Updates in Surgery最新文献

{"title":"Survival benefit and impact of adjuvant chemotherapy following neoadjuvant therapy in patients with locally advanced rectal cancer.","authors":"Pengwen Zheng, Mengzhen Xu, Dening Ma, Longhai Feng, Jing Qin, Xinyi Gao","doi":"10.1007/s13304-025-02175-4","DOIUrl":"10.1007/s13304-025-02175-4","url":null,"abstract":"<p><p>The controversy surrounding the continuation of postoperative adjuvant chemotherapy (AC) for locally advanced rectal cancer patients who underwent neoadjuvant therapy (NAT) still existed. The study aimed to identify the individuals that would benefit from AC from those with stage ypII/III rectal cancer. Data for this retrospective study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and the local database. Subgroup differentiation of the beneficiary population by classification and regression tree analysis. The primary endpoint was overall survival (OS). 15,671 patients were included from the SEER database and 508 patients from local database. The proportions receiving AC were 41.9% in the SEER database and 77.6% in local database, respectively. Analysis results illustrated that the AC benefited population in the SEER database was characterized as: stage ypT4/N + patients (HR 0.75, 95% CI 0.69-0.82, p < 0.001); stage ypT3N0 patients aged 70 years or older (HR 0.69, 95% CI 0.56-0.83, p < 0.001). Moreover, stage ypT4/N + patients also significantly benefited from AC in local database (HR 0.48, 95% CI 0.31-0.74, p < 0.001). The analysis of the two databases showed that stage ypT3N0 patients aged < 70 years could not significantly benefit from AC (HR 0.90, p = 0.114 in the SEER database; HR 0.90, p = 0.960 in local database). Postoperative adjuvant chemotherapy provides a significant benefit in patients with stage ypT4/N + rectal cancer following neoadjuvant therapy. Our study discovered that locally advanced rectal cancer patients with aggressive tumors might benefit from postoperative adjuvant chemotherapy and prolonged the survival.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"773-781"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664725","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 impact of postoperative recurrent postoperative ileus on the prognosis of colorectal cancer: a propensity score matched study.","authors":"Run Xie, Cuiping Qiu, Runsheng Lai, Zhipeng Que, Shuangming Lin, Dongbo Xu","doi":"10.1007/s13304-025-02142-z","DOIUrl":"10.1007/s13304-025-02142-z","url":null,"abstract":"<p><p>To assess the correlation between recurrent postoperative ileus (RPOI) and clinical prognosis in patients with colorectal cancer after radical surgery. A retrospective analysis of 682 stage I-III colorectal cancer patients undergoing surgery at Longyan First Hospital, Fujian Medical University (January 2016-December 2018), identified 50 patients (7.3%) with RPOI and 632 (92.7%) without. The primary endpoints were 3-year recurrence-free survival (RFS) and 3-year overall survival (OS). RFS and OS were compared using the Kaplan-Meier method. A Cox regression model was leveraged to appraise independent prognostic factors. The 3-year RFS rate in the RPOI group was 70.3%, significantly lower than that in the non-RPOI group (82.2%, P = 0.032); the 3-year OS rate in the RPOI group was 71.2%, also significantly lower than that in the non-RPOI group (90.7%, P = 0.004). After propensity score matching (PSM), the results remained unchanged. Univariate regression analysis indicated that lymphovascular invasion, nerve invasion, pT stage, pN stage, pTNM stage, preoperative serum carcinoembryonic antigen levels, RPOI, and serum albumin levels on the first postoperative day (POD 1) were associated with RFS in colorectal cancer patients (all P < 0.05). Multivariate analysis confirmed RPOI (HR = 2.240, 95% CI: 1.104-4.544, P = 0.025) as an independent negative prognostic factor for RFS. Patients who develop RPOI after radical colorectal cancer surgery experience longer intervals before their first postoperative chemotherapy, longer hospital stays, and poorer RFS and OS.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"791-804"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587204","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":"Exploring women representation in major surgical society annual meetings in Italy.","authors":"Roberta Tutino, Andrea Tamburini, Roberta Dimalio, Beatrice Salmaso, Bruno Scotto, Roberto Passera, Paola De Nardi","doi":"10.1007/s13304-025-02154-9","DOIUrl":"10.1007/s13304-025-02154-9","url":null,"abstract":"<p><p>Gender diversity is increasing in medical schools and among physicians, including in surgical residency and among surgeons. However, leadership roles do not appear to be growing proportionately. To assess whether gender equality within the surgical community is improving, we analyzed gender representation in leading roles at two major events within the field in Italy in 2023. Of the 1,566 participants in leadership roles, 199 (12.71%) were women and 1,368 (87.29%) were men. Women consistently made up less than 25% of session invited speakers, with the highest representation in breast (23.5%), peritoneum (21.6%), endocrine (21.5%), and emergency (20.1%) sessions. Female speakers accounted for less than 10% of the presentations in bariatric, colon, esophageal, and stomach sessions. Moreover, women made up just 5.1% and 21% of scientific secretaries in the two conferences, respectively. Gender representation was found to be independently associated with conference participation (p < 0.001), role (p < 0.001), and topic (p < 0.001). The underrepresentation of women at major annual surgical society meetings in Italy reflects a larger issue of gender disparity within the surgical field. To prevent this gender gap from perpetuating into future generations, the surgical community must prioritize this issue. A shift is needed from simply \"tolerating diversity\" to actively recognizing and promoting its importance.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"637-643"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650847","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":"Ex situ right posterior sectionectomy (H6,7) as liver graft reduction to overcome mismatch for small-body size adult.","authors":"Pietro Addeo, Pierre De Mathelin, Chloe Paul, Philippe Bachellier","doi":"10.1007/s13304-025-02269-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02269-z","url":null,"abstract":"<p><p>Small body size has been associated with an increased hazard ratio for mortality and dropout on the liver transplantation (LT) waitlist especially in female candidates. These findings could be explained by differences in anthropometric between genders, mainly due to smaller right anteroposterior diameter (RAP) of the right abdominal cavity in female. Reduction of graft volume by partial hepatectomy namely ex situ right posterior liver sectionectomy (H6,7) has been recently described to reduce liver grafts in adults. At our center, 4 female recipients, median RAP of 14 cm underwent LT with liver undergoing H6,7 graft reduction. Upon reduction, the graft weight passed from a median of 1654 g (range, 1640-1800) to 1365 g (range, 1230-1450) while the ratio graft weight/RAP passed from 114 g/cm (mean 111, range 102-120) to 93.3 g/cm (mean 92, range 82-98.5). The median cold ischemia time was 411 min (range, 343-478 min) and at a median follow-up of 268 days, all patients were alive with no vascular nor biliary complications and no retransplantation. Ex situ right posterior liver sectionectomy (H6, 7) represents a valid technical option to overcome mismatch for small-body size adult during liver transplantation. The need for this procedure remains exceptional and limited to small-body size adult recipient in urgent need for LT (i.e., fulminant liver failure, impairment of general conditions, ACLF, cancers, etc.) in which split liver transplantation could not be realized and/or is not available.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192293","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":"Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy.","authors":"Giovanni Guarneri, Stefano Turi, Nicolò Pecorelli, Giuseppe Culicchia, Alessia Vallorani, Renato Meani, Luigi Beretta, Massimo Falconi","doi":"10.1007/s13304-025-02268-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02268-0","url":null,"abstract":"<p><p>In the context of enhanced recovery pathways (ERP) for colorectal surgery, thoracic epidural analgesia (TEA) delays recovery compared to opioid-based patient-controlled intravenous analgesia (PCA). Limited evidence is available for laparoscopic pancreatic surgery. The objective of this study was to evaluate the impact of different analgesic modalities on the time to functional recovery (TFR) following laparoscopic distal pancreatectomy (LDP). Clinical data for consecutive patients undergoing LDP were reviewed. All patients were treated within an ERP including a multimodal analgesia protocol. The main analgesic techniques used were TEA, intravenous morphine PCA, and patient-controlled sublingual sufentanil tablet system (SSTS). TFR was defined as postoperative days (PODs) needed to achieve adequate mobilization, return of gastrointestinal function, sufficient oral intake with no need for intravenous infusion, and adequate pain control with oral analgesia. Overall, 336 patients were included; 109 (32%) patients received TEA, 124 (37%) PCA, and 103 (31%) SSTS. TFR was significantly shorter for the SSTS group with median of 4 [IQR 3-5] days compared to 5 [4-6] days in both the TEA and PCA groups (p < 0.001). This difference was due to faster time to sufficient oral intake and adequate pain control with oral analgesia. On POD1, patients treated with TEA had better pain control compared to other modalities; the median NRS pain score at rest was 0 [0-3] compared to 2 [0-4] for both PCA and SSTS groups (p = 0.003). Multivariate regression showed that SSTS was associated with a 17% reduction (95% CI - 29 to - 5; p = 0.005) of TFR compared to TEA. Patients treated with SSTS had a significantly shorter TFR after LDP compared with other analgesic modalities with no difference in adverse events.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188075","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":"Systematic review and network meta-analysis of cryptoglandular complex anal fistula treatment: evaluation of surgical strategies.","authors":"Isabel Sierra Fernández, Zutoia Balciscueta Coltell, Natalia Uribe Quintana","doi":"10.1007/s13304-025-02270-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02270-6","url":null,"abstract":"<p><strong>Background: </strong>Several surgical approaches are available for managing complex cryptoglandular perianal fistulas. However, a gold standard surgical technique has not yet been established. This network meta-analysis aims to assess and compare postoperative failure and anal incontinence pooled rates for different available surgical techniques for complex cryptoglandular anal fistulas.</p><p><strong>Methods: </strong>Systematic searches were carried out on Pubmed, Ovid, the Cochrane Library database and ClinicalTrials.gov up to June 2023. All randomized comparative trials of nine surgical techniques for cryptoglandular complex perianal fistulas in adult patients were included. A systematic review and network meta-analysis was conducted using the PRISMA-NMA methodology. The endorectal advancement flap was used as the control technique, and the odds ratios (ORs) were calculated through pairwise and network meta-analysis with random effects.</p><p><strong>Results: </strong>16 randomized trials were included in this study. Network meta-analysis was conducted for each outcome. Techniques, such as cutting seton, fistulotomy with sphincter reconstruction, LIFT, and VAAFT, obtained similar results in terms of technique failure to the transanal advancement flap with no statistically significant differences. PLUG (OR = 3.6 [95%CI 1.1-11.5]), fibrin glue (OR = 7.5 [95%CI 2.2-25], and platelet-rich plasma (PRP) (OR = 11.5[95%CI 1.3-99]) demonstrated a statistically significant increase in the pooled failure rate. For anal incontinence, only the cutting seton technique exhibited a higher risk of postoperative incontinence (OR = 8.6 [95%CI 1-72.5]).</p><p><strong>Conclusion: </strong>Our research highlights effective therapeutic approaches for complex anal fistulas, stressing the need to customize treatment based on location, anatomy, patient characteristics, and preferences. However, it advises against using plugs, fibrin glue, PRP therapy due to lower healing rates, and the seton technique because of its potential impact on anal continence. PROSPERO number CRD42022304345.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181240","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":"Perioperative blood transfusion is an independent risk factor for ileus following minimally invasive elective colectomy for cancer.","authors":"Kristina H-T La, Yosef Y Nasseri, Rachel Ma, Vincent Xu, Paola Solís Pazmiño, Abbas Smiley, Joshua Ellenhorn, Sean Langenfeld, Robert Bergamaschi, Moshe Barnajian","doi":"10.1007/s13304-025-02260-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02260-8","url":null,"abstract":"<p><p>We aim to investigate the correlation between perioperative blood transfusion and postoperative ileus in patients who have undergone minimally invasive elective colectomy for cancer. This is a retrospective study using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients with colon cancer who underwent elective laparoscopic or robotic colectomy were selected. Perioperative transfusion was defined as receiving one or more units of whole/packed RBCs within 72 h of onset of operation. Using multivariable logistic regression with backward elimination, comorbidities, and intraoperative and postoperative variables were analyzed to identify risk factors for postoperative ileus. 48,728 patients were included with a mean age of 64.7 years, 52.3% were males, and a mean BMI of 28.8 kg/m². Overall, men had a higher rate of ileus than women (13 and 7.6%, respectively, P = 0.0001). There was no difference in rates of ileus following robotic and laparoscopic surgery (10.4 and 10.4%, respectively, P = 0.8). Of the 2960 patients who had a blood transfusion, 516 (17.4%) had an ileus, whereas of the 45,768 patients who did not have a blood transfusion, 4569 (10.0%) had an ileus (P = 0.0001). On multivariable logistic regression analysis, patients with blood transfusions were 1.37 times more likely to develop an ileus (95% CI 1.2-1.5, P = 0.0001). Perioperative blood transfusion is an independent risk factor for ileus following minimally invasive colectomy for cancer.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174980","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":"Assessment of mesh displacement following laparoscopic enhanced view totally extraperitoneal technique: comparing mesh fixation and non-fixation in difficult inguinal hernias.","authors":"Abdullah Hilmi Yilmaz, Mehmet Esref Ulutas","doi":"10.1007/s13304-025-02271-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02271-5","url":null,"abstract":"<p><strong>Background: </strong>Mesh fixation, one of the controversial issues of laparoscopic surgery, has not been investigated in the enhanced view-totally extraperitoneal (eTEP) technique. This study aimed to compare mesh fixation (FX) and non-fixation (NFX) in difficult cases in the eTEP technique.</p><p><strong>Methods: </strong>A total of 61 consecutive patients diagnosed with inguinal hernias who underwent the eTEP procedure were randomized for the study. The groups were FX and NFX. The primary outcome was mesh displacement; secondary outcomes were recurrence, return to normal life, pain, and postoperative findings.</p><p><strong>Results: </strong>Mesh displacement, recurrence, mean operative time, length of stay, pneumoperitoneum, and postoperative complications were similar. VAS scores were higher in the FX group (p = 0.017, p < 0.001, p < 0.001, respectively). Return to normal life was more days in the FX group (p = 0.02). The mesh displacement at 6 months was higher than at 1 month in both groups (p < 0.001).</p><p><strong>Conclusions: </strong>There is no increased risk of mesh displacement and recurrence in difficult cases, such as scrotal and recurrent hernias, without mesh fixation. With the eTEP technique, mesh fixation can be safely avoided for less pain and a faster return to normal life.</p><p><strong>Trial registration: </strong>Clinicaltrials number: NCT06417359.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161142","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: \"Clinical impact of closed-incision negative-pressure therapy in DIEP flap breast reconstruction's donor site\".","authors":"Qi Xu","doi":"10.1007/s13304-025-02274-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02274-2","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161126","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":"At the earliest: a Hub and Spoke referral and referral-back pilot project increases access to liver transplantation and ensures good long-term care.","authors":"Cecilia Pravadelli, Alberto Ferrarese, Luisa Moser, Francesco Paolo Russo, Giacomo Germani, Marco Senzolo, Martina Gambato, Alberto Zanetto, Sara Battistella, Elisa Menotti, Flora Agugiaro, Giovanni Vettori, Giovanni de Pretis, Pamela Ballotta, Ivana Maioli, Armando Gabbrielli, Lucia Pilati, Tiziano Martello, Umberto Cillo, Patrizia Burra","doi":"10.1007/s13304-025-02262-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02262-6","url":null,"abstract":"<p><p>Liver transplantation (LT) represents an effective therapeutic option for patients with end-stage liver disease and hepatocellular carcinoma. However, barriers to access LT programs still exist for many patients, including distance from transplant centers and delays in referral. Furthermore, long-term care is required also in stable LT recipients. This pilot study aims to evaluate the characteristics and outcomes of patients with end-stage liver disease referred to Padua University Hospital following the implementation of a structured referral program with Trento Hospital. Furthermore, the study assesses the outcomes of LT recipients who were referred back and continued follow-up care at the Spoke Center. After an internal work reorganization at the Spoke Center to improve care for patients with liver disease, we designed this prospective pilot study based on a structured referral and referral-back program for managing patients before and after LT. Accordingly, all inpatients potentially eligible for LT were transferred from the Gastroenterology Unit at Trento Hospital to the Multivisceral Transplant Unit at Padua University Hospital between 2020-2023. Similarly, stable LT recipients were referred back to the Spoke Center for management of long-term follow-up. During the study period, 27 adult inpatients (59% male; median age 50 [42-51] years) deemed eligible for LT were consecutively referred from Trento to Padua. The median [IQR] MELD score at the time of referral was 26 [23-30], and the length of stay at the LT Center was 21 [18-23] days. At the end of follow-up, 6 (22%) patients underwent LT, while the transplant-free survival rate was 37%. During the same period, 27 stable adult LT recipients (55% male; median age at referral back 56 years; median time since LT 9 years) living near Trento were referred back to the Spoke Center. During the follow-up, n.19 (70%) patients experienced at least one medical complication (40% liver-related), the majority of these being managed at the Spoke Center. LT recipient satisfaction of this way of care Center was high. A structured Hub and Spoke collaboration increase access to LT, making it more equitable, and improves the management of stable LT recipients closer to home.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143564","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}