Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Transanal local excision reduces surgical burden without evidence of increased recurrence in lower rectal GIST: a multicenter inverse probability of treatment weighting analysis.","authors":"Zhuofei Li, Liang Huang, Taixuan Wan, Huashan Liu, Guoqing Lv, Shuangling Luo","doi":"10.1007/s00464-026-13508-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13508-8","url":null,"abstract":"<p><strong>Background: </strong>Lower rectal gastrointestinal stromal tumors (rGISTs) pose a surgical challenge, as complete resection must be balanced against anorectal function preservation. Transanal local excision (taLE) may offer a less invasive alternative to transabdominal laparoscopic radical resection (tlRR), but comparative evidence, particularly for larger tumors, is limited.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of patients with primary lower rGIST (lower tumor margin ≤ 5 cm from the anal verge; tumor size ≥ 2 cm and < 7 cm) undergoing taLE or tlRR (April 2015-April 2023). Inverse probability of treatment weighting (IPTW) balanced baseline characteristics, and doubly robust models adjusted residual imbalance. Perioperative outcomes, recurrence-free survival (RFS), and a prespecified ≥ 5 cm subgroup analysis were evaluated.</p><p><strong>Results: </strong>Among 101 patients (taLE, n = 74; tlRR, n = 27; median follow-up, 40 months), IPTW-adjusted analyses showed significantly reduced surgical burden with taLE: shorter operative time (- 118.4 min, P < 0.001), lower postoperative pain (- 2.5, P < 0.001), earlier drain removal (- 5.1 days, P = 0.008), no permanent stoma (0/74 vs. 5/27), and lower odds of temporary stoma (OR 0.05, P < 0.001) and reoperation (OR 0.02, P = 0.009). These advantages remained largely consistent in the ≥ 5 cm subgroup. Only four recurrences occurred, with no significant RFS difference (log-rank P = 0.43); power was limited.</p><p><strong>Conclusions: </strong>taLE was associated with substantially reduced surgical burden in selected patients with lower rGIST, and no significant difference in recurrence-free survival was observed during available follow-up. However, with only four events, the study was underpowered to establish oncologic equivalence. The taLE-based organ-preserving pathway may represent a promising option pending confirmation in larger cohorts.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228532","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":"Unmasking healthcare disparities: the underreporting of gender, race, and ethnicity data in high-impact factor minimally invasive surgery journals.","authors":"Amber Chen-Goodspeed, Victoria Ende, Xiaoyue Ma, Shahenda Khedr, Stephen Merola, Steven Chao","doi":"10.1007/s00464-026-13435-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13435-8","url":null,"abstract":"<p><strong>Background: </strong>Diverse representation in clinical research is essential for equitable healthcare. Despite mandates from organizations like the NIH and ICMJE, race and gender remain underreported in surgical research, raising concerns about the generalizability of findings. This study examines demographic reporting trends in minimally invasive surgery (MIS) and advanced endoscopy publications before and after the onset of the COVID-19 pandemic.</p><p><strong>Methods: </strong>A systematic review of Surgical Endoscopy, Journal of Robotic Surgery, and Surgical Innovation was conducted, analyzing articles published between January 1, 2018, and December 31, 2023. 472 studies were included. For each study, study type, journal, date, geographic origin, and reported demographic data were recorded. Reporting rates across time periods (pre- vs. post-March 2020), region of origin, study design, and journal were analyzed via Chi-square, Fisher's exact tests, and Cochran-Armitage trend tests.</p><p><strong>Results: </strong>Of the 472 studies, 61.2% were randomized controlled trials, with geographic representation from Asia (37.7%), Europe (34.8%), and North America (22.3%). Only 21 North American studies (20 U.S., 1 Canada) reported race; no studies from Asia or Europe did so. Among U.S. studies, race reporting did not differ significantly pre- vs. post-COVID (22.2% vs. 21.8%; p = 0.25), nor did gender reporting (p = 0.07). Regional differences in U.S. race reporting were significant (p = 0.003), with the Midwest having the lowest rate. Post-2020, gender reporting was significantly higher in Asia (94.9%) compared to Europe (84.7%) and North America (80.9%) (p = 0.005).</p><p><strong>Conclusions: </strong>Demographics remain underreported in MIS and advanced endoscopy research, particularly outside North America. Despite increased attention to health equity during the COVID-19 pandemic, reporting practices have not significantly improved. Broader adoption of standardized demographic reporting is needed to ensure evidence-based surgical care for all populations.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228573","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":"Early nationwide experience with robotic versus open lateral pancreaticojejunostomy for symptomatic wide-duct chronic pancreatitis.","authors":"Emin Kilinc, Charlotte L van Veldhuisen, Charlotte A Leseman, Marja A Boermeester, Stefan A Bouwense, Freek Daams, Joris I Erdmann, J Sven D Mieog, Bert A Bonsing, Bas Groot Koerkamp, Maxime J L Dewulf, Sebastiaan Festen, Hjalmar C van Santvoort, Rogier P Voermans, Roel Haen, Wouter J M Derksen, Olivier R Busch, Marc G Besselink","doi":"10.1007/s00464-026-13402-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13402-3","url":null,"abstract":"<p><strong>Background: </strong>Lateral pancreaticojejunostomy (LPJ) is the treatment of choice in patients with symptomatic wide-duct chronic pancreatitis and a normal-size pancreatic head. Adequate pain control in the first days after LPJ via laparotomy is often challenging in these patients due to opioid tolerance resulting from chronic opioid use. Although a robotic approach may improve short-term outcome, comparative multicenter data on robotic versus open LPJ are lacking.</p><p><strong>Methods: </strong>This nationwide multicenter retrospective cohort study included consecutive adults who underwent robotic or open LPJ for symptomatic wide-duct chronic pancreatitis in the Netherlands (2010-2025). Primary outcomes were hospital stay and major complications (Clavien-Dindo grade III or higher).</p><p><strong>Results: </strong>Overall, 133 patients undergoing LPJ were included, of whom 36 (27%) robotic and 97 (73%) open LPJ. The robotic LPJ conversion rate was 0% (0/36). In the overall cohort, 90-day mortality was 0% (0/133) and median hospital stay was 2 days shorter after robotic LPJ (5 [IQR, 4-7] vs 7 [6-10] days; P < 0.001) compared with open LPJ, while the rate of major complications did not differ significantly between groups (36.1% [13/36] vs 26.8% [26/97]; P = 0.405). Blood loss was less with robotic LPJ (100 [IQR, 50-100] vs 300 [125-500] mL; P < 0.001), whereas operative time was comparable (275 [IQR 180-330] vs 232 [188-276] minutes; P = 0.210), and the rate of postoperative pancreatic fistula (POPF) grade B/C was higher (22.2% [8/36] vs 7.2% [7/97]; P = 0.034). The main findings of the overall cohort remained broadly consistent after propensity score matching.</p><p><strong>Conclusions: </strong>In this early nationwide experience, robotic LPJ was associated with shorter hospital stay compared with open LPJ. Although operative time and major complications did not differ significantly between groups, POPF occurred more frequently after robotic LPJ. The potential benefits of robotic LPJ and the possible learning curve effect should be further assessed in randomized trials in experienced centers.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228510","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":"Bilateral R2 sympathetic surgery for craniofacial hyperhidrosis: a 10-year retrospective cohort study on long-term outcomes and development of a prognostic predictive model.","authors":"Zijie Wang, Hong Chen, Min Lin, Jianbo Lin, Quan Du, Jianfeng Chen","doi":"10.1007/s00464-026-13521-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13521-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term efficacy and safety of bilateral R2 sympathetic surgery for CFH, to characterize the 10-year longitudinal trajectory of postoperative CH and recurrence, and to identify clinically accessible predictors of CH and postoperative satisfaction that may assist in preoperative risk communication. Preliminary nomograms were developed and internally validated using the area under the curve (AUC), calibration plots, sensitivity, and specificity.</p><p><strong>Materials and methods: </strong>A total of 127 patients who underwent bilateral R2 sympathetic surgery for CFH between April 2013 and April 2023 were retrospectively analyzed. Baseline characteristics, operative details, and follow-up outcomes were extracted from medical records and structured telephone interviews. Predictive features were selected using least absolute shrinkage and selection operator (LASSO) regression. Cox proportional hazards and multivariate logistic regression models were subsequently applied to identify independent predictors of CH and satisfaction, respectively. Nomograms were developed and internally validated using the area under the receiver operating characteristic curve (AUC), calibration plots, sensitivity, and specificity.</p><p><strong>Results: </strong>All patients achieved immediate resolution of craniofacial sweating, accompanied by a significant postoperative heart rate reduction (84.8 ± 11.68 → 72.17 ± 7.54 bpm, P < 0.001). Severe CH (grade IV) developed in 70.1% of patients, predominantly involving the thoracoabdominal (84.3%) and thigh (54.3%) regions. Cox regression identified preoperative heart rate > 79.5 bpm (HR = 2.46, 95% CI 1.61-3.75, P = 0.0002) and sympathetic clamping (HR = 5.69, 95% CI 3.03-10.67, P = 0.001) as independent risk factors for severe CH. Logistic regression showed that lower preoperative thoracoabdominal sweating was associated with higher postoperative satisfaction (OR = 0.05, 95% CI 0.01-0.23, P = 0.001). The nomograms demonstrated adequate discrimination and calibration.</p><p><strong>Conclusion: </strong>Bilateral R2 sympathetic surgery achieves rapid and durable relief of craniofacial hyperhidrosis with sustained high satisfaction over 10 years. Beyond confirming efficacy, the extended follow-up uniquely demonstrates that CH severity stabilizes within the first postoperative year and does not worsen over time-a critical finding for patient reassurance. Preoperative resting heart rate > 79.5 bpm and the use of sympathetic clamping independently predict severe CH, whereas lower baseline thoracoabdominal sweating predicts superior satisfaction. Although the proposed nomograms require external validation before routine adoption, they offer a practical, individualized reference for preoperative risk communication and, combined with the intraoperative choice of electrocautery, support a dual-phase strategy for optimizing surgical outcomes in CFH patients.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228558","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":"Long-term follow-up in asymptomatic or oligosymptomatic inguinal hernias: watchful or watchless waiting?","authors":"A C Valinoti, S Aramburu, J Principe, J A Giacone, E E Sadava","doi":"10.1007/s00464-026-13475-0","DOIUrl":"https://doi.org/10.1007/s00464-026-13475-0","url":null,"abstract":"<p><strong>Background: </strong>Watchful waiting (WW) for inguinal hernia has been established as a safe strategy for selected patients. However, this approach relies on regular long-term follow-up and adherence rates to WW are poorly characterized.</p><p><strong>Methods: </strong>A retrospective cohort study was performed including patients with inguinal hernia enrolled in a WW surveillance protocol between May 2013 and May 2026. Follow-up visits were scheduled every 6 months during the first year and annually thereafter. Demographic, clinical, and long-term adherence to surveillance protocols were analyzed Patients who were lost to follow-up were contacted via a structured questionnaire to update their clinical status and identify causes for discontinuing protocol.</p><p><strong>Results: </strong>A total of 400 patients were included in the WW protocol. Overall follow-up adherence was low, with 240 patients (60.0%) failing to maintain scheduled surveillance at the end of this study. Kaplan-Meier analysis demonstrated a progressive drop out of the protocol over time. Younger age was an independent factor associated with follow-up discontinuation. Patients younger than 30 years demonstrated the highest rate of surveillance discontinuation (92.9%), compared with 63.6% among patients aged 30-50 years and 56.4% among patients older than 50 years (p = 0.015). Seventy-seven (32%) responded to the survey; the most frequent causes for discontinuation were the absence of symptoms and the lack of awareness of recommended follow-up intervals (36% and 27%, respectively). Eleven patients (14.1%) had an elective hernia repair at another institution. No emergency surgery was identified among patients who remained under institutional follow-up or among those successfully contacted after surveillance discontinuation.</p><p><strong>Conclusions: </strong>Watchful waiting appears to remain an acceptable management strategy for selected patients with asymptomatic or oligosymptomatic inguinal hernia. However, long-term adherence to surveillance beyond 2 years is low, posing a significant limitation to sustained WW management.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228480","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":"Robotic emergency surgery in geriatric care.","authors":"T Hess, Avery Miles, Rachel Nation, Phillip Kemp Bohan, Tanya Egodage","doi":"10.1007/s00464-026-13460-7","DOIUrl":"https://doi.org/10.1007/s00464-026-13460-7","url":null,"abstract":"<p><strong>Background: </strong>Older adults present unique challenges in emergency general surgery (EGS) due to increased comorbidities and frailty. While minimally invasive surgery (MIS), including laparoscopic (lap) and robotic techniques, reduces perioperative morbidity, the role of minimally invasive EGS in geriatric patients remains unclear. This study compares outcomes for geriatric EGS patients following robotic, lap, and open procedures. We hypothesize that MIS approaches would improve perioperative outcomes in geriatric patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the ACS-NSQIP database (2022-2023) including patients ≥65 years undergoing emergent or urgent intra-abdominal surgery. Operative approach was categorized as robotic, lap, or open. The primary outcome was severe complication, and secondary outcomes included length of stay (LOS), discharge disposition, and readmission.</p><p><strong>Results: </strong>58,940 patients were included: 1832 robotic, 30,137 lap, and 26,971 open. With robotic vs lap and open, operative time was shortest (82.5 vs 110 vs 96 min, p < 0.001), conversion to open was less frequent (6.2 vs 12.9%, p < 0.001), and LOS was shorter (4 vs 4 vs 8 days, p < 0.001). Readmission and reoperation were lowest following MIS (9.2 vs 7.9 vs 9.8%, and 3.7 vs 3.3% vs 7.6%, both p < 0.001). After propensity matching, robotic patients had higher ASA scores and more transfusions but lower rates of sepsis (2.6 vs 6.5%) and mortality (2.3 vs 2.7%) compared to the lap group (p < 0.001). Multivariable regression demonstrated decreased risk of severe complications for patients who underwent robotic surgery (p = 0.025) with no difference in operative time or LOS, and patients were more likely to be discharged home.</p><p><strong>Conclusions: </strong>Robotic EGS in geriatric patients is associated with fewer severe complications, lower conversion rates, shorter LOS, and favorable discharge disposition.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228521","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":"Targeting indocyanine green where it matters most: a CRP-stratified cohort study in acute cholecystitis.","authors":"Rubén Carramiñana-Nuño, Pilar Palacios-Gasós, Noelia Lete-Aguirre, Miguel Gasós-García, Álvaro Lagos-De Los Reyes, Sofía Fontana-Escartín, Vicente-Manuel Borrego-Estella","doi":"10.1007/s00464-026-13524-8","DOIUrl":"https://doi.org/10.1007/s00464-026-13524-8","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative indocyanine green (ICG) fluorescence cholangiography has been linked to fewer conversions to open surgery in emergency cholecystectomy, but it adds cost, and evidence for its effect on conversion and operative time is graded moderate to low even by the consensus statement recommending routine use. We asked whether preoperative C-reactive protein (CRP), a marker of surgical difficulty and conversion risk, identifies patients in whom ICG's benefit is greatest.</p><p><strong>Methods: </strong>Prospective cohort of 221 patients undergoing emergency laparoscopic cholecystectomy for acute cholecystitis, stratified by ICG use (85 ICG vs 136 conventional). We tested the interaction between CRP and ICG use on conversion using Firth penalized logistic regression, and on operative time, length of stay, and complications using linear/logistic regression with a log-CRP sensitivity analysis. We compared conversion rates across CRP tertiles and calculated a CRP-stratified estimated absolute risk reduction (ARR) and number needed to treat (NNT).</p><p><strong>Results: </strong>Conversion occurred only in the conventional arm (12/136, 8.8%; 0/85 ICG), rising from 0 to 15.4% across CRP tertiles. The formal CRP×ICG interaction for conversion was not significant (Firth model, p = 0.878), reflecting the absence of ICG-arm events; the ARR associated with ICG use rose from not estimable to 9.8 points (95% CI 3.9-22.5; NNT≈10) in the middle tertile and 15.4 points (95% CI 8.0-27.5; NNT 6.5) in the highest. The interaction was significant for operative time (p = 0.045), strengthening under a log-CRP sensitivity model (p = 0.001), with CRP-related lengthening of surgery markedly smaller in the ICG arm.</p><p><strong>Conclusions: </strong>In this cohort, ICG's clinical benefit was not uniform across the CRP range. The CRP×ICG interaction reached significance for operative time; for conversion, the pattern was consistent and clinically plausible but not statistically significant, and should be regarded as hypothesis-generating. A CRP-informed strategy for prioritising ICG may be worth testing prospectively.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228549","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":"Correction: VFA/TAMAI predicts aggravated organ damage after central line removal due to catheter‑related bloodstream infection in patients with enterocutaneous fistula.","authors":"Zhan Yu, Lei Luo, Risheng Zhao, Yunzhao Zhao, Zheng Yao, Xin Xu","doi":"10.1007/s00464-026-13416-x","DOIUrl":"https://doi.org/10.1007/s00464-026-13416-x","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228518","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":"Oncologic safety of transanal total mesorectal excision after neoadjuvant chemoradiotherapy for advanced rectal cancer: long-term outcomes compared with robot TME.","authors":"Jung Kyong Shin, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park","doi":"10.1007/s00464-026-13470-5","DOIUrl":"https://doi.org/10.1007/s00464-026-13470-5","url":null,"abstract":"<p><strong>Background: </strong>Transanal total mesorectal excision (taTME) was introduced to improve distal dissection in low rectal cancer, but some previous studies have concerns about increased local recurrence during taTME. This study compared the long-term oncologic outcomes of taTME and robotic TME (R-TME) in neoadjuvant chemoradiotherapy (nCRT)-treated advanced rectal cancer.</p><p><strong>Methods: </strong>We analyzed patients with advanced rectal cancer who received nCRT followed by minimally invasive TME using either taTME or robotic TME between 2008 and 2018. These patients were classified according to surgical approach: taTME and R-TME. The 5-year disease-free survival (DFS), local recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS) were primary end point. Subgroup analyses were performed by yp stage, yT stage and tumor height (AV < 5 vs ≥ 5 cm). Additional propensity score matching was performed to reduce treatment selection bias.</p><p><strong>Results: </strong>A total of 306 patients were included, of whom 94 underwent taTME and 212 underwent R-TME between 2008 and 2018. There were no significant differences in OS, DFS, LRFS, or DRFS between two groups. After 1:1 propensity score matching, 88 matched pairs were generated, and matched analyses also showed no statistically significant association between surgical approach and OS, DFS, LRFS, or DRFS. In subgroup analyses stratified by yp stage, yT stage, and by unfavorable factors (male, BMI ≥ 25 kg/m², and undergoing nCRT), long-term oncologic outcomes showed similar between taTME and R-TME. Among patients with ultra-low rectal cancer (AV < 5 cm), 5-year OS, DFS, and LRFS did not differ between two groups.</p><p><strong>Conclusion: </strong>In nCRT-treated advanced mid and low rectal cancer, taTME showed no statistically significant difference in long-term oncologic outcomes compared with R-TME, and no statistically significant increase in local recurrence was observed, including in ultra-low rectal cancer (AV< 5 cm). These findings suggest that taTME may be considered a reasonable surgical option in selected patients.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224903","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":"Are prophylactic antibiotics routinely necessary in laparoscopic adnexal surgery? A multicenter cohort study.","authors":"Hiromi Miyata, Eiji Kobayashi, Miki Yasuda, Hungwu Chien, Masahiko Takemura, Tomoko Tsujie, Kyoka Amemiya, Akiko Otake, Toshiya Yamamoto, Eiji Nakatani, Michiko Kodama, Yutaka Ueda","doi":"10.1007/s00464-026-13529-3","DOIUrl":"https://doi.org/10.1007/s00464-026-13529-3","url":null,"abstract":"<p><strong>Background: </strong>The benefit of routine prophylactic antibiotics for clean laparoscopic adnexal surgery remains unclear. We evaluated whether pre-incision cefazolin reduces the incidence of 30-day surgical site infections (SSIs), and we identified perioperative risk factors for SSIs.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study using clinical data from Osaka University and six affiliated hospitals. Among 1,865 patients who underwent laparoscopic adnexal surgery for benign conditions, 1,678 were included after specified exclusions. Patients received either pre-incision cefazolin (n = 1,415) or no prophylaxis (n = 263) according to institutional policy. The primary outcome was the incidence of SSI during the 30-day postoperative interval, classified according to CDC criteria. The association between prophylaxis and SSI was evaluated using inverse probability of treatment weighting (IPTW). Propensity scores were estimated using age, body mass index, diabetes mellitus, endometriosis, and previous abdominal surgery. Risk factors for SSI were assessed using multivariable logistic regression analysis. Exploratory subgroup analyses were performed by repeating the same IPTW procedure within specified subgroups, and procedure-specific supplementary analyses were performed for ovarian cystectomy.</p><p><strong>Results: </strong>SSI occurred in 1.1% of patients in both groups: 16/1,415 in the cefazolin group and 3/263 in the non-antibiotic group. In IPTW-adjusted analyses, the incidence of SSI did not differ between groups (1.1% vs. 1.2%; p = 0.915). In multivariable analysis, operative time ≥120 min was associated with SSI (adjusted odds ratio [aOR] 3.54, 95% confidence interval [CI] 1.41-8.85). In supplementary analyses restricted to an ovarian cystectomy subgroup, uterine manipulator use was associated with SSI (aOR 4.03, 95% CI 1.26-12.90).</p><p><strong>Conclusion: </strong>Routine prophylactic cefazolin was not associated with a significantly lower incidence of 30-day SSI after clean laparoscopic adnexal surgery. Given few SSI events and the potential for residual confounding, our findings support further evaluation of a selective rather than routine approach to prophylactic antibiotic use.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224779","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}