Langenbeck's Archives of Surgery最新文献

{"title":"Intersphincteric abdominoperineal excision versus low Hartmann's procedure in the robotic era: a single institution experience.","authors":"Muthanna Al-Jumaili, Aous Al-Sudany, Karam Matlub, Leena Anna Marie Vanderberg, Mark Bremholm Ellebæk, Nuunu Nielsen, Patrick Fuhlendorf, Issam Al-Najami","doi":"10.1007/s00423-026-04115-1","DOIUrl":"10.1007/s00423-026-04115-1","url":null,"abstract":"<p><strong>Purpose: </strong>Non-restorative surgical options for rectal cancer patients when primary anastomosis is not suitable, Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE) are common. Previous studies suggest higher pelvic sepsis after HP, but no data exist comparing exclusively robot-assisted approaches.</p><p><strong>Methods: </strong>This retrospective study included rectal cancer patients with significant comorbidities precluding anastomosis. Those patients underwent robot-assisted HP or IAPE at Odense University Hospital (2012-2022). Demographic, 30-day postoperative medical and surgical complications, reoperation, readmission, and 90-day mortality were analysed.</p><p><strong>Results: </strong>A total 224 patients were included (HP: n = 57; IAPE: n = 167), HP patients were older (77.0 ± 9.3 vs. 71.7 ± 11.5 years, p = 0.002) and had higher ASA scores (p = 0.001). Postoperative medical complications were low and comparable in both groups. Intra abdominal abscess was also comparable (3.5% for HP vs. 5.4% for IAPE, p = 0.832) Perineal wound infection still present in the IAPE group (6.6%) and perineal pain at 14 day was relatively high (11.4%) after IAPE. No significant difference was observed in the rate of readmission, reoperation and 90-day mortality.</p><p><strong>Conclusion: </strong>Complications rates did not significantly differ between HP and IAPE. However, IAPE was associated with perineal wound-related morbidity. In patents unfit for anastomosis, robot-assisted HP may considered a better and safer alternative for IAPE.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368844","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":"Management and outcomes in acute symptomatic hernias: a retrospective cohort study and review of cross-over to surgery.","authors":"Yichen Liu, Hiba Al-Khaffaji, Huarui Xue, Wen Yuan Chung, Hassan Nassar, Saman Habib, Molly Castagna, James Wolff","doi":"10.1007/s00423-026-04126-y","DOIUrl":"10.1007/s00423-026-04126-y","url":null,"abstract":"<p><strong>Purpose: </strong>Hernias are a frequent cause of acute surgical admission, yet optimal management remains uncertain. Watchful waiting (WW) and waiting-list delays may increase symptom recurrence and surgical crossover, creating uncertainty about when timely elective repair is indicated. This study evaluates acute hernia presentations and how different management pathways may influence outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 105 patients presenting with symptomatic hernias to the University Hospitals of Leicester from period of September 2024 to January 2025 with patient follow-up in September 2025. Outcomes analysed included length of hospital stay, complications, surgical crossover rates, and re-presentations.</p><p><strong>Results: </strong>A total of 105 patients met the inclusion criteria. 51(49%) patients were conservatively managed with WW, and 43(41%) listed for elective repair, and 11(10%) underwent emergency surgery at presentation. WW patients had higher re-presentation rates (35.3 vs. 14%, p = 0.0172) and surgical crossover rates (33.3 vs. 2.3%, p < 0.001) relative to those awaiting elective surgery. In the WW cohort, crossover occurred in 50% of inguinal hernias (9.1% to emergency; 40.9% to elective) and approximately 20.7% of ventral hernias (10.3% to emergency; 10.3% to elective). Emergency hernia repair was associated with increased length of stay compared to elective repair for both ventral (median 4 vs. 0.5 days, p = 0.0079) and inguinal hernias (median 1.5 vs. 0 days, p < 0.001).</p><p><strong>Conclusion: </strong>Observed surgical crossover and re-presentation among patients managed with watchful waiting may indicate the importance of identifying patients who are less suitable for prolonged non-operative management. Structured follow-up and reassessment may improve watchful waiting pathways and support shared decision-making regarding the appropriateness of surgical repair. Further studies are needed to validate these findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368775","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":"Osteosarcopenia as a prognostic indicator of gastric cancer compared with established nutritional markers.","authors":"Keiichiro Ryujin, Tetsuro Kawazoe, Yasuo Tsuda, Kensuke Kudou, Tomonori Nakanoko, Mitsuhiko Ota, Koji Ando, Eiji Oki, Tomoharu Yoshizumi","doi":"10.1007/s00423-026-04123-1","DOIUrl":"10.1007/s00423-026-04123-1","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative nutritional and immunological status is closely associated with postoperative outcomes in gastric cancer. Although osteopenia and sarcopenia have been reported as prognostic factors, the significance of their coexistence as osteosarcopenia and its value relative to established nutritional indices remain unclear. This study aimed to clarify the prognostic impact of osteosarcopenia in patients undergoing curative gastrectomy.</p><p><strong>Methods: </strong>This study included 273 patients who underwent curative gastrectomy for gastric cancer. Osteopenia and sarcopenia were assessed using preoperative computed tomography-derived bone mineral density and skeletal muscle index, respectively, and osteosarcopenia was defined as their coexistence. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazards models, and prognostic predictive ability was evaluated by time-dependent ROC analysis.</p><p><strong>Results: </strong>Osteopenia, sarcopenia, and osteosarcopenia were observed in 40.7%, 49.5%, and 22.3% of patients, respectively. Osteopenia and osteosarcopenia were independent predictors of poor OS and RFS, whereas sarcopenia alone was not. Osteosarcopenia was associated with older age, systemic inflammation, and poor nutritional status. A composite Cox model-based risk score integrating body composition and nutritional parameters demonstrated superior prognostic accuracy.</p><p><strong>Conclusion: </strong>Preoperative osteosarcopenia is a strong prognostic indicator in gastric cancer, and multidimensional assessment improves survival prediction.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361304","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":"Evidence map of appendicitis - a living systematic review with meta-analyses.","authors":"Dirk Kleindienst, Justyna Mohr, Katharina Maurer, Eva Kalkum, Julian-Camill Harnoss, Pia Antony, Alexander Dullenkopf, Pietro Renzulli, Pascal Probst, Markus K Mueller","doi":"10.1007/s00423-026-04113-3","DOIUrl":"10.1007/s00423-026-04113-3","url":null,"abstract":"<p><strong>Purpose: </strong>Appendicitis is one of the most common diseases of the gastrointestinal tract with a lifetime incidence of 7 to 9%. Appendectomy is one of the most performed emergency surgeries. Recently, non-operative treatments are emerging. It is almost impossible to keep the overview on the large and growing body of evidence on appendicitis. Therefore, the aim of this project was to create a systematic and living Evidence Map of Appendicitis.</p><p><strong>Methods: </strong>PubMed, CENTRAL, Web of Science, EMBASE were systematically and continuously searched for all published and ongoing randomized controlled trials (RCT) and systematic reviews (SR) dealing with diagnosis and treatment of appendicitis. Outcomes from every existing RCT were extracted and trial quality was assessed. RCTs and SRs on identical subjects were grouped to research topics. For specific treatment outcomes, meta-analyses were performed for all research topics with more than 3 RCTs.</p><p><strong>Results: </strong>Out of 16373 articles screened, 527 RCTs on 104331 patients and 408 SRs were included and grouped into 74 research topics with 31 living meta-analyses. Most RCTs were from Asia (43%),followed by Europe (32%) and North America (15%). Living meta-analyses were performed for 31 out of 74 research topics. For three out of 74 research topics (4%) there were no RCT available.</p><p><strong>Conclusion: </strong>The Evidence Map of Appendicitis is the ultimate go-to source for evidence on appendicitis. Constantly updated and freely accessible via www.EVIglance.com and as mobile phone app. Clinical decision-making, evidence-based patient information are supported by the primary data provided, as well as by living meta-analyses.</p><p><strong>Systematic review registration: </strong>PROSPERO 2023 CRD42023482686.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361306","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":"Longitudinal assessment of health-related quality of life in patients with borderline and locally advanced pancreatic cancer undergoing neoadjuvant FOLFIRINOX chemotherapy: results from a prospective multicenter trial.","authors":"Luís Filipe Abreu de Carvalho, Wim Ceelen, Annick Meertens, Niki Rashidian, Bruno Waked, Karen Geboes, Suzane Ribeiro, Koen Gorleer, Hans Dedecker, Lars Triest, Andrew Vervaecke, Steven Sas, Bart Sierens, Carolien Beyls, Mark Sie, Marjan van Dijk, Nick Verhaeghe, Frederik Berrevoet","doi":"10.1007/s00423-026-04121-3","DOIUrl":"10.1007/s00423-026-04121-3","url":null,"abstract":"<p><strong>Purpose: </strong>Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis and significantly affects health-related quality of life (HRQoL). In borderline resectable (BR) and locally advanced (LA) PDAC, neoadjuvant FOLFIRINOX may enable surgical resection, but its toxicity can further compromise HRQoL. Evidence on longitudinal HRQoL changes during FOLFIRINOX in this context remains limited. This study evaluated HRQoL trajectories in patients with BR and LA PDAC receiving neoadjuvant chemotherapy (NACT) within a surgical selection strategy.</p><p><strong>Methods: </strong>This longitudinal analysis included patients from the multicenter prospective PeRFormanCe trial (NCT05298722), investigating outcomes in BR and LA PDAC treated with FOLFIRINOX as NACT. HRQoL was assessed at baseline and after 4, 8, and 12 NACT cycles using EORTC QLQ-C30 and PAN26 questionnaires. Changes over time were analyzed using linear mixed-effect models. Clinically meaningful differences were defined as ≥10-point mean changes with 95% confidence intervals.</p><p><strong>Results: </strong>Twenty patients were included (35% female), 12 (60%) had LA PDAC. The median number of NACT cycles was 8 (IQR 7-12). Sixteen patients (80%) underwent surgical exploration, and 11 (55%) achieved resection. During NACT, patients reported improvements in insomnia, pain, hepatic symptoms, bloating and appetite loss. Muscle weakness, cognitive deterioration, and side effects increased. Among patients completing 12 cycles, weight loss and flatulence decreased, global health status (baseline 64, SE 4.05) and fatigue scores improved.</p><p><strong>Conclusion: </strong>In patients with BR and LA PDAC treated with FOLFIRINOX as NACT, HRQoL can be preserved over time despite variations in symptoms. These findings contribute to informed, patient-centered decision-making in the neoadjuvant setting.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT05298722. Date of registration March 28, 2022.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361296","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":"Transverse versus longitudinal skin incisions for totally implantable venous access port implantation: a randomized controlled trial.","authors":"Tomasz Drygalski, Aleksandra Żmuda, Paweł Maciejewski, Tomasz Składzień, Michał Cicio, Anna Kwinta, Wojciech Szpunar, Michał Terlecki, Jarosław Woroń, Tomasz Lonc","doi":"10.1007/s00423-026-04122-2","DOIUrl":"10.1007/s00423-026-04122-2","url":null,"abstract":"<p><strong>Background: </strong>Totally implantable venous access ports (TIVAPs) are widely used in oncologic patients requiring long-term vascular access. However, the impact of skin incision orientation on postprocedural pain, procedural efficiency, and early complications remains unclear. This study compared transverse and longitudinal incisions in terms of early postoperative pain, patient-reported discomfort, procedure duration, and complication rates.</p><p><strong>Methods: </strong>In this randomized, single-center study, 170 patients undergoing TIVAP implantation were assigned to either a transverse or longitudinal incision group (85 patients each). All procedures followed a standardized protocol with ultrasound-guided venous access and fluoroscopic confirmation of catheter tip position. Pain intensity was assessed using the numeric rating scale (NRS) within 24 h, and patient-reported discomfort was evaluated on day 7. Procedural characteristics and early complications were recorded.</p><p><strong>Results: </strong>Postprocedural pain was low in both groups, with most patients reporting NRS scores between 0 and 2. Analgesic requirements were minimal, with no significant between-group differences. Discomfort at day 7 was also low and comparable. Procedure duration showed a trend toward shorter times in the transverse incision group [20 (18; 30) vs. 25 (20; 35) minutes; p = 0.09]. Overall complication rates were low, with no major complications. Minor complications included local inflammatory reactions and hematomas. Bleeding within the port pocket was more frequent in the longitudinal incision group, although not statistically significant.</p><p><strong>Conclusions: </strong>Transverse and longitudinal incisions provide comparable outcomes in TIVAP implantation, with low pain, minimal discomfort, and low complication rates. A trend toward shorter procedure duration and less port pocket bleeding with transverse incisions suggests potential technical advantages.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT06766656 (Registered January 04, 2025).</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361224","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":"Preoperative proton pump inhibitor therapy and its influence on postoperative complications following major liver resection.","authors":"Lukas Pollmann, Aladdin Ali Deeb, Falk Rauchfuß, Felix Dondorf, Nicola S Pollmann, Utz Settmacher","doi":"10.1007/s00423-026-04119-x","DOIUrl":"10.1007/s00423-026-04119-x","url":null,"abstract":"<p><strong>Purpose: </strong>Proton pump inhibitors (PPIs) are frequently used perioperatively in patients undergoing major liver resection, although their impact on postoperative morbidity remains unclear. This study evaluated the association between preoperative PPI therapy and postoperative complications, particularly biliary leakage.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included patients undergoing major liver resection (≥ 4 Couinaud segments) between 2006 and 2024. Patients with and without preoperative PPI therapy were compared regarding postoperative morbidity, assessed using the Comprehensive Complication Index (CCI), and biliary leakage.</p><p><strong>Results: </strong>A total of 507 patients were included, of whom 220 (43.4%) received preoperative PPI therapy. Patients receiving PPI therapy had a significantly higher postoperative CCI compared with those without PPI therapy (24.4 ± 25 vs. 17.7 ± 19.7, p = 0.002). Biliary leakage occurred more frequently in the PPI group (38% vs. 26%, p = 0.009), including after propensity score matching. In multivariable logistic regression analysis, preoperative PPI therapy remained independently associated with postoperative biliary leakage (OR 1.95, 95% CI 1.21-3.14; p = 0.006). Microbiological analysis of biliary swabs showed no relevant differences in pathogen profiles between groups.</p><p><strong>Conclusions: </strong>Preoperative PPI therapy was associated with increased postoperative morbidity and biliary leakage after major liver resection, even after adjustment for baseline risk factors. Given the observational design, these findings should be considered hypothesis-generating and support careful evaluation of perioperative PPI use in patients without a clear indication.</p><p><strong>Trial registration: </strong>The study was registered in the German Clinical Trials Register (application number DRKS00038981).</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339008","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 survival outcomes and prognostic factors between intrahepatic and extrahepatic cholangiocarcinoma after surgical resection: a propensity score-matched study based on the SEER database.","authors":"Jize Tian","doi":"10.1007/s00423-026-04118-y","DOIUrl":"10.1007/s00423-026-04118-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore survival outcomes and prognostic factors between intrahepatic and extrahepatic cholangiocarcinoma after surgical resection.</p><p><strong>Methods: </strong>Patients diagnosed with primary intrahepatic or extrahepatic cholangiocarcinoma between 2010 and 2018 who underwent cancer-directed surgery were identified from the SEER database. A 1:1 Propensity Score Matching was performed. Survival outcomes were analyzed via Kaplan-Meier curves and Log-rank tests. Multivariable Cox proportional hazards regression models and Fine-Gray competing risk models were constructed.</p><p><strong>Results: </strong>A total of 1,586 eligible patients were included. After matching, 478 patients (239 per group) were balanced. In the matched cohort, intrahepatic patients exhibited significantly superior Overall Survival (OS) compared to extrahepatic patients (median OS: 45 vs. 25 months; HR = 1.244, 95% CI: 1.001-1.545, P = 0.049). Conversely, a Fine-Gray competing risk analysis showed no significant difference in Cancer-Specific Survival (CSS) between the subtypes (SHR = 0.818, 95% CI: 0.641-1.043, P = 0.105). Independent risk factors for OS included advanced age, T3/T4 stage, N1/N2 stage, and tumor size ≥ 5 cm. Notably, the retrieval of 4 or more lymph nodes was associated with improved OS (HR = 0.630, 95% CI: 0.469-0.846, P = 0.002), though its association with CSS was not statistically significant in the competing risk model.</p><p><strong>Conclusions: </strong>Results from this PSM analysis suggest that intrahepatic location is associated with better OS compared to extrahepatic disease, but cancer-specific survival is similar between the subtypes after accounting for competing risks. This divergence implies that survival differences might be driven by competing risks, potentially distinct long-term surgical morbidities, rather than intrinsic biological lethality. Furthermore, adequate lymphadenectomy (≥ 4 nodes) correlated with improved overall survival and staging accuracy, highlighting its potential role as a surgical quality metric for both subtypes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339050","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":"AI-assisted digital breast tomosynthesis as a decision-support tool for post-neoadjuvant surgical planning in breast cancer.","authors":"Adnan Gündoğdu, Nur Betül Ünal Özdemir, Ceyda Sönmez Wetherilt, Merve Aktaş, Damiano Gentile, Bülent Çomçalı, Osman Cem Yılmaz","doi":"10.1007/s00423-026-04116-0","DOIUrl":"10.1007/s00423-026-04116-0","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of residual disease after neoadjuvant chemotherapy (NAC) is essential for surgical planning and prevention of incomplete excision. This study evaluated artificial intelligence (AI)-assisted digital breast tomosynthesis (DBT) as a decision-support tool for post-NAC assessment in breast cancer.</p><p><strong>Methods: </strong>This retrospective study included 151 patients treated with NAC followed by surgery. Post-NAC DBT images were analyzed using Lunit INSIGHT DBT. An AI score threshold of 70 was used to classify patients as having low (< 70) or high (≥ 70) scores. In a paired subgroup of 70 patients, pre- and post-NAC AI scores were compared. Diagnostic performance and univariable and multivariable analyses were performed.</p><p><strong>Results: </strong>The overall pathological complete response (pCR) rate was 41.1% (62/151). Patients with low AI scores had higher pCR rates than those with high scores (49.5% vs. 28.3%, p = 0.010). High AI scores were associated with persistent microcalcifications and residual ductal carcinoma in situ (p < 0.001). Overall accuracy was 58.3% and varied by molecular subtype, with higher performance in triple-negative breast cancer and limited discrimination in HR+/HER2 - tumors. In multivariable analysis, AI score showed borderline significance (p = 0.070). In the paired cohort, AI scores decreased after NAC (p < 0.001), but delta change did not differ between pCR and non-pCR groups (p = 0.877).</p><p><strong>Conclusion: </strong>AI-assisted DBT may have potential complementary value as a decision-support tool for post-NAC surgical planning, particularly in triple-negative breast cancer and in cases with residual microcalcifications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339044","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":"ERAS enables safe ≤ 100-hour discharge after pancreatoduodenectomy: a multicenter cohort study.","authors":"Yasser Debakey, Mohamed Saber Mostafa, Ahmed Refaat, Sayed Shaker Sheier, Amr Nofal","doi":"10.1007/s00423-026-04088-1","DOIUrl":"10.1007/s00423-026-04088-1","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) pathways have been increasingly adopted in gastrointestinal surgery; however, their application to pancreatoduodenectomy (PD) remains variable due to concerns regarding postoperative morbidity and safety (1-3). This study aimed to evaluate the impact of ERAS on postoperative outcomes and the feasibility of ultra-early discharge following PD.</p><p><strong>Methods: </strong>A multicenter cohort study was conducted including 180 patients undergoing PD across four tertiary hepatopancreatobiliary centers. Sixty patients were managed prospectively under a standardized ERAS protocol, while 120 patients treated prior to ERAS implementation served as controls. Postoperative outcomes, including pancreatic fistula and delayed gastric emptying defined according to established criteria, were analyzed (4,5). Multivariate logistic regression was performed to identify predictors of discharge within ≤ 100 h.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. ERAS compliance exceeded 83% across key perioperative domains. Rates of clinically relevant pancreatic fistula were similar between groups (3.3% vs. 2.5%, p > 0.05). Delayed gastric emptying was significantly reduced in the ERAS cohort (13.3% vs. 31.7%, p = 0.011). Major complications (Clavien-Dindo ≥ III) occurred in 3.3% vs. 5.8%, readmission rates were 7.0% vs. 6.0%, and 90-day mortality was 3.3% vs. 1.7% in the ERAS and control groups, respectively. Mean length of stay was significantly shorter in the ERAS group (4.48 vs 10.91 days, respectively; p < 0.001), with 81.7% of patients achieving discharge within ≤100 hours compared to none in the control group. Importantly, while the majority of ERAS patients achieved early discharge, a small subset experienced prolonged hospital stay, resulting in partial overlap with the control group. ERAS implementation was the strongest independent predictor of early discharge.  CONCLUSION: ERAS pathways in pancreatoduodenectomy are safe and reproducible, and enable substantial acceleration of postoperative recovery without increasing morbidity, supporting their integration into routine pancreatic surgical practice.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05192044.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339075","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}