Updates in Surgery最新文献

{"title":"Real-world management of achalasia and esophagogastric junction outlet obstruction in Italy: results from a national survey.","authors":"Elettra Ugliono, Salvatore Buscemi, Danilo Consalvo, Angelo Iossa, Nicola Tamburini, Graziano Pernazza, Fabrizio Rebecchi","doi":"10.1007/s13304-025-02406-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02406-8","url":null,"abstract":"<p><p>There is significant variability in clinical guidelines for achalasia, and precise indications for Esophagogastric Junction Outflow Obstruction (EGJOO) are lacking. The recommendations provided in the published literature could be difficult to translate into the clinical practice due to the discrepancy in the available resources. This survey aims to provide insight into the different diagnostic and therapeutic approaches adopted nationwide. An electronic 31-item questionnaire was sent among the members of the Italian Society for Endoscopic Surgery of Endoscopic Surgery and New Technologies (SICE). A single response from each participating center was required. A total of 46 answers were obtained. The first approach to achalasia was Heller myotomy plus Dor fundoplication (H-D) in most cases, but there was an increased use of Per-Oral Endoscopic Myotomy (POEM) for subtype III achalasia. Botulin toxin injection (BTX) and PD were reserved for frail, older patients. Surgery was the primary approach for end-stage achalasia, mainly H-D (50.0%), esophagectomy (22.7%), and PD (20.5%). A conclusive diagnosis of EGJOO was managed through PD (32.6%), clinical observation (21.7%), H-D (17.4%), Proton Pump Inhibitors (PPIs) (13.0%), BTX (13.0%) and POEM (2.2%) while an inconclusive EGJOO diagnosis through clinical observation (39.1%), PD (23.9%), H-D (21.7%), PPIs (8.7%) and POEM (6.5%). The suggested timing was 3 months (72.7%) for clinical and 6 months (63.6%) for instrumental follow-up. In case of persistence of symptoms, the preferred treatments were H-D (50.0%) and PD (28.3%). This study provides a real-world snapshot of the management of achalasia and EGJOO in the Italian landscape, showing a wide variability in the clinical practice among the involved centers. A multidisciplinary approach is advisable, and clinical guidelines are warranted to provide shared decisions for the management of these disorders.</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":"145132029","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":"Robotic splenectomy with Hugo-Ras™ system: first worldwide report.","authors":"Claudia Tempesta, Tommaso Farolfi, Domenico Marchi","doi":"10.1007/s13304-025-02416-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02416-6","url":null,"abstract":"<p><p>Robotic-assisted surgery has emerged as a transformative approach for different general surgery procedures, offering enhanced precision, dexterity, and ergonomics. Medtronic's Hugo-RAS™ enters the already extremely competitive field of robotic surgery, but while its use is fully implemented in other specialties, comprehensive clinical data regarding its application in general surgery are still lacking, and the spectrum of procedures in which it has been used remains limited. This article reports the first global experience of robotic splenectomy performed using the Hugo RAS™ system, performed by an experienced surgeon. A detailed description of trocar placement and the docking set-up is provided, along with a step-by-step overview of the surgical technique. No intra- or postoperative complications were observed. The intraoperative time was 155 min. The docking time of the four robotic arms lasted 12 min. The console time was 114 min. No fever, biochemical alterations, or any complication within 30 days, according to Clavien-Dindo occurred. No readmission was reported. Postoperative follow-up at 3 months revealed the clinical well-being of the patient. Robotic splenectomy can be safely performed with Hugo-RAS™, and it can be achieved with favorable intra- and postoperative outcomes, comparable to those available in the existing literature.</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":"145132019","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":"Key genetic determinants of diabetes remission in patients with obesity following bariatric surgery.","authors":"Maryam Mahjoubin-Tehran, Jonanne Talebloo, Kishore M Gadde, Vasily N Sukhorukov, Tannaz Jamialahmadi, Amirhossein Sahebkar","doi":"10.1007/s13304-025-02408-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02408-6","url":null,"abstract":"<p><p>Obesity represents a significant public health challenge on a global scale. Bariatric surgery is an effective intervention for individuals with severe obesity, leading to the amelioration or resolution of numerous obesity-related comorbidities with improved quality of life. Numerous studies have demonstrated that bariatric surgery is more effective than medical weight management interventions for remission of type 2 diabetes (T2D) among patients with obesity; however, there is heterogeneity of response in this regard. In the current analysis, we examined critical differentially expressed genes (DEGs) in patients with obesity and T2D who had remission versus non-remission after bariatric surgery, i.e., responders versus non-responders. We downloaded the gene expression profile GSE271700 from the Gene Expression Omnibus and preprocessed it with GEO2R. 73 differential expressed genes with │ LFC │ > 1 and p value < 0.05 have been recognized in the responder group which were examined in subsequent analyses. SRSF5, MAGOH, LTF, NUP153, CAMP, CEACAM8, and HBD are identified as hub genes using cytoHubba plugin in cytoscape. Moreover, CAMP, CEACAM8, HBD, and LTF were shared between hub genes and the best module (identified using the MCODE plugin). ZBTB33, TAF1, and BCLAF1 were recognized as the most significant transcription factors, and CSNK2A1, CDK1, and MAPK14 were found as the most significant kinases. Moreover, functional analysis showed that DEGs affect mRNA processing and mRNA surveillance pathways. Innate immune response and regulation of cellular response to heat were the best results of biological processes. These results could help to better understand the differences in diabetes remission among patients with obesity.</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":"145138736","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":"Metabolic bariatric surgery in 2025: between obesity-management medications and endoscopic approaches.","authors":"Mario Musella, Chetan Parmar, Karl P Rheinwalt","doi":"10.1007/s13304-025-02419-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02419-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126104","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":"Machine learning model for predicting a high comprehensive complication index following rectal cancer surgery.","authors":"Zhen Wang, Lei Huang, Liang He, Shuang Li, Siyu Peng, Yang Gong, Dongmei Mu, Quan Wang","doi":"10.1007/s13304-025-02401-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02401-z","url":null,"abstract":"<p><p>Postoperative complications following rectal cancer surgery can significantly affect patient's health and prognosis. It has been reported that the comprehensive complication index (CCI) is a more sensitive assessment tool for severe complications than the Clavien-Dindo classification (CDC) system. This study aims to construct a predictive model for high postoperative CCI using machine learning methods to guide clinical practice. A total of 1029 patients with mid and low rectal cancer who underwent rectal resection were included. Preoperative, intraoperative clinicopathological characteristics and pelvic measurement data were collected. Five predictive models were constructed using machine learning methods, including Random Forest (RF), LightGBM, Logistic Regression (LR), Naive Bayes Model (NBM) and XGBoost, and their performances were compared. Finally, the Shapley Additive exPlanations (SHAP) was used to visually interpret the predictive variables of the best model. Six predictive variables, including surgical time, interspinous distance, pelvic depth, age, diabetes, and tumor distance, were included in the model construction. Among the five models, LightGBM was the optimal model, with an AUC of 0.746 in the training set, 0.760 in the testing set and 0.709 in the validation set. It had the best DCA curve for most thresholds, indicating excellent performance in predicting high CCI. This study developed a predictive model for assessing the risk of high CCI following anterior resection for rectal cancer. It could provide personalized treatment strategies for patients at high risk of severe complications, improves patient prognosis, and promotes its use through an online web tool ( https://mypredict.shinyapps.io/CDC_CCI/ ).</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114183","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":"From indiscriminate malabsorption to global bariatric surgery.","authors":"Nicola Basso","doi":"10.1007/s13304-025-02418-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02418-4","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125971","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 effect of receptor for advanced glycation end products (RAGE) expression on the occurrence, development, and prognosis of gastric cancer.","authors":"Li-Juan Wang, Yu-Hang Diao, Quan Lv, Yong Cheng","doi":"10.1007/s13304-025-02412-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02412-w","url":null,"abstract":"<p><p>We conducted this study to determine whether the receptor for advanced glycation end products (RAGE) expression has an effect on the occurrence, development, and prognosis of gastric cancer (GC).We conducted a systematic search in three databases (PubMed, Embase, and the Cochrane Library) to identify clinical articles that examined RAGE expression in GC. The association between RAGE and clinical characteristics associated with GC was estimated using odds ratios (ORs) and associated 95% confidence intervals (CIs). The registration ID of this current study on PROSPERO is CRD42024547708.We included a total of 2834 patients from nine studies in the current study. After pooling up all the data, we found that RAGE expression was higher in GC than in normal tissues (OR = 6.21, I² = 0%, 95% CI 3.60 to 10.71, P < 0.01). RAGE expression was associated with higher lymph node metastasis rate (OR = 2.65, I² = 0%, 95% CI 1.29 to 3.28, P < 0.01) and worse prognosis (HR = 2.03, I² = 0%, 95% CI 1.48 to 2.80, P < 0.01). RAGE expression was increased in GC and was associated with the risk of lymph node metastasis and worse prognosis. These results suggested that RAGE might serve as a potential biomarker for GC, which might help us to further explain the pathogenesis of GC and find new therapeutic directions.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114181","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":"Surgical stabilization of flail chest: a retrospective evaluation of clinical outcomes and injury score predictive validity.","authors":"Erhan Özer, Hüseyin Dülger","doi":"10.1007/s13304-025-02402-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02402-y","url":null,"abstract":"<p><p>Flail chest is a severe thoracic injury associated with high morbidity, prolonged hospitalization, and an increased risk of chronic pain. Surgical stabilization of rib fractures (SSRF) has become an increasingly accepted treatment modality in selected patients. However, the optimal timing of intervention and the prognostic value of radiologic injury scoring systems remain areas of investigation. Our findings confirm prior evidence supporting the early use of SSRF in selected patients and further explore the predictive value of radiologic injury scores in postoperative outcomes. This retrospective study included 74 patients who underwent SSRF for flail chest between 2012 and 2023. Demographic data, radiologic injury scores (AIS Thorax, RibScore, BPC18), timing of surgery, and clinical outcomes were analyzed. Patients were grouped according to age (≤ 65 vs. > 65 years) and timing of surgery (≤ 2 days vs. ≥ 3 days post-admission). Primary endpoints included ICU and hospital length of stay, postoperative complications, mortality, return to normal activity, and incidence of chronic pain. The median number of fractured ribs was 7 (IQR: 3-10), with a median AIS Thorax score of 4.05, RibScore of 4.66, and BPC18 score of 2.66. Early surgery (≤ 48 h) was associated with a significantly shorter hospital stay (median 8 vs. 10 days, p = 0.037), although ICU stay, complication rates, and return to activity did not significantly differ between early and late surgery groups. No statistically significant differences in outcomes were observed between the age groups. AIS Thorax showed the strongest correlation with ICU stay (r = 0.513, p < 0.001), followed by BPC18 (r = 0.377, p = 0.001) and RibScore (r = 0.317, p = 0.003). All three scores were significantly correlated with total hospital stay duration as well. However, none were associated with chronic pain or time to return to normal activity. Chronic pain developed in 20.2% of the patients. Logistic regression analysis revealed no independent predictors of chronic pain, including age, sex, number of fractured ribs, injury severity scores, or surgical timing. SSRF is a safe and effective treatment for flail chest, including in elderly and severely injured patients. Early surgery supports faster recovery without added complications. While injury scores reflect acute outcomes, they do not predict chronic pain or long-term recovery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114192","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":"Indocyanine green (ICG)-based perfusion assessment enhanced by artificial intelligence for reducing anastomotic leaks in left-sided colorectal surgery.","authors":"Amman Ather Malik, Ayesha Javed, Mohamed Ahmed Sherif","doi":"10.1007/s13304-025-02417-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02417-5","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103053","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":"Histopathologic regression in lymph nodes predicts occult metastasis in ypT0 colorectal cancers after neoadjuvant therapy: a retrospective cohort study.","authors":"Chaoyuan Xiao, Yu Shen, De He, Hai-Ning Chen","doi":"10.1007/s13304-025-02407-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02407-7","url":null,"abstract":"<p><p>In locally advanced colorectal cancer (LACRC), neoadjuvant therapy (NT) followed by total mesorectal or complete mesocolic excision is standard. Although a pathological complete response at the primary site (ypT0) predicts excellent survival, this benefit is offset when residual nodal metastasis (ypT0N⁺) is present. Reliable predictors of ypT0N⁺ are lacking. We retrospectively reviewed LACRC patients (2009-2024) who received NT and achieved ypT0 after curative surgery. Clinicopathologic variables were analyzed by uni- and multivariable logistic regression. A lymph node (LN) showing fibrosis, necrosis, acellular mucin, or foamy-cell reaction without viable carcinoma was classified as a regressed LN (RLN). An external ypT1-4 cohort treated during 2022-2024 served for validation. Among 503 ypT0 patients, 29 (5.8%) were ypT0N⁺. RLN-positivity occurred in 38% of ypT0N⁺ versus 10% of ypT0N0 cases (p < 0.001). On multivariable analysis, RLN-positivity was the sole independent risk factor for ypT0N⁺ (OR 4.11, 95% CI 1.71-9.52, p = 0.001). In the validation cohort (n = 615), RLNs remained enriched in ypN⁺ patients (21% vs 13%, p = 0.001), corroborating the association. RLN-positivity is a robust histologic marker of occult nodal metastasis in ypT0 LACRC. ypT0N0 should be diagnosed cautiously when RLNs are present, and such patients may require intensified adjuvant therapy and surveillance.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092549","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}