Updates in Surgery最新文献

{"title":"At the earliest: a Hub and Spoke referral and referral-back pilot project increases access to liver transplantation and ensures good long-term care.","authors":"Cecilia Pravadelli, Alberto Ferrarese, Luisa Moser, Francesco Paolo Russo, Giacomo Germani, Marco Senzolo, Martina Gambato, Alberto Zanetto, Sara Battistella, Elisa Menotti, Flora Agugiaro, Giovanni Vettori, Giovanni de Pretis, Pamela Ballotta, Ivana Maioli, Armando Gabbrielli, Lucia Pilati, Tiziano Martello, Umberto Cillo, Patrizia Burra","doi":"10.1007/s13304-025-02262-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02262-6","url":null,"abstract":"<p><p>Liver transplantation (LT) represents an effective therapeutic option for patients with end-stage liver disease and hepatocellular carcinoma. However, barriers to access LT programs still exist for many patients, including distance from transplant centers and delays in referral. Furthermore, long-term care is required also in stable LT recipients. This pilot study aims to evaluate the characteristics and outcomes of patients with end-stage liver disease referred to Padua University Hospital following the implementation of a structured referral program with Trento Hospital. Furthermore, the study assesses the outcomes of LT recipients who were referred back and continued follow-up care at the Spoke Center. After an internal work reorganization at the Spoke Center to improve care for patients with liver disease, we designed this prospective pilot study based on a structured referral and referral-back program for managing patients before and after LT. Accordingly, all inpatients potentially eligible for LT were transferred from the Gastroenterology Unit at Trento Hospital to the Multivisceral Transplant Unit at Padua University Hospital between 2020-2023. Similarly, stable LT recipients were referred back to the Spoke Center for management of long-term follow-up. During the study period, 27 adult inpatients (59% male; median age 50 [42-51] years) deemed eligible for LT were consecutively referred from Trento to Padua. The median [IQR] MELD score at the time of referral was 26 [23-30], and the length of stay at the LT Center was 21 [18-23] days. At the end of follow-up, 6 (22%) patients underwent LT, while the transplant-free survival rate was 37%. During the same period, 27 stable adult LT recipients (55% male; median age at referral back 56 years; median time since LT 9 years) living near Trento were referred back to the Spoke Center. During the follow-up, n.19 (70%) patients experienced at least one medical complication (40% liver-related), the majority of these being managed at the Spoke Center. LT recipient satisfaction of this way of care Center was high. A structured Hub and Spoke collaboration increase access to LT, making it more equitable, and improves the management of stable LT recipients closer to home.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biodegradable internal stent versus no stent for patients at increased risk of pancreatic fistula after pancreaticoduodenectomy: a single-center propensity score matching analysis.","authors":"Michele Mazzola, Andrea Zironda, Alessandro Giani, Carlotta Bellomo, Davide Paolo Bernasconi, Pietro Calcagno, Michele Paterno, Giovanni Ferrari","doi":"10.1007/s13304-025-02252-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02252-8","url":null,"abstract":"<p><p>Postoperative pancreatic fistula (POPF) is considered the main trigger for further dangerous sequelae following pancreaticoduodenectomy (PD). This study compared the short-term postoperative results of patients at increased risk of POPF undergoing pancreaticojejunal (PJ) anastomosis with and without internal biodegradable stent. Data from a prospectively collected database of patients undergoing PD at increased risk of POPF (ISGPS type B, C, D) between January 2017 and June 2023 were retrieved and analyzed, comparing the postoperative outcomes of those with and without an internal biodegradable stent, using a propensity score matching analysis. In the study period, 183 patients were selected. After matching, a total of 59 with stent (SG) and 59 without (NSG) were compared. The overall POPF rate was 21.2%. No difference was seen between the groups regarding POPF and other postoperative outcomes. A higher rate of biochemical leakage in the SG (53.1% vs 31.9%, p 0.033) was found among patients in the type D class of risk. The present study showed no significant difference in terms of 90-day overall, severe and pancreas-specific postoperative complications among patients at increased risk of POPF who received PJ anastomosis with and without internal biodegradable stent.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143565","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":"Surveillance and follow-up in acute diverticulitis with pericolic free gas (ADiFas II): an age-specific analysis.","authors":"Adnan Alsourani, Carlos Pastor, Jorge Arredondo, Renan Carlo Colombari, Gianluca Pellino, Patricia Tejedor","doi":"10.1007/s13304-025-02251-9","DOIUrl":"10.1007/s13304-025-02251-9","url":null,"abstract":"<p><p>The objective of this study was to examine the differences in clinical presentation and complications during the first year of follow-up in patients who experienced an episode of acute diverticulitis (AD) with pericolic free gas, comparing outcomes across different age groups. A prospective subanalysis was conducted on a cohort from the ADiFAS study, which originally included 1099 patients. After excluding 289 patients who did not meet the inclusion criteria, 810 patients remained for analysis. From this cohort, 330 patients with AD and pericolic free gas were selected using propensity score matching and divided into two age groups: < 65 years and ≥ 65 years. The groups were matched based on sex, BMI, diabetes mellitus (DM), cardiovascular disease, previous episodes of AD, and the presence of free fluid on CT scan. Data were assessed for Hinchey classification, surgical procedures, complications, and the frequency of surveillance through colonoscopy and CT scans. The study found a significantly higher rate of surgery in the older group during the index episode (17% vs. 4.2%, p = 0.000). A higher proportion of patients in the older group were misclassified as Hinchey II (18.2% vs. 6.4%, p = 0.007) and Hinchey III (2.3% vs. 0.7%, p = 0.304). All patients classified as Hinchey III (1 in the younger group and 3 in the older group) underwent emergency surgery. In the younger group, 2 out of 8 emergency surgeries were for patients classified as Hinchey II, compared to 11 out of 28 in the older group. Only 58% of patients underwent any form of imaging or endoscopic surveillance during the first year of follow-up. Among those, complications such as abscess, fistula, or stenosis were observed in 17% of patients, occurring more frequently in the older group (16.9% vs. 5.7%, p = 0.089). Nearly 50% of these patients required surgery, with 6 cases in the younger group and 9 in the older group. Emergency surgeries were more common in the older group (2.4% vs. 0.6%, p = 0.186), as was elective surgery (10.3% vs. 7.9%, p = 0.283). A conservative approach, combined with meticulous monitoring through regular follow-ups and imaging, can be effectively employed in managing patients with acute diverticulitis and pericolic free gas. However, our findings highlight the critical need for rigorous surveillance, especially in older patients, due to the higher prevalence of long-term complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143569","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":"How do it: tips and tricks during full-robotic pancreaticoduodenectomy.","authors":"T Piardi, G Badessi, S A Biondo, C Del Basso","doi":"10.1007/s13304-025-02264-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02264-4","url":null,"abstract":"<p><p>Robotic pancreaticoduodenectomy (RPD) is increasingly recognized as a standard procedure due to its minimally invasive nature and associated benefits such as reduced blood loss and faster recovery. This paper presents a set of tips and tricks, focusing on the management of pancreatic and biliary sections, the application of the falciform ligament for vascular protection, and the precise positioning of drainage systems. Key strategies include the use of 4/0 PDS stitches to control pancreatic vessel bleeding, preventing ischemia by refraining from the use of energy during pancreas dissection, and ensuring optimal drainage placement. The incorporation of a modified Blumgart anastomosis with a single-thread technique and the use of hydrogel sheets are also highlighted as crucial in reducing fistula formation. We think that these measures can significantly lower the incidence and severity of POPF and postoperative bleeding, thereby enhancing surgical outcomes. This paper aims to contribute to the growing body of knowledge on RPD, offering practical tips that can be safely and effectively integrated into routine clinical practice.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143566","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":"Programmed death-ligand 1 expression in surgically resected thymomas.","authors":"Luca Frasca, Antonio Sarubbi, Filippo Longo, Valentina Marziali, Alexandro Patirelis, Pierfilippo Crucitti, Vincenzo Ambrogi","doi":"10.1007/s13304-025-02242-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02242-w","url":null,"abstract":"<p><p>Thymomas are one of the most common neoplasms of the anterior mediastinum with limited therapeutic options, particularly in advanced stages. The molecular profiles of these tumors remain poorly investigated. This study aims to evaluate the expression of programmed death ligand 1 (PD-L1) in a selected cohort of intentionally curative resected thymomas and evaluate a possible relationship with the risk of recurrence. This retrospective bicentric study analyzed a group of patients who underwent complete thymectomy with curative intent. PD-L1 expression was assessed through immunohistochemistry using the Ventana PD-L1 assay. PD-L1 expression was assessed as low if <50% or high when ≥50%. The Kaplan-Meier method and Cox regression analysis were performed to evaluate a possible relationship between PD-L1 expression and disease-free survival. High PD-L1 expression was observed in 46.2% of patients. Overexpression of this protein was significantly associated with aggressive (B2/B3) thymomas histotypes (p<0.001). During follow-up period, 12/52 patients developed recurrence. High PD-L1 expression correlated with reduced disease-free survival with Kaplan-Meier method (p<0.001). Furthermore, PD-L1 expression more than 50% resulted to be related to a worse prognosis at multivariable Cox regression analysis (hazard ratio 5.4, 95% confidence interval 1.5-16.9, p=0.028) together with histology (p=0.044) and Masaoka-Koga stage (p=0.026). The elevated expression of PD-L1, particularly in aggressive thymoma subtypes, underscores its potential as a prognostic biomarker. These findings support the need for further research to explore the potential of immunotherapy in treating these rare malignancies.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143568","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":"Predicting catheter removal in peritoneal dialysis peritonitis patients visiting the emergency department: a multivariable logistic regression and decision tree analysis.","authors":"Cheng-Chih Chang, Cheng-Chi Liu, Ching-Chuan Hsieh, David Ming Then Tsai, Shih-Jiun Lin, Da-Wei Lin, Ya-Hsueh Shih, Yung-Chien Hsu, Chun-Liang Lin","doi":"10.1007/s13304-025-02256-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02256-4","url":null,"abstract":"<p><p>Peritonitis is a debilitating complication of peritoneal dialysis (PD). Identifying high-risk patients requiring PD catheter removal based on early information in the emergency room (ER) is critical. This cross-sectional study included 518 PD patients who visited the ER in the Chang Gung Memorial Hospital, Chia-Yi branch between 2002 and 2018. Among the 518 PD patients, 31 (6%) required PD catheter removed during the visit. Decision tree analysis, incorporating five key factors (neutrophil count, CRP, age, sodium, and albumin), identified 16 terminal nodes (TNs), with four higher risk groups (> 20%): lower neutrophils with lower CRP and younger age (TN1), lower neutrophils with higher CRP (TN4), higher neutrophils with moderate age and lower albumin (TN14), and high neutrophils with older age (TN16). Decision tree analysis effectively predicts the optimal timing for catheter removal in PD peritonitis patients. Clinically, this approach helps reduce mortality resulting from delayed catheter removal.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143567","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":"Optimizing arm placement in the Hugo^™ RAS system-based hysterectomy: development and validation of a simplified \"Narrow setting\" approach.","authors":"Takahiro Nozaki, Keiko Kagami, Eriko Kawataki, Mitsunori Uchida, Kosuke Matsuda, Ikuko Sakamoto","doi":"10.1007/s13304-025-02254-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02254-6","url":null,"abstract":"<p><p>We aimed to determine the usefulness of the new setup, the \"Narrow setting,\" by examining our initial experience with the Hugo^™ RAS system. 78 hysterectomies using the Hugo^™ RAS system performed in \"Narrow setting\" at our institution from November 2023 to December 2024 were included in this study. We retrospectively examined the patient's clinical information and surgical outcomes from the medical record. We also investigated the learning curve of docking time in this setting by cumulative summation analysis. The median age, body mass index, and uterine weight of the patients were 48 (31-76) years, 22.9 kg/m² (16.1-42.4), and 178 g (40-2000 g), respectively. More than half of the surgical indications were uterine myomas (52.6%, 41/78). The median operative, console, and docking times were 68 min (48-198 min), 46 min (29-151 min), and 9 min (6-31 min), respectively. The median estimated blood loss was 5 mL (5-220 mL). A total of eight perioperative complications were observed, but only one was classified as Clavien-Dindo grade III or higher. No conversion to open or laparoscopic surgery was required. The learning curve for docking time showed that docking in the \"Narrow setting\" can be proficient in 19 cases. We reported on our initial experience with hysterectomy using the Hugo^™ RAS system and found the \"Narrow setting\" to be safe and efficient.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136337","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":"Acute abdomen during chemotherapy: is surgery worthwhile? Insights from a single-center experience.","authors":"Paolo Ossola, Emanuele Doria, Diego Coletta, Valeria Cherubini, Simona Dagatti, Elia Giuseppe Lunghi, Edoardo Castellano, Ugo Parisi, Roberto Bona, Luca Mazza, Carlo Moro, Carlo Gennaro, Vincenzo Sorisio, Maria Carmela Giuffrida","doi":"10.1007/s13304-025-02253-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02253-7","url":null,"abstract":"<p><p>Chemotherapy (CT) has improved cancer treatment, particularly for locally advanced or metastatic diseases. However, CT systemic effects complicate surgical management, especially in emergency scenarios like acute abdomen. This study evaluates outcomes of emergency abdominal surgery in patients undergoing CT. A retrospective analysis was conducted at the Surgical Department of Cardinal Massaia Hospital, Italy, from January 2019 to June 2024. Patients aged ≥ 18 years undergoing emergency surgery for acute abdomen within 30 days of CT were included. Data on demographics, CT regimens, surgical and postoperative outcomes, and survival were analyzed using statistical software. Ethical approval was obtained. Thirty patients (15 males, 15 females; mean age 64.2 ± 10.3 years) were included. Indications for surgery included intestinal obstruction (80%), gastrointestinal perforation (13.3%), and colovesical fistula (6.7%). Peritoneal carcinomatosis was present in 66.7%, and R0 resection was achieved in only one case. Derivative colostomies were performed in 30% of cases. Postoperative complications occurred in 20%, but no re-operations or ICU admissions were required. The 30-day mortality rate was 6.7%. CT was resumed in 46.7% of patients, with median survival of 249 days for obstruction cases. Emergency surgery during CT is rare but feasible, with acceptable morbidity and mortality rates. Prompt resolution of acute conditions allows for CT resumption, improving overall survival. Multicenter studies are needed to validate these findings and establish standardized protocols.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129007","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: Comparison of different surgical techniques and anastomosis methods in short-term outcomes of right colon cancer: a network meta-analysis of open surgery, laparoscopic, and robot-assisted techniques with extracorporeal and intracorporeal anastomosis.","authors":"Baodong Liao, Xueyi Xue, Hao Zeng, Wen Ye, Tingjiang Xie, Xiaojie Wang, Shuangming Lin","doi":"10.1007/s13304-025-02266-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02266-2","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120959","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":"SHAPE-skin-sparing hemorrhoidectomy and PExy: a novel technique for the surgical treatment of hemorrhoidal disease.","authors":"Ugo Grossi, Giulio A Santoro, Gaetano Gallo, Eleonora Mollica","doi":"10.1007/s13304-025-02255-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02255-5","url":null,"abstract":"<p><p>Hemorrhoidal disease (HD) is a prevalent condition that often requires surgical intervention in advanced stages. This study evaluates the short-term outcomes of Skin-Sparing Hemorrhoidectomy and Pexy (SHAPE), a novel hybrid technique that integrates the excisional approach of closed hemorrhoidectomy with the tissue-sparing and fixation benefits of suture ligation with mucopexy. SHAPE selectively excises the internal hemorrhoidal column while preserving the anoderm and incorporates mucopexy to reposition prolapsed tissue, potentially reducing both recurrence and morbidity. A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns. At 1-month follow-up, patients experienced a significant reduction in symptoms, with the Hemorrhoidal Disease Severity Score (HDSS) decreasing from a median of 16 to 0 (p < 0.001) and the Short Health Scale (SHS) from 20 to 4 (p < 0.001). The median operative time was 22 min, and hospital stay was typically 1 day. Complications occurred in five patients (four cases of urinary retention, one bleeding requiring revision). No persistent pain was reported. SHAPE appears to be a promising alternative that combines the advantages of excisional and tissue-sparing techniques. Further studies are needed to assess its long-term efficacy and recurrence rates.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120960","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}