Updates in Surgery最新文献

{"title":"Totally robotic proximal gastrectomy with esophagogastrostomy using a double-flap technique.","authors":"P M Lombardi, T Kinoshita, M Mazzola, G Ferrari","doi":"10.1007/s13304-025-02214-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02214-0","url":null,"abstract":"<p><p>Proximal gastrectomy (PG) with D1 + lymphadenectomy and anti-reflux reconstruction is a standard surgical procedure for early-stage (EGC) proximal gastric cancer (PGC) in the East. The double-flap technique (DFT) for esophagogastrostomy has been established as an optimal anti-reflux reconstructive method after PG. However, its technical difficulty makes it a procedure not yet performed in the West. We present the technique of robotic PG with D1 + lymphadenectomy and DFT. The technique was learned during a period of attendance at the National Cancer Center Hospital East, Japan. A 70-year-old patient was submitted to endoscopic submucosal dissection for EGC-PGC. The pathologic report showed pT1b R1 disease. Additional surgery was recommended. Surgery was accomplished via a totally robotic approach (da Vinci Xi Surgical System). The patient was placed in a supine position with legs apart. Four robotic trocars and two laparoscopic trocars were placed above the transversal umbilical line. The surgical steps are summarized as follows: opening of the lesser omentum; dissection of the abdominal esophagus and lymphadenectomy of no. 1, 2 stations; partial omentectomy with lymphadenectomy of no. 4sa and 4sb stations and ligation of the left gastro-epiploic vessels; lymphadenectomy of no. 3a, 7, 8a, 9, 11p stations; transection of the esophagus; proximal gastrectomy; dissection of the posterior aspect of the remnant stomach; creation of the seromuscular flap; posterior esophageal suspension; anastomosis; flap closure. Pathology report showed the absence of residual disease with 27 lymph nodes collected from the specimen. After 1 year, the patient is disease free; no reflux esophagitis, weight loss, or anastomotic stricture was reported on follow-up. To the best of our knowledge, no other previous cases have been reported in the West describing the present surgical technique. The authors propose that PG with DFT seems feasible in a Western setting, representing an important and desirable skill for any referral center for gastric cancer surgical oncology.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997059","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":"Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center.","authors":"Long Cong Duy Tran, Thanh Quoc Nguyen, Mohammad Najm Dadam, Thuan Duc Nguyen, Dat Tien Le, Viet Quoc Dang, Phu Hong Pham, Nghia Phuoc Phan, Thinh Quan Vo, Federica Cucè, Abdallfatah Abdallfatah, Nguyen Tien Huy","doi":"10.1007/s13304-025-02190-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02190-5","url":null,"abstract":"<p><p>Portal vein embolization (PVE) allows for liver regeneration to enhance reduced residual liver volume before resection in hepatocellular carcinoma (HCC) patients with systemic liver disease. A retrospective review of medical records was conducted, including patients who underwent PVE and subsequent major hepatectomy to treat resectable non-metastatic HCC at the University Medical Center in Ho Chi Minh City between 01/2016 and 6/2023. Patient demographics, timing of procedures, surgical interventions, intra- and postoperative complications, pattern of recurrence, and survival were analyzed. A total of 58 patients with HCC were included, and the median length of stay after surgery was 8 days (range 5-24). Post-hepatectomy liver failure (PHLF) occurred with an overall incidence of 31% (18/58 cases). Severe PHLF occurred in 6 cases: grade B in 5 cases (8.6%) and grade C in 1 case (1.7%), resulting in patient death. Postoperative bleeding and bile leak each occurred in 1 case (1.7%). Univariable and multivariable analyses identified portal vein pressure (PVP) after PVE as the only significant preoperative parameter associated with outcomes, correlating with PHLF occurrence (OR 1.27, p = 0.009) at a cut-off of 15 mmHg (p = 0.018). The overall survival at 3, 6, and 12 months was 96%, 94%, and 94%, respectively, with disease-free survival rates of 94%, 90%, and 87%, respectively. Major hepatectomy can be performed safely and effectively in HCC patients who have PVE-induced liver hypertrophy (sFLR ≥ 40%) and preserved liver function (Child-Pugh A) maintaining low morbidity. Multivariate analysis revealed that a post-PVE PVP cutoff of 15 mmHg significantly correlated with perioperative parameters, including operating time, blood loss, and PHLF occurrence.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020504","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":"Efficacy and safety of terlipressin infusion during liver surgery: a meta-analysis.","authors":"Lin Ding, Yi Duan, Zuozhi Li, Qiyue Wu, Lan Yao, Zhifeng Gao","doi":"10.1007/s13304-025-02197-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02197-y","url":null,"abstract":"<p><p>Although numerous studies have investigated terlipressin (TP) administration in liver surgery to mitigate bleeding, its efficacy remains controversial. This meta-analysis evaluates the effects of TP on estimated blood loss (EBL), blood transfusion requirements, and patient outcomes. We systematically searched PubMed, EMBASE, Cochrane Library, and Web of Science (WOS) for studies on perioperative TP use in liver surgery from their inception through February 2024. Only English-language publications were included. Primary outcomes included EBL and allogeneic blood transfusion volume. Twelve studies involving 988 eligible subjects were included. No significant differences were observed in EBL (weighted mean difference [WMD] =  - 99.09; 95% confidence interval [CI], - 318.41 to 120.24; P = 0.38), red blood cell (RBC) transfusion volume (standardized mean difference [SMD] =  - 0.10; 95% CI =  - 0.74 to 0.54; P = 0.76), or fresh frozen plasma (FFP) transfusion volume (SMD = 0.07; 95% CI =  - 0.24 to 0.37; P = 0.67). Subgroup analysis demonstrated that continuous TP infusion significantly reduced intraoperative EBL (WMD =  - 336.22; 95% CI =  - 562.13 to - 110.31; P = 0.004). TP infusion does not reduce intraoperative EBL or allogeneic blood transfusion requirements in liver surgery. However, continuous TP infusion may lower EBL.PROSPERO registration number: CRD42023450333.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029629","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":"Comparing robot-assisted versus laparoscopic Ladd's procedure in children with congenital intestinal malrotation.","authors":"Ken Chen, Shuhao Zhang, Qingjiang Chen, Zhigang Gao","doi":"10.1007/s13304-025-02177-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02177-2","url":null,"abstract":"<p><p>The aim of this study was to perform a comparative analysis of robot-assisted versus laparoscopic Ladd's procedure on peri- and postoperative outcomes. All Ladd's procedures performed on patients with congenital intestinal malrotation between January 2020 and December 2023 were identified. Peri- and postoperative data were collected and compared between robot-assisted and laparoscopic groups. Fifty-seven robot-assisted and 38 laparoscopic Ladd's procedure cases were identified and compared for outcomes. No robotic cases were converted to open procedure, while four laparoscopic cases were converted to open procedure (p = 0.048). Although robotic cases suffered higher hospitalization costs (p < 0.001), the postoperative complication rate was lower for the robotic group compared to the laparoscopic group (p = 0.038). Robot-assisted Ladd's surgery is safe and effective for the treatment of congenital intestinal malrotation in children, reducing the difficulty of surgery, but at increased cost.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034721","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":"Preoperative weight loss by noninvasive approach in patients with obesity scheduled for bariatric and metabolic surgery: an update narrative review of indications and results available until 2024.","authors":"Ilenia Grandone, Monica Nannipieri, Caterina Conte, Edda Cava, Luigi Schiavo","doi":"10.1007/s13304-025-02198-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02198-x","url":null,"abstract":"<p><p>Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity and its metabolic complications. Currently, most MBSs are performed laparoscopically. However, high weight associated with an enlarged liver (especially the left lobe liver section, LLLS) may complicate the technical aspects of this surgery. Therefore, before MBS, moderate preoperative weight loss (PreopWL), and reduction in LLLS are desirable. Moreover, studies are inconclusive regarding which is the best approach to apply. This narrative review aimed to describe the current scientific evidence on the effect of a noninvasive approach, such as dietary or pharmacotherapy or space-occupying devices on PreopWL, peri-operative complications, hospital length of stay, and post-operative complications in patients with obesity scheduled for MBS. We conducted a literature search and screening for relevant publications from January 2010 to June 2024. We found that PreopWL before MBS is helpful for both patients and surgeons, as it leads to various benefits, such as a decrease in body weight and LLLS size, a lower risk of intra- and post-operative complications, shorter surgery times, and reduced hospital stays. In this context, concerning dietary approaches, several dietary protocols have been introduced over time, among which very low-calorie diets and very low energy ketogenic therapy are widely prescribed; however, larger randomized-controlled trials (RCTs) with well-defined dietary protocols are necessary to make definitive conclusions. Obesity management medications, such as the lipase inhibitor orlistat, phentermine/topiramate, naltrexone/bupropion, the glucagon-like peptide-1 receptor agonists (GLP-1RAs) liraglutide and semaglutide, and the novel dual glucose dependent insulinotropic peptide (GIP)/GLP-1 receptor agonist tirzepatide, has shown to be effective in promoting PreopWL before MBS; however, larger, well-designed RCTs are needed to establish optimal treatment protocols and assess their true benefits in patients scheduled for MBS. Space-occupying devices such as the swallowable intragastric balloon and hydrogel capsules, represent a promising tools but further research is essential to confirm their role.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025303","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 comparison of doppler-guided haemorrhoidal artery ligation and the tissue selecting technique for patients with grade III/IV haemorrhoids: a retrospective cohort study.","authors":"Xiaojun Liu, Liangxian Jiang, Weilin Wang","doi":"10.1007/s13304-025-02202-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02202-4","url":null,"abstract":"<p><p>This study aimed to evaluate the efficacy and the safety of Doppler-guided hemorrhoid artery ligation (DG-HAL) and tissue-selecting technique (TST) in patients with grade III/IV hemorrhoids. We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021. Among them, 119 patients had received TST, and the remaining 132 patients received DG-HAL. We collected and compared clinical characteristics of both groups, including post-operative visual analog scale (VAS) for pain, post-operative bleeding, post-operative defecation, urinary retention, and recurrence rate (prolapse and bleeding). The VAS pain score of the first post-operative defecation and at the post-operative day (POD)1 and 2 for the DG-HAL group was lower than those for the TST group (P = 0.006 and P = 0.029). The incidence of post-operative complications (including bleeding, urinary retention and sensation of rectal tenesmus) in the DG-HAL group was lower than that in the TST group (P = 0.021, P = 0.035 and P = 0.047). At follow-up by telephone or outpatient 3 years after surgery, the recurrence rate (prolapse) was lower in the TST group than in the DG-HAL group (P = 0.013). Subgroup analysis showed a higher prolapse recurrence rate in grade IV patients than grade III patients after DG-HAL (P = 0.013). DG-HAL had fewer complications, lower bleeding rates, and less early post-operative pain but showed a higher recurrence rate than TST at the 3-year follow-up, especially in grade IV patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of spread through air spaces (STAS) and lymphovascular invasion (LVI) on prognosis in NSCLC: a comprehensive pathological evaluation.","authors":"Can Kutlay, Selim Şakir Erkmen Gülhan, Leyla Nesrin Acar, Muhyettin Aslan, Fatma Benli Tanrıkulu","doi":"10.1007/s13304-025-02170-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02170-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048612","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":"ICG fluorescence-guided sentinel lymph node biopsy for decision-making in lateral lymph node dissection in local advanced rectal cancer: a retrospective study.","authors":"Wenlong Qiu, Cheng Zhou, Wei Zhao, Shiwen Mei, Qian Liu","doi":"10.1007/s13304-025-02169-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02169-2","url":null,"abstract":"<p><p>Local advanced rectal cancer (LARC) carries high recurrence risks, especially with lateral lymph node (LLN) involvement. This study aims to evaluate the role of ICG-guided sentinel lymph node biopsy (SLNB) in patients with clinical negative LLNs (maximum diameter < 7 mm), potentially reducing unnecessary surgeries and associated complications in patients with LARC. A retrospective analysis of 301 consecutive patients with lower LARC who underwent fluorescent lateral pelvic sentinel lymph node biopsy (FL-SLNB) or conventional LLND at the Cancer Hospital, Chinese Academy of Medical Sciences between 2018 and 2022 was conducted. Clinical and pathological data were collected, and the patients were grouped into FL-SLNB and non-SLNB groups. Postoperative complications, recurrence rates, and survival outcomes were assessed. Statistical analysis was performed using χ² tests, Mann-Whitney U tests, Kaplan-Meier survival curves, and Cox proportional hazards models. FL-SLNB (173 patients) showed better perioperative outcomes than non-SLNB (128 patients), with shorter hospital stays (7 vs. 10 days, P = 0.027), less blood loss (150 vs. 180 mL, P = 0.032), and fewer complications: intraoperative bleeding (2.9% vs. 6.3%, P = 0.041), anastomotic leakage (1.7% vs. 3.9%, P = 0.045), and urinary dysfunction (3.5% vs. 7.0%, P = 0.039). No significant differences were observed in survival or recurrence rates (P > 0.05). pN stage was a significant predictor of distant metastasis (HR 1.953, P = 0.037). ICG-guided SLNB enhanced surgical precision and reduced unnecessary LLND in lower LARC with clinically negative LLNs, and improved surgical decision-making and minimizes postoperative complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical approach and survival prediction of malignant phyllode tumor by machine learning.","authors":"Gongyin Zhang, Foyan Xu, Lixian Wan","doi":"10.1007/s13304-025-02191-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02191-4","url":null,"abstract":"<p><p>We aimed to analyze the effect of surgical approach on patients with malignant phyllode tumor of the breast (MPTB) and to develop a prognostic prediction model for patients with MPTB. We extracted MPTB patients aged 18-80 years between 2000 and 2020 from the SEER database. Covariable imbalance was reduced using the propensity-score matching (PSM) method. An analysis of Cox proportional hazard regression was performed to compare breast cancer-specific survival (BCSS) with overall survival (OS). The survival curves were generated using the Kaplan-Meier method. The 5-year BCSS and 5-year OS of patients with MPTB were predicted by ten models based on machine learning. According to multivariate Cox analysis, surgical treatment of MPTB does not affect long-term survival outcomes (p > 0.05). Among our study, the survival outcomes of mastectomy and BCS would not be statistically significant even for patients with poor pathologic type of MPTB (p > 0.05). In terms of AUC, CatBoost performed better than other algorithms with a 5-year BCSS of 0.8488 and a 5-year OS of 0.8512. BCS and mastectomy do not make a significant difference in the long-term survival outcomes of patients with MPTB. Therefore, we suggest that BCS is feasible and preferred provided that surgical margin requirements can be met. As a trusted model, CatBoost provides better guidance and support for the systemic treatment of patients with MPTB.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796518","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":"Can early postoperative ultrasound replace routinary flexible laryngoscopy after neuromonitoring-assisted thyroid surgery?","authors":"Luca Sessa, Andrea Attard, Francesco Cupido, Stefania Marchisotta, Adele Maniglia, Francesco Pennestrì, Carmela De Crea, Marco Raffaelli","doi":"10.1007/s13304-025-02199-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02199-w","url":null,"abstract":"<p><p>Ultrasound (US) has been proposed to assess vocal cord motility after thyroid surgery since early post-operative flexible laryngoscopy (FL) is not readily available in all centers. We aimed to verify if FL can be avoided in intraoperative neuromonitoring (IONM)-assisted thyroid surgery followed by early US vocal cord motility evaluation. Two hundred and thirty-four patients who underwent IONM-assisted thyroidectomy were included. When total thyroidectomy (TT) was planned, the surgical procedure was stopped in case of loss of signal (LOS) or significant signal reduction (SSR) after the dissection of the first lobe. US vocal cord motility evaluation and FL were performed in all patients on postoperative day 1. Among 377 nerves at risk (91 thyroid lobectomies and 143 TT), post-operative FL showed 9 unilateral vocal cord palsies and 4 unilateral hypomotilities. IONM results showed 15 LOS and 10 SSR. US vocal cord motility evaluation confirmed unilateral vocal cord palsy in 8 cases and correctly identified normal post-operative vocal cord motility in 13 patients with altered IONM results. FL was able to diagnose 4 unilateral vocal cord hypomotilities in patients with normal IONM results and US evaluation. Overall accuracy was 91.4% for IONM and 96.5% for US, respectively. Early postoperative US evaluation after IONM-assisted thyroid surgery improves the overall accuracy of IONM alone in assessing laryngeal function after thyroid surgery. Nonetheless, IONM results and post-operative US do not replace FL, which remains the gold standard for early detection of laryngeal motility changes also in asymptomatic patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796430","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}