Updates in Surgery最新文献

{"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}

{"title":"Comments on 'Should we adopt a 'laparoscopy first' strategy? A comparison of 30‑day outcomes between converted open from laparoscopic and planned open colectomy for volvulus'.","authors":"Sabri Selcuk Atamanalp","doi":"10.1007/s13304-025-02188-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02188-z","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765150","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":"Genetic predictors of postoperative recurrence in node-negative intrahepatic cholangiocarcinoma.","authors":"Bo Zhang, Xiang-Yu Wang, Lu-Yu Yang, Xiao-Tian Shen, Ying Zhu, Wen-Wei Zhu, Jie Fan, Lu Lu, Jin-Hong Chen","doi":"10.1007/s13304-025-02189-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02189-y","url":null,"abstract":"<p><p>Recent studies have revealed the prognostic value of genetic alterations in intrahepatic cholangiocarcinoma (ICC). However, the influence of individual mutations on postoperative recurrence has not been comprehensively evaluated, especially for lymph node-negative cases. A total of 589 localized ICCs with clinically or pathologically negative lymph node (cN0M0 or pN0M0) from 3 independent cohorts were included. The impact of clinicopathological and mutational parameters on recurrence-free survival (RFS) and post-recurrence survival (PRS) was analyzed using the Cox proportional hazards model. The effect of prognostic mutations on RFS and PRS was estimated by Kaplan-Meier analysis. Extremes of survivorship analysis was used to reveal distinct genomic profiles between cases with very early recurrence (VER) and long-term no recurrence (LNR). Among the recurrent mutations, only TP53 and KRAS showed significant association with RFS in both of the two screening cohorts. In the validation cohort, TP53 and KRAS mutations were both independent predictors for shorter RFS. Compared with wild-type patients, TP53 and KRAS mutations were more frequently observed in VER group than in LNR group, and were more enriched in patients with intrahepatic and extra-hepatic recurrence (IER). Furthermore, TP53 mutation was significantly associated with worse survival and lower probability of repeated hepatectomy in patients suffered from recurrence. TP53 and KRAS mutations were important genetic predictors that correlated with earlier and more aggressive recurrence in node-negative ICC patients after surgery. Effective peri-operative therapies for these high-risk tumor biology are needed to improve the clinical outcome for related patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773435","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":"Laparoscopic versus open liver resection for large (≥ 5 cm) hepatocellular carcinoma in elderly patients: a multicenter propensity score-matched study.","authors":"Gianluca Cassese, Fabio Giannone, Federica Cipriani, Antonio Cubisino, Rami Rhaiem, Bruno Branciforte, Edoardo Maria Muttillo, Bader Al Taweel, Alessandro Tropea, Emanuele Felli, Raffaele Brustia, Daniele Sommacale, Ephrem Salame, Patrick Pessaux, Salvatore Gruttadauria, Gian Luca Grazi, Guido Torzilli, Tullio Piardi, Ho-Seong Han, Mickael Lesurtel, Luca Aldrighetti, Fabrizio Panaro","doi":"10.1007/s13304-025-02113-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02113-4","url":null,"abstract":"<p><p>The outcomes of laparoscopic liver resection (LLR) for large (≥ 5 cm) hepatocellular carcinoma (HCC) in elderly (≥ 70 years old) patients have not been deeply investigated so far. The aim of the study was to compare short- and long-term results of LLR vs. open liver resection (OLR) in this setting. Data regarding all patients undergoing liver resection for large HCC were retrospectively collected from referral European and Asian HPB centers. The cases were propensity score matched for age, BMI, center, underlying liver cirrhosis, comorbidities, extent of the resection, tumor size, and numbers. After matching 363 patients with large HCC aged ≥ 70 years old, two cohorts of 90 patients were compared. The laparoscopic group showed a shorter median length of hospital stay (7 vs 9 days, p = 0.01), with a lower rate of R1 resections (4.4% vs 13.3%, p = 0.03). No statistically significant differences were found in the median operative time (p = 0.34), intraoperative blood transfusions (p = 1.00), severe postoperative complications (p = 0.29), postoperative hemorrhage (p = 0.30), post-hepatectomy liver failure (p = 0.47), or in-hospital mortality (p = 0.31). After a median follow-up of 35 months (95% CI 27.6-42.3), there were no statistically significant differences in both overall survival (p = 0.28) and disease-free survival (p = 0.42). LLR was safe and effective in selected cases of large HCC in elderly patients and was proven to shorten median hospital stay and to reduce the R1 rates, without affecting both short- and long-term survival outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765155","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":"Robotic bariatric surgery: the Italian point of view to go beyond.","authors":"Giovanni Fantola, Beniamino Pascotto, Giuseppe Navarra, Marco Raffaelli","doi":"10.1007/s13304-025-02146-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02146-9","url":null,"abstract":"<p><p>Italian robotic community discussed critical issues about data of robotic bariatric surgery activity in Italy. A working group of Italian bariatric surgeon evaluated the current evidence on robotic use discussed its limits, advantages and future perspective in bariatric field. The chair of the working group (MR) and a group of participants (G.F., B.P., G.N.) reported results of Italian SICOB Registry data and discussed about future perspective on the behalf of the Italian Working Group on Robotic Bariatric Surgery (IGRoBS).</p><p><strong>Material: </strong>Database of SICOB Italian Registry was analysed since 2014. All procedures were categorized by years from 2014 to October 2024 and evaluated compared than total bariatric procedures (robotic rate). Type of procedures was classified: Roux-en-Y gastric bypass (RYGB), One-anastomosis gastric bypass (OAGB), Sleeve Gastrectomy (SG), Single anastomosis duodenal-ileal bypass (SADIS), Gastric Plication (GP), Gastric Banding (GB) .</p><p><strong>Results: </strong>168.309 bariatric procedures from 2014 to October 2024 was recorded in SICOB Registry. 1086 procedures (0.64%) were recorded as robotic approach. Robotic bariatric procedures increased by years from 19 robotic procedures in 2014 to 344 procedures in the first 10 months in 2024. Robotic bariatric rate increased in the last years from 0,2% in 2014 to 3,7% in 2024. Robotic procedure types were RYGB 549, SG 433, OAGB 73, SADIS 21, GP 10, GB 5. In the last year, robotic SG was more widespread than other procedures (174 SG versus 147 RYGB).</p><p><strong>Conclusion: </strong>Data showed an increased robotic activity in Italy. Literature reported that more complex procedures, such as revisional procedures, bariatric procedures combined with hiatal hernia repair, and complex cases, including superobese patients and procedures requiring manual anastomosis are promising areas for validating the use of robotic surgery. Future prospective could be resume in three answer: could robotic platforms be more useful than laparoscopy for achieving a safe and efficient learning curve? Could it offer a viable path toward solo-surgery? Could it value for AI applications, and for training and proctoring of new users?</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773527","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":"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":"481-491"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","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}