Updates in Surgery最新文献

{"title":"Different intestinal bipartition procedures: early retrospective results from a multicenter Italian experience in 202 patients.","authors":"Giulia Vitali, Laura Agostinelli, Luigi Romeo, Marco Antonio Zappa, Vittorio Corso, Alessandra Sguera, Marco Anselmino, Lorenzo Cinelli, Rosario Bellini, Stefano Olmi, Davide Moioli, Antonio Susa, Angelo Michele Schettino, Stefano Amadori, Antonio Braun, Massimiliano De Palma, Sergio Carandina, Giovanni Fantola, Paolo Bernante, Francesca Balsamo, Cosimo Callari, Beatrice D'Orazio, Giuliano Sarro, Vincenzo Consalvo, Marco Raffaelli, Paolo Gentileschi, Giuseppe Navarra, Fabio Guccione, Amanda Belluzzi, Maurizio De Luca, Andrea Lucchi","doi":"10.1007/s13304-026-02887-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02887-1","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy with intestinal transit bipartition (SG-TB) represents an emerging metabolic bariatric strategy designed to enhance ileal stimulation while preserving physiological nutrient absorption. Different technical variants have been developed, but real world data from multicenter national experiences remain limited. This study aimed to evaluate the preliminary outcomes of intestinal bipartition procedures in Italy.</p><p><strong>Methods: </strong>This retrospective multicenter observational study included 202 consecutive patients who underwent Roux-en-Y Transit Bipartition (RYTB), One Anastomosis Transit Bipartition/ Single Anastomosis Sleeve-Ileal bypass (OATB/SASI), or Duodeno-Ileal Transit Bipartition (DITB) between July 2019 and November 2025 across 13 Italian metabolic bariatric centers. Primary outcomes were weight loss expressed as BMI change, percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) at 3, 6 and 12 months. Secondary outcomes included weight related disorders resolution, perioperative outcomes, and complications.</p><p><strong>Results: </strong>Mean baseline BMI was 45.7 kg/m². At 12 months, BMI decreased to 31.9 kg/m², with a mean %EWL of 65.7% and %TWL of 30.9%. Primary RYTB achieved superior weight loss compared with conversional OATB (%EWL79.7% vs. 64.7%; %TWL 41.7% vs. 29.5%).At 12 months, remission rates were 58.5% for hypertension, 34.2% for type 2 diabetes (50% improved), 76.1% for OSAS, and 75% for dyslipidemia. Early complications occurred in 9.9% of patients, with major complications (Clavien-Dindo ≥IIIb) in 1.5%. Readmission rate was 2.5%.</p><p><strong>Conclusions: </strong>Intestinal bipartition procedures demonstrated effective weight loss, significant metabolic improvement, and a favorable safety profile in a real world multicenter setting, in our early (12 months) results. Primary procedures achieved more consistent weight loss, although conversional surgery provided clinically meaningful outcomes. Standardization of technical parameters, particularly common channel length, may further optimize results.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246487","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":"Neutrophil-to-lymphocyte ratio as a predictor of severity and adverse outcomes in complicated acute diverticulitis.","authors":"Gustavo Martínez-Mier, Kevin J De Dios-Sanchez, Gustavo A Navarro-Fernandez, Octavio Avila-Mercado, José M Reyes-Ruiz, Miguel A Carrasco-Arroniz, Ofir D Tecalco-Avendaño","doi":"10.1007/s13304-026-02904-3","DOIUrl":"https://doi.org/10.1007/s13304-026-02904-3","url":null,"abstract":"<p><p>Complicated acute diverticulitis (CAD) requires accurate risk stratification to guide emergency management and surgical decision-making. Hemogram-derived inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), may provide rapid and accessible prognostic information. This study evaluated the diagnostic and prognostic utility of these biomarkers compared with the APACHE II score in patients with CAD. This retrospective study included 204 adult patients with CT-confirmed CAD treated at a tertiary referral center in Mexico between March 2022 and December 2024. Admission inflammatory biomarkers, including NLR, PLR, RDW, and WBC count, together with APACHE II score, were analyzed. Primary outcomes included disease severity (abscess versus peritonitis), need for surgery, postoperative complications, and in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed. Most patients presented with severe disease, with peritonitis observed in 86.8% of cases. Mean NLR was significantly higher in patients with peritonitis, those requiring surgery, and non-survivors (p < 0.001). PLR was significantly higher in patients with abscesses (p = 0.008). ROC analysis demonstrated that NLR showed good discriminatory performance for peritonitis (AUC 0.758) and excellent performance for in-hospital mortality (AUC 0.962). In surgically treated patients (n = 177), APACHE II was the strongest independent predictor of major postoperative complications (OR 1.34; p < 0.001), whereas preoperative NLR remained an independent predictor of postoperative mortality (OR 14.54; p = 0.001). NLR is an inexpensive and widely available biomarker with strong prognostic performance in complicated acute diverticulitis. It may assist in early identification of patients at increased risk of severe disease, surgical intervention, and mortality. Combining CBC-derived inflammatory biomarkers with validated severity scoring systems such as APACHE II may improve emergency triage and perioperative risk stratification in CAD.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246478","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":"Single-port versus multi-port robotic complete mesocolic excision for right colon cancer.","authors":"Riccardo Magarini, Pietro Achilli, Guglielmo Niccolò Piozzi, Matteo Origi, Colomba Frattaruolo, Michele Migliorini, Pietro Carnevali, Giovanni Ferrari","doi":"10.1007/s13304-026-02919-w","DOIUrl":"https://doi.org/10.1007/s13304-026-02919-w","url":null,"abstract":"<p><p>Minimally invasive approaches have transformed right cancer surgery, with robotic platforms enhancing challenging techniques like complete mesocolic excision (CME). While traditionally performed using the da Vinci® Multiport system (MP), the introduction of the Single Port™ platform (SP) offers a valuable alternative. This study aims to evaluate the technical feasibility and pathologic surrogates of resection adequacy of robotic right colectomy with CME performed with the daVinci SP® compared to the daVinci Xi® platform in selected patients. From February 2024 to February 2025 consecutive patients who underwent robotic right colectomy and CME either with MP or SP platform were enrolled in the study. The two populations of patients were compared with particular attention to number and location of lymph nodes harvested as a surrogate outcome for oncologic adequacy. From February 2024 to February 2025, 52 consecutive patients were enrolled in the study. There were no differences in population characteristics with the exception for BMI, which was lower in the SP group. Operative times were longer in the SP group. No differences were noticed in either postoperative outcomes such as length of stay (LOS) or complications rate nor in pathological findings, especially in the number of apical lymph node harvested. SP robotic right colectomy with CME appears feasible and achieves pathologic surrogates of resection adequacy comparable to MP surgery in highly selected patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246525","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":"Calcium-stimulated calcitonin and procalcitonin in borderline hypercalcitoninemia: histopathologic and nodal correlates in a thyroidectomy cohort.","authors":"Utku Soyaltın, Rukiye Dilara Tekin Uzman, Tuğba Matlım Özel, Hüseyin Karatay, Ilgın Yıldırım Şimşir","doi":"10.1007/s13304-026-02906-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02906-1","url":null,"abstract":"<p><p>Mild basal calcitonin elevation represents a diagnostic gray zone in patients undergoing thyroid surgery for non-medullary thyroid carcinoma (MTC) indications. We evaluated calcium-stimulated calcitonin and procalcitonin kinetics according to final histopathology and nodal status in this setting. This retrospective study included 37 adults with reproducible borderline basal calcitonin elevation (< 50 pg/mL) selected from 577 patients who underwent total thyroidectomy for non-MTC indications between 2021 and 2024. All patients underwent calcium stimulation testing with measurement of calcitonin and procalcitonin at baseline and after stimulation. Biochemical responses were compared with final histopathology. Median basal calcitonin was 13.1 [11.0-16.8] pg/mL and median peak stimulated calcitonin (psCT) was 480 [320-790] pg/mL. Final histopathology showed MTC in seven patients (18.9%), all microcarcinomas, C-cell hyperplasia (CCH) without MTC in nine, and no C-cell pathology in 21. Median psCT was highest in MTC, intermediate in CCH without MTC, and lower in patients without C-cell pathology (820 [640-1040], 460 [310-670], and 360 [270-540] pg/mL, respectively; nominal p = 0.047 for MTC vs CCH). psCT values ≥ 500 pg/mL were observed in 6 of 7 MTC cases compared with 1 of 9 CCH cases without MTC. Central lymph-node metastasis was documented in 3 of 7 MTC patients and was accompanied by numerically higher psCT and fold-rise values. wf45g6 Procalcitonin increment and fold-rise were greater in MTC than in CCH without MTC, but no stable procalcitonin-based threshold or combined rule was identified. Occult micro-MTC may show marked calcium-stimulated calcitonin responses despite mild basal hypercalcitoninemia. These findings are exploratory and do not validate diagnostic or surgical thresholds.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246469","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":"PTH-to-tumor-volume ratio as a potential exploratory marker in parathyroid carcinoma: a retrospective cohort study.","authors":"Magdalena Kwapisz, Jacek Gałczyński, Elwira Bakuła Zalewska, Agnieszka Żyłka, Piotr Góralski, Aleksandra Dworakowska, Marek Dedecjus","doi":"10.1007/s13304-026-02868-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02868-4","url":null,"abstract":"<p><strong>Background: </strong>Parathyroid carcinoma is a rare endocrine malignancy that remains difficult to distinguish preoperatively from benign causes of primary hyperparathyroidism due to overlapping clinical and biochemical features. This study evaluates the serum parathyroid hormone (PTH)-to-tumor volume ratio as a potential parameter for differentiating parathyroid carcinoma from benign parathyroid lesions.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 344 patients who underwent surgery for primary hyperparathyroidism between 2017 and 2024. Patients were divided into carcinoma (n = 8) and benign lesion groups (n = 336). Clinical, biochemical, and ultrasound-derived tumor volume data were analyzed and compared between groups.</p><p><strong>Results: </strong>Patients with parathyroid carcinoma had significantly higher PTH levels than those with benign lesions (median, 659 vs. 136.4 pg/mL; p = 0.002) and markedly larger tumor volumes (median, 10.14 vs. 0.69 ml; p < 0.001). Despite higher absolute PTH concentrations, the PTH-to-tumor volume ratio was significantly lower in the carcinoma group (median 89.7 vs. 214.56; p = 0.011). In logistic regression analysis, a lower PTH-to-tumor volume ratio was associated with an increased likelihood of parathyroid carcinoma (OR, 0.990; 95% CI: 0.896-0.993; p = 0.04).</p><p><strong>Conclusions: </strong>In this cohort, parathyroid carcinoma was characterized by a substantially greater tumor burden and higher circulating PTH concentrations, while the PTH-to-tumor-volume ratio was lower than in benign parathyroid lesions. The observed difference in the ratio is hypothesis-generating and warrants confirmation in larger, multicenter studies. Given the limited number of carcinoma cases, its role in clinical decision-making remains to be established.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208101","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":"Durable improvements in lipid profile and atherogenic indices more than a decade after laparoscopic sleeve gastrectomy.","authors":"Charalampos Lampropoulos, Dimitrios Kehagias, Aggeliki Bellou, George Markopoulos, Ioannis Kehagias","doi":"10.1007/s13304-026-02903-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02903-4","url":null,"abstract":"<p><p>Long-term effects of laparoscopic sleeve gastrectomy (LSG) on lipid metabolism, particularly beyond 10 years, are not well defined. This study evaluated changes in standard lipid parameters and atherogenic indices more than 11 years after stand-alone LSG. This retrospective cohort study included adults who underwent primary stand-alone LSG between 2005 and 2009. Patients with revisional bariatric procedures or major gastrointestinal or appetite-related disorders were excluded. Lipid profiles were assessed preoperatively and at follow-up beyond 11 years. Primary outcomes were long-term changes in triglycerides, total cholesterol, LDL-C, HDL-C, and non-HDL-C. Secondary outcomes included changes in the atherogenic index of plasma, triglyceride/HDL-C ratio, Castelli risk indices I and II, atherogenic coefficient, and use of lipid-lowering medications. Multivariable linear regression was used to identify independent predictors of lipid change. Eighty-six patients (79.1%, female) were analyzed, with a mean follow-up of 13.4 ± 1.3 years. Mean total body weight loss (%TBWL) was 28.8 ± 12.5%. Triglyceride levels decreased from 130.7 ± 64.9 to 91.2 ± 36.8 mg/dL, HDL-C increased from 45.2 ± 9.5 to 62.6 ± 14.7 mg/dL, and non-HDL-C decreased from 151.9 ± 38.0 to 134.0 ± 27.4 mg/dL (all p < 0.001). Total cholesterol remained unchanged, while the reduction in LDL-C was no longer significant after adjustment for multiple comparisons. All five atherogenic indices showed significant improvement (p < 0.001). Greater %TBWL was independently associated with higher HDL-C and lower triglyceride levels at follow-up. More than a decade after stand-alone LSG, improvements in triglycerides, HDL-C, non-HDL-C, and atherogenic indices remain robust. However, these findings should be interpreted cautiously regarding cardiovascular and atherosclerotic risk.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208166","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":"Prognostic nomogram for early-onset locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy: a SEER analysis.","authors":"Yi-Kai Kao, Pin-Chun Chen, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen","doi":"10.1007/s13304-026-02890-6","DOIUrl":"https://doi.org/10.1007/s13304-026-02890-6","url":null,"abstract":"<p><strong>Objective and rationale: </strong>Early-onset locally advanced rectal cancer presents unique challenges in treatment and prognosis. This study aimed to develop and validate a prognostic nomogram for patients aged 18-50 years with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy, addressing the lack of tailored prognostic tools for this growing patient population.</p><p><strong>Methods: </strong>Using the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed 2,853 patients who received neoadjuvant chemoradiotherapy between 2010 and 2020. Patients were divided into training (n = 1,990) and validation (n = 863) cohorts. Cox proportional hazard regression models identified prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Nomograms were constructed and validated using Harrell's C-index and receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Independent predictors of poor OS and CSS included male sex, unmarried status (particularly divorced/separated/widowed), non-Hispanic black and American Indian/Alaskan native races, advanced T stage, increased positive regional nodes, and positive carcinoembryonic antigen (CEA). The nomogram demonstrated good discriminative ability in the validation cohort, with area under the curve (AUC) values of 0.767 and 0.742 for 3-year OS and CSS, respectively, and 0.705 and 0.697 for 5-year OS and CSS, respectively.</p><p><strong>Conclusions: </strong>The developed nomogram and identified prognostic factors provide valuable tools for individualized risk stratification and treatment optimization in young patients with locally advanced rectal cancer. These findings can aid in clinical decision-making and patient counseling. However, further external validation and prospective evaluations are necessary to confirm the clinical utility of this prognostic model in diverse healthcare settings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208141","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 \"predictors of time to surgical recurrence after ileal or ileocolonic resection in Crohn's disease: role of integrin αvβ6 and development of a predictive nomogram\".","authors":"Sahir Omrani, Zied Hadrich, Ghada Gharbi","doi":"10.1007/s13304-026-02893-3","DOIUrl":"https://doi.org/10.1007/s13304-026-02893-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184806","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":"Lymph node yield in T1N0M0 colorectal cancer: a threshold built on unstable ground.","authors":"Yu Zhang","doi":"10.1007/s13304-026-02883-5","DOIUrl":"https://doi.org/10.1007/s13304-026-02883-5","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184777","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":"Nipple or skin-sparing mastectomy flap: can preoperative breast-MRI predict post-operative complications?","authors":"L I Sgaramella, A Pasculli, F P Prete, F Cofone, M Moschetta, M Maruccia, R Elia, M Telegrafo, V De Ruvo, M Bisceglie, M M Miccoli, F Palma, C Testini, G Giudice, M Testini, A Gurrado","doi":"10.1007/s13304-026-02843-z","DOIUrl":"https://doi.org/10.1007/s13304-026-02843-z","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the role of skin flap thickness (SFT), measured by preoperative breast magnetic resonance imaging (MRI), in predicting postoperative complications after nipple-sparing or skin-sparing mastectomy, and to assess its value in guiding reconstructive strategy selection.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study including patients who underwent preoperative breast MRI and nipple-sparing or skin-sparing mastectomy for breast cancer or BRCA1/2 mutations between January 2019 and August 2025. Demographic, clinical, and perioperative data were collected. Patients were stratified into two groups based on mean preoperative SFT: >8 mm (Group A) and <8 mm (Group B). Postoperative complications were recorded and analyzed using univariate and multivariate models.</p><p><strong>Results: </strong>Sixty patients (mean age 47.5 ± 9.1 years) and 80 breasts (40 unilateral, 20 bilateral procedures) were included. Group A comprised 54 breasts (67.5%), while Group B included 26 (32.5%). Postoperative hospital stays and incision type differed significantly between groups (p < 0.05). Overall postoperative morbidity was 16.25%. Partial nipple-areola complex necrosis (11.5%) and hematoma (7.7%) occurred significantly more often in Group B compared to Group A (both p < 0.05). Multivariate analysis confirmed preoperative SFT <8 mm as an independent predictor of these complications (odds ratio 13.40, p = 0.012).</p><p><strong>Conclusion: </strong>Preoperative magnetic resonance imaging assessment of skin flap thickness reliably identifies patients at increased risk of postoperative complications. Integrating this parameter into surgical planning may support personalized reconstructive decision-making and improve clinical outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184760","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}