Surgery最新文献

{"title":"Comparative learning curves and outcomes of robotic versus laparoscopic transabdominal preperitoneal inguinal hernia repair","authors":"Leonardo Solaini MD ,&nbsp;Davide Cavaliere MD ,&nbsp;Riccardo Turrini MD ,&nbsp;Sara Pellegrini MD ,&nbsp;Giuseppe Rocco MD ,&nbsp;Francesco Pasini MD ,&nbsp;Giulia Bonini MD ,&nbsp;Daniela Di Pietrantonio MD ,&nbsp;Giorgio Ercolani MD, PhD","doi":"10.1016/j.surg.2025.109415","DOIUrl":"10.1016/j.surg.2025.109415","url":null,"abstract":"<div><h3>Background</h3><div>Transabdominal preperitoneal inguinal hernia repair is a common surgical procedure that can be performed using either robotic or laparoscopic approaches. Understanding the learning curve for each method is crucial for optimizing surgical outcomes and training. This study aims to compare the learning curves of each approach and to evaluate the outcomes of the proficiency phases.</div></div><div><h3>Methods</h3><div>All consecutive transabdominal preperitoneal procedures performed in 2 centers were included. The learning curves, based on operative time, of 5 surgeons (2 performing robotic transabdominal preperitoneal and 3 performing laparoscopic transabdominal preperitoneal) were analyzed using cumulative sum analysis and compared after pooling the data according to the surgical approach. In addition, a comparison of the outcomes of the postlearning phase was conducted.</div></div><div><h3>Results</h3><div>A total of 463 transabdominal preperitoneal procedures were included (248 robotic approach). The laparoscopic transabdominal preperitoneal learning curve indicated a learning phase up to the 39th procedure, and the robotic up to the 29th. Comparing the postlearning phase data revealed similar postoperative complication rates (14/187 vs 3/103, <em>P</em> = .126) with comparable baseline characteristics. In addition, the median operative time was significantly lower in the robotic group than in the laparoscopic group (59 vs 65 minutes, <em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that robotic and laparoscopic transabdominal preperitoneal have distinct learning curves, with the robotic approach reaching proficiency slightly faster. Postlearning phase safety outcomes were similar between the 2 techniques. The robotic approach also had a significantly shorter operative time than the laparoscopic approach. These findings suggest that both approaches are safe, and the choice of method may depend on surgeon preference and experience.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109415"},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to comments to \"IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer\".","authors":"Melania Scarpa, Andromachi Kotsafti, Astghik Stepanyan, Gaia Tussardi, Barbara Di Camillo, Marco Scarpa","doi":"10.1016/j.surg.2025.109404","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109404","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109404"},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for readers","authors":"","doi":"10.1016/S0039-6060(25)00271-5","DOIUrl":"10.1016/S0039-6060(25)00271-5","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109419"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover 1(with editorial board)","authors":"","doi":"10.1016/S0039-6060(25)00269-7","DOIUrl":"10.1016/S0039-6060(25)00269-7","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109417"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SURGERY Virtual Special Issues","authors":"Caitlin W. Hicks MD, MS,&nbsp;Steven D. Wexner MD, PhD","doi":"10.1016/j.surg.2025.109424","DOIUrl":"10.1016/j.surg.2025.109424","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109424"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewer Acknowledgement","authors":"","doi":"10.1016/S0039-6060(25)00275-2","DOIUrl":"10.1016/S0039-6060(25)00275-2","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109423"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a place for laparoscopic reoperation for complications after minimally invasive pancreatectomy?","authors":"Alexandra Nassar MD ,&nbsp;Charles De Ponthaud MD ,&nbsp;Stylianos Tzedakis MD, PhD ,&nbsp;Safi Dokmak MD, PhD ,&nbsp;Olivier Soubrane MD, PhD ,&nbsp;Baudouin Thebault MD ,&nbsp;Laurent Sulpice MD, PhD ,&nbsp;Johan Gagnière MD, PhD ,&nbsp;Ali-Reza Kianmanesh MD, PhD ,&nbsp;Francois Regis Souche MD, PhD ,&nbsp;Regis Fara MD, PhD ,&nbsp;Lilian Scwharz MD, PhD ,&nbsp;Sebastien Gaujoux MD, PhD ,&nbsp;Ugo Marchese MD, PhD","doi":"10.1016/j.surg.2025.109413","DOIUrl":"10.1016/j.surg.2025.109413","url":null,"abstract":"<div><h3>Introduction</h3><div>Although the use of the minimally invasive approach is expanding in pancreatic surgery, indications and results of laparoscopic reinterventions after pancreatectomy are unknown.</div></div><div><h3>Methods</h3><div>Based on the multicenter AFC (Association Française de Chirurgie) cohort (2010–2021), patients who underwent open (open reoperation group) or laparoscopic (laparoscopic reoperation group) reoperation within 90 days after minimally invasive pancreatectomy were included and compared. Inverse probability of treatment weighting analysis was performed to determine the impact of laparoscopic reoperation on postoperative mortality.</div></div><div><h3>Results</h3><div>Of the 3,412 patients who underwent minimally invasive pancreatectomy, 298 (8.7%) underwent reoperation, with a median delay of 9 days (interquartile range: 4–19 days). Most frequent causes of reintervention were pancreatic fistula with uncontrolled sepsis (postoperative pancreatic fistula) (23%) and hemorrhage (postpancreatectomy hemorrhage) (46%). Sixty-five patients (22%) underwent laparoscopic and 233 (78%) open reoperation. Laparoscopic reoperation was mostly performed for postoperative pancreatic fistula drainage (43%), postpancreatectomy hemorrhage (26%), bowel obstruction (20%), or peritonitis (8%). Patients in the laparoscopic reoperation group were more often reoperated on after distal pancreatectomy (54% vs 36% in open reoperation group, <em>P</em> = .017). After pancreatoduodenectomy, laparoscopic reoperation was more often performed for bowel obstruction compared with open reoperation (20% vs 4%, <em>P</em> = .005). After reintervention, the postoperative mortality rate was 13%. Hospital stay was significantly shorter after laparoscopic reoperation (28 vs 36 days, <em>P</em> = .037). After adjustment for inverse probability of treatment weighting, laparoscopic revision was statistically associated with less postoperative mortality (odds ratio = 0.81, 95% confidence interval: 0.81–0.95).</div></div><div><h3>Conclusion</h3><div>The laparoscopic approach may be an option for surgical reintervention after minimal invasive pancreatectomy in non–life-threatening indications, mainly after distal pancreatectomy for postoperative pancreatic fistula drainage or after pancreatoduodenectomy for occlusion.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109413"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of care in patients with asymptomatic stage IV colon cancer: A population-based analysis","authors":"Lauren Weaver MD ,&nbsp;Catherine G. Tran MD ,&nbsp;Amanda R. Kahl MPH ,&nbsp;Alexander Troester MD ,&nbsp;Aditi Mishra MD ,&nbsp;Ajay Prakash MD, PhD ,&nbsp;David Brauer MD ,&nbsp;Mary E. Charlton PhD ,&nbsp;Imran Hassan MD ,&nbsp;Paolo Goffredo MD","doi":"10.1016/j.surg.2025.109408","DOIUrl":"10.1016/j.surg.2025.109408","url":null,"abstract":"<div><h3>Background</h3><div>Currents guidelines recommend chemotherapy with or without biologic agents for asymptomatic stage IV colon cancer treatment, whereas primary tumor resection is reserved for symptomatic tumors or resectable metastases. However, US treatment patterns are understudied. Our study aims to identify real-world treatment patterns for asymptomatic metastatic colon cancer.</div></div><div><h3>Methods</h3><div>Adults with asymptomatic metastatic colon cancer were identified in the 2014 Surveillance, Epidemiology, and End Results Patterns of Care database and categorized into 6 groups: chemotherapy with or without biologic agents, chemotherapy with or without biologic agents with primary tumor resection and metastasectomy, chemotherapy with or without biologic agents and primary tumor resection alone, primary tumor resection only, no treatment, or other treatments. Multinomial logistic regression was used to examine factors associated with receiving each treatment modality. Cox proportional hazard models were used to assess the relationships between treatments and survival.</div></div><div><h3>Results</h3><div>Among 1,717 weighted patient cases, 28% received chemotherapy with or without biologic agents, 23% chemotherapy with or without biologic agents with primary tumor resection, 12% chemotherapy with or without biologic agents with primary tumor resection and metastasectomy, 12% primary tumor resection only, 23% no treatment, and 2% other treatment. Younger patients were more likely to receive chemotherapy with or without biologic agents with primary tumor resection and metastasectomy than chemotherapy with or without biologic agents alone (odds ratio, 3.32; 95% confidence interval, 1.3–8.6) and less likely to undergo no treatment (odds ratio, 0.05; 95% confidence interval, 0.02–0.17). Patients treated by chemotherapy with or without biologic agents with primary tumor resection and metastasectomy had the greatest median survival of 61 months, whereas those with no treatment had a 1-month median survival.</div></div><div><h3>Conclusion</h3><div>Almost one quarter of patients with asymptomatic stage IV colon cancer received no treatment. Meanwhile, 12% of patients underwent curative systemic and surgical treatment, which was associated with a median survival of 5 years, validating reported outcomes of this approach by institutional studies. These data provide an important benchmark for future interventions pertaining to asymptomatic patients with stage IV colon cancer.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109408"},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periarterial divestment for borderline and locally advanced pancreatic cancer: An analysis of 125 cases in a single center","authors":"Feng Yang MD, PhD ,&nbsp;Yecheng Xu MD,&nbsp;Chen Jin MD, PhD,&nbsp;Hang He MD, PhD,&nbsp;Ji Li MD, PhD,&nbsp;Deliang Fu MD, PhD","doi":"10.1016/j.surg.2025.109412","DOIUrl":"10.1016/j.surg.2025.109412","url":null,"abstract":"<div><h3>Background</h3><div>Literature on factors influencing prognosis after periarterial divestment for borderline resectable or locally advanced pancreatic ductal adenocarcinoma and preventative measures for postpancreatectomy hemorrhage is scarce. This study aimed to evaluate the efficacy of Neuro-Patch for arterial reinforcement in preventing postpancreatectomy hemorrhage and explore the oncologic outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma following periarterial divestment.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 125 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma involving arteries who underwent periarterial divestment between January 2018 and May 2022.</div></div><div><h3>Results</h3><div>Among the study cohort, 54 patients underwent pancreaticoduodenectomy, 43 had distal pancreatectomy, and 28 received total pancreatectomy, with 74 patients also undergoing combined venous resection. Periarterial divestment was performed on the hepatic artery in 47 patients, the celiac artery in 3, the superior mesenteric artery in 22, and multiple arteries in 53. Neoadjuvant chemotherapy was administered to 24% of patients, with an R0 resection rate of 33.6%. The median postoperative hospital stay was 10 days, with a 90-day mortality rate of 3.2%. Neuro-Patch was used in 51 patients, leading to a significant reduction in postpancreatectomy hemorrhage (odds ratio 0.073, 95% confidence interval 0.007–0.783, <em>P</em> = .031). The median overall survival was 20.6 months, with 1- and 3-year survival rates estimated at 73.2% and 22.9%, respectively. Neoadjuvant chemotherapy (hazard ratio 0.494, 95% confidence interval 0.291–0.839, <em>P</em> = .009) and venous invasion (hazard ratio 2.041, 95% confidence interval 1.308–3.186, <em>P</em> = .002) emerged as independent predictors of overall survival.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant chemotherapy significantly enhances survival outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma undergoing periarterial divestment, and it should be regarded as a standard preoperative approach. The Neuro-Patch provides structural reinforcement to the arterial wall, potentially reducing the risk of postpancreatectomy hemorrhage. However, randomized controlled trials are necessary to substantiate its efficacy and safety.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109412"},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative hyperlipasemia and pancreatic fistula risk: A critical reappraisal of diagnostic criteria and cohort heterogeneity.","authors":"Xiang Zhou, Shunqi Xie","doi":"10.1016/j.surg.2025.109399","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109399","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109399"},"PeriodicalIF":3.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}