Updates in Surgery最新文献

{"title":"The aim of donor safety: surgical approaches and current results.","authors":"Christian Tibor Josef Magyar, Woo Jin Choi, Zhihao Li, Mark Steven Cattral, Nazia Selzner, Anand Ghanekar, Blayne Amir Sayed, Gonzalo Sapisochin","doi":"10.1007/s13304-024-01881-9","DOIUrl":"10.1007/s13304-024-01881-9","url":null,"abstract":"<p><p>Living liver donation (LLD) has been suggested as a potential solution to reduce the waitlist mortality for liver transplantation (LT) recipients by facilitating living donor liver transplantation (LDLT). Ensuring both donor and recipient safety is a critical aspect of LDLT. An accurate understanding of the complexity and extend of safety outcomes of the donor is imperative to maintain the high-quality standard this medical program requires. This review seeks to outline safety outcome parameters of interest for donors. Early postoperative mortality is very low with no significant differences comparing left lobe to right lobe LLD. Complications most commonly are biliary (leakage or strictures), bleeding, respiratory or pulmonary, gastrointestinal or infectious. Return to full-time work and quality of life are essential parameters in the mid and long term. As evidence continues to accumulate, outcomes may evolve with the expansion of minimal invasive surgery practice and currently laparoscopic approach is recommended in large experienced centers. By offering safer operations that require fewer incisions or liver resections, living liver donations can be further encouraged, and the perception of the procedure can be improved. Rational consideration of the safety of the donor and in-depth discussion and evaluation with the patient is of utmost importance.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1755-1766"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447149","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":"RAPID procedure in patients with cirrhosis with or without hepatocellular cancer: a brief selection of candidates and a detailed description of the techniques.","authors":"Deniz Balci, Olivier Scatton","doi":"10.1007/s13304-025-02323-w","DOIUrl":"10.1007/s13304-025-02323-w","url":null,"abstract":"<p><p>The RAPID technique, i.e., Resection And Partial Liver Transplantation With Delayed Total Hepatectomy, represents one of the latest advancements in the field, recently discussed at the Zurich consensus meeting of the ISLS (International Society of Liver Surgeons).RAPID can be applied in the setting of either liver metastases developed on normal liver or of cirrhosis with or without hepatocellular carcinoma (HCC). RAPID for cirrhosis represents a stepwise evolution however, two main characteristics distinguish the RAPID technique in healthy liver from RAPID for cirrhosis: first, the functional reserve of the native cirrhotic liver is limited that is difficult to accurately estimate preoperatively, and second, existing portal hypertension (PHT) related to the cirrhosis complicates parenchymal transection and may also injure the implanted small graft. In this paper, we will describe the selection of the best candidates and the RAPID technique for cirrhosis. The measurement and modulation modalities of the portal flow will be particularly addressed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1881-1888"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769106","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":"Indications and results of right-lobe living donor liver transplantation.","authors":"Ivan Vella, Fabrizio di Francesco, Caterina Accardo, Ugo Boggi, Salvatore Gruttadauria","doi":"10.1007/s13304-024-01785-8","DOIUrl":"10.1007/s13304-024-01785-8","url":null,"abstract":"<p><p>The shortage of deceased liver donor organs over the years has always posed the need to expand the donor pool. A viable alternative to deceased donors is that of the living donor. Indeed, the living donor in liver transplantation, initially in pediatric transplantation, but for several years now also in adult transplantation, is a more than viable alternative to deceased liver donation. In fact, right liver lobe donation has proven to be a surgical procedure with low impact on the donor's life in terms of morbidity and mortality, with excellent results in recipients of such organs. In recent years, an increasing number of studies have been published that show excellent results in right-lobe living donor liver transplantation, encouraging this practice not only in countries that have historically had a shortage of deceased donor organs, such as Asian countries, but making it a practice of increasing use in Western countries as well. In addition, thanks to improvements in surgical technique and the experience of high-volume centers, this surgery has also begun to be performed using minimally invasive surgical techniques, allowing us to envision ever better outcomes for both donor and recipient in the coming years.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1839-1851"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155666","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":"Future perspectives of robotics in liver transplantation.","authors":"Rammohan A, Rela M","doi":"10.1007/s13304-024-01906-3","DOIUrl":"10.1007/s13304-024-01906-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1903-1905"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293732","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":"Current perspectives on living donor selection in liver transplantation.","authors":"Colin Powers, Vikraman Gunabushanam, Leonardo Centonze, Abhinav Humar","doi":"10.1007/s13304-025-02131-2","DOIUrl":"10.1007/s13304-025-02131-2","url":null,"abstract":"<p><p>The careful selection of donors is crucial to achieving a successful outcome in living donor liver transplantation. The evaluation process involves obtaining a comprehensive medical history and pertinent laboratory testing, evaluating surgical anatomy using cross-sectional radiologic imaging and understanding donor motivation and psycho social considerations. This review outlines the evaluation of a potential living liver donor and discussed frequently encountered special considerations that may need to be addressed by the transplant team.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1745-1753"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469285","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":"Trends of liver transplantation in Asia.","authors":"Ning Qi Pang, Albert C Y Chan, Alfred Wei Chieh Kow","doi":"10.1007/s13304-024-01924-1","DOIUrl":"10.1007/s13304-024-01924-1","url":null,"abstract":"<p><p>Liver transplantation (LT) in Asia started comparatively early in 1964, just 1 year after Starzl's trail-blazing first attempt. Despite the quick start, LT was slow to develop in this region. Limited access to universal healthcare, lack of public understanding and support as well as the absence of strong legislation, on a backdrop of a wide range of diverse social, religious, economic and cultural background are all contributory factors. Through strong administrative efforts, the number of DDLTs in selected Asian countries has been slowly rising in recent years. However, Asians are generally still less likely to donate organs than Caucasians after death. The strong demand for LT with limited access to deceased organs has, therefore, led to constant need for innovation in LT this region, with the pioneering of various LDLT techniques and safe expansion of donor pool being driven primarily by Asian centers. Familiarity and the development of technical expertise in donor surgery have also resulted in Asian centers repeatedly pushing the boundaries on minimally invasive donor and recipient surgery. In this article, we focus on the past and present states of LT in Asia and explore the future trends of LT in this region.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1717-1727"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752932","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":"Artery first approach in robotic pancreatoduodenectomy: right-sided uncinate first technique.","authors":"Philipp Seeger, Asmus Heumann, Thilo Hackert, Faik Güntac Uzunoglu","doi":"10.1007/s13304-025-02384-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02384-x","url":null,"abstract":"<p><p>Several advances have been made since the first days of pancreatic surgery and the Whipple-Kausch procedure: the artery-first approach and TRIANGLE resection for pancreatic cancer of the head have been reported in different variations for open surgery to achieve a complete R0 resection. Since this is one of the main factors for oncologic outcome, it is essential to transfer these techniques to the newest iteration of surgical evolution: robotic pancreatoduodenectomy has shown its comparability to the open approach in the last few years. In this paper, we describe our technique of robotic uncinate-first approach for superior mesenteric artery dissection and provide short-term outcomes from a small patient series. The robotic right-sided uncinate-first approach is feasible and allows safe transfer of oncologic vascular dissection techniques to the minimally invasive setting.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201324","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":"Current indications for surgery in patients with lung cancer after neoadjuvant targeted therapy: a systematic review.","authors":"Leonardo Teodonio, Valentina Peritore, Claudio Andreetti","doi":"10.1007/s13304-025-02354-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02354-3","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Neoadjuvant targeted therapy with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is emerging as a strategy to improve outcomes in resectable stage IIIA/IIIB non-small cell lung cancer (NSCLC) with EGFR mutations. We conducted a systematic review of clinical trials and studies, following PRISMA guidelines, to evaluate the efficacy, safety, and surgical feasibility of neoadjuvant EGFR-TKI therapy in this setting. Literature was searched for studies reporting outcomes of neoadjuvant TKIs (e.g., gefitinib, erlotinib, afatinib, osimertinib) in resectable stage III NSCLC. Key endpoints included radiologic response rates, pathological response (pCR and major pathologic response, MPR), complete resection (R0) rates, surgical outcomes, and adverse events. A total of 15 studies (including one randomized trial and multiple phase II trials/cohorts) were analyzed, encompassing over 400 patients. Neoadjuvant EGFR-TKIs yielded high objective response rates (pooled ORR ~ 57%, up to 70-80% with third-generation TKIs). However, pathological complete response was rare (pooled pCR ~ 3%) and MPR rates remained modest (often &lt; 15%), underscoring a difference compared to neoadjuvant chemoimmunotherapy. Complete resection (R0) rates were excellent (approximately 90% in patients undergoing resection), and neoadjuvant TKIs enabled surgical downstaging in ~ 40-74% of cases. Treatment was well tolerated, with primarily grade 1-2 rash and diarrhea; severe adverse events ≥ grade 3 were under 10%. Importantly, surgery after TKI therapy was feasible, with no increase in perioperative morbidity reported. In some cases, tumor shrinkage allowed conversion of an initially unresectable or complex case to a less extensive resection (e.g., sleeve lobectomy instead of pneumonectomy). In comparison to historical neoadjuvant chemotherapy, EGFR-targeted therapy significantly improved radiologic response and progression-free survival, while avoiding the added toxicity of chemotherapy. Compared to neoadjuvant chemo-immunotherapy (which achieves higher pCR rates), targeted therapy is specific to oncogene-driven tumors and has shown efficacy in EGFR-mutant tumors where immunotherapy alone is often ineffective. This review highlights that neoadjuvant EGFR-TKI therapy is a safe and feasible approach that can increase resectability and preserve lung tissue in stage III EGFR-mutant NSCLC. The combination of novel targeted agents with advanced surgical techniques (including sleeve resections and robotic-assisted approaches) offers promising results. Nevertheless, due to the lack of significant pathological complete responses, adjuvant therapy and long-term outcomes remain concerns. Ongoing trials (e.g., NeoADAURA) will further clarify the role of EGFR-TKIs ± chemotherapy in the neoadjuvant setting. In conclusion, for resectable stage III EGFR-mutant NSCLC, neoadjuvant EGFR-targeted therapy achieves high response rates and surgical success with manageable toxicity. ","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138791","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":"Optimal timing for cholecystectomy following percutaneous cholecystostomy: insights from a multicenter retrospective cohort study.","authors":"Antonio Pesce, Camilo Ramírez-Giraldo, Matteo Matteucci, Juan Camilo Toro-Rodríguez, Simón Macías-Segura, Gaetano Piccolo, Riccardo Masserano, Gabriella Capolupo, Valentina Miacci, Filippo Carannante, Giovanni Cestaro, Carlo Stracqualursi, Francesco Roscio, Alessandro Gemini, Antonia Rizzuto, Mimi Yen, Andrea Mingoli, Bruno Cirillo, Augusto Lauro, Vito D'Andrea, Andrés Isaza-Restrepo, Roberto Cirocchi","doi":"10.1007/s13304-025-02398-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02398-5","url":null,"abstract":"<p><p>Laparoscopic cholecystectomy is the standard of care for patients with acute cholecystitis. However, in high-risk surgical candidates who do not respond to conservative management, percutaneous cholecystostomy is recommended. When used as bridge therapy, the optimal timing for performing laparoscopic cholecystectomy as definitive treatment still remains uncertain. The primary outcome of this study was to assess the incidence of major perioperative complications, defined as Clavien-Dindo grade ≥ III. A retrospective, multicenter, observational cohort study was conducted across nine hospitals-seven in Italy and two in Colombia. We reviewed the medical records of all patients who underwent cholecystectomy following percutaneous cholecystostomy at the participating institutions between January 2020 and December 2024. Patients were stratified into two groups based on the 50th percentile (median) of the time interval between procedures, which was 59 days. Accordingly, the groups were defined as ≤ 59 days (approximately ≤ 8 weeks) and > 59 days (approximately > 8 weeks). A total of 123 patients were included in the study. The median age was 75.0 years, and the majority were male (56.1%). Logistic regression analysis showed that older age and an open surgical approach were significantly associated with a higher risk of major complications. The time interval between cholecystostomy and cholecystectomy was not significantly associated with the risk of major complications in any model. However, in the sensitivity analysis-after excluding outliers above the 95th percentile and below the 5th percentile-the incidence of major complications was 21.1% in the ≤ 8 weeks group versus 11.3% in the > 8 weeks group, without statistically significant differences (p = 0.262). The results of this study suggest that, within the observed range of intervals, no definitive advantage can be attributed to either earlier or delayed surgery based solely on timing. There remains a critical need for a rigorously designed, multicenter prospective study to determine the optimal timing of surgery based on clinically meaningful endpoints.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132056","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":"Unveiling publishing patterns in the European Society of Endocrine Surgeons congress abstracts: a retrospective multicentric publication analysis.","authors":"Max Schneider, Agata Dukaczewska, Dirk-Jan van Beek, Klaas Van Den Heede, Gunjan Sharma, Martin Almquist","doi":"10.1007/s13304-025-02216-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02216-y","url":null,"abstract":"<p><p>Since 2004, the European Society of Endocrine Surgeons (ESES) has hosted biennial congresses as a platform for presenting key research. However, the publication rate of abstracts presented at these congresses is unknown. We searched for full publications using titles and authors of abstracts presented orally or as posters at ESES congresses from 2004 to 2018. Abstract factors, such as type of study and number of patients, were investigated in relation to publication rate, journal impact factor, and citation rates of published studies. Out of 733 abstracts presented at ESES during this period, 207 (28%) were presented orally and 528 (72%) as a poster, Overall, 456 of the abstracts (62%) were published, with a median time of 11.4 months from the ESES congress to publication [range - 64.5 to 156]. The median number of citations per published abstract was 21 [range 0-821], the average annual citation rate was 2.3 [0-54], and the median journal impact factor was 2.2 [0-21.3]. The median number of patients included per study was small, accounting for 71.5 [range 1-22,580]. While factors predicting higher chances for publication were oral format (OR 5), 2006 and 2008 ESES congresses (OR 21 and 12.6, respectively), larger sample sizes, oral presentation format, native English authorship, and randomized trials had higher annual citation rates. While the publication rates of ESES congress abstracts are high, collaborative efforts to conduct multicentric prospective studies could increase the publication rate of abstracts and enhance the overall scientific impact of the ESES congresses.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132022","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}