Updates in Surgery最新文献

{"title":"Analysis of histological features and recurrence risk assessment of papillary thyroid carcinoma according to presurgery FNAC category.","authors":"Sium Wolde Sellasie, Stefano Amendola, Leo Guidobaldi, Tommaso Piticchio, Isabella Nardone, Simona Zaccaria, Giovanni Tacchi, Francesco Pedicini, Luigi Uccioli, Pierpaolo Trimboli","doi":"10.1007/s13304-025-02121-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02121-4","url":null,"abstract":"<p><p>Identifying preoperatively cases of more indolent papillary thyroid carcinoma (PTC)could be of high interest. The aim of this study was to verify previously published data on the prognostic value of fine needle aspiration cytology (FNAC)in PTC, also comparing findings from high-volume (HV)and low-volume (LV)institutions. From January 2022 to June 2024, the institutional database of the endocrinological surgery unit of Sant'Eugenio Hospital (Rome, Italy)was retrospectively reviewed to select patients who underwent thyroid surgery for PTC. To evaluate the prognostic value of presurgical FNAC, all histological features and the ATA risk of the study groups were compared. Later, data of patients entirely managed at our institution, considered as an HV institute, were compared with that of cases operated at our institution following FNAC performed LV centres.The 159 PTC nodules included were classified as TIR3B (20.1%),TIR4 (32.7%),and TIR5 (47.2%).The distribution of FNAC report between HV and LV was different (p = 0.01). The presence of lymph node metastasis (p = 0.004), and peri-thyroid tissue invasion (p = 0.02)increased according to the FNAC category. Significant difference among the three FNAC categories was also observed in PTC subtype (p = 0.006)and Hashimoto's thyroiditis (p = 0.02).In addition, a significant different trend was found in ATA risk assessment, being the risk of recurrence more prevalent according to the FNAC category (p = 0.008). According to the second study aim, the higher prevalence of low-risk cases in TIR3B was confirmed in both HV (p = 0.04) and LV (p = 0.03)subgroups.PTCs with preoperative TIR3B have different histological features and ATA risk assessment with respect to cases with presurgical FNAC of TIR4/5.Particularly, PTC from TIR3B should have a pattern of more indolent cancers. As non-negligible extension, this data is not influenced by the institutional setting with high or low thyroid-FNAC volume.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome prediction after emergency cholecystectomy: performance evaluation of the ACS-NSQIP surgical risk calculator and the 5-item modified frailty index.","authors":"Andrea Spota, Stefano Granieri, Amir Hassanpour, Eran Shlomovitz, Eisar Al-Sukhni","doi":"10.1007/s13304-025-02128-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02128-x","url":null,"abstract":"<p><p>Pre-operative risk assessment tools and frailty scores are increasingly common due to the growing number of elderly, comorbid and frail patients. This study aims to assess the performance of the ACS-NSQIP-SRC (American College of Surgeons- National Surgical Quality Improvement Program- Surgical Risk Calculator) and the 5mFI (5-items modified Frailty Index) in predicting clinical outcomes after emergency cholecystectomy. This is a retrospective cohort study of patients with acute calculous cholecystitis admitted at our tertiary care center from 2018 to 2023. We evaluated discrimination, calibration, and accuracy of the ACS-NSQIP-SRC and 5mFI in predicting any complication, mortality, length of hospital stay (LOS), need for readmission and supported discharge (30-day follow-up). Among 365/642 patients who underwent surgery, the 5mFI showed poor discrimination for all outcomes but good overall accuracy in the prediction of a supported discharge. In 198 operated patients with available data for the ACS-NSQIP-SRC, it underestimated complications and need for readmission while overestimated the need for supported discharge. There was no concordance between predicted and observed LOS. Among 277/642 patients undergoing non-operative management, 2/3 were frail or mild frail and had a predicted rate of any unfavorable outcome after surgery between 0 and 20%, being 95% above the average risk of each outcome. Mortality couldn't be studied because no death was reported. ACS-NSQIP-SRC and 5mFI performance in predicting outcomes after emergency cholecystectomy for acute cholecystitis was poor. In the emergency cholecystectomy setting, the ACS-NSQIP-SRC may be less informative, and the 5mFI may be excessively simplistic by neglecting the multidimensional nature of frailty.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective observational study of laparoscopic approaches for suspected gallbladder cancer in Yamaguchi (YPB-002 LAGBY).","authors":"Yukio Tokumitsu, Toru Kawaoka, Satoshi Matsukuma, Eijiro Harada, Shigeyuki Suenaga, Masahiro Tanabe, Hidenori Takahashi, Yoshitaro Shindo, Hiroto Matsui, Masao Nakajima, Tatsuya Ioka, Taro Takami, Katsuyoshi Ito, Hidekazu Tanaka, Kimikazu Hamano, Hiroaki Nagano","doi":"10.1007/s13304-025-02119-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02119-y","url":null,"abstract":"<p><p>We have previously reported laparoscopic total biopsy methods for suspected gallbladder cancer (GBC). The present prospective observational study evaluated the safety and feasibility of a novel two-stage algorithm using laparoscopic total biopsy methods. The two-stage algorithm was applied for 40 patients with suspected GBC between July 2018 and September 2022. Laparoscopic whole-layer cholecystectomy (LWLC) was performed for early-stage or suspected malignant lesions without liver invasion and laparoscopic gallbladder bed resection (LGBR) was performed for lesions with an unclear border between the gallbladder and liver. The appropriate strategy could be selected postoperatively depending on the final pathological diagnosis according to examination of permanent sections of gallbladder. If preoperative imaging reveals enlarged lymph nodes (LNs) with possible metastases, LN sampling with intraoperative pathological diagnosis is performed prior to gallbladder removal to determine whether to introduce neoadjuvant chemotherapy. As the first diagnostic procedure, we performed LWLC in 30 cases, LGBR in 8 cases, and LN sampling alone in 2 cases. Median operation time was 165 min and median blood loss was 5.5 ml. No bile leakage caused by intraoperative perforation of the gallbladder was observed. Histologically, GBC was diagnosed in 16 cases (pTis, n = 2; pT1a, n = 2; pT1b, n = 2; pT2, n = 6; pT3, n = 4). Seven of the 10 pT2/3 cases underwent additional open lymphadenectomy. The two-stage algorithm using laparoscopic total biopsy methods for suspected GBC appears to represent a safe, feasible procedure that could play an important role in the optimal treatment strategy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspectives on living donor selection in liver transplantation.","authors":"Colin Powers, Vikraman Gunabushanam, Leonardo Centonze, Abhinav Humar","doi":"10.1007/s13304-025-02131-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02131-2","url":null,"abstract":"<p><p>The careful selection of donors is crucial to achieving a successful outcome in living donor liver transplantation. The evaluation process involves obtaining a comprehensive medical history and pertinent laboratory testing, evaluating surgical anatomy using cross-sectional radiologic imaging and understanding donor motivation and psycho social considerations. This review outlines the evaluation of a potential living liver donor and discussed frequently encountered special considerations that may need to be addressed by the transplant team.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook outcome following pancreaticoduodenectomy in elderly patients: age-stratified analysis and predictive factors.","authors":"F Mocchegiani, A Benedetti Cacciaguerra, T Wakabayashi, F Valeriani, P Vincenzi, F Gaudenzi, D Nicolini, G Wakabayashi, M Vivarelli","doi":"10.1007/s13304-025-02130-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02130-3","url":null,"abstract":"<p><p>Despite advancements in pancreatic surgery, managing elderly patients undergoing pancreaticoduodenectomy (PD) remains challenging. Textbook Outcome (TO) serves as a benchmark for surgical success, but its relevance in elderly patients has not been well explored. This study aims to evaluate TO in elderly patients undergoing PD and identify predictors of TO failure. A retrospective analysis was conducted on elderly patients (≥ 70 years) who underwent PD between January 1, 2017, and December 31, 2023 in two international HPB centers. TO achievement rates were assessed and stratified by age groups (70-74, 75-79, ≥ 80). Uni- and multivariate logistic regression analyses were performed to identify risk factors for TO failure. Of 222 patients, 54.5% achieved TO after PD. TO rates decreased with age, with only 35.0% of octogenarians achieving TO, compared to 57.1% in those aged 70-74. Multivariate analysis revealed that age ≥ 80, an ASA score ≥ 2, and histopathologic types other than pancreatic ductal adenocarcinoma or distal cholangiocarcinoma were significant risk factors for failing to achieve TO. Nearly half of elderly patients achieved TO, with a lower likelihood in older age groups, particularly among octogenarians. Higher ASA scores were also associated with lower TO achievement. These findings underscore the importance of a comprehensive preoperative assessment, considering age, to optimize surgical outcomes in elderly patients undergoing PD.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic radial incision combined with local injection of triamcinolone acetonide for refractory esophageal stenosis after endoscopy submucosal dissection.","authors":"Hoi-Ioi Ng, Yi Liu, Yong Liu, Li-Zhou Dou, Shun He, Gui-Qi Wang","doi":"10.1007/s13304-025-02069-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02069-5","url":null,"abstract":"<p><p>Refractory esophageal stenosis (RES) after endoscopic submucosal dissection (ESD) is challenging in clinical practice. This study aimed to evaluate endoscopic radial incision (ERI) combined with the local injection of triamcinolone acetonide for RES and to assess its safety and efficacy. A total of nine patients (five males; age range: 50-76 years) who underwent ERI + triamcinolone acetonide for RES after ESD between August 2019 and November 2022 were analyzed. The primary endpoint was the duration of treatment. The length of the stenosed portion, procedure time, sessions of endoscopic therapy, effectiveness rate, success rate, dysphagia grade, complications, and quality of scores were also analyzed. The effectiveness and success rates were 100% and 88.9%, respectively. The mean number of sessions of ERI + triamcinolone acetonide was 2.2 (1.0-4.0). The mean procedure time was 25.9 ± 3.8 min. No severe complications, including bleeding or perforation, were observed during the perioperative period. Dysphagia symptoms were relieved in all patients after endoscopic treatment. Patients had significantly better functional scales for social functioning and global health status and lower rates of fatigue, gastrointestinal symptoms, and financial difficulties after treatment. ERI + triamcinolone acetonide can be considered a safe and effective treatment for RES after ESD. Larger prospective clinical trials are needed to confirm its utility.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of robotic platforms for repeat hepatectomies: a propensity score matched study of clinical outcomes.","authors":"Bhavya Bansal, Tara M Pattilachan, Sharona Ross, Maria Christodoulou, Iswanto Sucandy","doi":"10.1007/s13304-025-02117-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02117-0","url":null,"abstract":"<p><p>Robotic surgical approaches have demonstrated improved outcomes in primary hepatectomies. However, data on their effectiveness in redo hepatectomies (subsequent liver resections) are limited. This study aims to compare the outcomes of patients undergoing primary and redo robotic hepatectomies, with additional analysis comparing outcomes of robotic versus open redo hepatectomies. With IRB approval, we prospectively followed 101 patients from a parent population of 465, who were classified as either primary (non-redo) or redo robotic hepatectomy patients between 2013 and 2023. A Propensity Score Matched (PSM) analysis was conducted to compare perioperative variables between the two cohorts, using age, sex, BMI, IWATE score, tumor size, and tumor type as matching variables. Data are presented as median (mean ± standard deviation). Significance was accepted at p ≤ 0.05. After 3:1 PSM analysis (3 primary patients to 1 robotic redo patient), no significant differences were observed in pre-, intra-, or postoperative variables, except for the Model for End-Stage Liver Disease (MELD) score (p = 0.022). Additional analysis comparing robotic and open redo hepatectomies showed similar perioperative outcomes, with the robotic approach demonstrating comparable safety and feasibility. Length of stay, blood loss, operative duration, morbidity, and mortality showed no significant differences between the two groups. Major complications (Clavien-Dindo score ≥ III) occurred in 4% of non-redo patients, with none observed in the redo group. The findings suggest that patients undergoing redo robotic hepatectomies achieve outcomes comparable to those of primary hepatectomy patients. This indicates the potential of robotic platforms to mitigate the added complexities and risks associated with redo hepatectomies. Further multi-center collaboration is necessary to validate these findings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All that glisters is not gold.","authors":"Fariba Abbassi, Milo A Puhan, Pierre-Alain Clavien","doi":"10.1007/s13304-025-02114-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02114-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment to: Immediate repair of the recurrent laryngeal nerve during thyroid surgery via a tension-free end-to-side anastomosis with the Vagus.","authors":"Mehmet Eşref Ulutaş","doi":"10.1007/s13304-025-02132-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02132-1","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omental patch as prevention for bile leak in patients undergoing subtotal cholecystectomy: a propensity score analysis.","authors":"Camilo Ramírez-Giraldo, Violeta Avendaño-Morales, Alejandro González-Muñoz, Isabella Van-Londoño, Juan Felipe Díaz-Castrillón, Andrés Isaza-Restrepo","doi":"10.1007/s13304-025-02129-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02129-w","url":null,"abstract":"<p><p>Subtotal cholecystectomy is one of the most frequent bail-out procedures performed during difficult cholecystectomy. A common complication to this procedure is bile leak, and thus multiple strategies have been created to avoid its appearance. This study aims to evaluate the effectivity of using an omental patch as bile leak prevention in patients undergoing subtotal cholecystectomy. A retrospective cohort study including patients who underwent subtotal cholecystectomy between 2014 and 2022 was performed. 17 patients had an omental patch, while 378 did not; the latter were included to evaluate surgical outcomes with bile leak as a primary outcome using a propensity score matching analysis (PSM). Patients' median age in both groups after PSM was 71.00 (IQR: 59.00-81.00) and 69.00 (IQR: 61.75-80.25) years, respectively. The dominant sex in both groups was male. In most cases surgical procedure indication was cholecystitis. Patients who had an omental patch did not present statistically significant differences for bile leak rates compared to patients who did not (29.4% versus 17.6%, p = 0.456, respectively). Similar results were observed when evaluating the need for postoperative ERCP for bile leak management (23.5 versus 5.9%, p = 0.078). A statistically significant higher proportion of major complications were observed in patients who had an omental patch (47.1% versus 19.1%, p = 0.038). Pedicled omental patch was not an effective measure for preventing bile leak, and it even presented a higher rate of complications. It is thus imperative to continue evaluating other strategies for the prevention of bile leak during subtotal cholecystectomy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}