Updates in Surgery最新文献

{"title":"Safety and efficacy of robotic repeat hepatectomy compared to laparoscopic and open repeat hepatectomy: a retrospective comparative study.","authors":"Eleonora Garosi, Lorenzo Bernardi, Raffaello Roesel, Gioia Pozza, Francesco Mongelli, Pietro Majno-Hurst, Alessandra Cristaudi","doi":"10.1007/s13304-026-02878-2","DOIUrl":"https://doi.org/10.1007/s13304-026-02878-2","url":null,"abstract":"<p><p>Repeat hepatectomies are challenging due to adhesions and altered anatomy. Robotic surgery, with enhanced dexterity and visualization, may expand the role of minimally invasive liver surgery (MILS) in this setting. The aim of this study was to explore the safety and efficacy of robotic repeat hepatectomy. We conducted a retrospective cohort study comparing repeat robotic (R-RLR), laparoscopic (L-RLR), and open liver resections (O-RLR) performed between January 2019 and December 2024. The primary outcome was postoperative morbidity. Secondary outcomes included conversion to laparotomy, use of Pringle maneuver, blood loss, hospital stay and postoperative mortality. For oncologic efficacy, rates of negative surgical margins (R0) or equivalent (R1 vascular), recurrences and survival were assessed. Forty-two patients underwent repeat hepatectomy (O-RLR = 15, L-RLR = 13, R-RLR = 14). Over time, O-RLR and L-RLR declined in favor of R-RLR. Main indications were colorectal liver metastases and hepatocellular carcinoma. Groups had similar age and comorbidities; however, cirrhosis and portal hypertension were more frequent in R-RLR. Mean Iwate scores were 6 (O-RLR), 4 (L-RLR), and 5 (R-RLR) (p = 0.240). Postoperative morbidity was significantly lower in L-RLR (7.6%) and R-RLR (7.7%) compared to O-RLR (40%) (p = 0.030). Mean Comprehensive Complication Index was 11.7 (O-RLR), 0.7 (L-RLR), and 0.6 (R-RLR) (p = 0.025). Two L-RLR cases required conversion. Pringle maneuver, blood loss, and hospital stay decreased progressively from O-RLR to L-RLR to R-RLR. There was no postoperative mortality.R0 resection was achieved in 73% (O-RLR), 100% (L-RLR), and 78.5% (R-RLR); R1 vascular rates were 13.3%, 0%, and 21.5%, respectively (p = 0.14). The three groups had similar overall and hepatic recurrence rates; survival (recurrence-free and overall) was also similar. Repeat robotic hepatectomy is safe and provides good oncologic outcomes. The robotic approach may allow MILS in more complex cases, including patients with cirrhosis and portal hypertension.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147982","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":"Interpreting DRIP-guided follow-up after ileostomy.","authors":"Yaqian Zhu, Yanqin Guo, Xiaoxue You","doi":"10.1007/s13304-026-02884-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02884-4","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148883","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":"Recurrence patterns and survival outcomes in advanced papillary thyroid carcinoma: a retrospective cohort analysis.","authors":"Ann-Kathrin Lederer, Adriana Fiedler, Julia I Staubitz-Vernazza, Oana Lozan, Marie Oliver Metzig, Hauke Lang, Thomas J Musholt","doi":"10.1007/s13304-026-02875-5","DOIUrl":"https://doi.org/10.1007/s13304-026-02875-5","url":null,"abstract":"<p><p>Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumor, with a small proportion of patients presenting with advanced disease. The recent European Society of Endocrine Surgeons (ESES) consensus introduced a refined definition of advanced thyroid cancer. This study aimed to characterize real-world clinical features, treatment patterns, and surgical outcomes of patients with advanced PTC according to the updated ESES definition treated at a high-volume endocrine surgery center. This monocentric, retrospective cohort study included all patients who underwent primary surgery for advanced PTC at a high-volume endocrine surgery center between 2015 and 2023. Clinical data originated from our own patients in the EUROCRINE^® registry. A total of 33 patients with advanced PTC were included. Median age at diagnosis was 54 years, 52% were male, and median Charlson Comorbidity Index (CCI) was 2, indicating a low comorbidity burden. Among patients disease-free after surgery (n = 27), 11 (41%) experienced tumor recurrence, most frequently in lymph nodes and lung combined (36%) or in lymph nodes alone (27%). Median recurrence-free survival was 98 months. Patients with persistent disease after surgery had a poor prognosis, with a median progression-free survival of 4.5 months. Age > 55 years was associated with reduced overall survival (p = 0.007), while male sex was associated with increased recurrence risk (p = 0.047); both findings should be interpreted with caution. Despite advanced disease, most patients achieved disease-free status after primary surgery, with the majority being alive at last follow-up. Due to the limited sample size and missing follow-up data for some patients, these findings should be taken with caution, and larger studies are needed to confirm potential predictors of survival and recurrence.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115258","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 \"Short- and long-term outcomes of robotic versus laparoscopic resection for diverticular disease: a comparative study from a tertiary referral center\".","authors":"Guoqin Yang, Lichun Fang","doi":"10.1007/s13304-026-02850-0","DOIUrl":"https://doi.org/10.1007/s13304-026-02850-0","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115166","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":"Obesity and pathological features of tumour aggressiveness and lymph node staging in colon cancer: a multicentre propensity score-matched study.","authors":"Marta Goglia, Mattia Leonardo Giancola, Gabriella Distefano, Francesco Maria Carrano, Marco Catarci, Marcello Gasparrini, Paolo Mercantini, Roberto Santoro, Gianfranco Silecchia","doi":"10.1007/s13304-026-02870-w","DOIUrl":"https://doi.org/10.1007/s13304-026-02870-w","url":null,"abstract":"<p><strong>Aim: </strong>To investigate whether obesity (BMI ≥ 30) influences pathological markers of tumour aggressiveness and lymph node staging quality (≥ 12 retrieved nodes) in patients undergoing elective colon cancer surgery.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included adults undergoing elective surgery for colon adenocarcinoma at three tertiary referral centres. Patients with rectal cancer, emergency surgery, metastatic disease, neoadjuvant therapy, or incomplete data were excluded. Obesity was defined as a BMI ≥ 30 kg/m². Clinical, surgical, and pathological data were collected from prospectively maintained databases. Associations between obesity and study outcomes were evaluated using multivariable logistic regression adjusted for age, sex, ASA score, tumour location, T stage, and MSI status.</p><p><strong>Results: </strong>A total of 126 patients undergoing elective surgery for colon adenocarcinoma were included, of whom 42 (33.3%) BMI > 30. Obesity was not associated with lymphovascular invasion, tumour necrosis, or high-grade histology. In contrast, obesity independently predicted both perineural invasion (OR 3.59, 95%CI 1.16-11.50; p = 0.011) and peritumoral deposits (OR 2.82, 95%CI 1.03-7.69; p = 0.032). Higher T stage correlated with aggressive pathological features, whereas MSI status showed a protective effect. Regarding lymph node assessment, the proportion of patients with ≥ 12 retrieved nodes was high and similar between obese and non-obese patients (88.1% vs. 83.3%, p = 0.48). Obesity was not independently associated with adequate lymph node staging (OR 1.48, 95%CI 0.50-4.43; p = 0.48).</p><p><strong>Conclusion: </strong>Obesity did not compromise nodal staging or most tumour aggressiveness markers, but its association with perineural invasion and tumour deposits highlights a potentially distinct, clinically relevant tumour biology.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115217","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":"Clinical characteristics and survival outcomes for undifferentiated carcinoma with/without osteoclast-like giant cells of the pancreas.","authors":"Haoxiang Wu","doi":"10.1007/s13304-026-02799-0","DOIUrl":"https://doi.org/10.1007/s13304-026-02799-0","url":null,"abstract":"<p><p>Undifferentiated carcinoma of the pancreas (UCP) are extremely rare entities and there is currently no standardized treatment guideline for it, with its characteristics and prognosis remaining unclear. UCP with osteoclast-like giant cells (OGCs) and without OGCs represent two different pathological types of pancreatic ductal adenocarcinoma. This study aimed to improve our understanding of these entities with a focus on the comparison between these two entities. Patients diagnosed with undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) and UCP without OGCs (non-UCOGCP) were identified through the Surveillance Epidemiology and End Results (SEER) database. Demographic and clinical characteristics were collected and compared. Kaplan-Meier method and Cox proportional hazards models were applied to investigate the overall survival (OS) and prognostic factors. A total of 210 patients with UCP with/without osteoclast-like giant cells were included retrospectively in the study. There was no difference in the patient age, race distribution, primary site and tumor size between the two groups. However, the majority of UCOGCP patients were diagnosed between 2011-2021 and had a localized or regional disease when compared to patients with non-UCOGCP. Besides, more patients with UCOGCP received surgery (P < 0.001), chemotherapy (P = 0.003) and radiotherapy (P = 0.002). Patients with UCOGCP had a longer median OS compared to non-UCOGCP (11 months vs. 2 months, P < 0.001). Further multivariate analysis showed that patients with both tumors had a worse prognosis when they developed distant metastases. And surgical resection was independent prognostic factor of both UCOGCP (HR: 1.73, P = 0.033) and non-UCOGCP (HR: 2.55, P = 0.018). Chemotherapy was a prognostic factor of non-UCOGCP, but not of UCOGCP. Our study revealed that undifferentiated carcinoma with/without osteoclast-like giant cells of the pancreas are rare malignant tumors with different clinical characteristics and outcomes. UCOGCP patients had a better prognosis. Surgical resection was beneficial to the survival of both UCOGCP and non-UCOGCP patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115178","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 projected rise of pancreatic cancer mortality in Italy: forecasts until 2035.","authors":"Samuele Grandi, Giampaolo Perri, Patrick Maisonneuve, Umberto Cillo, Giovanni Marchegiani","doi":"10.1007/s13304-026-02862-w","DOIUrl":"https://doi.org/10.1007/s13304-026-02862-w","url":null,"abstract":"<p><p>Temporal trends and future projections of pancreatic cancer mortality in Italy were examined to identify and characterize areas of interventions at medical and administrative level. Pancreatic cancer mortality data for 2005-2022 and demographic data including projections of Italian population through 2035 were retrieved from the Italian National Institute of Statistics public database. Age- and sex-specific mortality rates were projected until 2035 using Bayesian age-period-cohort analysis. The average annual number of deaths from pancreatic cancer in Italy is projected to increase through 2035, with a cumulative rise of +15.4% for males (M), and +13.0% for females (F), compared to the 2020-2022 period. While males consistently have higher Age Standardized Mortality Rates (ASMR) across all macro-regions, the national ASMR trend is projected to decrease slightly for both sexes (M: - 3.8%, F: - 0.6%). At a macro-regional level, those at lowest development index - southern Italy and islands-are the only macro-areas projected to experience an ASMR increase for both sexes. The largest projected ASMR increases were found for females in the islands (+ 22.7%) and for males in the southern regions (+ 18.8%). In contrast, the North-East regions showed the most favorable trend, with the largest projected ASMR decrease for females (- 8.7%). In parallel with population ageing, the absolute burden of pancreatic cancer mortality in Italy is projected to increase substantially, with significant macro-regional disparities. Addressing this growing challenge will require coordinated strategies and region-specific healthcare planning to optimize resource allocation and ensure equitable access to care.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115275","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: Updates in surgery for colorectal cancer: incidence and risk factors for acute anastomotic leak-a retrospective study.","authors":"Tamer A A M Habeeb, Abdulzahra Hussain, Massimo Chiaretti, Igor A Kryvoruchko, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A M Adsam, Mohamed A Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H Alsayed, Esmail Tharwat Kamel Awad, Emad A Ibrahim, Mohamed Fathy Labib, Sobhy Rezk Ahmed Teama, Mohamed Sobhy Shaaban, Mohammed Hassan Elshafey, Abdelhafez Seleem, Amr Radwan, Hamada Rashad Mohamed Abdelkader, Ahmed Fayez Othman, Nasreldin Mohammed Algalaly, Mostafa Mahmoud Salama Mostafa, Mohammed Abbas Abdou Abouelseoud, Mohamed Ibrahim Abo Alsaad, Abouelatta Kh Ali, Hamdi Elbelkasi, Mahmoud Ali Abou Zaid, Basma Ahmed Mohamed, Islam Mohamed Ibrahim, Ahmed Gamal Eldin Metwally, Mahmoud El Azawy, Amr Khalil, Sameh Tolba Abu-Elela, Ahmed Kamal El Taher, Mahmoud Abdou Yassin, Mohamed Lotfy, Bassam Mousa, Baher Atef, Mohamed Elnemr, Ahmed Mesbah Abdelaziz, Tamer Wasefy, Mohamed Ibrahim Mansour, Abdelrahman Mohamed Hasanin Nawar","doi":"10.1007/s13304-026-02882-6","DOIUrl":"https://doi.org/10.1007/s13304-026-02882-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115198","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":"Use of the periprosthetic capsule in aesthetic and reconstructive breast surgery: literature review and practical applications.","authors":"Fernando Rosatti, Gaia Ghiringhelli, Simone La Padula, Mattia Siliprandi, Andrea Vittorio Emanuele Lisa","doi":"10.1007/s13304-026-02876-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02876-4","url":null,"abstract":"<p><p>Periprosthetic capsule formation is an inevitable consequence of implant-based breast surgery and has traditionally been regarded as an undesirable outcome because of its association with capsular contracture. Nevertheless, growing surgical experience has highlighted that this biologically active, vascularised, and mechanically resistant tissue may represent a valuable autologous resource in selected reconstructive and aesthetic procedures. This narrative review provides an updated overview of the current literature, summarising the biological rationale for capsule reuse, its surgical applications, potential benefits, and the limitations of the available evidence. Published reports describe the use of the periprosthetic capsule as either a pedicled flap or a free graft in a variety of clinical settings, including implant salvage, pocket reinforcement, correction of implant malposition, inframammary fold reconstruction, management of rippling and contour deformities, and lower pole support. Overall, the available literature suggests that capsule reuse may provide reliable structural support and soft-tissue coverage while reducing the need for heterologous materials or donor-site morbidity in carefully selected patients. No oncologically relevant adverse events directly attributable to capsule reuse have been reported in the published literature to date, although the available evidence remains limited. This review aims to provide surgeons with a practical and comprehensive overview of the current indications, technical considerations, and potential applications of periprosthetic capsule reuse in breast surgery. However, the evidence is based predominantly on case reports and small case series, with heterogeneous indications, surgical techniques, and follow-up. Consequently, definitive conclusions regarding long-term safety and effectiveness cannot yet be drawn, highlighting the need for larger prospective studies.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115369","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":"Novel side-to-end anastomosis as an alternative in ileocecal Crohn's disease - an observational study.","authors":"Adam Dziki, Kamil Ostojski, Zofia Mik, Joanna Braszczyńska-Sochacka, Michał Mik","doi":"10.1007/s13304-026-02874-6","DOIUrl":"https://doi.org/10.1007/s13304-026-02874-6","url":null,"abstract":"<p><p>Crohn's disease (CD) is characterized by periods of remission and recurrence. In patients who have undergone surgery, recurrence most often occurs at the anastomosis site or in the small intestine proximal to the anastomosis. The aim of the study is to evaluate early and long-term results of treatment in patients with ileocecal CD who underwent ileocecal resection and primary side-to-end anastomosis. The study included patients who underwent primary ileocecal resection with the novel side-to-end anastomosis. The study is a retrospective analysis conducted at a single high-volume center. The analysis included a group of 122 patients (71 women, mean age 34±11 years) with ileocecal CD. Anastomotic leakage was found in5 patients (4.0%). The observation period was 79 months (65-90). Surgical recurrence was observed in 5.6% of patients, and endoscopic recurrence in 9.0% of patients. Side-to-end anastomosis after ileocecal resection in patients with CD is safe and associated with a low risk of disease recurrence, even in the long term. In our opinion, the presented anastomosis can be considered in this group of patients. Our study is the first one to describe early and long-term results after this type of anastomosis in patients; however, it needs further prospective comparative studies.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115304","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}