Surgical Endoscopy And Other Interventional Techniques最新文献

{"title":"Efficacy and safety of three methods of endoscopic retrograde cholangiopancreatography in removing small common bile duct stones: a prospective multicenter randomized controlled study.","authors":"Qiang Ye, Jin Zhang, Jun Yao, Qiang Zhan, Lisheng Tao, Xiaobing Xu, Xinyun Qiu, Tao Chen, Jinliang Ni, Jingjing Ma, Lisha Jiang, Guoxin Zhang, Hong Zhu, Shunfu Xu","doi":"10.1007/s00464-025-12135-z","DOIUrl":"https://doi.org/10.1007/s00464-025-12135-z","url":null,"abstract":"<p><strong>Background: </strong>In endoscopic retrograde cholangiopancreatography (ERCP), common bile duct stones (CBDSs) can be removed through strategies, including endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), and endoscopic sphincterotomy plus balloon dilation (ESBD). By comparing the efficacy and safety of these three methods, we aimed to determine the optimal technique for the removal of small CBDSs (≤ 10 mm in size).</p><p><strong>Methods: </strong>This was a multicenter, prospective, parallel controlled study involving patients with small CBDSs undergoing ERCP in three tertiary medical institutions in Jiangsu Province, China, who were randomly divided into the EST group, EPBD group, and ESBD group. The efficiencies of these three techniques were compared by analyzing the first-session and overall success rates of stone removal and the use of endoscopic mechanical lithotripsy (EML). Their safety was compared by measuring the incidences of post-ERCP pancreatitis (PEP) and other adverse events.</p><p><strong>Results: </strong>A total of 350 patients were enrolled. Eligible patients were randomly assigned to the EST group (n = 116), EPBD group (n = 118), and ESBD group (n = 116). Sex, median age, number, and median size of small CBDSs were comparable. The first-session (all > 97%) and overall success rates of stone removal (all 100%) were high. No significant difference was detected in the incidence of EML (all < 1%). The incidences of PEP (all < 6%), bleeding, perforation, infection, and hyperamylasemia were low in all three groups, with no significant among-group differences.</p><p><strong>Conclusion: </strong>EST, EPBD, and ESBD all exhibit excellent efficacy and safety in the removal of small CBDSs. EPBD is recommended as the optimal method for removing small CBDSs due to its simple procedures, functional preservation of the sphincter of Oddi, and fewer long-term complications.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226000","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":"Effectiveness of transoral endoscopic fundoplication with or without hiatal hernia repair in patients with gerd and chronic cough.","authors":"Eric Swei, Jose A Almario, Kerry Dunbar, Rena Yadlapati, Brett Parker, Olaya Brewer-Gutierrez, Peter Janu, Michael Murray, Amit Sohagia, David L Diehl, Harshit Khara, Barham Abu Dayyeh, Reem Sharaiha, Rasa Zarnegar, Jennifer Kolb, Ninh Nguyen, Kenneth Chang, Marcia I Canto","doi":"10.1007/s00464-025-12246-7","DOIUrl":"https://doi.org/10.1007/s00464-025-12246-7","url":null,"abstract":"<p><strong>Aims: </strong>Gastroesophageal Reflux Disease (GERD) is a common cause of chronic cough. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) may be suitable treatments. We studied the effectiveness of TIF/cTIF in patients with chronic cough and proven GERD.</p><p><strong>Methods: </strong>Patients with proven GERD from 9 centers (TIF registry) were evaluated before and at a minimum of 6 months post TIF/cTIF. Patients with cough-predominant phenotype were identified (chief complaint of cough and reflux symptom index (RSI) troublesome cough subscore ≥ 2) and compared to those without. The primary outcome was improvement in RSI score compared to baseline. Secondary outcomes were normalization of RSI, improvement in RSI cough sub-scores, GERD symptom improvement, discontinuation of proton pump inhibitor, and patient satisfaction.</p><p><strong>Results: </strong>One hundred and ninety-eight patients underwent TIF/cTIF. Follow-up for 177 patients (median 12 months [IQR 6,12]) showed decrease in median RSI score from 18 [IQR 13, 27] to 5 [IQR 2, 11] (p < 0.0001). Eighty-three percent of patients with elevated baseline RSI normalized their scores. Seventy-five percent and 72% had improvement in cough when lying down and troublesome cough, respectively. Eighty-three percentsuccessfully discontinued or decreased PPI. Satisfaction improved from 5.6% at baseline to 68.8% (p < 0.0001). Patients with cough-predominant phenotype (n = 63) experienced an additional 5-point decrease in in RSI score (p = 0.01). Patients with typical GERD symptoms were more likely to have a favorable response for cough symptoms (p < 0.0001).</p><p><strong>Conclusion: </strong>TIF/cTIF are effective barrier therapies for patients with cough-predominant pH-positive GERD.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207705","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":"Short-term outcomes of single-port robotic surgery versus single-port laparoscopic surgery for colon cancer: a multicenter matched-cohort analysis.","authors":"Gyoung Tae Noh, Young Il Kim, Seung Ho Song, Hye Jin Kim, Song-Soo Yang, Yong Sik Yoon, Ji Hoon Kim, Hyung Jin Kim, Byung Mo Kang, Chang Woo Kim, Suk-Hwan Lee, Jun Gi Kim, Yoon Suk Lee","doi":"10.1007/s00464-025-12275-2","DOIUrl":"https://doi.org/10.1007/s00464-025-12275-2","url":null,"abstract":"<p><strong>Background: </strong>Single-port laparoscopic surgery (SPLS) improves patient comfort; however, it has limitations, including poor instrument triangulation. The da Vinci® SP system used in single-port robotic surgery (SPRS) addresses these challenges. Most studies on SPRS involve small case series or comparisons with multiport procedures, usually lacking direct comparisons with SPLS for colon cancer. Therefore, this study aimed to evaluate the surgical outcomes of SPRS and compare its short-term results with those of SPLS for colon cancer.</p><p><strong>Methods: </strong>This study included patients who underwent SPRS for colon cancer between March 2019 and April 2023 at four tertiary referral centers. Medical records of these patients were reviewed. Eligible patients were aged 19-85 years, with American Society of Anesthesiologists class I or II, and confirmed adenocarcinoma of the ascending or sigmoid colon without distant metastasis. The data obtained were compared with those of the SPLS cohort from the SIngle-port versus MultiPort Laparoscopic surgEry multicenter randomized trial. A matched cohort analysis accounted for baseline differences.</p><p><strong>Results: </strong>Overall, 185 and 179 patients were included in the SPRS and SPLS groups, respectively. After matching, 95 and 86 patients who underwent SPRS and SPLS, respectively, were analyzed with balanced baseline characteristics. SPRS was associated with less blood loss, lower conversion rates, fewer intraoperative complications, and faster recovery, including earlier diet resumption and shorter hospital stays, than SPLS.</p><p><strong>Conclusions: </strong>SPRS provides superior perioperative advantages over SPLS, including reduced blood loss, lower conversion rates, fewer complications, and faster recovery. These findings highlight SPRS as a promising option for minimally invasive colorectal surgery, pending further validation to confirm these benefits and ensure long-term efficacy.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207652","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":"Evaluation of 350 robotic liver resections performed by an early adopter in laparoscopic liver surgery: clinical outcomes and critical appraisal of the learning curve.","authors":"Tom Vandaele, Ismaël Chaoui, Celine De Meyere, Louis Desmet, Jens Goemaere, Isabelle Parmentier, Bram Vanhoof, Mathieu D'Hondt","doi":"10.1007/s00464-025-12274-3","DOIUrl":"https://doi.org/10.1007/s00464-025-12274-3","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted liver surgery is increasingly adopted, offering many advantages over conventional laparoscopy. This study evaluates perioperative outcomes, learning curves, instrument use, and cost price of the first 350 robotic liver resections (RLRs) performed by a high-volume HPB surgeon with extensive open and laparoscopic experience. Additionally, we assess whether established laparoscopic difficulty scoring systems can reliably predict surgical complexity and outcomes in robotic procedures.</p><p><strong>Methods: </strong>All RLRs performed by a single surgeon from February 2020 to April 2025 were identified from a prospectively maintained database. Perioperative outcomes were analyzed, and learning curves for minor, anatomically major, and technically major resections were defined using cumulative sum analysis of operative time. Multivariate regression was used to assess the impact of case volume and preoperative difficulty scores on operative time and blood loss. And a descriptive analysis of instrument use, robotic techniques, and cost price is provided.</p><p><strong>Results: </strong>Of the 350 RLRs, 147 were minor, 43 were anatomically major, and 160 were technically major resections. Median operative time was 145 min (IQR: 122-188), with median estimated blood loss of 30 mL (IQR: 20-90). Our conversion rate to open surgery was 0.6% (n = 2). Major complications (Clavien-Dindo ≥ III) occurred in 6%, with a median hospital stay of 3 days and a 90-day mortality rate of 1.1%. Learning plateaus were reached at 28 (minor) cases, 15 (anatomically major) cases, and 54 (technically major) cases. Case volume was not associated with operative time (p = 0.79) or blood loss (p = 0.93). In contrast, IWATE, Southampton, and IMM scores strongly predicted both (p < 0.001). A clear instrument preference was observed; most procedures required the use of 3-4 instruments, and the mean hospitalization cost was €5,408.50.</p><p><strong>Conclusion: </strong>Robotic liver resection is safe, feasible, and cost-effective in experienced hands, with a short learning curve and strong predictive value from laparoscopic difficulty scores.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207633","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":"Analysis of risk factors for bleeding after gastric endoscopic submucosal dissection with an emphasis on age and sex differences: A nationwide population-based study.","authors":"Jae Yong Park, Mi-Sook Kim, Beom Jin Kim, Jae Gyu Kim","doi":"10.1007/s00464-025-12201-6","DOIUrl":"https://doi.org/10.1007/s00464-025-12201-6","url":null,"abstract":"<p><strong>Background: </strong>Gastric endoscopic submucosal dissection (ESD) has been increasingly performed in elderly patients. However, bleeding remains a major complication. We aimed to comprehensively evaluate the risk factors of post-procedural bleeding, focusing on age and sex differences.</p><p><strong>Methods: </strong>This was a nationwide, population-based, retrospective study utilizing the Korean NHIS database, comprising patients who underwent gastric ESD from November 2011 to December 2022. Operational definitions were created to identify the target population and post-procedural bleeding within 30 days. Mixed-effect logistic regression models were used to identify risk factors for bleeding. The variables comprehensively included basic demographic factors, tumor characteristics, comorbidities, medication usage, and lifestyle behaviors.</p><p><strong>Results: </strong>7825 bleeding events occurred in 164,968 procedures. In multiple logistic regression, significant risk factors included young age, male sex, higher Charlson Comorbidity Index (CCI), gastric cancer, multiple lesions, several comorbidities (highest aOR for renal failure undergoing hemodialysis) and antithrombotic agents (highest aOR for warfarin), underweight, current smoking, and heavy drinking. Being overweight and obese, however, showed a protective effect. Certain variables impacted bleeding risk differently based on age and sex. In the elderly group, high CCI and DOAC use were more influential, while male sex, smoking, and drinking had a diminished effect. Sex differences were more pronounced in the non-elderly group, with gastric cancer, warfarin use, and heavy drinking having a greater impact, while SES and obesity offered stronger protection in females.</p><p><strong>Conclusions: </strong>This study identified risk factors for post-ESD bleeding and highlighted the role of age and sex in risk stratification and personalized treatment.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201453","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":"Analysis of the long-term impact of glucagon-like peptide-1 (GLP-1) receptor agonists for control of obesity and obesity-related comorbidities: a meta-analysis.","authors":"Iwanger-I-Ter T Jia, Grace C Bloomfield, Mike Y Chen, Marcus H Cunningham, Dan E Azagury, Yewande R Alimi, Nicholas J Prindeze","doi":"10.1007/s00464-025-12086-5","DOIUrl":"https://doi.org/10.1007/s00464-025-12086-5","url":null,"abstract":"<p><strong>Introduction: </strong>GLP-1 receptor agonist medications are a promising new medical weight loss therapy and have been shown to reduce rates of obesity-related comorbidities. The aim of this meta-analysis was to examine the long-term effects of these medications.</p><p><strong>Methods: </strong>A meta-analysis was performed following PRISMA guidelines. Data were collected on weight change, type 2 diabetes, and hypertension prevalence with GLP-1 or placebo therapy in studies meeting inclusion criteria per study protocol.</p><p><strong>Results: </strong>A total of 54 articles and 59,856 patients were included in this study. GLP-1-treated patients were noted to lose an average of 10.6% of total body weight (TBW) compared to placebo at 3.9%, with a peak occurring at 12-18 months of treatment. When subdivided into intention-to-treat and adherent patients, those maintaining medication use lost more weight at a peak of 12% TBW loss. Weight regain with medication discontinuation was found to occur within weeks at a rate of 0.55% original TBW per month. The incident rate of type 2 diabetes was reduced sevenfold by GLP therapy over placebo. Hypertension resolution was also noted to be higher in the GLP-1-treated patients at a peak of 23% reduction compared to 11% for placebo.</p><p><strong>Conclusion: </strong>GLP-1 medications are effective at weight reduction and can produce diabetes and hypertension remission. Medication adherence is critical for efficacy, and non-compliance dramatically reduces the impact of these therapies. Additionally, medication discontinuation results in rapid weight regain within weeks; however, longer-term data are needed to qualify the durability of GLP-1-mediated weight loss.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201370","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":"Urgent endoscopic retrograde cholangiopancreatography improves clinical outcomes in acute cholangitis from choledocholithiasis: a propensity score-matched study.","authors":"Ronnakorn Kongsakon, Manus Rugivarodom, Pochamana Phisalprapa, Khemajira Karaketklang, Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi","doi":"10.1007/s00464-025-12233-y","DOIUrl":"https://doi.org/10.1007/s00464-025-12233-y","url":null,"abstract":"<p><strong>Background: </strong>Early endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage is recommended for acute cholangitis based on disease severity. However, the optimal timing of ERCP remains unclear. This study aimed to evaluate the impact of urgent ERCP (≤ 24 h) on clinical outcomes in patients with common bile duct (CBD) stone-related acute cholangitis.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among patients who underwent ERCP for acute cholangitis due to CBD stones between 2008 and 2017. Patients were categorized according to ERCP timing: urgent (≤ 24 h) and non-urgent (> 24 h). Outcomes included in-hospital mortality, organ failure at 72 h, length of hospital stay, procedure-related complications, and 30-day readmission. Propensity score matching (PSM) was applied to balance baseline characteristics, including age, sex, comorbidities, Charlson comorbidity index, and cholangitis severity according to the Tokyo Guidelines 2018.</p><p><strong>Results: </strong>Among 455 eligible patients, 191 matched pairs were analyzed. The mean age was 66 ± 16 years, and 50% were male. Among them, 21.5% had severe cholangitis, 40.4% moderate, and 38.1% mild disease. Following matching, patient characteristics of the two groups were balanced, except for a higher percentage of patients with moderate cholangitis in the non-urgent group. In-hospital mortality was significantly lower in the urgent ERCP group (0.5% vs 21%; adjusted OR 0.09; 95% CI: 0.01-0.73; p = 0.024). Median hospital stay was shorter (5 vs 8 days; p < 0.001), while stone clearance rates (approximately 75%), persistent organ failure, procedural complications, and readmission were comparable between groups. Subgroup analysis revealed a mortality benefit of urgent ERCP in moderate (p < 0.01) and severe (p = 0.024) cholangitis, but not in mild cases.</p><p><strong>Conclusions: </strong>Urgent ERCP within 24 h significantly reduces in-hospital mortality and shortens hospitalization in patients with moderate to severe cholangitis due to CBD stones. These findings support early intervention as a key component of management in this population.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193069","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: Fluorescence-guided sleeve gastrectomy and gastric bypass: first-in-human trial using novel gastric calibration tube.","authors":"Salim Abunnaja, Diane Bronikowski, Acara Turner, Nova Szoka, Rebekah Guillow, Stephanie Cox, Lawrence Edward Tabone","doi":"10.1007/s00464-025-12237-8","DOIUrl":"https://doi.org/10.1007/s00464-025-12237-8","url":null,"abstract":"","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192938","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":"Single-incision laparoscopic endorectal pull-through for Hirschsprung disease: a prospective institutional study and systematic review with meta-analysis.","authors":"Hien Duy Pham, Dung Duc Dao, Quynh Anh Tran, Nhung Thi Nguyen, Dung Boi Ly, Hau Duc Bui, Liem Thanh Nguyen, Quang Thanh Nguyen","doi":"10.1007/s00464-025-12114-4","DOIUrl":"https://doi.org/10.1007/s00464-025-12114-4","url":null,"abstract":"<p><strong>Background: </strong>Single-incision laparoscopic endorectal pull-through (SILEP) has emerged as an alternative to conventional laparoscopic surgery for Hirschsprung disease (HSCR), offering improved cosmetic outcomes with comparable efficacy. However, its adoption remains limited, and evidence supporting its long-term safety and functional outcomes is sparse. This study presents our institutional experience with SILEP, alongside a systematic review and meta-analysis evaluating perioperative outcomes, postoperative complications, bowel function, and cosmesis.</p><p><strong>Patients and methods: </strong>A prospective study was conducted at our institution involving 93 pediatric patients diagnosed with HSCR, who underwent SILEP between 2020 and 2021. Demographic data, perioperative details, and postoperative outcomes, including bowel function score (Rintala) and cosmetic results (Manchester Scar Scale), were prospectively collected and analyzed. Additionally, a systematic review and meta-analysis were performed following PRISMA guidelines, pooling data from nine studies comprising 420 patients.</p><p><strong>Results: </strong>The mean operative time was 70.0 ± 30.3 min, significantly shorter than the pooled estimate from the meta-analysis (166.44 min; 95% CI 137.74-195.14, p < 0.001). No intraoperative complications or conversions were recorded. The mean hospital stay was 5.23 ± 2.69 days, consistent with prior reports. Enterocolitis occurred in 16.1% of cases, comparable to the pooled estimate (12%; 95% CI 7-21%). Among patients aged ≥ 4 years (n = 64), 84% achieved good to excellent bowel function scores. The mean Manchester Scar Score was 5.73 ± 1.38.</p><p><strong>Conclusion: </strong>SILEP is a safe, effective, and cosmetically superior approach for HSCR, with favorable perioperative outcomes and functional results. Our findings, supported by meta-analysis data, reinforce the feasibility of SILEP as a viable alternative for HSCR management.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193036","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 and survival outcomes of pT2N0 rectal adenocarcinoma treated by transanal local excision: a retrospective cohort study.","authors":"Alberto Arezzo, Carlo Alberto Ammirati, Giovanni Distefano, Michele Barbiero, Roberto Passera, Mario Morino","doi":"10.1007/s00464-025-12239-6","DOIUrl":"https://doi.org/10.1007/s00464-025-12239-6","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of pT2N0 rectal adenocarcinoma remains controversial, especially when tumours are incidentally diagnosed after local excision. Although total mesorectal excision (TME) is the standard approach, its associated morbidity has led to the exploration of conservative strategies. This study compares oncologic outcomes amongst three post-excision management options: salvage surgery, adjuvant radiotherapy, and no further treatment.</p><p><strong>Methods: </strong>This retrospective cohort comprised 90 patients with pT2N0 rectal adenocarcinoma who were treated by transanal excision at a single tertiary centre from 1993 to 2025. All patients were staged N0 on MRI and divided into three groups: Group A (no further treatment), Group B (adjuvant radiotherapy), and Group C (completion salvage surgery). The primary outcomes were overall survival (OS) and disease-free survival (DFS), with additional analyses of histopathologic prognostic factors.</p><p><strong>Results: </strong>Median follow-up was 31 months. OS varied significantly across groups (p = 0.015), with the highest survival in Group B, followed by Group C and Group A. DFS showed no significant difference between groups. Patients in Group B had the lowest mortality (8.7%) and recurrence (30.4%) rates. Tumour budding was a significant predictor of poor prognosis in multivariate analysis. Local excision alone was associated with higher recurrence and mortality rates.</p><p><strong>Conclusion: </strong>In selected patients with pT2N0 rectal cancer discovered after transanal excision, adjuvant radiotherapy may provide outcomes comparable to salvage surgery and serve as an alternative in patients not suitable for surgery. High-risk histopathologic features should inform further management, as local excision alone was associated with worse outcomes. Multidisciplinary evaluation remains crucial for treatment planning.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193008","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}