Updates in Surgery最新文献

{"title":"CT-based radiomics improves survival prediction in colorectal liver metastases: beyond clinical scores.","authors":"Angela Ammirabile, Gilda Matteucci, Francesco Fiz, Elisa Ragaini, Sofia Moroni, Ezio Lanza, Lara Cavinato, Jacopo Galvanin, Chiara Masci, Guido Costa, Andrea Laghi, Guido Torzilli, Francesca Ieva, Luca Viganò","doi":"10.1007/s13304-026-02649-z","DOIUrl":"10.1007/s13304-026-02649-z","url":null,"abstract":"<p><p>Surgery with perioperative chemotherapy offers a potentially curative treatment for colorectal liver metastases (CRLM). Selection of candidates for resection relies on survival prediction, but available prognostic factors have limited reliability. This study evaluated the potential of preoperative CT-based radiomics to predict overall survival, focusing on the impact of the CT-surgery interval and peritumoral tissue analysis. All consecutive patients undergoing resection for CRLM (2010-2020) with contrast-enhanced CT performed ≤ 60 days before surgery and at least one CRLM ≥ 10 mm were considered. Manual tumor segmentation (Tumor-VOI) and automatic 5-mm peritumoral expansion (Margin-VOI) were performed on portal phase images. From each VOI, 110 IBSI-compliant radiomic features were extracted. Three prediction models were developed: Clinical, Clinical+Tumor-radiomics, Clinical+Tumor/Margin-radiomics. Features selection was performed using Boruta algorithm, followed by Random Forest classification with 10-fold cross-validation. Model performance was evaluated in the entire cohort and in patients with CT-surgery interval ≤ 30 days. 306 patients were included (mean age 63 years; 187 men). Five-year survival was 40.9% (mean follow-up 34 months). At internal validation, the clinical model achieved C-index = 0.629. Radiomics provided modest improvement in the entire cohort, with greater impact in the 212 patients with a CT-surgery interval ≤ 30 days: the Clinical+Tumor-radiomics model reached C-index = 0.691, increasing to 0.717 with Margin-VOI features. Clinical-radiomic models outperformed established scores (Fong, GAME, RAS-mutation clinical scores; C-indices range = 0.502-0.593). Radiomic features of CRLM and peritumoral tissue extracted from preoperative CT improve survival prediction beyond conventional clinical scores. A CT-surgery interval of ≤ 30 days appears essential to optimize model performance.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1889-1900"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MYELOstudy: lymph node stage of aggressiveness in medullary thyroid cancer-a retrospective multi-center study analysis.","authors":"Theodossis Papavramidis, Angeliki Chorti, Sohail Bakkar, Marco Raffaelli, Andro Košec, Van Trung Hoang, James Y Lim, Volkan Genc, Michele N Minuto, Pietro Giorgio Calò, Andrzej Hellmann, Giacomo Di Filippo, Lampros Karakozis, Alexandra Chrisoulidou, Viyey Kishore Doulatram Gamgaram, Chutintorn Sriphrapradang, Jean-Christophe Leclère, Aida Orois, Demarchi Marco, Muthuswamy Dhiwakar, Loredana de Pasquale, Antoine Buemi, Cédric Nesti, Rumen Pandev, Andres Chala, Selen Soylu Yalıman, Jiannis Hajiioannou, Shirley Yuk-Wah Liu, Sergii Cherenko, Nikolaos Voloudakis, Ioannis Koutelidakis, Konstantinos Nastos, Ramacciotti Constanza, Chiara Dobrinja, Maximilian Brunner, Lovenish Bains, Ramakanth Bhargav Panchangam, Fábio Muradás Girardi, Akif Enes Arikan, Hadj Omar El Malki, Michael de Cillia, Luigi Oragano, Ioannis Pliakos, Moysis Moysidis, Francesco Pennestrì, Carmela De Crea, Mateo Čukman, Andro Tarle, Olga S Senashova, Maisie L Shindo, İlgiz Tüzken, Mustafa Anil Turhan, Emanuela Varaldo, Manuela Albertelli, Fabio Medas, Gian Luigi Canu, Federico Cappellacci, Maciej Śledziński, Giovanni Lazzari, Eleonora Morelli, Stavros Karakozis, Maria Boudina, Michael Katsamakas, Marta Iturregui Guevara, Rangsima Aroonroch, Martí Manyalich, Oscar Vidal, Frederic Triponez, Nathalie Masse, Lokesh Kathirvel, Rajeshwari Muthusamy, Paula La Rubia, Luca Castellani, Burlacu Maria-Cristina, Furnica Raluca-Maria, Reto Kaderli, Serkan Teksoz, Tom Chi-Man Chow, Man Sze Lai, Liuchiia Shchekaturova, Evangelia Bellou, Maria Banus, Roxana Da Milano, Manuela Mastronardi, Robert Grützmann, Luiz Alberto Hauth, Aliende Lengler Abentroth, Onur Dulgeroglu, Cihan Uras, Giuseppe Placentino, Monica Leutner","doi":"10.1007/s13304-025-02513-6","DOIUrl":"10.1007/s13304-025-02513-6","url":null,"abstract":"<p><p>Medullary thyroid carcinoma (MTC) is a rare, but biologically aggressive cancer that accounts for 1-2% of all thyroid malignancies. Its aggressiveness has been linked to distinct clinicopathological features. Novel pathological predictors of aggressiveness have also been described in the literature. However, these remain contentious, to date. To assess the prognosticators of aggressiveness for MTC and establish potentially novel ones. The primary endpoint was to establish predictors for central and/or lateral cervical nodal metastatic disease. Whereas secondary endpoints include defining biochemical and histopathologic markers of aggressiveness. A multi-center retrospective analysis of prognosticators of aggressiveness in MTC. 785 patients with MTC were enrolled. The mean age was 56 years with a female to male ratio of 1: 1.7. Regression analysis demonstrated that aggressive prognosticator predictive of nodal metastasis included: age, pre- and post-operative Calcitonin and CEA levels, tumor size, multifocality, capsular and lymphovascular invasion, the presence of extrathyroidal extension, Ki-67, and RET positivity, desmoplasia, and inflammatory scores. This study provides an expanded spectrum of prognosticators of tumor aggressiveness. Furthermore, it also highlights the potential meaningful therapeutic implications of preoperative inflammatory scores, tumor desmoplastic reaction, and metastatic nodal ratio.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2153-2166"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the quality of general surgery continuous quality improvement rounds: lessons learned from British Columbia.","authors":"Nathan Louie, Sam M Wiseman","doi":"10.1007/s13304-026-02692-w","DOIUrl":"10.1007/s13304-026-02692-w","url":null,"abstract":"<p><p>Continuous quality improvement rounds (CQIRs) play an important role in medical education, quality assurance, and accreditation in Canadian hospitals. This study aimed to establish a more thorough understanding of their specific application and perceived value in general surgery departments within hospitals in British Columbia (BC), Canada. A 27-item (and one additional optional item) cross-sectional survey was conducted between August-December 2023 amongst general surgery department heads across BC hospitals, with the goal of obtaining information on CQIR logistics such as scheduling, format, and content, as well as surgeons' subjective assessments of impact on quality improvement, educational value, and barriers to participation. Thirteen complete responses representing surgical departments across the province were qualitatively analyzed. Most reported monthly or every 4 months CQIR meetings, lasting at least one hour, with strong attendance by attending surgeons. Noted areas for improvement included the absence of specific inclusion criteria, the need for standardized error classification, and lack of post-CQIR engagement for learning assessment. Respondents expressed satisfaction with CQIR effectiveness but communicated a desire for more in-person meetings and increased structure. CQIRs in BC are effective but occur less frequently than is ideal for medical education and quality improvement. This study suggests an increase in meeting frequency and organization in case selection and analysis may enhance the delivery and application of key learning objectives. Future research in this area is needed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2281-2289"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206427","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":"Partial adrenalectomy in pheochromocytomas offers equal safety compared to total adrenalectomy.","authors":"D Buzanakov, H T Groeben, B J Nottebaum, M K Walz, P F Alesina","doi":"10.1007/s13304-026-02652-4","DOIUrl":"10.1007/s13304-026-02652-4","url":null,"abstract":"<p><p>Surgery of pheochromocytomas is basically associated with hemodynamic fluctuations. Partial adrenalectomy (PA) is indicated especially for patients with bilateral pheochromocytomas, as it avoids long-term steroid supplementation. However, PA means direct manipulations and transection of pheochromocytoma-bearing tissue which may further accentuate intraoperative hemodynamic changes. A retrospective analysis of 550 operations on pheochromocytoma, performed between January 2006 and December 2024, was conducted. After exclusion of operations performed for unilateral recurrence, metastatic disease, simultaneous bilateral operation, and cases with missing intraoperative data, 240 partial and 178 total adrenalectomies (TA) were included in the analysis. A propensity-score matching was performed based on age, sex, body mass index, tumor size, genetic status, and tumor biochemical profile. Intraoperative hemodynamic parameters were analysed both before and after matching, including the maximal mean arterial pressure, the total intraoperative dose of nitroprusside, and the number of intraoperative episodes in which systolic arterial pressure exceeded 160 mmHg. In the unmatched cohort, patients in the TA group demonstrated a higher maximal systolic pressure (209 [164-250] vs. 178 [144-216]; p < 0.001), a higher total intraoperative nitroprusside dose (4.0 [0.0-8.8] vs. 1.0 [0.0-4.0], p < 0.001), and a higher number of episodes of systolic blood pressure spikes exceeding 160 mmHg (4 [2-5] vs. 2 [1-3]. p < 0.001), compared to the PA group. After the matching, there were no statistically significant differences between the groups in all assessed parameters. Additionally, the influence of the transection of the main adrenal vein on the hemodynamic in the PA group was evaluated. Patients were stratified based on whether the adrenal vein was preserved (n = 112) or transected (n = 128). No significant differences were observed between subgroups. Partial adrenalectomy is not associated with an increased risk of intraoperative hypertensive episodes in patients with pheochromocytoma and represents a safe and viable treatment option.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2187-2193"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975716","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":"Prediction of intensive care unit requirement and in-hospital mortality in Fournier's gangrene: a comparative analysis of conventional statistical and machine learning models.","authors":"Ramazan Uğur, Direnç Özbörü, Emin Taha Keskin, Turan Özdemir, Halil Lutfi Canat","doi":"10.1007/s13304-026-02715-6","DOIUrl":"10.1007/s13304-026-02715-6","url":null,"abstract":"<p><p>This study aimed to evaluate the need for intensive care unit (ICU) admission and identify factors associated with in-hospital mortality (IHM) in patients with Fournier's gangrene (FG) using traditional statistical methods complemented by machine learning-based models. This retrospective cohort study included surgically treated FG patients at a tertiary referral center. Demographic, clinical, laboratory, and perioperative variables were analyzed. Established prognostic indices, including the Fournier's Gangrene Severity Index, Uludağ Fournier's Gangrene Severity Index, Laboratory Risk Indicator for Necrotizing Fasciitis, Systemic Immune-Inflammation Index, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio, were evaluated. Patients were stratified according to ICU requirement and survival status. Multivariable logistic regression was performed to identify independent predictors. In addition, exploratory machine learning models, including k-Nearest Neighbors (KNN), Random Forest (RF), Support Vector Machine, and Decision Tree algorithms, were applied to assess predictive performance. Multivariable logistic regression analysis revealed that PLR and heart failure (HF) were independent predictors of ICU requirement. Regarding IHM, PLR remained the only independent predictor. In the exploratory ML analysis, KNN and RF showed AUC values of 0.886 and 0.873 for ICU prediction, and 0.787 and 0.765 for IHM prediction, respectively. However, given the limited sample size and low number of outcome events, these performance estimates should be interpreted cautiously. This study highlights the prognostic relevance of inflammatory markers, particularly PLR, and comorbid conditions including HF, chronic kidney disease, cerebrovascular disease and concurrent malignancy, in disease severity and IHM in FG. Machine learning-based models showed promising performance, although these findings should be considered preliminary and require validation in larger, multicenter cohorts.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1989-1997"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253593","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 surgeon's existential crisis: challenges and the threat to the profession.","authors":"Michael El Boghdady","doi":"10.1007/s13304-026-02688-6","DOIUrl":"10.1007/s13304-026-02688-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2313-2314"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035502","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":"Revisiting national allocation policies for combined liver transplantation in light of the delayed allocation approach.","authors":"Salvatore Gruttadauria, Alessandro Bertani, Fabrizio di Francesco","doi":"10.1007/s13304-026-02710-x","DOIUrl":"10.1007/s13304-026-02710-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2151-2152"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151205","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":"Correction: Omentopexy after laparoscopic sleeve gastrectomy in children and adolescents: is it effective in reducing post-operative complications?","authors":"Mohamed Mahfouz, Mohammad Daboos, Mohamed Abdelmaboud, Ibrahim Gamaan, Abd-Elfattah Kalmoush, Hatem Alsherbiny, Tharwat Hussien, Ahmed Azab, Mahmoud Mousa, Mohamed Emara","doi":"10.1007/s13304-026-02618-6","DOIUrl":"10.1007/s13304-026-02618-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2333-2335"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook outcome in surgery for primary hyperparathyroidism: first steps toward a composite quality metric.","authors":"Juan José Ruiz-Manzanera, Beatriz Febrero, Natalia Escavy, Miriam Abellán, María Teresa Soriano, Alfonso Aliaga, Inmaculada Ros-Madrid, José M Rodríguez","doi":"10.1007/s13304-026-02573-2","DOIUrl":"10.1007/s13304-026-02573-2","url":null,"abstract":"<p><p>Textbook Outcome (TO) is a composite quality metric reflecting the ideal postoperative course through the simultaneous achievement of multiple desirable endpoints. Although widely explored in other surgical specialties, its application in endocrine surgery remains limited, and has not been specifically assessed in primary parathyroidectomy for sporadic primary hyperparathyroidism. A retrospective cohort study was conducted including 100 consecutive patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism (PHPT) between January 2019 and February 2023 at a tertiary endocrine surgery unit. TO was defined by the absence of postoperative complications (wound events, symptomatic hypocalcemia, vocal cord dysfunction), hospital stay ≤ 24 h, histopathological confirmation of parathyroid tissue, absence of 90-day readmission or mortality, biochemical cure at six months, and absence of recurrence at one year. Descriptive and univariate analyses were performed. TO was achieved in 78% of patients. The most frequent reasons for failure were hospital stay longer than 24 h (n = 7) and lack of biochemical cure at six months (n = 7). Most failures (68.2%) were due to a single unmet criterion. In univariate analysis, absence of dyslipidemia (p = 0.016), single-gland resection (p = 0.022), and histopathological confirmation of a solitary adenoma (p = 0.026) were significantly associated with TO achievement. Application of TO to parathyroidectomy for sporadic PHPT proved feasible and informative. The analysis of failures identified prolonged hospitalization and lack of biochemical cure at six months as the most frequent reasons for non-achievement. TO may provide a comprehensive benchmark that complements traditional outcome measures and supports future quality improvement initiatives in endocrine surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"2177-2186"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A meta-analysis of the effects of preoperative mechanical intestinal preparation and oral antibiotics on surgical site infection after rectal tumor resection.","authors":"Yue Hu, Jun Feng Ou Yang, Pradeep Narayan Bharti, Rui Zhi Cao, Chao Zhang, Yan Fu","doi":"10.1007/s13304-026-02577-y","DOIUrl":"10.1007/s13304-026-02577-y","url":null,"abstract":"<p><p>To systematically evaluate the effect of preoperative mechanical bowel preparation combined with oral antibiotics on surgical site infection after elective rectal resection. PubMed, Web of Science, Embase, Cochrane library, CNKI database, Wanfang database, Chinese Science and Technology Journal full text database, Chinese Biomedical Literature Database, In addition, the relevant studies on the effects of mechanical bowel preparation before rectal resection combined with oral antibiotics and surgical site infection were systematically searched in Chinese ClinicalTrial Registry and ClinicalTrials.gov until 2 October 2025. References were screened according to inclusion and exclusion criteria, literature quality assessment and data extraction were performed, and data analysis was performed using RevMan 5.3 software. 8 studies including 7516 patients with rectal tumours were included. The results of the meta-analysis showed that preoperative mechanical bowel preparation combined with oral antibiotics was associated with a lower risk of surgical site infection (RR = 0.46, 95%CI = 0.32-0.67, p < 0.0001) and was more significantly associated with a lower incidence of anastomotic fistula (RR = 0.34, P < 0.00001). 95% CI = 0.21-0.54, p < 0.00001).and preoperative mechanical devices combined with oral antibiotics were associated with a reduced risk of surgical site infection in the remaining subgroups. According to the results of this meta-analysis, the combination of preoperative mechanical bowel preparation and oral antibiotics is significantly associated with a reduction in the risk of surgical site infection in elective rectal resection and may reduce the risk of surgical site infection in organs and body cavities such as the incidence of anastomotic leakage (AL).</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1945-1958"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272617","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}