Updates in Surgery最新文献

{"title":"Correction: Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis.","authors":"Alaa Hussein Alwan Alsalaumy","doi":"10.1007/s13304-026-02647-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02647-1","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843253","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":"Ablation of cystic thyroid nodules with or without the injection of ethanol prior to aspiration: a one-year follow-up study.","authors":"Lorenzo Scappaticcio, Nicole Di Martino, Pamela Ferrazzano, Silvia Angelino, Michela Di Nuzzo, Miriam Longo, Alessandro Monaco, Giovanni Docimo, Maria Ida Maiorino, Katherine Esposito, Giuseppe Bellastella","doi":"10.1007/s13304-026-02607-9","DOIUrl":"https://doi.org/10.1007/s13304-026-02607-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843338","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":"Anterior approach with liver hanging maneuver vs conventional approach in major hepatic resections: can 3D visualization technology affect complex surgical maneuvers?","authors":"C Cotsoglou, G Pugliese, S Granieri, G M Ettorre, F Izzo, F Panaro, R Memeo, E Gjoni, A Germini, B Torre, G Berardi, S Caringi, M Maione, E Tessitore, E M Muttillo, M Puglia, A Di Lucia, M Cavicchioli, A V Gatti","doi":"10.1007/s13304-026-02662-2","DOIUrl":"https://doi.org/10.1007/s13304-026-02662-2","url":null,"abstract":"<p><p>The anterior approach (AA) with liver hanging maneuver (LHM) has been proposed as an alternative to the conventional approach (CA) for major hepatectomies. Despite its potential advantages, LHM remains underutilized, partly due to concerns about vascular injury and tumor rupture. Three-dimensional visualization technology (3DVT) may improve anatomical comprehension and inform preoperative decision-making in selecting surgical strategies. We retrospectively analyzed 20 patients undergoing major hepatic resections (right/left hepatectomy and right posterior sectionectomy) between 2019 and 2024. Four expert hepatobiliary surgeons (HPB) and four postgraduate surgical trainees (PGY5) independently assessed surgical strategy based on 2D imaging, followed by reevaluation with 3D reconstructions. Patient-specific 3D structures were generated using an AI-assisted segmentation pipeline and systematically revised by physician specialists, a board-certified abdominal radiologist and two hepatobiliary surgeons. Intra-rater concordance was evaluated using Cohen's Kappa. Primary endpoint was the rate and directionality of surgical plan modifications due to 3DVT. Secondary endpoints included perioperative outcomes and segmentation performance metrics. 3DVT prompted significant changes in surgical planning, particularly in assessing LHM feasibility. Trainees exhibited a higher proportion of positive shifts in decision-making (No → Yes: 17.6%) compared to experts (10.8%), whereas experts more frequently reversed previously affirmative decisions (Yes → No: 9.5%). In select raters, negative Kappa values indicated systematic reassessment driven by 3D data. No significant differences in intraoperative blood loss, operative time, transfusion rate, complications, or mortality were observed between AA + LHM and CA cohorts. 3D segmentation achieved high concordance with manual ground truth (median Dice similarity coefficient for liver parenchyma: 0.98). 3DVT exerts a quantifiable influence on preoperative strategy, particularly for complex hepatic resections. It facilitates surgical planning among trainees and enhances precision among experienced surgeons. Integration of 3DVT may support safer adoption of technically demanding maneuvers such as LHM, especially in minimally invasive settings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843288","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":"Risk of malignancy and necessity of completion thyroidectomy in patients with indeterminate thyroid nodules (Bethesda III and IV), more than expected in endemic region.","authors":"Aykut Çelik, Tuğba Matlım Özel, Sezer Akbulut, Görkem Yıldız, Fatih Mert Dogukan, Serkan Sarı","doi":"10.1007/s13304-026-02655-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02655-1","url":null,"abstract":"<p><p>American Thyroid Association (ATA) argues that the prevalence of malignancy of the indeterminate nodules may vary substantially among regions, and states that it is crucial to know the prevalence of malignancy within each indeterminate cytological category at one's institution. Our aim is to draw attention to the malignancy rates of indeterminate nodules that cannot be underestimated in an endemic region and raise awareness to differences across different populations. Between March-2021 and June-2024, 13,531 fine needle aspirations were performed on thyroid nodules in a single institution. Of these 2121 nodules were classified as indeterminate (Bethesda III-IV) and 242 patients underwent surgery. Demographic characteristics, nodule size, risk of malignancy, tumor types and subtypes were evaluated. The necessity of radioactive iodine (RAI) therapy and consequent completion thyroidectomy was investigated. Of the 242 patients 123 (50.8%) underwent lobectomy and 119 (49.2%) underwent total thyroidectomy. In total, 115 (47.5%) of 242 patients resulted in malignancy (186 patients were Bethesda-III and 82 (44.1%) of them were malignant; 56 were Bethesda-IV and 33 (58.9%) of them were malignant). Incidental carcinoma was detected in a different focus other than the indeterminate nodule in 17 patients. RAI therapy was indicated in 39 patients (33.9%) primarily based on the ATA guideline, and 24 (20.8%) patients who initially underwent lobectomy required completion thyroidectomy. Risk of malignancy in indeterminate thyroid nodules varies endemically. Each region should know their own risk and each patient's treatment should be tailored accordingly. In this way, under-overtreatment and related morbidities will be prevented.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782238","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 on 'Outcome of lateral internal sphincterotomy for anal fissure in a retrospective cohort of patients'.","authors":"Min Lv, Liyi Zhu, Shaoou He","doi":"10.1007/s13304-026-02660-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02660-4","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782468","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":"Compliance with an enhanced recovery pathway and postoperative outcomes in elderly colorectal cancer patients: a real-world cohort and structural pathway analysis.","authors":"Liping Feng, Qingyong Huang, Songchun Liu, Shuang Wu","doi":"10.1007/s13304-026-02634-6","DOIUrl":"https://doi.org/10.1007/s13304-026-02634-6","url":null,"abstract":"<p><p>ERAS programmes are widely used in colorectal surgery, but the impact of overall pathway compliance on outcomes in elderly colorectal cancer patients and the mechanisms linking compliance to recovery are unclear. We retrospectively analysed 206 elderly patients (median age 72 years) who underwent elective colorectal cancer resection within an ERAS pathway (2020-2023). Overall ERAS compliance was classified as high (≥ 70%, n = 114) or low (< 70%, n = 92). Outcomes included major complications (Clavien-Dindo III-V), length of stay (LOS), Comprehensive Complication Index (CCI), time to first flatus/defecation, readmission, mortality, and hospital costs. Subgroup analyses and structural equation modelling (SEM) assessed direct and indirect pathways between compliance and outcomes. High compliance was associated with fewer major complications (16.7% vs 29.3%, P = 0.048), lower CCI (18.6 ± 9.5 vs 22.1 ± 10.4, P = 0.014), and shorter LOS (8.2 ± 2.6 vs 10.1 ± 3.1 days, P = 0.003). Gastrointestinal recovery was faster (flatus 2.3 ± 0.8 vs 2.9 ± 1.0 days; defecation 3.8 ± 1.1 vs 4.5 ± 1.2 days; both P < 0.001), and costs were lower (64.8 ± 15.2 vs 72.5 ± 18.1 × 10³ RMB, P = 0.003). Readmission and 30-day mortality were low and similar between groups. SEM indicated that higher compliance directly reduced complications, CCI, and LOS, and indirectly reduced 30-day readmission via complications and LOS. In elderly colorectal cancer surgery, higher ERAS compliance is associated with lower morbidity, faster recovery, shorter LOS, and lower costs without increased short-term readmission or mortality, supporting efforts to monitor and improve adherence.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782537","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":"Multimodal AI approach combining deep learning imaging and clinical machine learning for pancreatic cancer detection.","authors":"Enes Şahin, Ozan Can Tatar","doi":"10.1007/s13304-026-02650-6","DOIUrl":"https://doi.org/10.1007/s13304-026-02650-6","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis due to late diagnosis, limitations of computed tomography (CT) imaging, and low accuracy of clinical biomarkers. This study aimed to develop and validate a multimodal artificial intelligence (AI) approach integrating imaging-based deep learning (DL) and clinical data-driven machine learning (ML) to improve PDAC diagnosis. A retrospective cohort of 158 patients (123 PDAC, 35 benign) undergoing pancreatic surgery was analyzed. A YOLOv8-based DL model was trained on contrast-enhanced CT scans to detect pancreatic lesions, while clinical data (age, sex, serum CA19-9) were analyzed with a Random Forest ML classifier. Predictions from both models were combined into a multimodal fusion model, optimized to maximize diagnostic accuracy. Performance metrics included precision, recall, accuracy, F1-score, and ROC-AUC. The imaging-based DL model achieved strong tumor detection performance (mAP: 87.0%, precision: 86.5%, recall: 81.2%). The clinical ML model showed excellent specificity (precision: 100%, ROC-AUC: 0.931) but limited sensitivity (60%). The multimodal AI fusion model outperformed both individual models, significantly improving sensitivity, specificity, and overall diagnostic accuracy. A multimodal AI strategy integrating DL imaging analysis with ML-based clinical predictions markedly enhances diagnostic performance in pancreatic cancer. This approach offers potential as an effective decision-support tool, facilitating earlier diagnosis and optimized clinical decision-making.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782478","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":"Heterogeneity in the management of patients with locally advanced pancreatic cancer: current surgeons' perspective and lessons for the future.","authors":"Ilaria Pergolini, Marc Martignoni, Alexander Novotny, Mert Erkan, Güralp O Ceyhan, Helmut Friess, Ugo Boggi, Ihsan Ekin Demir","doi":"10.1007/s13304-026-02651-5","DOIUrl":"https://doi.org/10.1007/s13304-026-02651-5","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782489","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":"Management of inguinal and femoral hernias in women: meta analysis of current practices and review of international guidelines.","authors":"Anna-Katharina Huber, Annina Kaiser, Stephan Gerdes, Perparim Limani, Victor Lopez-Lopez, Sarvar Abdurakhmonov, Adham Jalilow, Francesca Da Canal, Raphael Knechtle, Jose Oberholzer, Diana Vetter, Dilmurodjon Eshmuminov","doi":"10.1007/s13304-026-02659-x","DOIUrl":"https://doi.org/10.1007/s13304-026-02659-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782486","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":"Certainty of evidence assessment using the CINeMA framework in a network meta-analysis of surgical strategies for complex cryptoglandular anal fistulas.","authors":"Isabel Sierra Fernández, Zutoia Balciscueta Coltell, Natalia Uribe Quintana","doi":"10.1007/s13304-026-02640-8","DOIUrl":"https://doi.org/10.1007/s13304-026-02640-8","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782492","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}