Updates in Surgery最新文献

{"title":"Comparison of modified versus conventional laparoscopic transcystic biliary drainage in the management of cholecystocholedocholithiasis: safety and efficacy.","authors":"Yunyi Zhang, Xue Yu, Gang Wang, Zhi Xu, Lixin Wang, Long Cui, Chunsheng Hou, Xiaofeng Ling, Lingfu Zhang","doi":"10.1007/s13304-026-02845-x","DOIUrl":"https://doi.org/10.1007/s13304-026-02845-x","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic transcystic biliary drainage (LTCBD) combined with cholecystectomy have been explored as a treatment for cholecystocholedocholithiasis, but early dislodgment of the drainage tube remains a major challenge. We developed a modified laparoscopic transcystic biliary drainage approach and aims to evaluate its safety and efficacy by comparing it with the conventional approach.</p><p><strong>Methods: </strong>From April 2020 to December 2023, a total of 81 patients with cholecystocholedocholithiasis underwent LTCBD. In the early phase of the study, the conventional LTCBD (c-LTCBD) approach was performed, while in the later phase, a modified LTCBD (m-LTCBD) approach was implemented. The safety and efficacy of these two techniques were compared.</p><p><strong>Results: </strong>Among the 81 patients, c-LTCBD was performed in 14 patients, while the remaining 67 patients underwent m-LTCBD. There were no significant differences between the two groups in age, sex, presence of jaundice, cystic duct diameter, common bile duct diameter, number of stones, or the requirement for emergency treatment. Further analysis revealed that no significant differences were observed between the two techniques on surgical outcomes including surgical duration, complication rates, extended functions, C-tube removal time, or mean maximum drainage volume. Importantly, the hospital stay duration was shorter in the m-LTCBD compared to the c-LTCBD group (t = 3.206, P = 0.002). Additionally, 9 cases of C-tube related adverse events (C-tube dislodgement /displacement) were observed, with the incidence significantly lower in the m-LTCBD group (5/67 vs. 4/14, respectively; χ² = 5.224, P = 0.022).</p><p><strong>Conclusion: </strong>m-LTCBD is a safe and effective technique for external drainage and therapeutic access, offering a viable alternative for managing cholecystocholedocholithiasis.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931255","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":"Nonlinear association between number of lymph nodes resected and survival in T1N0M0 colorectal cancer: a SEER-based analysis.","authors":"Jinyi Xu, Taiwei Ye, Haoliang Ni, Xihan Jin, Jianping Wang, Bin Lai, Xiaoqiang Niu","doi":"10.1007/s13304-026-02837-x","DOIUrl":"https://doi.org/10.1007/s13304-026-02837-x","url":null,"abstract":"<p><p>The number of lymph nodes retrieved (NLNR) is a key prognostic factor in colorectal cancer (CRC), yet its relationship with outcomes in early-stage (T1N0M0) disease remains unclear. We performed a retrospective cohort study using SEER data (2010-2022) including 8,012 T1N0M0 CRC patients treated with radical resection. Patients were dichotomized by NLNR (< 12 vs. ≥ 12) and propensity score matching (PSM) was applied. Survival was evaluated by Kaplan-Meier analysis; multivariable Cox regression examined NLNR as a continuous predictor of overall survival (OS). Restricted cubic spline (RCS) modelling explored nonlinear associations, including within subgroups defined by tumor location: right-sided colon, transverse colon, left-sided colon, and rectal cancer. Subgroup analyses were also performed. Before PSM, the ≥ 12-node group showed superior OS and cancer-specific survival (CSS) (both p < 0.001); after PSM differences were no longer statistically significant (OS p = 0.059; CSS p = 0.090). In multivariable Cox analysis NLNR was independently associated with improved OS (HR 0.992, 95% CI 0.985-0.998). RCS revealed a significant nonlinear relationship with OS (P for nonlinearity = 0.019): each additional node below 25 conferred reduced mortality (HR 0.982 per node, 95% CI 0.972-0.993, p < 0.001), whereas benefit plateaued beyond 25 nodes (HR 1.001, p = 0.343). The nonlinear association between NLNR and OS remained significant in the left-sided colon and rectal cancer subgroups but was not statistically significant among patients with right-sided or transverse colon cancer. Subgroup analyses were broadly consistent; a significant interaction with sex was observed (P for interaction = 0.012). In T1N0M0 CRC, NLNR is an independent predictor of long-term survival and exhibits a distinct threshold effect. This effect is more pronounced in left-sided colon and rectal cancers.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931285","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":"A preoperative model for predicting microvascular invasion in hepatocellular carcinoma based on laboratory findings and MRI features.","authors":"Lei Zhuang, Chengzhi Zhang, Shuyi Zhang, Yunhui Cai, Andong Xu, Guangjun Zhou","doi":"10.1007/s13304-026-02821-5","DOIUrl":"https://doi.org/10.1007/s13304-026-02821-5","url":null,"abstract":"<p><p>Microvascular invasion (MVI) is an important adverse prognostic factor in hepatocellular carcinoma (HCC), and accurate preoperative prediction of MVI may help optimize treatment planning. This study aimed to develop and validate a preoperative model based on laboratory indicators and MRI features for predicting MVI in patients with HCC. This retrospective study included 535 patients with HCC who underwent surgical resection at two hospitals. Patients from the Affiliated Xuzhou Hospital of Xuzhou Medical University were assigned to the training cohort (n = 388), and those from Yancheng First People's Hospital were assigned to the validation cohort (n = 147). Univariate logistic regression was performed to identify potential risk factors for MVI, and variables with statistical significance were entered into multivariate logistic regression to establish a predictive model. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression identified AFP > 400 ng/mL, larger tumor size, and absence of a radiological capsule as independent predictors of MVI. A predictive model incorporating these three variables was constructed. The model showed acceptable discriminatory ability in both the training cohort (AUC = 0.782) and the validation cohort (AUC = 0.776). AFP > 400 ng/mL, larger tumor size, and absence of a radiological capsule were independent predictors of MVI in HCC. A preoperative model combining laboratory and MRI features may provide supportive information for estimating the risk of MVI and assisting clinical decision-making.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931219","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":"Comparison between cryoanalgesia, epidural anaesthesia and erector spinae plane block for postoperative analgesia after minimally-invasive anatomic lung resection: a randomized controlled trial.","authors":"Marco Mammana, Giovanni Maria Comacchio, Nicolò Sella, Giulia Pagliarini, Fares Shamshoum, Tatiana Falcioni, Serena Zanardo, Stefano Silvestrin, Maria Luisa Brezzi, Demetrio Pittarello, Samuele Nicotra, Andrea Dell'Amore","doi":"10.1007/s13304-026-02840-2","DOIUrl":"https://doi.org/10.1007/s13304-026-02840-2","url":null,"abstract":"<p><p>Regional anaesthesia technique play a fundamental role in pain control after minimally invasive anatomic lung resection. In this setting, cryoanalgesia has been scarsely investigated. The aim of this study is to compare cryoanalgesia with two among the most effective regional anaesthesia techniques: erector spinae plane block (ESPB), and epidural analgesia (EA). Patients scheduled for minimally invasive anatomic lung resection were randomized to receive either cryoanalgesia, ESPB or EA (25 patients per group). Static and dynamic pain scores were evaluated at multiple time points up to 2 months postoperatively. The primary outcome measure was the static pain score, assessed with the numeric rating scale (NRS) at 24 h from surgery. Secondary outcomes included opioid consumption, patient satisfaction, and use of painkillers at two months. Static NRS pain scores at 24 h showed no significant difference between groups (1.92 (± 2.12), 2.63 (± 2.14), and 2.45 (± 1.95) for cryoanalgesia, ESPB, and EA, respectively, p= 0.494). Among secondary outcomes, EA was associated with lower intraoperative remifentanil doses and a trend towards better patient satisfaction at 2 months than the two other techniques; while pain scores at other time points and postoperative opioid consumption were comparable. No significant differences in postoperative pain control were observed among patients receiving cryoanalgesia, EA, or ESPB during the first 48 postoperative hours or at 2 months after surgery. Further studies are needed in order to understand how to improve the efficacy of cryoanalgesia for minimally-invasive lung resections.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913698","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 ICG fluorescence uptake in laparoscopic lymphoma biopsy: the role of a 20 mm node size cut-off.","authors":"Marco Casaccia, Matteo Mascherini, Adalberto Ibatici, Chiara Ghiggi, Marco Mora, Franco De Cian","doi":"10.1007/s13304-026-02833-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02833-1","url":null,"abstract":"<p><p>This study investigated the correlation between lymph node (LN) size, histopathological architecture, and intraoperative fluorescence in patients undergoing Fluorescence-Guided Laparoscopic Lymph Node Biopsy (FGLLB) for suspected lymphoma. Between April 2022 and September 2025, 32 patients with sub-mesocolic aortic and iliac lymphadenopathy underwent FGLLB for disease staging purposes or to establish a diagnosis. The degree of intraoperative fluorescence was recorded and correlated with LN size and microscopic findings. A Receiver Operating Characteristic (ROC) curve analysis was performed to determine the predictive value of LN size on fluorescence uptake and to identify an optimal dimensional cut-off. Biopsies were excisional in 15 patients, incisional in 12, and 5 had both types. A total of 53 lymphatic tissue samples were analyzed. Fluorescent LNs were significantly smaller than non-fluorescent ones (p = 0.019). ROC curve analysis revealed an Area Under the Curve (AUC) of 0.74 (95% CI: 0.58-0.90). An optimal dimensional cut-off of 20 mm was identified for predicting fluorescence failure, yielding a sensitivity of 85% and a specificity of 67%. Microscopic examination confirmed that non-fluorescence in nodes > 20 mm was strictly associated with total architectural effacement, whereas fluorescence was preserved in larger nodes only when the follicular structure remained intact. This study identifies a significant correlation between LN size and ICG uptake, suggesting a 20-mm threshold beyond which architectural disruption appears to impair fluorescence. Although these findings require validation in larger cohorts to ensure generalizability, they provide a valuable roadmap: while ICG excels for small occult nodes, surgeons should prioritize anatomical landmarks and preoperative imaging for bulky disease > 2 cm.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913651","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":"Multicentric pragmatic randomized controlled trial of mesh fixation system in primary and recurrent ventral hernia repair.","authors":"Francesco Prete, Giuseppe Massimiliano De Luca, Francesco Vittore, Alessandro Pasculli, Luigi Marano, Giuseppe Carbotta, Giuseppe Cavallaro, Diego Cuccurullo, Lorenzo Fracasso, Stefania Romano, Giorgio Soliani, Carlo Sagnelli, Mariasole Fracasso, Riccardo Maglio, Silvia Malerba, Giuliana Rachele Puglisi, Alfio Gianalberto Testini, Michele Covelli, Angela Gurrado, Giampiero Campanelli, Mario Testini","doi":"10.1007/s13304-026-02817-1","DOIUrl":"https://doi.org/10.1007/s13304-026-02817-1","url":null,"abstract":"<p><p>Controversy persists regarding the ideal type of fixation for hernia mesh. Transfixing methods have been linked to tissue trauma and to the development of chronic pain. In ventral hernia repair (VHR), retrospective studies showed a potential for fixation with cyanoacrylate of being as effective as conventional suture or tacks methods but with less postoperative pain and complications. A pragmatic randomized trial was conducted on patients undergoing primary and incisional VHR, analyzing mesh fixation by cyanoacrylate (experimental group) versus sutures or reabsorbable tacks (control group), stratifying a priori by laparoscopic(LVHR) and open approach(OVHR) to account for distinct anatomical and biomechanical environments. Primary outcome was chronic postoperative pain. Secondary outcomes were postoperative complications, recurrence, operating time, intraoperative blood loss, pain during admission. Univariable and multivariable analysis were conducted. Two hundred fourteen patients were included, of which 109 treated laparoscopically. Overall chronic pain occurred exclusively within the open surgery cohort (12/105 cases, 11.4%), with no statistical difference between fixation arms. Cyanoacrylate for mesh fixation was independent factor for fewer perioperative complications (OR 0.457, 95% CI 0.244-0.855, p = 0.014), shorter operating time (- 7.172 min, 95%CI - 23.040/- 2.008, p = 0.02), reduced pain at hospital discharge (- 0.356 VAS point, 95%CI - 0.691/- 0.022, p = 0.037). In LVHR, non-transfixing mesh positioning was also a factor for less intraoperative blood loss. In OVHR there were no significant difference in outcomes between groups. In a pragmatic real-world setting, long-term chronic pain appears primarily driven by surgical access and wound-related factors rather than the independent effect of the mesh fixation method. Cyanoacrylate fixation provides significant perioperative advantages, particularly in LVHR.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907258","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 the risk of dehydration and readmission among rectal cancer patients with ileostomy: a multicenter observational study.","authors":"Francesco Ferrara, Gianluca Rizzo, Dario Parini, Diletta Cassini, Marco Della Sanità, Fabrizio Alessi, Andrea Bondurri","doi":"10.1007/s13304-026-02709-4","DOIUrl":"https://doi.org/10.1007/s13304-026-02709-4","url":null,"abstract":"<p><p>Dehydration is a frequent complication among rectal cancer patients after ileostomy, often resulting in hospital readmission. The Dehydration Readmission after Ileostomy Prediction (DRIP) score was used to identify patients at risk of dehydration-related readmission. The aim of this study is to assess the predictive value of the DRIP score for dehydration-electrolyte imbalance (DIE) and hospital readmission in a multicenter Italian cohort. A total of 306 patients with rectal adenocarcinoma who underwent anterior resection with protective ileostomy in 2022 were included. The main outcome measures were the incidence of early and late DIE, hospital readmission due to DIE, and correlations between the DRIP score and other clinical variables. Early DIE occurred in 16.3% of the patients, with 2.6% requiring readmission. Late DIE occurred in 13.7% of the patients, with 3.6% requiring readmission. The DRIP score was significantly correlated with early DIE. A high DRIP score was associated with an increased risk of early and late DIE. Independent predictors of early DIE included high BMI and early postoperative complications. Parastomal infection was the only independent predictor of late readmission. The DRIP score represents a useful tool for identifying patients at risk of early dehydration following ileostomy. While its ability to predict hospital readmission is limited, it provides clinically relevant risk stratification for early DIE and may support targeted postoperative monitoring strategies. Future studies should integrate dynamic patient-specific data to increase the predictive accuracy of the score and guide both inpatient and outpatient care.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907254","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 surgery across surgical specialties: an Italian survey on implementation, training, and satisfaction levels among trainees and young attendings: on behalf of the Italian Multispecialty Society of Young Surgeons (SPIGC).","authors":"Francesco Del Giudice, Valerio Santarelli, Giulia Fiori, Sara Mastrovito, Beatrice Trabalza Marinucci, Sara Mantovani, Alberto Bolletta, Giuseppe Rovere, Danilo Di Giorgio, Fabio Massimo Oddi, Dalila Carino, Mattia Di Bartolomeo, Benjamin I Chung, Felice Crocetto, Michele Maruccia, Roberto Meniconi, Alessandro Pasculli, Marco Angrisani","doi":"10.1007/s13304-026-02747-y","DOIUrl":"https://doi.org/10.1007/s13304-026-02747-y","url":null,"abstract":"&lt;p&gt;&lt;p&gt;European surgical institutions have been recently criticized for the insufficient endorsement of standardized robotic training curricula. In the present study, we report the results of a nationwide survey on the status of robotic surgery training and satisfaction across trainees from multiple surgical specialties in Italy. A modified-Delphi consensus was implemented with n = 41 multiple-choice or open-ended question surveys later distributed to Residents, Fellows, PhD students, Young Attendings or Assistant Professors, in n = 10 different surgical specialties. Demographics, program characteristics, exposure to robotic surgery, and satisfaction with robotic training were explored. Composite variables were created, and multivariable regression modeling adopted to explore variables associated with higher surgical training satisfaction. Similarly, predictors of minimum requirements necessary for designation as a 'reference center' for robotic surgical training institutions were further explored. A total of n = 735 trainees participated and were included for final analysis. The vast majority were male (63.5%), residents (52.1%), from University Hospitals (53.7%), and from the Central Regions of Italy (47.9%). General Surgery was the most represented specialty (44.4%) followed by Urology (26%). Availability of a dual robotic console, simulation software, and scheduled lectures were reported in 45.6%, 58.2%, and 23.4% respectively. Most respondents (61.6%) reported that the robotic console was exclusively operated by senior/experienced attendings, and the majority (88.3%) believed that the lack of standardized robotic exposure negatively impacted their training. On univariable analysis, Urology achieved the highest satisfaction with robotic training (median score 6 [IQR: 5-8], p &lt; 0.001). However, on multivariable modeling, the surgical specialty did not impact overall satisfaction, which was instead influenced by simulation software availability (adjusted Odds Ratio [aOR]: 1.72, 95% CI 1.22-2.44), dedicated lectures (aOR: 1.72, 95% CI 1.16-2.56), higher volume of robotic-assisted procedures per center (aOR: 9.69, 95% CI 5.62-16.70), and trainee with more active role during robotic cases (aOR: 2.43, 95% CI 1.29-4.57). Finally, centers with urology specialty (p &lt; 0.001), &gt; 400 procedures/year (aOR: 1.92, 95% CI 1.01-4.51), &gt; 1 robotic platform (aOR: 1.29, 95% CI 1.07-1.55), and providing robotics fellowship/masters programs (aOR: 1.43, 95% CI 0.99-2.36) were more likely to reach the minimum requirements as per robotic training 'reference center' definition. We highlighted a nationwide lack of standardized training pathways, limited mentoring opportunities, and widespread dissatisfaction among robotic surgery trainees. These findings may guide robotic programs in recognizing unmet educational needs and implementing strategies to develop equitable, structured, and standardized curricula for robotic surgical training across the multiple robotic-assist","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907311","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":"Predictors of time to surgical recurrence after ileal or ileocolonic resection in Crohn's disease: role of integrin αvβ6 and development of a predictive nomogram.","authors":"Haiting Xie, Yao Ye, Xiujun Liao, Yurong Jiao, Jianqing Yu, Federico Maria Mongardini, Ludovico Docimo, Jun Li","doi":"10.1007/s13304-026-02793-6","DOIUrl":"10.1007/s13304-026-02793-6","url":null,"abstract":"<p><p>Surgical recurrence, defined as the need for reoperation at the anastomotic site, remains a critical challenge in Crohn's disease (CD) management. This study aimed to identify clinical and molecular risk factors associated with time to surgical recurrence and develop a validated nomogram for individualized risk stratification. 280 patients were included in this study. Integrin αvβ6 expression was quantified via immunohistochemistry in resection specimens using a validated semiquantitative scoring system. Univariate and multivariable Cox regression analysis were used to identify the variables associated with time to surgical recurrence. A nomogram was then constructed based on the above risk factors. Over a median post-resection follow-up of 71.4 months, surgical recurrence occurred in 32 patients (11.4%) at a median of 52.8 months. Multivariable Cox analysis identified active smoking (HR = 3.749, 95% CI: 1.823-7.710; P < 0.001) and high integrin αvβ6 expression (immunohistochemistry score > 3; HR = 3.738, 95% CI: 1.381-10.117; P = 0.009) as independent predictors of earlier recurrence. Conversely, B1 or B2 phenotype of CD (HR = 0.431, 95% CI: 0.212-0.880; P = 0.021) and postoperative biologic therapy (HR = 0.444, 95% CI: 0.210-0.938; P = 0.033) were associated with delayed recurrence. The nomogram incorporating these factors demonstrated good discriminative ability and calibration for 5 year recurrence prediction. High integrin αvβ6 expression, active smoking, penetrating phenotype, and absence of postoperative biologics drive earlier surgical recurrence of CD. The developed nomogram offers a clinically actionable tool for precise risk stratification, enabling personalized prophylactic strategies to mitigate reoperation and improve long-term outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881301","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":"Perioperative changes in systemic inflammatory markers predict major complications after distal pancreatectomy.","authors":"Alfredo Verastegui, Sibi Krishna Thiyagarajan, Rachel J Lew, Mary Tice, John A Stauffer, Katherine E Poruk","doi":"10.1007/s13304-026-02815-3","DOIUrl":"https://doi.org/10.1007/s13304-026-02815-3","url":null,"abstract":"<p><p>Postoperative complications after distal pancreatectomy (DP), notably clinically relevant postoperative pancreatic fistula (CR-POPF) and peripancreatic fluid collections, drive morbidity. Existing scores rely on intraoperative variables and do not capture individual inflammatory responses. We evaluated whether preoperative, postoperative, and perioperative changes in routine inflammatory indices predict complications. Single-center retrospective cohort of patients undergoing DP for pancreatic malignancy (2010-2024). Pre- and postoperative inflammatory indices were derived from complete blood counts: neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI). Associations with outcomes were assessed using Firth's penalized logistic regression and time-to-event analyses. Of 568 patients, 198 met inclusion criteria. Postoperative fluid collection occurred in 71 (35.9%) and CR-POPF in 20 (10.1%). On multivariable analysis, male sex independently predicted fluid collection (OR 1.91, CI 1.02-3.62; p = 0.044) and intensive care unit (ICU) admission predicted CR-POPF (OR 4.24, CI 1.22-14.91; p = 0.024). Postoperative NLR, SII, and SIRI were associated with adverse events on univariable analysis but were not independently predictive. Receiver-operating characteristic analysis gave modest discrimination for preoperative SIRI (AUC 0.602) and higher discrimination for perioperative change in SIRI (ΔSIRI) and SIRI ratio for major adverse events (MAE) (AUC 0.759). Kaplan-Meier analysis showed earlier fluid collections in patients with elevated preoperative SIRI, SII, and postoperative NLR. Perioperative changes in routine inflammatory markers outperformed static preoperative values for predicting MAE after DP. These inexpensive, widely available indices merit prospective validation as adjuncts for risk-adapted surveillance and management.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881334","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}