strong>Conclusions: </strong>With now a strong evidence base regarding clinical benefit, the survey respondents articulate remaining challenges for ICGFA as standard of care. Levels of expected benefit are largely in keeping with its reported performance.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"73"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441265","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":"Open versus laparoscopic oncologic resection for gallbladder cancer after index cholecystectomy: international multicenter comparative study.","authors":"Łukasz Masior, Maciej Krasnodębski, Emilia Kruk, Martín de Santibañes, Pedro Uad, Juan Ramos, Michał Pędziwiatr, Wojciech Serednicki, Gilton Marques Fonseca, Paulo Herman, Robert P Sutcliffe, Ravi Marudanayagam, Alessandro Parente, Arianeb Mehrabi, Ali Ramouz, Peter Lodge, Keyur Shah, Hauke Lang, Constantin Scholz, Ganesh Gunasekaran, Nazanin Khajoueinejad, Samantha Troob, Marek Krawczyk, Michał Grąt","doi":"10.1007/s00423-025-03643-6","DOIUrl":"10.1007/s00423-025-03643-6","url":null,"abstract":"<p><strong>Background: </strong>Liver resection and lymphadenectomy is a standard procedure in patients with incidental gallbladder cancer. Data regarding laparoscopic approach in this setting are scarce. The aim of this study was to compare laparoscopic and open approach in this population.</p><p><strong>Methods: </strong>This was a multicenter retrospective study including 177 patients. The primary outcome measure was overall survival (OS). The secondary outcomes measures were recurrence-free survival (RFS), lymph node yield, operative time, postoperative complications and length of hospital stay.</p><p><strong>Results: </strong>Surgery was laparoscopic in 60 (33.9%), including 18 conversions (30.0%). By intention to treat analysis, 3 and 5 year OS were 72.1% and 51.8% after laparoscopic surgery compared to 62.8% and 36.2% after open surgery (p = 0.201). 3- and 5-year RFS were 29.1% and 19.4% after laparoscopic surgery and 28.7% and 19.1% after open surgery (p = 0.697). Severe (grade ≥ 3 ) complications (p = 0.032) and Comprehensive Complication Index (CCI; p = 0.027) were both significantly higher after laparoscopic surgery (p = 0.032), although length of hospital stay was significantly shorter after laparoscopic procedures both on intention-to-treat (median 6 vs. 8 days; p = 0.004) and per protocol analysis (median 6 vs. 8 days; p = 0.004).</p><p><strong>Conclusions: </strong>Laparoscopic approach is feasible in patients with gallbladder cancer and may shorten the duration of hospital stay.</p><p><strong>Synopsis: </strong>This retrospective cohort study suggests that laparoscopic liver resection is feasible in patients with gallbladder cancer and may shorten the duration of hospital stay. Minimally invasive procedures should be performed by surgeons experienced in laparoscopic liver surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"74"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of cerebrospinal fluid diversion in patients with intracranial germinoma at Ramathibodi Hospital.","authors":"Wasawat Muninthorn, Wattana Mahattanakul, Siriwut Pokanan, Atthaporn Boongird, Tanaporn Jaroenngarmsamer, Ake Hansasuta","doi":"10.1007/s00423-025-03631-w","DOIUrl":"10.1007/s00423-025-03631-w","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial germinoma has a favorable prognosis with modern therapies, but the long-term outcome of cerebrospinal fluid (CSF) diversion for its associated hydrocephalus has been rarely focused on.</p><p><strong>Purpose: </strong>To evaluate the long-term success of CSF diversion methods-endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal (VP) shunt-in intracranial germinoma patients.</p><p><strong>Methods: </strong>Only pure intracranial germinomas with obstructive hydrocephalus and a minimum follow-up duration of 24 months were retrospectively reviewed. Their demographics, as well as pre-and postoperative data, were recorded. Patients were stratified into the ETV and the non-ETV groups and subsequently compared to determine the longevity and morbidity related to the procedures. Factors associated with the failure of CSF diversion were examined.</p><p><strong>Results: </strong>From 1993 to 2022, eighty-three pathologically confirmed intracranial germinomas were identified. Excluding four cases of mixed pathology, eight with incomplete data, and two with insufficient follow-up, we enrolled 69 eligible patients for analysis. Among them, forty-three cases with obstructive hydrocephalus were classified into the ETV (n = 22) and non-ETV (n = 21) groups. No intraoperative or immediate postoperative complications occurred. With a median follow-up of 101 months (IQR 77.75-139.75), the ETV group had no failures. In the non-ETV cohort (median follow-up 144 months (IQR 97-210)), two VP shunt cases (9.5%) required revision due to blockage, and two patients (9.5%) experienced transient over-drainage. These 4 patients were without long-term difficulty despite short-term cumbersome events. No significant factors predicting CSF diversion failure were identified. To date, all 43 patients are alive without metastases, maintaining a good quality of life.</p><p><strong>Conclusion: </strong>This study highlights ETV as a preferred CSF diversion method in pure intracranial germinoma, achieving 100% success without morbidity. Apart from simultaneous biopsy, avoiding a separate operation, this approach eliminates shunt-related complications, ensuring long-term quality of life in patients with extraordinary prognoses from modern chemo- and radiotherapy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"70"},"PeriodicalIF":2.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425642","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":"Identification of three subtypes of thyroid cancer based on IFN-γ-related genes to reveal their prognostic characteristics.","authors":"Fang Huang, Qian Sui, Ke Li","doi":"10.1007/s00423-025-03623-w","DOIUrl":"10.1007/s00423-025-03623-w","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer is one of the deadliest malignancies. Increasing evidence suggests that interferon-γ (IFN-γ) plays an important role in anti-tumor immunity and its treatment. However, the effectiveness of classifying, predicting prognosis, and immunotherapy for thyroid cancer based on IFN-γ-related genes has not been discovered.</p><p><strong>Methods: </strong>We used the Gene Set Enrichment Analysis (GSEA) database to obtain IFN-γ-related genes and classified thyroid cancer patients from The Cancer Genome Atlas (TCGA). We systematically explored the differences among various thyroid cancer subtypes from multiple perspectives, such as Kaplan-Meier survival analysis, tumor mutation analysis, immune analysis, enrichment analysis, and drug sensitivity analysis. Finally, we screened some potential drugs suitable for each population.</p><p><strong>Results: </strong>Through clustering analysis, we obtained three thyroid cancer subtypes with different IFN-γ-related gene expression levels. The survival analysis results showed significant survival differences among these three subtypes. In addition, gene mutation analysis in different subtypes found that BRAF, TTN, and TG were the top three genes with the highest mutation frequency in the three subtypes, which may be related to their prognosis. Cluster 1 and cluster 2 were the two subtypes with the greatest difference in immune cell infiltration levels, and the differentially expressed genes were mainly enriched in immune-related biological processes or signaling pathways such as leukocyte-mediated immunity, regulation of T cell activation, and chemokine signaling pathway. Eighteen compounds such as Cyclopamine, Erlotinib, FH535, Imatinib, and A-770,041 were selected as potential therapeutic drugs in this study, and their sensitivity to different subtypes varied.</p><p><strong>Conclusion: </strong>Based on bioinformatics analysis, we discovered a new classification method based on IFN-γ genes, which could divide thyroid cancer patients into three populations with significant characteristics. Different populations had different mutation patterns, immune infiltration levels, and candidate therapeutic drugs.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"69"},"PeriodicalIF":2.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425639","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":"Comparative analysis of metabolic and bariatric surgery outcomes and complications in patients under and over 50 years of age.","authors":"Alireza Rezapanah, Parisa Ebrahimi, Hamzeh Sherafati, Amin Dalili, Ali Jangjoo, Maryam Emadzadeh, Pooyan Parhizgar","doi":"10.1007/s00423-025-03644-5","DOIUrl":"10.1007/s00423-025-03644-5","url":null,"abstract":"<p><strong>Objective: </strong>The prevalence of obesity is increasing globally, necessitating effective treatment strategies. The effectiveness of Metabolic and Bariatric surgery (MBS) as a therapeutic option across different age groups remains debated. This study aimed to compare the outcomes and complications of MBS in patients less than 50 years old and 50 years or older.</p><p><strong>Methods and materials: </strong>This retrospective study analyzed data from patients who underwent MBS in a referral hospital in Mashhad, Iran, between April 2012 and March 2017. The recorded follow-up information was included for patients with at least six months post-surgery.</p><p><strong>Results: </strong>The study included 709 patients, 519 patients aged ≤ 50 years, and 190 patients > 50. The average age, weight, and BMI of the participants were 42.7 ± 13.24 years, 126.6 ± 31.23 kg, and 47.2 ± 10.37 kg/m2, respectively. Both age groups demonstrated significant improvements in BMI, cholesterol, and TG levels post-surgery, while significant improvements in FBS levels were observed only in the younger group (p < 0.05). Overall, substantial reductions in the prevalence of obesity-related comorbidity were observed in both age groups post-surgery (p < 0.05). None of the post-surgical complications had a statistically significant difference between the two age groups (p > 0.05).</p><p><strong>Conclusion: </strong>MBS is effective in reducing obesity-related comorbidities, regardless of age. Age should not be a limiting factor for MBS, as the benefits and complications do not differ significantly between patients under and over 50 years old.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"71"},"PeriodicalIF":2.1,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425638","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":"Disparity in endoscopic localisation of early distal colorectal cancers: a retrospective cohort analysis from a single institution.","authors":"Aiswarya Sukumar, Shafquat Zaman, Omar E S Mostafa, Jamie Patel, Akinfemi Akingboye, Peter Waterland","doi":"10.1007/s00423-025-03642-7","DOIUrl":"10.1007/s00423-025-03642-7","url":null,"abstract":"<p><strong>Background: </strong>Accurate staging of distal colorectal cancers is paramount in guiding neoadjuvant therapy, peri-operative, and ostomy planning. Early colonic lesions can be difficult to visualise on computed tomography (CT) scans, with tumour location solely deduced via endoscopy with the potential for introducing error. We aimed to address the paucity in literature in this area and assessed the accuracy of radiological and endoscopic localisation of distal colorectal cancers.</p><p><strong>Methods: </strong>Retrospective analysis of an electronic database of patients at a large District General Hospital (DGH) diagnosed with distal colorectal cancer between January 2014 to January 2023 was performed. Patient demographics, investigations, endoscopic, and operative findings were analysed. Outcomes were assessed to determine disparities between pre-operative endoscopy and final tumour location.</p><p><strong>Results: </strong>A total of 212 patients were endoscopically diagnosed with distal sigmoid tumour. Of these, 207 (97.6%) had a CT scan performed with 25.1% (52/207) lesions not being identified on this imaging modality with the remainder (74.9%; 155/207) being reported as visible. 38.2% (79/207) of tumours were in the sigmoid colon, 17.4% (36/207) rectosigmoid, and 19.3% (40/207) in the rectum. Pre-operative magnetic resonance imaging (MRI) was performed in 42.5% (90/212) of cases showing 84 tumours: 6.0% (5/84) sigmoid colon, 9.5% (8/84) rectosigmoid and 83.3% (70/84) rectal cancers (upper: 34, mid-rectum: 26, low: 10), with one anal cancer. 42.3% (22/52) of patients with non-visible lesions on CT had MRI scans: 68.2% (15/22) had rectal cancer (upper: 10, mid-rectum: 4, low: 1). Of the 30 where MRI was not performed, 46.7% (14) had sigmoid cancer, 16.7% (5) rectosigmoid, and 33.3% (10) rectal intraoperatively. Overall, 30.7% (65/212) of patients reported as having a distal sigmoid lesion endoscopically in fact had rectal cancer intra-operatively (rectosigmoid lesions excluded).</p><p><strong>Conclusion: </strong>Endoscopic localisation of distal colorectal tumours can be unreliable for accurate staging and operative planning. A pre-operative MRI scan should be considered in such instances, and particularly for non-visible lesions on CT scan. This may improve peri-operative planning, staging accuracy and patient outcomes.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"68"},"PeriodicalIF":2.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408785","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":"Overall survival is comparable between percutaneous radiofrequency ablation and liver resection as first-line therapies for solitary 3-5 cm hepatocellular carcinoma.","authors":"Shih-Da Chung, Chee-Chien Yong, Kwong-Ming Kee, Sheng-Nan Lu, Tsung-Hui Hu, Jing-Houng Wang, Chao-Hung Hung, Chien-Hung Chen, Yueh-Wei Liu, Wei-Feng Li, Chih-Chi Wang, Yi-Hao Yen, Chih-Yun Lin","doi":"10.1007/s00423-025-03632-9","DOIUrl":"10.1007/s00423-025-03632-9","url":null,"abstract":"<p><strong>Purpose: </strong>Few studies have compared survival outcomes between liver resection (LR) and percutaneous radiofrequency ablation (RFA) for treating solitary 3-5 cm hepatocellular carcinoma (HCC). We aimed to clarify this issue.</p><p><strong>Methods: </strong>Patients with Child-Pugh class A liver disease and a solitary HCC of 3-5 cm without macrovascular invasion or extrahepatic metastasis who underwent LR or percutaneous RFA between 2011 and 2021 were enrolled in this retrospective study; 310 patients underwent LR and 114 patients underwent percutaneous RFA. Propensity score matching (PSM) was used to balance baseline variables, including age, sex, alpha-fetoprotein level, and Model for End-Stage Liver Disease score, between the two groups.</p><p><strong>Results: </strong>Before PSM, 5-year overall survival (OS) and recurrence-free survival (RFS) were significantly lower in the percutaneous RFA group than in the LR group (both p < 0.001). After PSM, 5-year OS was comparable between the two modalities (p = 0.367); however, 5-year RFS was significantly lower in the RFA group than in the LR group (p = 0.001). The two modalities did not differ in severe post-treatment complications (p = 1.000).</p><p><strong>Conclusions: </strong>Five-year OS did not differ between treatment modalities for patients with a solitary HCC of 3-5 cm; however, the LR group's 5-year RFS was superior. LR should be recommended as the first-line treatment for these patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"66"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399025","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 importance of incisional hernia in patients resected for colorectal liver metastases: quality of life and abdominal wall symptoms.","authors":"Peter Strandberg Holka, Gert Lindell, Bobby Tingstedt, Christian Sturesson","doi":"10.1007/s00423-025-03638-3","DOIUrl":"10.1007/s00423-025-03638-3","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernia (IH) after open liver surgery is a well-recognized complication. The clinical importance of IH detected on computed tomography in terms of objective abdominal wall discomfort and impairment of quality of life (QoL) is less well known.</p><p><strong>Methods: </strong>Patients who underwent curative surgery for colorectal liver metastases between 2010 and 2015 at a single center and were alive in February 2017 were asked to complete a ventral hernia pain questionnaire and the EORTC QLQ-C30 QoL questionnaire.</p><p><strong>Results: </strong>A total of 105 patients (80%) completed the questionnaires. Forty-three patients (42%) developed IH. The majority (77%) of IHs were < 2.5 cm. Patients who had an IH before liver surgery developed a new IH to a greater extent (P = 0.001). There were no significant differences regarding abdominal wall symptoms and QoL between patients with and without IH. However, about half (48%) of all patients had abdominal wall symptoms after a median follow-up of 34 months.</p><p><strong>Conclusion: </strong>Radiologically detected IH after open liver surgery has low clinical importance. About half of all patients who underwent liver surgery experienced abdominal wall symptoms a long after surgery, but these symptoms were not related to IH.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"67"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398332","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":"Short-acting urapidil compared to long-acting phenoxybenzamine in the management of pheochromocytoma.","authors":"A Feld, I Mintziras, S Wächter, M Zentgraf, D K Bartsch, F Czubayko, K Holzer","doi":"10.1007/s00423-025-03627-6","DOIUrl":"10.1007/s00423-025-03627-6","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with pheochromocytoma current guidelines recommend preoperative alpha-adrenoceptor blockade with selective or nonselective antagonists for at least 7-14 days. To date, no information exists about orally administered urapidil retard, a short-acting selective antagonist.</p><p><strong>Methods: </strong>The medical records of consecutive patients with pheochromocytoma between 2010 and 2023 were reviewed. Patients received phenoxybenzamine between 2010 and 2017, intravenous urapidil was given between 2017 and 2019. Orally administered urapidil retard has been used from 2019 until present.</p><p><strong>Results: </strong>Forty-nine patients with pheochromocytomas were included. Twenty-six patients received orally administered long-acting phenoxybenzamine and 23 patients were pretreated with short-acting intravenous (n = 8) or orally administered urapidil (n = 15). Treatment prior to surgery was significantly shorter with intravenously (3 days (IQR, 3-4), p = 0.015) or orally administered urapidil (2 days (IQR 2-3), p = 0.003) compared to phenoxybenzamine (7 days (IQR, 4-10)). Side effects were more often in the phenoxybenzamine group (17/26 vs 6/23, p = 0.02). The modified hemodynamic instability (HI) score was low and there was no significant difference between patients treated with phenoxybenzamine and those treated with intravenous or oral urapidil (29 (IQR 18.5-38); 26 (IQR 18-42); 31 (IQR 15-36) ns). No 30-day postoperative mortality or cardiovascular complications occurred in any of the three groups. The postoperative hospital stay was significantly shorter in the orally administered urapidil group compared to the phenoxybenzamine group (3 days (IQR 3-5)) vs 4 days (IQR 4-5)), p = 0.04).</p><p><strong>Conclusion: </strong>Oral pretreatment with urapidil retard is well tolerated for patients with pheochromocytoma, enabling a safe intra- and postoperative course.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"65"},"PeriodicalIF":2.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399059","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":"High risk of short-term mortality and postoperative complications in patients with generalized peritonitis undergoing major emergency abdominal surgery-a cohort study.","authors":"Maria Olausson, Mette A Tolver, Ismail Gögenur","doi":"10.1007/s00423-025-03637-4","DOIUrl":"10.1007/s00423-025-03637-4","url":null,"abstract":"<p><strong>Background: </strong>Secondary generalized peritonitis is a potentially life-threatening condition. The aim of this study was to investigate the association between secondary generalized peritonitis and short-term mortality and postoperative complications in patients undergoing major abdominal emergency surgery.</p><p><strong>Methods: </strong>The study included patients with the age ≥ 18 years undergoing major emergency abdominal surgery in a University Hospital from 2017 to 2019 after the introduction of a perioperative bundle care program. The primary outcome measures were short-term mortality, defined as death within 30 and 90 days after surgery and postoperative complications within 30 days after surgery. Uni- and multivariable logistic regression analyses were performed to evaluate risk factors for 30- and 90-days mortality and 30-days postoperative complications.</p><p><strong>Results: </strong>A total of 591 patients were included, of whom 21% (124/591) had generalized peritonitis. The overall 30 day-mortality rate was 12.5% (74/591). Patients with generalized peritonitis had a significantly higher 30-day mortality rate than patients with non-generalized peritonitis 18.5% (23/124) vs. 10.9% (51/467), P = 0.033. Generalized peritonitis was an independent risk factor for 30- and 90- days mortality. There was a significantly higher rate of admission to ICU for patients with generalized peritonitis 39.5% (49/124) vs. 12.6% (59/467), P < 0.001. Patients with generalized peritonitis had significantly higher rates of surgical and non-surgical complication compared to patients with non-generalized peritonitis 87.1% (108/124) vs. 65.7% (307/467), P < 0.001. Generalized peritonitis was an independent risk factor of 30 days postoperative complications.</p><p><strong>Conclusion: </strong>In a population undergoing major emergency abdominal surgery treated in a perioperative optimization protocol, generalized peritonitis was an independent risk factor for both 30- and 90-days mortality and postoperative complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"64"},"PeriodicalIF":2.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11814017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398284","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}