Updates in Surgery最新文献

{"title":"Primary bilateral macronodular adrenal hyperplasia (PBMAH): from rare to common cause of Cushing syndrome in clinical practice.","authors":"Sergii Cherenko, Liuchiia Shchekaturova","doi":"10.1007/s13304-025-02385-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02385-w","url":null,"abstract":"<p><p>Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH) is considered a rare cause of Cushing syndrome (CS). Despite progress in understanding the pathogenesis, clinical evaluation of the disease and optimal treatment remain relevant. Data were retrieved from institutional/hospital databases. The first group of PBMAH patients comprised 34 cases from a total of 634 adrenalectomies (including 166 CS cases) performed 2009-2015. The second group included 51 patients from 356 adrenalectomies (including 160 CS cases) conducted 2016-2023. Follow-up results are available for 79 patients. PBMAH is an increasingly recognized cause of adrenal CS (21% and 32% in consequent groups). The age of patients was 53.4 ± 7.1 years (range 39-71), with a female prevalence of 77.6%. Patients predominantly exhibited mild CS, accompanied by arterial hypertension, obesity, hyperglycemia, and osteoporosis. We found a high percentage of coexisting primary aldosteronism in both groups (44.1% and 37.3%). All patients, after confirmation of CS, ACTH independence, and imaging visualization, proceeded to unilateral laparoscopic adrenalectomy. Follow-up demonstrated normalization of serum cortisol and clinical improvement in all patients. We detected 4 cases (4.7%) of laboratory recurrence of CS; two of these patients underwent contralateral adrenal resection (both acquired adrenal insufficiency), while the other two continued treatment with blockage of discovered aberrant cortical receptors (using β-blockers and octreotide). PBMAH is not a rare adrenal disease, accounting one-quarter of all operated CS patients. Laparoscopic adrenalectomy of the larger gland leads to long-term remission in most patients and does not result in permanent adrenal insufficiency. Primary aldosteronism is an underestimated condition in PBMAH patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970812","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":"Tailored surgery for large adrenal tumors: the minimally invasive to open (hybrid) approach.","authors":"Agata Dukaczewska, Konrad Ilgner, Catarina Alisa Kunze, Jennifer Sladek, Eva Maria Dobrindt, Peter E Goretzki, Johann Pratschke, Martina T Mogl, Frederike Butz","doi":"10.1007/s13304-025-02388-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02388-7","url":null,"abstract":"<p><p>Conversion from minimally invasive techniques to open surgery has mostly been considered as an undesirable event associated with intraoperative complications or poor preoperative planning. However, the impact of conversion to open surgery during adrenalectomy for large adrenal tumours remains unclear. This study investigates the outcomes of conversion from minimally invasive to open surgery for adrenal masses ≥ 60 mm with an additional focus on the identification of survival predictors in patients with large adrenocortical carcinoma (ACC). We retrospectively analyzed 97 patients who underwent unilateral adrenalectomy for tumours ≥ 60 mm. Patient characteristics, tumour features, surgical approaches, and outcomes were compared. Survival outcomes in ACC patients (n = 34) were assessed using Kaplan-Meier analysis, with prognostic factors evaluated via univariate Cox regression and Ridge Regression modeling. Of 97 patients, 41 (42%) underwent minimally invasive adrenalectomy (MIA), 40 (41%) open adrenalectomy (OA), and 16 (17%) required conversion to open surgery (hybrid adrenalectomy, HA). HA had a longer operative time (median 226.5 vs. 108.5 min; p < 0.001) and hospital stay (median 9 vs. 4 days; p < 0.001) compared to MIA but not OA (median 188 min; p = 0.102; 10 days; p = 0.519, respectively). Overall, complications were more frequent in HA (43.7%) than MIA (7.3%; p = 0.003) but similar to OA (37.5%; p = 0.897). Minor complications were more common in HA than MIA (31 vs. 7%; p = 0.032), while major complications were comparable (12.5 vs. 7.5%; p = 0.617). Tumours in HA cases more often showed vascular infiltration (p = 0.001) and required multivisceral resection (p = 0.002). ENSAT tumour stage (OS: HR = 4.66, p = 0.041; PFS: HR = 2.52, p = 0.005) and the S-GRAS score (OS: HR = 6.00; PFS: HR = 1.50) were significant survival predictors in ACC, whereas the operative technique was not. Conversion to open surgery increases minor complications compared to MIA but not OA. ENSAT tumour stage and S-GRAS score predict survival in ACC, while the surgical approach does not. Timely conversion should be performed to ensure oncological safety when needed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970759","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":"Preservation of EUS-guided gastrojejunostomy LAMS during pancreaticoduodenectomy: a paradigm shift in the surgical management of borderline resectable pancreatic cancer.","authors":"R V De Rosa, T Wallenhorst, F Robin, L Sulpice","doi":"10.1007/s13304-025-02380-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02380-1","url":null,"abstract":"<p><p>Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with lumen-apposing metal stents (LAMS) is increasingly employed for palliation in pancreatic ductal adenocarcinoma (PDAC). We report the first European case in which a EUS-GJ LAMS was preserved and functionally integrated during pancreaticoduodenectomy (PD), supporting the concept that endoscopic bypass can be part of a curative surgical pathway. A 59-year-old male with borderline resectable PDAC and failed ERCP underwent sequential endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and gastrojejunostomy with LAMS. After completing a full course of neoadjuvant chemotherapy and showing tumor regression, he underwent PD with en bloc portal vein resection. The preexisting LAMS was intraoperatively preserved and incorporated as the definitive gastrojejunostomy. Outcome: The patient had an uneventful recovery. Final pathology confirmed ypT1c N0 M0 R0 PDAC. At 6-month follow-up, he was recurrence-free. EUS-GJ with LAMS can be successfully preserved and integrated during PD, suggesting a potential shift from exclusively palliative use to potentially curative indications. Further investigation in multidisciplinary settings is warranted.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970732","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":"Consider the unexpected! An overlooked, elusive, rare but dramatic diagnosis: anorectal melanoma.","authors":"Rossella Melcarne, Chiara Eberspacher, Massimiliano Mistrangelo, Pietro Quaglino, Rebecca Senetta, Arcangelo Picciariello, Leonardo Vincenti, Daniela Rega, Paolo Delrio, Corrado Caracò, Mariarosaria Portinaio, Stefano Arcieri, Giovanni Paolino, Santo Raffaele Mercuri, Carmen Cantisani, Chiara Scorziello, Tal Deborah Engel, Laura Giacomelli, Marco Biffoni, Domenico Mascagni","doi":"10.1007/s13304-025-02367-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02367-y","url":null,"abstract":"<p><strong>Background: </strong>Anorectal melanoma (AM) is a rare and aggressive malignancy, often misdiagnosed due to its clinical resemblance to benign anorectal conditions. Early diagnosis remains challenging, with a poor prognosis and high rates of metastasis at presentation.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study of 21 patients diagnosed with AM between 2013 and 2023 across four high-volume Italian surgical centers. Patients were stratified into two groups based on whether AM was suspected at initial evaluation (Group A) or incidentally diagnosed after surgery for presumed benign disease (Group B). Clinical, diagnostic, treatment, and outcome data were analyzed.</p><p><strong>Results: </strong>Only 24% of patients had AM suspected at first presentation. These patients were younger (median age 49 vs. 70 years) and had larger, more readily identifiable tumors. However, nodal and distant metastases were equally frequent in both groups (lymph node metastases: 52.4%; distant metastases: 19%). Most patients underwent wide local excision (71.4%), while only one required abdominoperineal resection. Postoperative recurrence occurred in 47.6% of cases. Median survival was 11 months in Group A and 24 months in Group B. In 90.5% of cases, previous specialist consultations had failed to achieve timely diagnosis, highlighting missed diagnostic opportunities.</p><p><strong>Conclusions: </strong>AM is frequently overlooked due to its rarity and non-specific presentation. Earlier recognition alone may not improve outcomes, but systematic histopathological assessment, targeted biopsy, and multidisciplinary management remain essential. Conservative surgery with early use of systemic therapy should be prioritized when feasible.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970423","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":"Early C-reactive protein as a predictive biomarker for postoperative complications following robot-assisted surgery for rectal cancer.","authors":"Fuminori Teraishi, Ryusei Takahashi, Hiroki Okabayashi, Masashi Utsumi, Hideaki Miyaso, Ryohei Shoji, Toshiyoshi Fujiwara, Toshiharu Mitsuhashi, Masaru Inagaki","doi":"10.1007/s13304-025-02379-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02379-8","url":null,"abstract":"<p><p>This retrospective cohort study aimed to assess the predictive value of early postoperative C-reactive protein (CRP) levels for complications following robot-assisted rectal surgery (RARS) for rectal cancer. We analyzed data from 117 consecutive patients who underwent elective RARS at Okayama University Hospital between September 2020 and January 2025. Serum CRP levels were routinely measured preoperatively and on postoperative days (POD) 1 and 4. The primary outcome was the occurrence of any postoperative complication within 30 days, classified according to the Clavien-Dindo grading system. Postoperative complications were observed in 26 patients, representing 22.2% of the cohort. Univariate analysis revealed that several factors were significantly associated with complications, including older age, higher ASA score, neoadjuvant therapy, stoma creation, prolonged operative time, and elevated CRP levels on POD1 and POD4. Notably, multivariate logistic regression analysis identified POD1 CRP as a robust independent predictor of overall postoperative complications (adjusted odds ratio 0.77, 95% confidence interval (CI) [0.63-0.93], p < 0.01). In the ROC analysis, the AUC was 0.735 (bootstrap bias-corrected 95% CI 0.544-0.848). The optimal cutoff value of POD1 CRP was 5.63 mg/dl, at which Youden's index, yielding a sensitivity of 0.615 and specificity of 0.868. In conclusion, early postoperative measurement of CRP on POD1 serves as a valuable and independent biomarker for predicting complications following RARS for rectal cancer. Incorporating POD1 CRP into postoperative surveillance may facilitate the early identification of high-risk patients, thereby facilitating timely interventions and ultimately improving surgical outcomes in this patient population.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970701","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":"Advocating biomarker-guided perioperative hydrocortisone therapy to reduce morbidity after pancreatoduodenectomy.","authors":"Muhammad Zahir Shah, Azmat Ullah, Abu Talha","doi":"10.1007/s13304-025-02391-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02391-y","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970436","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":"Designing a SPIKES-based protocol for communicating uncertainty in indeterminate thyroid cytology: a mixed-method analysis within a pilot study.","authors":"Rossella Melcarne, Fabrizio Consorti, Giorgio Grani, Tal Deborah Engel, Eva Iannuzzi, Carla Ammendolia, Laura Giacomelli, Cosimo Durante, Marco Biffoni","doi":"10.1007/s13304-025-02346-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02346-3","url":null,"abstract":"<p><p>Indeterminate thyroid cytology presents a significant diagnostic challenge, often leading to difficult treatment decisions for both physicians and patients. Effective communication of these uncertainties is crucial, especially in a surgical setting, where decisions can have long-lasting impacts. This is particularly important for younger surgeons who may lack extensive clinical experience. This study aimed to plan, develop, implement, and pilot a communication protocol designed for surgeons, particularly those in training, to navigate uncertainty and build trust with their patients. Additionally, it documented the reactions of patients managed using this approach. Fifty-two patients diagnosed with indeterminate thyroid cytology were enrolled between March 2023 and January 2024 at the Endocrine Surgery Unit of \"Azienda Ospedialiera Universitaria Policlinico Umberto I\" in Rome, Italy. A communication protocol based on the SPIKES model (Setting, Perception, Invitation, Knowledge, Emotion, Strategy), a six-step protocol for guiding  difficult conversations, was designed to structure discussions around uncertain diagnoses. Patient consultations were conducted in three phases: the initial outpatient visit, pre-surgery admission, and a follow-up one week after surgery. During each encounter, patients' emotional responses were recorded using open-ended questions. To ensure clarity, a Decision Aid (DA) tool was introduced during the K-Knowledge phase of SPIKES, to better explain the risks and treatment options. A mixed-methods approach was used to analyze both qualitative and quantitative data from patient feedback. The adapted protocol was found to be effective in enhancing patient comprehension and emotional response. Approximately 80% of patients reported emotional relief after the first consultation, and by the third encounter, 91% expressed a sense of well-being or trust. The most frequently reported emotional states across all three encounters were serenity, reassurance, and trust. A small subset of patients continued to experience concern or fatigue. Additionally, 96% of participants rated the communication as clear, and 88.5% considered the final therapeutic decision as the correct one. This pilot study suggests that a structured SPIKES-based communication protocol can help address gaps in patient understanding, trust, and satisfaction when managing indeterminate thyroid cytology. Implementing such protocols may streamline communication in surgical settings, improve  patient-centered care, and support physicians, particularly trainees, in managing complex patient interactions.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970682","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":"Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH).","authors":"Matteo Serenari, Francesca Ratti, Mohammed Abu Hilal, Francesco Ardito, Giammauro Berardi, Ugo Boggi, Alberta Cappelli, Matteo Cescon, Umberto Cillo, Alessandro Cucchetti, Luciano De Carlis, Francesco De Cobelli, Fabrizio Di Benedetto, Giorgio Ercolani, Giuseppe Maria Ettorre, Massimo Fedi, Alessandro Ferrero, Felice Giuliante, Gian Luca Grazi, Enrico Gringeri, Salvatore Gruttadauria, Francesco Izzo, Marcello Maestri, Paolo Magistri, Marco Massani, Vincenzo Mazzaferro, Riccardo Memeo, Federico Mocchegiani, Cristina Mosconi, Damiano Patrono, Matteo Ravaioli, Fabrizio Romano, Gianluca Rompianesi, Nadia Russolillo, Andrea Ruzzenente, Carlo Sposito, Roberto Troisi, Giovanni Vennarecci, Luca Viganò, Marco Vivarelli, Giacomo Zanus, Pedro M Baptista, Karl Oldhafer, Erik Schadde, Luca Aldrighetti, Elio Jovine","doi":"10.1007/s13304-025-02364-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02364-1","url":null,"abstract":"<p><p>In candidates for hepatectomy, different techniques to induce liver hypertrophy and modulate the future liver remnant are available. However, their use in specific clinical scenarios is highly heterogeneous and there is no consensus about minimal safety standards needed to incorporate these strategies into routine clinical practice. The aim of this position paper was to summarize newly available evidence in the field and compare medical practice among different hepatobiliary surgical units to evaluate the transformative potential of liver hypertrophy techniques in surgical oncology. This paper sets the stage for a future structured consensus on the application of liver hypertrophy techniques before hepatectomy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970655","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":"Pushing the boundaries of indocyanine green fluorescence angiography in colorectal surgery.","authors":"Roberto Peltrini, Francesco Ferrara, Vincenzo Pilone","doi":"10.1007/s13304-025-02389-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02389-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970767","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":"Impact of donor-recipient ethnic matching on survival after lung transplantation in Italy.","authors":"Alessandro Palleschi, Marco Schiavon, Paola Besani, Federico Rea, Daniele Diso, Federico Venuta, Chiara Catelli, Luca Luzzi, Matteo Marro, Massimo Boffini, Matteo Petroncini, Filippo Antonacci, Lorenzo Rosso, Mario Nosotti","doi":"10.1007/s13304-025-02371-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02371-2","url":null,"abstract":"<p><p>Disparities in access to and outcomes of lung transplantation have been extensively studied in North America, but little is known about these disparities in Europe. This study evaluates the impact of ethnicity on lung transplantation outcomes in Italy, including the role of ethnic mismatch between donor and recipient. We conducted a retrospective cohort study of patients undergoing lung transplantation between 2010 and 2020 in six Italian transplant centers. Demographic, clinical, and survival data were analyzed. The primary endpoint was survival following bilateral lung transplantation in Caucasian and non-Caucasian patients. Cox proportional hazards regression was used to identify factors associated with survival. Of the 959 patients studied, 93.4% were Caucasian and 6.6% non-Caucasian. Significant differences in access to transplantation were observed by ethnicity (p = 0.002). Non-Caucasian patients showed a trend toward lower unadjusted survival (p = 0.069), with significant differences linked to donor-recipient racial mismatch (p = 0.002). Cox regression identified recipient age, restrictive lung disease, education level, and donor-recipient mismatch as independent predictors of survival. Our study highlights disparities in lung transplantation outcomes linked to ethnicity and education level in Italy. Strategies to improve access and address donorrecipient mismatches could enhance equity in transplant care.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970713","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}