Updates in Surgery最新文献

{"title":"Impact of surgical approach and survival prediction of malignant phyllode tumor by machine learning.","authors":"Gongyin Zhang, Foyan Xu, Lixian Wan","doi":"10.1007/s13304-025-02191-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02191-4","url":null,"abstract":"<p><p>We aimed to analyze the effect of surgical approach on patients with malignant phyllode tumor of the breast (MPTB) and to develop a prognostic prediction model for patients with MPTB. We extracted MPTB patients aged 18-80 years between 2000 and 2020 from the SEER database. Covariable imbalance was reduced using the propensity-score matching (PSM) method. An analysis of Cox proportional hazard regression was performed to compare breast cancer-specific survival (BCSS) with overall survival (OS). The survival curves were generated using the Kaplan-Meier method. The 5-year BCSS and 5-year OS of patients with MPTB were predicted by ten models based on machine learning. According to multivariate Cox analysis, surgical treatment of MPTB does not affect long-term survival outcomes (p > 0.05). Among our study, the survival outcomes of mastectomy and BCS would not be statistically significant even for patients with poor pathologic type of MPTB (p > 0.05). In terms of AUC, CatBoost performed better than other algorithms with a 5-year BCSS of 0.8488 and a 5-year OS of 0.8512. BCS and mastectomy do not make a significant difference in the long-term survival outcomes of patients with MPTB. Therefore, we suggest that BCS is feasible and preferred provided that surgical margin requirements can be met. As a trusted model, CatBoost provides better guidance and support for the systemic treatment of patients with MPTB.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796518","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":"Can early postoperative ultrasound replace routinary flexible laryngoscopy after neuromonitoring-assisted thyroid surgery?","authors":"Luca Sessa, Andrea Attard, Francesco Cupido, Stefania Marchisotta, Adele Maniglia, Francesco Pennestrì, Carmela De Crea, Marco Raffaelli","doi":"10.1007/s13304-025-02199-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02199-w","url":null,"abstract":"<p><p>Ultrasound (US) has been proposed to assess vocal cord motility after thyroid surgery since early post-operative flexible laryngoscopy (FL) is not readily available in all centers. We aimed to verify if FL can be avoided in intraoperative neuromonitoring (IONM)-assisted thyroid surgery followed by early US vocal cord motility evaluation. Two hundred and thirty-four patients who underwent IONM-assisted thyroidectomy were included. When total thyroidectomy (TT) was planned, the surgical procedure was stopped in case of loss of signal (LOS) or significant signal reduction (SSR) after the dissection of the first lobe. US vocal cord motility evaluation and FL were performed in all patients on postoperative day 1. Among 377 nerves at risk (91 thyroid lobectomies and 143 TT), post-operative FL showed 9 unilateral vocal cord palsies and 4 unilateral hypomotilities. IONM results showed 15 LOS and 10 SSR. US vocal cord motility evaluation confirmed unilateral vocal cord palsy in 8 cases and correctly identified normal post-operative vocal cord motility in 13 patients with altered IONM results. FL was able to diagnose 4 unilateral vocal cord hypomotilities in patients with normal IONM results and US evaluation. Overall accuracy was 91.4% for IONM and 96.5% for US, respectively. Early postoperative US evaluation after IONM-assisted thyroid surgery improves the overall accuracy of IONM alone in assessing laryngeal function after thyroid surgery. Nonetheless, IONM results and post-operative US do not replace FL, which remains the gold standard for early detection of laryngeal motility changes also in asymptomatic patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796430","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":"Self-expanding metal stent as a bridge to elective surgery versus immediate emergency surgery in left-sided obstructive colorectal cancer: a retrospective comparative study.","authors":"Engeng Chen, Li Chen, Wei Zhang, Wei Zhou","doi":"10.1007/s13304-025-02187-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02187-0","url":null,"abstract":"<p><p>Left-sided colorectal obstruction represents a formidable challenge in colorectal cancer management, often necessitating urgent intervention. Although self-expanding metal stents (SEMS) may act as a bridge to more controlled, elective surgery, the question remains whether this strategy confers measurable advantages over immediate emergency surgery (ES). We conducted a single-center, retrospective study comparing outcomes in patients with left-sided colorectal obstruction who underwent either SEMS placement followed by elective resection or direct ES. Between January 2018 and August 2023, 189 eligible patients were included. Perioperative variables, stoma formation, operative blood loss, and survival rates were documented. Kaplan-Meier analyses were performed to assess overall and disease-free survival in both groups. Of the 99 patients allocated to the SEMS group, 98 achieved successful stent deployment and 89 (91%) proceeded to elective surgery without stent-specific complications. Compared with the 100 patients in the ES group, the SEMS cohort exhibited significantly lower intraoperative blood loss (p < 0.001) and an increased rate of minimally invasive surgeries (p < 0.001). While all patients in the ES group underwent colostomy, only 80 in the SEMS group required ileostomy, and an additional 9 underwent primary anastomosis without a diversion. Ileostomy closure was completed more frequently (p = 0.002) and required less operative time (p < 0.001) than colostomy closure, resulting in reduced hospitalization. No significant differences in overall survival (p = 0.091) or disease-free survival (p = 0.22) were observed between the two treatment groups. In selected patients with obstructing left-sided colorectal cancers, SEMS placement as a bridge to elective surgery may reduce operative trauma, facilitate minimally invasive procedures, and lessen the burden of stoma formation, all without compromising long-term oncologic outcomes. Careful patient selection and strict procedural vigilance are fundamental to ensuring the safe adoption of this strategy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796522","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":"Full RAMIE vs Hybrid RAMIE: a retrospective study on outcomes evaluation and cost considerations.","authors":"Elettra Ugliono, Fabrizio Rebecchi, Sara Salomone, Caterina Franco, Felice Borghi, Mario Morino","doi":"10.1007/s13304-025-02180-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02180-7","url":null,"abstract":"<p><p>To compare the results of Minimally Invasive Esophagectomy performed with a Fully Robot-Assisted technique (F-RAMIE) and a Hybrid approach with laparoscopic abdominal phase (H-RAMIE). Multicentric retrospective analysis of patients who underwent F-RAMIE and H-RAMIE between 2018 and 2023. The primary endpoint was the rate of postoperative complications, secondary endpoints were clinical outcomes, oncological results and costs. Survival analyses were calculated according to the Kaplan-Meier method. The economic evaluation included costs related to operating room time, length of stay, surgical tools, and robotic system maintenance. A total of 100 patients from two experienced surgical centers were included: 64 H-RAMIE and 36 F-RAMIE. The two groups were comparable in baseline clinical conditions and staging. F-RAMIE was associated with longer operative time (434.7 ± 46.4 Vs. 477.3 ± 47.5 min, p < 0.001) and shorter length of Intensive Care Unit stay (1.1 ± 1.1 Vs. 2.3 ± 2.3 days, p = 0.002) than H-RAMIE. There were no significant differences in conversion rate, postoperative complications and length of stay. F-RAMIE demonstrated superior lymph node retrieval (43.8 ± 15.2 Vs. 22.4 ± 10.3, p < 0.001), but no differences in R0 resection rates. Overall survival and recurrences were comparable. Cost analysis revealed a slight economic advantage for F-RAMIE (20,556.3 ± 3,601.2 € Vs. 23,302.4 ± 5,894.5 € p = 0.012), mainly due to hospital stay-related cost (11,267.6 ± 5,912.8 € for H-RAMIE Vs. 8,360.3 ± 3,550.6 €, p = 0.007). F-RAMIE and H-RAMIE proved to be equally safe and effective in terms of postoperative complications and oncological outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796516","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 systematic review of preoperative radiological factors associated with the development of low anterior resection syndrome (LARS).","authors":"Gianpiero Gravante, Veronica De Simone, Gaetano Gallo, Giuseppe Currò","doi":"10.1007/s13304-025-02184-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02184-3","url":null,"abstract":"<p><p>The aim of this systematic review is to summarise the available evidence for radiological changes associated with postoperative low anterior resection syndrome (LARS). A literature search was undertaken for all studies focusing on preoperative radiological predictors of postoperative LARS. Articles were selected from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up to October 2024. Eighty-four articles were screened: eighty-one were excluded and three were included in the analysis. All included studies focused on preoperative Magnetic Resonance Imaging (MRI) already performed as part of the oncological assessments, no study examined ultrasound or defecography. Authors retrospectively selected patients that underwent LAR, screened them with the LARS score, and reviewed preoperative MRI images with specific softwares in order to find radiological characteristics associated with LARS. Results showed that particular anatomical characteristics were present in patients that subsequently developed major LARS: the volume of the pubococcygeal + iliococcygeus muscles in 27 LARS patients out of 46 LAR (odds ratio-OR 14.7, 95% CI 1.7-128.3; p = 0.02), the thickness of the anorectal joint in 136 LARS out of 255 LAR preceded by neoadjuvant chemoradiotherapy (OR 0.653, 95% CI 0.565-0.756; p = 0.001) and the mesorectal/pelvic volumes in 135 LARS out of 236 LAR (Cox Regression analysis, p = 0.0017 and p = 0.0001 respectively). Pelvic floor musculature is a factor, among the others, that contributes to LARS. Future prospective studies need to validate these retrospective results, further delineate its influence, and investigate the potential contribution of other radiologic investigations (ultrasound and defecography) in this setting.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789247","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":"Vitamin D receptor: a possible biomarker for sporadic parathyroid adenoma?","authors":"Angeliki Chorti, Angeliki Cheva, Kassiani Boulogeorgou, Anthoula Chatzikyriakidou, Charoula Achilla, Despoina Tsalkatidou, Despoina Krokou, Sohail Bakkar, Papavramidis Theodossis","doi":"10.1007/s13304-025-02182-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02182-5","url":null,"abstract":"<p><p>Parathyroid adenoma is the main cause of primary hyperparathyroidism. The genetic basis of the disease is still unclear. Vitamin D receptor (VDR) is involved in parathormone regulation. The aim of this study is to evaluate Vitamin D receptor expression in sporadic parathyroid adenoma. Fifty-one patients with parathyroid adenoma and 51 healthy volunteers were enrolled in the study and genetic and immunohistochemical studies were conducted. VDR polymorphism TaqI was correlated with parathyroid adenoma development, while VDR stained positive in immunohistochemical study. Our study suggests VDR as a major contributor to sporadic parathyroid adenoma formation in Greek population.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789192","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":"Comparative analysis of surgical versus medical treatment in non-localized primary hyperparathyroidism: renal and skeletal outcomes.","authors":"Stefano Radellini, Antonella Scerrino, Pierina Richiusa, Gregorio Scerrino, Sergio Mazzola, Carla Giordano, David Taïeb, Nunzia Cinzia Paladino, Frédéric Sebag","doi":"10.1007/s13304-025-02186-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02186-1","url":null,"abstract":"<p><p>Primary hyperparathyroidism (PHPT) presents diverse phenotypic variations. Few studies have investigated potential peculiarities of non-localized PHPT. This retrospective study aimed to compare renal and skeletal outcomes in patients with non-localized PHPT subjected to medical versus surgical treatment. Patients with non-localized PHPT from two European Tertiary Centers were divided into Group A (medical treatment, 42 patients) and Group B (Surgery, 45 patients). Biochemical markers, renal function, and bone mineral density (BMD) were assessed at baseline and 18-24 months post-treatment. At initial univariate analysis, Student's t test, Fisher's exact test, Wilcoxon test, and Friedman's non-parametric test were utilized. The two groups displayed significant differences in age and vitamin D levels. Group B exhibited notable post-operative reductions in serum calcium (p value < 0.00001, versus p < 0.001 for group A), PTH (p < 0.00001 versus 0.078 for group A), and calciuria (p < 0.05 versus 0.3657 for group A). Surgical intervention yielded significant improvements in BMD (group B: p < 0.0001; group A: p = 0.3359) at femoral and lumbar sites, with no post-treatment fractures in Group B, contrasting with Group A (4 new fractures). The GFR of group A showed a statistically non-significant change with a p value of 0.631. Conversely, for the group B, the GFR displayed a statistically significant change (p < 0.001.). Surgical intervention in non-localized PHPT showcased distinct advantages in normalizing calcemia and PTH levels and improving skeletal metabolism. Although few significant differences in renal function were observed post-surgery, the apparent advantage of group B should be interpreted taking into account the different average ages of the two cohorts.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789249","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":"Case report: laparoscopic keyhole splenopexy with composite mesh for wandering spleen.","authors":"Giovanni Cesana, Carolina Rubicondo, Matteo Uccelli, Stefano Olmi","doi":"10.1007/s13304-025-02181-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02181-6","url":null,"abstract":"<p><p>Wandering spleen is a rare condition that can necessitate urgent laparotomic splenectomy. Prompt recognition of symptoms is crucial for preserving the spleen by performing laparoscopic splenopexy. We present a laparoscopic technique that enables safe and durable splenopexy using a composite keyhole-shaped mesh (13-month follow-up).</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781273","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":"Pedunculated gastric tube with distal partial gastrectomy for esophageal reconstruction in synchronous or metachronous esophagectomy.","authors":"Shirou Kuwabara, Kazuaki Kobayashi, Natsuru Sudo, Masanori Nobuhiro, Ai Tashiro","doi":"10.1007/s13304-025-02196-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02196-z","url":null,"abstract":"<p><p>While the stomach is commonly used as an esophageal substitute after esophagectomy, it may not be a viable option in some cases. One alternative for esophageal reconstruction is a pedunculated gastric tube with distal partial gastrectomy (PGT-DPG). However, no studies have comprehensively analyzed its efficacy. We retrospectively evaluated the clinical characteristics and surgical outcomes of patients who underwent PGT-DPG between 2011 and 2023, and reviewed previously published studies on the surgical outcomes of PGT-DPG. Among the nine patients in the current study, seven underwent PGT-DPG for gastric cancer; of which, five were performed concurrently with esophagectomy, while two were conducted following prior esophagectomy. Additionally, PGT-DPG was performed in two cases with benign gastric lesions. The major postoperative complications included pneumonia (two cases), anastomotic leakage (two cases), and recurrent laryngeal nerve paralysis (one case). No graft necrosis or mortality was observed. Our review of these cases, along with previously reported cases, indicated that PGT-DPG showed efficacy due to its availability for antral early gastric cancer, avoidance of bowel reconstruction, simplified technique, and improved cervical elevation. PGT-DPG is a valuable rescue option in cases in which gastric tube reconstruction is challenging. Therefore, esophageal surgeons should be well acquainted with this technique.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773437","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":"The efficacy analysis of laparoscopic treatment of pediatric urachal cysts.","authors":"Chengpin Tao, Yongsheng Cao, Changkun Mao","doi":"10.1007/s13304-025-02185-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02185-2","url":null,"abstract":"<p><p>To explore the methods and outcomes of laparoscopic treatment for pediatric urachal cysts. A retrospective analysis was conducted on the clinical data of 25 pediatric patients with urachal cysts treated at Anhui Children's Hospital from November 2014 to August 2023. In all patients, there were 24 males and 1 female, with an average age of 5 years. Among them, 9 cases presented with infection and abscess formation, which were initially managed with local anesthesia for abscess drainage. Surgery was scheduled after controlling the infection. All 25 patients underwent laparoscopic urachal cyst excision. All 25 surgeries were successfully completed without conversion to open surgery. The average surgery duration was 87.3 ± 42.4 min, with blood loss of 1.4 ± 0.5 mL, a catheterization time of 4.2 ± 1.9 days, and a postoperative hospital stay of 7.2 ± 3.6 days. Pathological examination confirmed the diagnosis of urachal cysts in all cases. Follow-up ranged from 5 months to 2 years, during which all 25 patients had an excellent recovery. Follow-up ultrasound examinations showed no residual cysts or cyst recurrence. The abdominal incision scars were minimal, and the parents were satisfied with the treatment outcomes. Laparoscopic urachal cyst excision is a feasible and safe method for treating pediatric urachal cysts. It is effective, minimally invasive, and associated with rapid recovery. It can be considered as the first choice for the treatment of urachal cysts in children.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781289","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}