Langenbeck's Archives of Surgery最新文献

{"title":"Preoperative predictive indicators for resolution of hypertension in patients with unilateral primary aldosteronism: development of a nomogram model.","authors":"Lin Yang, Lei Yan, Laiyuan Qiu, Yi Sun, Gangli Gu","doi":"10.1007/s00423-025-03615-w","DOIUrl":"10.1007/s00423-025-03615-w","url":null,"abstract":"<p><strong>Background: </strong>Primary aldosteronism (PA) is the leading surgically treatable cause of hypertension, with adrenalectomy as the definitive treatment for unilateral PA (UPA). However, some patients have persistent hypertension after surgery. This study aims to identify preoperative factors affecting surgical outcomes and develop a predictive model for postoperative hypertension resolution.</p><p><strong>Methods: </strong>We reviewed and analyzed the medical records of 206 patients who underwent unilateral adrenalectomy for UPA at Qilu Hospital of Shandong University (2011-2022). As a training cohort, the data of the 166 patients from 2013 to 2022 was analyzed using univariate and multivariate logistic regression to explore the relationship between preoperative clinical and biochemical data and postoperative BP normalization. The remaining 40 patients from 2011 to 2012 were used as a validation cohort. A predictive model of the nomogram was constructed utilizing significant variables through multivariate logistic regression analysis. The model's effectiveness was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves and compared with previous prediction models using the Delong test.</p><p><strong>Results: </strong>In the training cohort of 166 patients, 78 (46.9%) achieved postoperative normotension without medication, while 88 (53.1%) required ongoing antihypertensive treatment. Multifactorial analysis identified age, number of antihypertensive medications, preoperative maximum systolic blood pressure (SBP), left ventricular ejection fraction (LVEF), serum creatinine (Cr) levels, and a history of hypokalemia as independent predictors of postoperative BP normalization. Calibration curves showed excellent agreement between predicted and actual outcomes, and DCA indicated that clinical interventions based on this model are beneficial at various risk thresholds. Comparison with previous models showed our model outperformed the Aldosteronoma Resolution Score (ARS) in the Asian population and was comparable to the Morisaki score.</p><p><strong>Conclusion: </strong>A predictive model developed with variables including age, number of anti-hypertensive medications, preoperative maximum SBP, LVEF, serum Cr levels, and history of hypokalemia effectively predicts therapeutic outcomes following unilateral adrenalectomy for UPA patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"52"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052899","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":"Can surgeons trust AI? Perspectives on machine learning in surgery and the importance of eXplainable Artificial Intelligence (XAI).","authors":"Johanna M Brandenburg, Beat P Müller-Stich, Martin Wagner, Mihaela van der Schaar","doi":"10.1007/s00423-025-03626-7","DOIUrl":"10.1007/s00423-025-03626-7","url":null,"abstract":"<p><strong>Purpose: </strong>This brief report aims to summarize and discuss the methodologies of eXplainable Artificial Intelligence (XAI) and their potential applications in surgery.</p><p><strong>Methods: </strong>We briefly introduce explainability methods, including global and individual explanatory features, methods for imaging data and time series, as well as similarity classification, and unraveled rules and laws.</p><p><strong>Results: </strong>Given the increasing interest in artificial intelligence within the surgical field, we emphasize the critical importance of transparency and interpretability in the outputs of applied models.</p><p><strong>Conclusion: </strong>Transparency and interpretability are essential for the effective integration of AI models into clinical practice.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"53"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052889","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":"Effect of internal pancreatic duct stent on reducing long-term pancreaticojejunostomy stenosis following pancreaticoduodenectomy.","authors":"Wei-Hsun Lu, Ying-Jui Chao, Ting-Kai Liao, Ping-Jui Su, Chih-Jung Wang, Yan-Shen Shan","doi":"10.1007/s00423-025-03622-x","DOIUrl":"10.1007/s00423-025-03622-x","url":null,"abstract":"<p><strong>Background: </strong>As survival following PD improved, long-term complications have emerged as an issue in current era. Pancreaticojejunostomy stenosis is the common long-term sequel after PD but rarely addressed. This study aimed to investigate the benefit of pancreatic duct stent in reducing PJ stenosis after PD.</p><p><strong>Methods: </strong>Between July 2006 and July 2019, patients undergoing PD with follow-up more than 1 year were recruited. Patients were divided into internal stent, external stent, and no stent groups. We reviewed the Computed tomography (CT) to measure the diameter of pancreatic duct and stent migration at 3 months and 1 year after PD. PJ stenosis was defined as pancreatic duct diameter > 3 mm. Perioperative variables were collected for analysis.</p><p><strong>Results: </strong>Totally, 506 patients were included 349 patients in internal stent group, 84 patients in the external stent, and 73 patients in no stent group. There was no difference in preoperative P-duct size between the IS and ES group (3.39 ± 1.78 mm vs 3.26 ± 1.89 mm, p = 0.481), while the P-duct size was larger in ES group compared to the IS group (3.22 ± 2.44 mm vs. 1.94 ± 2.08 mm, p < 0.001) one year after PD. In the internal stent group, the rate of stent migration was 22.1% at 3 months and 67.9% at 1 year post-operatively. CR-POPF (OR 2.24, p = 0.015) and P-duct stent retention at PJ > 3 months (OR 0.45, p < 0.001) were the independent factors for 1-year PJ stenosis in multivariate analysis.</p><p><strong>Conclusion: </strong>Retention of internal pancreatic duct stents at the anastomosis for more than 3 months can reduce post-PD PJ stenosis. Extended retention of internal pancreatic duct stents reduces PJ stenosis, highlighting its critical role in preventing long-term complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"51"},"PeriodicalIF":2.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047084","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":"Diaphragmatic stripping versus full-thickness diaphragmatic resection in cytoreductive surgery: a meta-analysis of the current evidence.","authors":"Maria Chara Stylianidi, Sascha Vaghiri, Alireza Pandkhahi, Sultan Kazziha, Ward Al Akeel, Wolfram Trudo Knoefel, Dimitrios Prassas","doi":"10.1007/s00423-025-03611-0","DOIUrl":"10.1007/s00423-025-03611-0","url":null,"abstract":"<p><strong>Purpose: </strong>The primary objective was to compare the intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis who underwent cytoreductive surgery.</p><p><strong>Methods: </strong>According to the PRSIMA guidelines, a comprehensive literature search was conducted for studies comparing postoperative pulmonary complications as well as intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis necessitating cytoreductive surgery. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and standardized mean differences (SMDs) with 95 per cent confidence intervals were calculated.</p><p><strong>Results: </strong>Ten studies with 1325 patients were included in this meta-analysis. Diaphragmatic stripping was associated with lower incidence of pleural effusion (OR 0.47, 95% CI 0.35-0.63, p < 0.00001) and pneumothorax (OR 0.52, 95% CI 0.35-0.78, p = 0.002), less severe postoperative complications (Clavien-Dindo Grade ≥ 3) (OR 0.43, 95% CI 0.30-0.63, p < 0.0001), and shorter duration of surgery (SMD -0.31, 95% CI -0.54 - -0.08, p = 0.007). No significant differences were observed in postoperative subdiaphragmatic abscess occurrence, intraoperative blood loss, hospital- and ICU-stay, and 90-day mortality.</p><p><strong>Conclusions: </strong>Diaphragmatic stripping leads to a significantly lower rate of postoperative pulmonary and severe complications compared to diaphragmatic full-thickness resection, while oncological outcomes do not appear to be worse. Larger trials with standardized study protocols and long-term survival data are needed to validate the results presented here.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"50"},"PeriodicalIF":2.1,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039384","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":"A systematic review and meta-analysis on the effects of intravenous dexamethasone on postoperative outcomes in patients undergoing total knee arthroplasty.","authors":"Peijie Li, Yongjie Qiao, Jiankang Zeng, Jiahuan Li, Fei Tan, Yafei Cao, Haoqiang Zhang, Tao Wang, ShengHu Zhou","doi":"10.1007/s00423-025-03618-7","DOIUrl":"10.1007/s00423-025-03618-7","url":null,"abstract":"<p><strong>Purpose: </strong>Dexamethasone has shown promising efficacy in alleviating pain and enhancing outcomes undergoing TKA. However, an optimal route of administration, dosage, and treatment duration have not yet been established. This study is to assess the effects of intravenous dexamethasone administration on postoperative pain management and prognosis in patients undergoing TKA.</p><p><strong>Methods: </strong>Data were retrieved from PubMed, Embase, the Cochrane Library, and Web of Science to compare the effects of intravenous dexamethasone administration versus non-administration on outcomes following TKA. Primary endpoints included pain scores and morphine consumption. Secondary endpoints comprised walking distance, ROM, patients requiring rescue analgesics and antiemetics, LOS, levels of CRP and IL-6, QoR, and the incidence of adverse events.</p><p><strong>Results: </strong>This meta-analysis included 15 RCTs involving 2,584 patients. The study indicated that intravenous dexamethasone can decrease VAS scores at rest (24 h, 95% CI: -0.71 [-0.86, -0.55], I²=66%, P < 0.00001; 48 h, 95% CI: -0.30 [-0.43, -0.18], I²=46%, P < 0.00001) and movement (24 h, 95% CI: -0.89 [-1.23, -0.55], I²=91%,P < 0.00001; 48 h, 95% CI: -0.42 [-0.62, -0.23], I²=84%, P < 0.0001). Moreover, it can reduce morphine consumption (24 h, 95% CI: -3.06 [-4.82, -1.30], I²=46%, P = 0.0006; 48 h, 95% CI: -5.23 [-8.28, -2.18], I²=76%, P = 0.0008) and increase walking distances on postoperative days 1 to 3, and improve the ROM on postoperative day 1 to 2. Furthermore, intravenous dexamethasone reduced the need for requiring rescue analgesics and antiemetics, shortened LOS, lowered CRP and IL-6 levels, and improved the quality of life after TKA. The incidence of infection, gastrointestinal hemorrhage, wound healing, or deep vein thrombosis/pulmonary embolism did not differ significantly. Subgroup analyses revealed no significant differences between single-administration and repeat-administration groups, except in the context of rescue antiemetic requirements.</p><p><strong>Conclusion: </strong>Our study revealed that a single intravenous dose of dexamethasone, ranging from 8 to 16 mg administered before or after the induction of anesthesia or one hour prior to surgery, is efficacious in diminishing postoperative pain and cumulative morphine consumption, reducing the necessity for rescue analgesics and antiemetics, and shorten LOS for TKA. Additionally, it contributed to an increase in postoperative walking distance, ROM, and overall quality of postoperative recovery.</p><p><strong>Trial registration: </strong>We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42024521224) in January 2025.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"49"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039382","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 survival analysis based on tumor location in patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy following neoadjuvant chemoradiotherapy.","authors":"Benson Kaluba, Naohisa Kuriyama, Tatsuya Sakamoto, Haruna Komatsubara, Koki Maeda, Daisuke Noguchi, Kazuyuki Gyoten, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno","doi":"10.1007/s00423-025-03609-8","DOIUrl":"10.1007/s00423-025-03609-8","url":null,"abstract":"<p><strong>Background: </strong>The study aimed at assessing whether long-term survival outcomes were different based on tumor location in pancreatic ductal adenocarcinoma (PDAC) patients who underwent pancreatectomy following neoadjuvant chemoradiotherapy (CRT).</p><p><strong>Methods: </strong>Following CRT, resection rate was 60.5% (286/473) and the resected patients had pancreatic head (n = 218), body (n = 34) and tail (n = 34) tumors. Survival analyses were conducted, independent predictors of disease-free survival (DFS) and overall survival (OS) were identified, and then survival outcomes were stratified by the predictors of DFS and OS.</p><p><strong>Results: </strong>Resection rates were; 64.7% (head) vs. 46.6% (body) and 54.0% (tail) cases, p = 0.009. Among these cases, pancreatic head patients exhibited a higher incidence of initial clinical stage 3 tumors; 48.2% (head) vs. 29.4% (body) and 0% (tail) cases, p < 0.001 with more unresctable-locally advanced tumors; 22.0% (head) vs. 11.8% (body) and 0% (tail), p < 0.001, but demonstrated a better response to CRT; Evans grades 3/4 in 49.1% (head) vs. 23.5% (body) and 26.5% (tail), p = 0.012. Five-year DFS rates were; 19.9% (head) vs. 11.8% (body) vs. 24.6% (tail), p = 0.565 and OS rates; 25.4% (head) vs. 27.7% (body) vs. 32.0% (tail), p = 0.341. Significant predictors of DFS and OS included post-CRT CA19-9 levels, tumor differentiation, resection margins and pathological portal vein invasion. Based on these predictors, survival outcomes were also comparable. Pathological nodal invasion influenced DFS, while pathological stage impacted OS.</p><p><strong>Conclusion: </strong>Pancreatic head patients had the best resection rate and long-term survival outcomes were comparable, attributable to the better response to CRT by pancreatic head than the body and tail PDAC patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"47"},"PeriodicalIF":2.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007795","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":"Temporal variation in nutritional status and preoperative anemia among patients with retroperitoneal soft tissue sarcoma: a retrospective longitudinal cohort study.","authors":"Franziska Willis, Anna-Marlen Trunk, Julian Musa, Jonathan M Harnoss, Moritz J Strowitzki, Cosima Engerer, Julian-C Harnoss, Mohammed Al-Saeedi, Markus W Büchler, Martin Schneider","doi":"10.1007/s00423-024-03585-5","DOIUrl":"10.1007/s00423-024-03585-5","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal management of retroperitoneal soft tissue sarcoma (RPS) often requires extensive tumor resections, frequently involving gastrointestinal organs. The impact of these procedures on the nutritional status and hemoglobin (Hb) levels of RPS patients remain unexplored. In this study, we aimed to evaluate preoperative nutritional status as well as the prevalence of anemia in RPS patients, and to investigate longitudinal changes throughout the disease course in order to identify potential strategies for prehabilitation.</p><p><strong>Materials and methods: </strong>Patients undergoing resection of primary and recurrent RPS at Heidelberg University Hospital were retrospectively analyzed. Changes in nutritional parameters and Hb levels throughout the disease course were analyzed using hierarchical linear regression models. Multivariable Cox regression analyses were performed to identify independent predictors of overall survival. Subgroup analyses were conducted for primary tumors, first, second and third recurrences.</p><p><strong>Results: </strong>Amongst 370 patients analyzed, comprising 219 with primary disease, we observed neither a significant prevalence of preoperative malnutrition nor notable changes in BMI or serum albumin levels throughout the disease course. Preoperative anemia affected up to 40% of RPS patients, and Hb levels significantly decreased over the course of the disease (p = 0.022), particularly in correlation with the number of tumor resections performed (p = 0.010). Low preoperative Hb levels were associated with increased 30-day mortality and they were identified as an independent prognostic factor for shorter overall survival in primary RPS as well as in second and third recurrences.</p><p><strong>Conclusion: </strong>Anemia screening should be performed preoperatively and during regular follow-ups to enable early-on therapy, thus potentially improving patient outcomes in RPS.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"48"},"PeriodicalIF":2.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007798","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":"Development and validation of a preoperative prediction model for geriatric emergency general surgery.","authors":"Dequan Xu, Haoxin Zhou, Limin Hou","doi":"10.1007/s00423-025-03610-1","DOIUrl":"10.1007/s00423-025-03610-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to establish a scoring system for preoperative assessment of postoperative mortality in elderly patients undergoing emergency general surgery.</p><p><strong>Methods: </strong>A retrospectively database of geriatric emergency general surgery (EGS) patients who underwent emergency surgery was used for the development of the scoring system.</p><p><strong>Results: </strong>In total, 1500 patients were enrolled with mean age of 69.8 years in the study. Through the development and comparison of models, we ultimately derived a rating scale known as GES (Geriatric Emergency Surgery Score). This score has a c-statistic of 0.892 for mortality (95% CI 0.854-0.931). The observed probability of mortality in hospital gradually increased from 1.1% at a score of 0 to 30.3% at a score of 5 and 100% at a score of 8.</p><p><strong>Conclusion: </strong>The GES scoring model in this study will accurately predict the mortality risk of elderly patients with acute abdomen, optimize the allocation of medical resources, and standardize the assessment of patients' conditions based on scientific criteria. Further prospective multicenter trials are needed to externally validate the model developed.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"45"},"PeriodicalIF":2.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007791","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":"Retrospective analysis of criteria for oncological completion surgery of neuroendocrine tumors of the appendix.","authors":"Sabine Wächter, Dimitrios Panidis, Moritz Jesinghaus, Anja Rinke, Monika Heinzel-Gutenbrunner, Elisabeth Maurer, Detlef K Bartsch","doi":"10.1007/s00423-024-03603-6","DOIUrl":"10.1007/s00423-024-03603-6","url":null,"abstract":"<p><strong>Purpose: </strong>Neuroendocrine neoplasms of the appendix (aNET) are rare tumors that are often diagnosed by pathology as an incidental finding after appendectomy for acute appendicitis. Several guidelines proposed risk criteria to indicate oncological completion surgery after appendectomy. The aim of this study was to evaluate the reliability of proposed criteria for completion surgery of aNET.</p><p><strong>Methods: </strong>Patients with aNET treated at ENETS center of excellence Marburg between 2002 and 2022 were retrieved from a prospective data base. Demographic data, histopathological findings, including formerly proposed criteria to indicate oncological completion surgery, histological results of the completion resection and disease-free survival were evaluated.</p><p><strong>Results: </strong>82 patients with a median age of 35 (range 8-82) years were analysed. 72 (88%) patients underwent an emergency appendectomy because of acute appendicitis. 11 (13%) patients received an ileocecal resection or right hemicolectomy. Seven (8.5%) patients had lymph node metastases and three (3.6%) patients had distant metastases at the initial operation. 27 (33%) patients underwent completion surgery by right hemicolectomy according to guideline criteria, but postoperative histology detected lymph node and distant metastases in only six (22%) and zero patients resulting in an overtreatment of 21 (75%) patients. A tumor size of > 2 cm was the only significant criterion which was associated with lymph node metastases (p < 0.05). After a median follow-up of 62 months (range 2-264) 76 (96%) of the patients in stages I to III were alive with no evidence of disease.</p><p><strong>Conclusion: </strong>aNET have an excellent prognosis in stages I-III and distant metastases are rare. Formerly proposed criteria for oncological completion surgery have to be adopted and discussed for every patient, as they might result in an overtreatment in at least 75% of patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"46"},"PeriodicalIF":2.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007796","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":"Surgeon's imposter syndrome: a systematic review.","authors":"Michael El Boghdady, Béatrice Ewalds-Kvist","doi":"10.1007/s00423-024-03582-8","DOIUrl":"https://doi.org/10.1007/s00423-024-03582-8","url":null,"abstract":"<p><strong>Introduction: </strong>Imposter syndrome (IS) refers to the psychological experience of imagining that one's achievements do not originate from one's own authentic competence. Surgeons are constantly faced with life-threatening decisions and can easily feel inadequate or insecure despite their years of training and experience. Imposter syndrome can distress surgeons at all career stages and has profound psychological and professional consequences. We aimed to review imposter syndrome in surgeons.</p><p><strong>Methods: </strong>A systematic search was performed in compliance with The PRISMA checklist. Search was performed in the PubMed and ScienceDirect databases. We included articles about IS in surgeons. We excluded narrative articles, commentaries and studies involving medical students or other specialties. Citations were quality assessed by MERSQI and evidence graded (GRADE). Risk of bias was assessed among the included citations.</p><p><strong>Results: </strong>The search revealed 695 citations, from which a final list of 12 was compiled after applying the inclusion and exclusion criteria. Participants included trainees and consultant surgeons across various surgical specialties. The following research questions were answered: Are surgeons with IS predisposed to mental or physical challenges? Do surgeons experience gender differences in IS? Can the feeling of IS be reduced?</p><p><strong>Conclusion: </strong>There is a high prevalence of imposter syndrome among surgeons. Surgeons with IS are predisposed to experience mental or physical challenges. Female surgeons experience IS more frequently than their male counterparts. Feelings of IS can decline with increasing age but also with other included methods. Risks and multiple preventative measures were explored. The key to reducing IS is to train oneself to discern fact from fiction, thereby undermining distorted thoughts that perpetuate feelings of being an imposter.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"44"},"PeriodicalIF":2.1,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055969","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}