Updates in Surgery最新文献

{"title":"Development and risk stratification of a prognostic nomogram for hepatoblastoma: analysis of the SEER database.","authors":"Wenqi He, Zhengbing Yang","doi":"10.1007/s13304-025-02140-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02140-1","url":null,"abstract":"<p><p>Hepatoblastoma, the most common primary liver malignancy in children, exhibits significant clinical and biological heterogeneity, leading to varying prognoses. This study aimed to identify independent prognostic factors for overall survival in pediatric hepatoblastoma patients, develop and validate a nomogram prediction model, and establish a risk stratification system. We conducted a retrospective analysis of patients aged ≤18 years with hepatoblastoma using data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Univariate and multivariate Cox regression analyses identified age, race, tumor stage, tumor size, surgery, and chemotherapy as independent prognostic factors. We developed a nomogram prediction model based on these factors, which underwent internal and external validation. The model accurately predicts 1-, 3-, and 5-year overall survival rates. We also established a risk classification system that stratifies patients into low, intermediate, and high-risk groups. Subgroup analysis revealed that low-risk patients had better survival outcomes with hepatectomy, while intermediate-risk patients benefited more from liver transplantation. The developed nomogram enables individualized prediction of overall survival rates in pediatric hepatoblastoma patients, and the risk stratification system can guide early and accurate prognostic assessment.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567607","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":"Role of conservative management of acute appendicitis in pediatric age: a monocentric experience.","authors":"Martina Monti, Marco Agamennone, Michela Cing Yu Wong, Maria Grazia Calevo, Giuseppe Losurdo, Stefano Avanzini, Girolamo Mattioli","doi":"10.1007/s13304-025-02136-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02136-x","url":null,"abstract":"<p><p>Historically, appendectomy was the standard treatment for acute appendicitis (AA). Recently, interest has grown in conservative management of uncomplicated AA (UA). This study compared outcomes between non-operative management (NOM) and appendectomy, exploring preoperative factors to guide optimal UA management. In a monocentric retrospective study, we reviewed data on 774 pediatric patients with a primary diagnosis of AA from July 2017 to July 2022. We analyzed demographic, clinical, laboratory, and ultrasound data at first and last admission. Operated patients were stratified by management type and surgery timing. Minimum follow-up was 6 months. Of the 530 children (68.5%) who underwent surgery at first admission, 316 had UA and 214 had CA. The 244 patients (31.5%) not indicated for surgery received intravenous antibiotics. Of these, 104 underwent appendectomy at second admission, with 9 presenting CA, requiring multiple antibiotic therapy and a hospital stay of 9.1 ± 3.1 days. Twenty-eight underwent surgery at their third admission and 112 never underwent surgery. In conclusion, more invasive approach may be preferable for patients with significant clinical signs at first presentation, minimizing hospital stay, costs, antibiotic use, and complications. Further studies on NOM in acute appendicitis are essential to optimize its use.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543622","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":"Estimation of physiologic ability and surgical stress (E-PASS) predicts postoperative complications after adrenalectomy.","authors":"Mehmet Vehbi Kayra, Mehmet Eflatun Deniz, Cevahir Ozer, Sibel Catalca, Serdar Toksoz, Hakan Yabanoglu","doi":"10.1007/s13304-025-02145-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02145-w","url":null,"abstract":"<p><p>The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score, initially developed for gastrointestinal surgery, is a validated system used to predict postoperative complications by evaluating preoperative and intraoperative factors. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications following adrenalectomy. In this single-center retrospective study, we analyzed data from 202 patients who underwent adrenalectomy by a single surgeon between January 2017 and March 2024. 182 patients with complete data and who met the study criteria were included in the study. Demographic, clinical, intraoperative, and postoperative data were collected and analyzed, including preoperative complaints, ASA classification, ECOG performance status, presence of systemic diseases, type of surgery, and intraoperative details, such as blood loss and complications. Postoperative complications were classified using the Clavien-Dindo Classification. The mean age of the patients was 48.7 ± 13.6 years. The mean BMI was 24.1 kg/m². Postoperative complications were observed in 26.4% of patients, categorized as Grade 1 (54.1%), Grade 2 (25%), Grade 3 (16.7%), and Grade 4 (4.2%). Multivariate logistic regression identified higher BMI (OR = 1.394) and an E-PASS CRS score > - 0.0677 (OR = 6.17) as independent risk factors for complications. ROC curve analysis determined this CRS score cut-off with an AUC of 0.866 (CI 0.808-0.923; p < 0.001). The E-PASS scoring system effectively predicts postoperative complications in adrenalectomy. Its integration into clinical practice can enhance the identification of high-risk patients, optimize perioperative management, and potentially reduce adverse outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543504","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":"'Head-first Approach' for small duct chronic pancreatitis.","authors":"Srikanth Gadiyaram, Murugappan Nachiappan","doi":"10.1007/s13304-025-02137-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02137-w","url":null,"abstract":"<p><p>Small duct pancreatitis is a rare variant of chronic pancreatitis characterized by a main pancreatic duct (MPD) measuring less than 5 mm. Traditionally, resectional procedures have been advocated as a treatment for small duct pancreatitis. However, these procedures are associated with worse post-operative results and a gradual functional decline over the long term. Parenchyma-preserving hybrid extended drainage procedures have been shown to provide more comprehensive pain relief, improved functional outcomes, and enhanced quality of life (QOL). However, the identification of the MPD in these patients presents a technical challenge. We describe the 'head-first approach' for the identification of the MPD in patients with small duct pancreatitis undergoing extended drainage procedures. The study includes patients of small duct pancreatitis who underwent the extended drainage procedure during a 6-year period from April 2017 to March 2023. During the study period, 41 patients underwent surgical management for chronic pancreatitis. Thirty-two patients underwent an extended drainage procedure, with pain being the indication for surgery in all cases. Twelve of these patients had small duct disease. The 'head-first approach' for identification of the MPD was successfully employed in all 12 patients. The median blood loss during surgery was 180 mL, and the median duration from the beginning of head coring to the identification of the duct was 45 min. Of the 32 patients, post-operative bleeding was seen in 4, external pancreatic fistula was observed in 2, and superficial surgical site infection was seen in 2 patients. All four patients with bleeding were managed conservatively with blood transfusions, and no re-explorations or re-interventions were required. There were no mortalities in this cohort. The 'head-first approach' for pancreatic duct identification is a safe and feasible technique to enable an extended drainage procedure with all the advantages of a parenchyma-preserving procedure for surgical palliation of pain in small duct chronic pancreatitis.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543520","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":"Humans-written versus ChatGPT-generated abstracts: beyond the discussion on \"who wrote it\".","authors":"Shigeki Matsubara","doi":"10.1007/s13304-025-02160-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02160-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543524","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":"Should we adopt a \"laparoscopy first\" strategy? A comparison of 30-day outcomes between converted open from laparoscopic and planned open colectomy for volvulus.","authors":"Renxi Li","doi":"10.1007/s13304-025-02133-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02133-0","url":null,"abstract":"<p><p>While the majority of colectomy for volvulus is performed by an open approach, laparoscopy can be used as a potentially safer alternative. However, conversion to open is needed when the laparoscopic approach is unsuccessful. This study aimed to compare the 30-day outcomes of patients who had converted open from laparoscopy vs planned open colectomy for volvulus to assess a possible \"laparoscopy first\" strategy. In addition, this study identified risk factors associated with the conversion during laparoscopy. National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Patients with volvulus as the primary indication for laparoscopic and open colectomy were selected. Patients who had a conversion from laparoscopic to open surgery and planned open surgery were further identified. A 1:5 propensity-score matching was applied to converted open and planned open to match sex, race and ethnicity, age, baseline characteristics, preoperative preparation, and indication for surgery (if emergent). Thirty-day postoperative outcomes were examined. There were 1774 (22.10%) and 6254 (77.90%) patients who underwent laparoscopic and planned open colectomy for volvulus, respectively. From laparoscopy, 336 (18.94%) patients were converted to open surgery and 1,680 planned open cases were matched to the converted open cases. After propensity-score matching, patients underwent converted open and planned open had a comparable mortality rate (5.06% vs 3.99%, p = 0.37). However, patients who underwent converted open surgery had higher risks of renal complications (2.68% vs 0.60%, p < 0.01), bleeding requiring transfusion (9.82% vs 6.55%, p = 0.04), and wound complications (17.86% vs 12.26%, p = 0.01). Risk factors associated with conversion from laparoscopic to open colectomy included perforation (aOR = 4.767, p < 0.01), obstruction (aOR = 2.223, p < 0.01), sepsis 48 h before surgery (aOR = 2.952, p < 0.01), chronic kidneys disease (aOR = 1.602, p = 0.01) and preoperative infection (aOR = 1.489, p = 0.03). These identified risk factors demonstrated both strong discriminative (c-statistics = 0.713) and predictive (Brier score = 0.132) powers for open conversion. While laparoscopy for colonic volvulus may offer safer outcomes, a ubiquitous \"laparoscopy first\" strategy may be approached with caution. The increased risks of complications upon conversion to open surgery, particularly in patients with identified risk factors, suggest that careful patient selection may be crucial.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537736","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":"Analysis of histological features and recurrence risk assessment of papillary thyroid carcinoma according to presurgery FNAC category.","authors":"Sium Wolde Sellasie, Stefano Amendola, Leo Guidobaldi, Tommaso Piticchio, Isabella Nardone, Simona Zaccaria, Giovanni Tacchi, Francesco Pedicini, Luigi Uccioli, Pierpaolo Trimboli","doi":"10.1007/s13304-025-02121-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02121-4","url":null,"abstract":"<p><p>Identifying preoperatively cases of more indolent papillary thyroid carcinoma (PTC)could be of high interest. The aim of this study was to verify previously published data on the prognostic value of fine needle aspiration cytology (FNAC)in PTC, also comparing findings from high-volume (HV)and low-volume (LV)institutions. From January 2022 to June 2024, the institutional database of the endocrinological surgery unit of Sant'Eugenio Hospital (Rome, Italy)was retrospectively reviewed to select patients who underwent thyroid surgery for PTC. To evaluate the prognostic value of presurgical FNAC, all histological features and the ATA risk of the study groups were compared. Later, data of patients entirely managed at our institution, considered as an HV institute, were compared with that of cases operated at our institution following FNAC performed LV centres.The 159 PTC nodules included were classified as TIR3B (20.1%),TIR4 (32.7%),and TIR5 (47.2%).The distribution of FNAC report between HV and LV was different (p = 0.01). The presence of lymph node metastasis (p = 0.004), and peri-thyroid tissue invasion (p = 0.02)increased according to the FNAC category. Significant difference among the three FNAC categories was also observed in PTC subtype (p = 0.006)and Hashimoto's thyroiditis (p = 0.02).In addition, a significant different trend was found in ATA risk assessment, being the risk of recurrence more prevalent according to the FNAC category (p = 0.008). According to the second study aim, the higher prevalence of low-risk cases in TIR3B was confirmed in both HV (p = 0.04) and LV (p = 0.03)subgroups.PTCs with preoperative TIR3B have different histological features and ATA risk assessment with respect to cases with presurgical FNAC of TIR4/5.Particularly, PTC from TIR3B should have a pattern of more indolent cancers. As non-negligible extension, this data is not influenced by the institutional setting with high or low thyroid-FNAC volume.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504382","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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","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":"Textbook outcome following pancreaticoduodenectomy in elderly patients: age-stratified analysis and predictive factors.","authors":"F Mocchegiani, A Benedetti Cacciaguerra, T Wakabayashi, F Valeriani, P Vincenzi, F Gaudenzi, D Nicolini, G Wakabayashi, M Vivarelli","doi":"10.1007/s13304-025-02130-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02130-3","url":null,"abstract":"<p><p>Despite advancements in pancreatic surgery, managing elderly patients undergoing pancreaticoduodenectomy (PD) remains challenging. Textbook Outcome (TO) serves as a benchmark for surgical success, but its relevance in elderly patients has not been well explored. This study aims to evaluate TO in elderly patients undergoing PD and identify predictors of TO failure. A retrospective analysis was conducted on elderly patients (≥ 70 years) who underwent PD between January 1, 2017, and December 31, 2023 in two international HPB centers. TO achievement rates were assessed and stratified by age groups (70-74, 75-79, ≥ 80). Uni- and multivariate logistic regression analyses were performed to identify risk factors for TO failure. Of 222 patients, 54.5% achieved TO after PD. TO rates decreased with age, with only 35.0% of octogenarians achieving TO, compared to 57.1% in those aged 70-74. Multivariate analysis revealed that age ≥ 80, an ASA score ≥ 2, and histopathologic types other than pancreatic ductal adenocarcinoma or distal cholangiocarcinoma were significant risk factors for failing to achieve TO. Nearly half of elderly patients achieved TO, with a lower likelihood in older age groups, particularly among octogenarians. Higher ASA scores were also associated with lower TO achievement. These findings underscore the importance of a comprehensive preoperative assessment, considering age, to optimize surgical outcomes in elderly patients undergoing PD.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450039","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":"Endoscopic radial incision combined with local injection of triamcinolone acetonide for refractory esophageal stenosis after endoscopy submucosal dissection.","authors":"Hoi-Ioi Ng, Yi Liu, Yong Liu, Li-Zhou Dou, Shun He, Gui-Qi Wang","doi":"10.1007/s13304-025-02069-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02069-5","url":null,"abstract":"<p><p>Refractory esophageal stenosis (RES) after endoscopic submucosal dissection (ESD) is challenging in clinical practice. This study aimed to evaluate endoscopic radial incision (ERI) combined with the local injection of triamcinolone acetonide for RES and to assess its safety and efficacy. A total of nine patients (five males; age range: 50-76 years) who underwent ERI + triamcinolone acetonide for RES after ESD between August 2019 and November 2022 were analyzed. The primary endpoint was the duration of treatment. The length of the stenosed portion, procedure time, sessions of endoscopic therapy, effectiveness rate, success rate, dysphagia grade, complications, and quality of scores were also analyzed. The effectiveness and success rates were 100% and 88.9%, respectively. The mean number of sessions of ERI + triamcinolone acetonide was 2.2 (1.0-4.0). The mean procedure time was 25.9 ± 3.8 min. No severe complications, including bleeding or perforation, were observed during the perioperative period. Dysphagia symptoms were relieved in all patients after endoscopic treatment. Patients had significantly better functional scales for social functioning and global health status and lower rates of fatigue, gastrointestinal symptoms, and financial difficulties after treatment. ERI + triamcinolone acetonide can be considered a safe and effective treatment for RES after ESD. Larger prospective clinical trials are needed to confirm its utility.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415281","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}