Minerva Surgery最新文献

{"title":"From PDTA to PIDTA: a new integrated care pathway to improve survival and quality of life in breast cancer patients.","authors":"Gianluca Franceschini, Stefano Magno","doi":"10.23736/S2724-5691.26.11195-2","DOIUrl":"10.23736/S2724-5691.26.11195-2","url":null,"abstract":"<p><p>The Percorso Diagnostico-Terapeutico Assistenziale (Diagnostic, Therapeutic and Care Pathway, PDTA), has long provided a structured framework for cancer care, supporting continuity and adherence to clinical standards. However, as improvements in cancer outcomes are accompanied by increasing complexity in patient needs, particularly in breast cancer, greater attention is being directed towards models of care that extend beyond survival to include quality-of-life outcomes and long-term survivorship needs. Within this context, interest is emerging in the PIDTA (Percorso Integrato Diagnostico-Terapeutico Assistenziale; Integrated Diagnostic, Therapeutic and Care Pathway) as a conceptual extension of the PDTA model. The PIDTA framework proposes the integration of evidence-informed supportive interventions alongside standard oncologic care within a multidisciplinary setting across the cancer continuum. These may include psycho-oncological support, nutritional counselling, structured physical activity programs, and other supportive care interventions embedded within routine clinical pathways. Initial experience from specialized breast units, including at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, suggests the feasibility of implementing such an integrated model within clinical practice. Early observations indicate potential improvements in treatment adherence, symptom management, and patient-reported quality-of-life outcomes, alongside the incorporation of structured prehabilitation and survivorship planning. The PIDTA represents an evolving conceptual framework in breast cancer care that seeks to integrate clinical excellence with structured supportive care. Further systematic evaluation, including prospective studies and implementation research, is required to define its impact and inform potential scalability within different healthcare settings.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"282-287"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the therapeutic effects between ligament advanced reinforcement system artificial ligament and four-strand hamstring tendon autograft in patients with acute anterior cruciate ligament injury.","authors":"Miao-Lin Zhang, Dan-Feng Dai, Guo-Fu Zheng, Baojie Shen, Di Ruan, Hui-Hui Zhang","doi":"10.23736/S2724-5691.23.10168-7","DOIUrl":"10.23736/S2724-5691.23.10168-7","url":null,"abstract":"","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":" ","pages":"288-289"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure to rescue and predictors of severe morbidity after esophagectomy: a single-center experience from a high-volume Italian referral center.","authors":"Simona Grimaldi, Pietro M Lombardi, Monica Gualtierotti, Paolo DE Martini, Vincenzo Nicastro, Michele Mazzola, Giovanni Ferrari","doi":"10.23736/S2724-5691.26.11170-8","DOIUrl":"https://doi.org/10.23736/S2724-5691.26.11170-8","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy for cancer remains a high-risk procedure. Failure to rescue (FTR) - death following a major complication - is a key metric for surgical quality. This study evaluates FTR incidence and predictors of severe morbidity in a high-volume center with standardized clinical pathways.</p><p><strong>Methods: </strong>We analyzed a prospectively maintained database of patients undergoing curative- intent esophagectomy at a high-volume Italian referral center (2017-2024). Failure to Rescue (FTR) - defined as 90-day mortality after Clavien-Dindo ≥IIIa complications - was tracked as the primary benchmark outcome. To investigate the clinical drivers behind the FTR pathway, multivariable logistic regression was specifically utilized to identify independent predictors of its mandatory clinical substrate, namely severe postoperative morbidity.</p><p><strong>Results: </strong>Out of 102 included patients, 39 (38.2%) experienced major complications. The overall 90-day mortality was 2.9% (N.=3), resulting in an FTR rate of 7.7%. Pulmonary complications (45.1%) and anastomotic leakage (10.8%) were the most frequent adverse events. On multivariable analysis, preoperative malnutrition (MUST score >2; OR 2.82, 95% CI: 1.03-7.73, P=0.044) and high comorbidity burden (aCCI ≥5; OR 3.35, 95% CI: 1.17-9.60, P=0.025) were independent predictors of severe postoperative morbidity.</p><p><strong>Conclusions: </strong>Our FTR rate of 7.7% aligns with international high-volume benchmarks. Preoperative nutritional status and comorbidity burden are critical for risk stratification. Enhancing outcomes requires a dual strategy: proactive prehabilitation for high-risk patients and a robust, multidisciplinary rescue system to manage unavoidable complications.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"228-235"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entrustable professional activities in general surgery residency: a comparative review of five national training systems.","authors":"Hameeda A Arain, Namra Q Shaikh, Brenessa Lindeman","doi":"10.23736/S2724-5691.26.11220-9","DOIUrl":"https://doi.org/10.23736/S2724-5691.26.11220-9","url":null,"abstract":"<p><p>Entrustable professional activities (EPAs) are a framework for competency-based assessment that focus on observable units of clinical work and are increasingly used in general surgery training. This narrative review compares EPA implementation across five national systems and examines validity evidence, administrative burden, and digital infrastructure. The databases PubMed, Embase, Scopus, Web of Science, and ScienceDirect were searched using terms related to EPAs and general surgery training. Two reviewers independently screened records, with disagreements resolved by consensus, and framework details were supplemented by documents from national certifying bodies. EPA implementation differed substantially across systems. The Netherlands has the longest experience, with EPAs embedded in a competency-based curriculum and electronic portfolio. The United States uses 18 core EPAs, mobile microassessments, and certification-linked reporting beginning in 2028. Canada's Competence by Design organizes training into four stages with competence committee review. Australia and New Zealand integrate specialty-specific EPAs within Surgical Education and Training, while South Africa is developing a locally responsive workplace-based assessment framework. Validity evidence is strongest in the United States and Canada for relationships with training level, milestone ratings, and committee confidence, but evidence regarding the consequences of entrustment decisions remains limited. Across systems, administrative burden, inconsistent engagement, and variable feedback quality threaten formative value. Digital platforms improve feasibility but do not ensure sustained use without leadership and workflow integration. EPAs provide a practical bridge between competency frameworks and daily surgical practice, though implementation has varied across systems. Future work should prioritize consequences evidence, reduce documentation burden where possible, and strengthen assessment cultures that support meaningful feedback, appropriate supervision, and safe progression toward independent practice.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"270-281"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular aortic arch repair: a review of current technologies, clinical outcomes, and future directions.","authors":"Emanuele C Grasso, Federico F Pennetta, Lucie Derycke, Alessandro Costanzo, Dominique Fabre, Stéphan Haulon","doi":"10.23736/S2724-5691.26.11214-3","DOIUrl":"https://doi.org/10.23736/S2724-5691.26.11214-3","url":null,"abstract":"<p><p>Endovascular treatment of the aortic arch (EndoArch) has emerged as an increasingly important therapeutic option for the management of complex aortic arch disease, driven by continuous advances in device technology, imaging, procedural planning, and operator experience. Although conventional open arch replacement remains the reference treatment for many patients, endovascular approaches have considerably expanded therapeutic options for individuals considered at high surgical risk. However, the anatomical complexity of the aortic arch, the need to preserve supra-aortic trunk perfusion, and the risk of neurological complications continue to make these procedures technically demanding. This review provides an updated overview of contemporary EndoArch, with a particular focus on currently available endovascular and hybrid strategies, clinical outcomes, procedure-related complications, and future perspectives. Available evidence demonstrates encouraging technical success and acceptable early and mid-term results in carefully selected patients treated at experienced aortic centers, although most data derive from retrospective observational studies and long-term durability has yet to be established. Careful patient selection, meticulous procedural planning, and a multidisciplinary approach remain fundamental to achieving optimal outcomes. Ongoing technological developments, including improvements in endograft design, procedural standardization, advanced imaging, and the progressive extension of endovascular treatment to more proximal aortic segments, are expected to further broaden the applicability of EndoArch. Continued clinical experience and longer-term follow-up will be essential to better define the role of these techniques in contemporary management of aortic arch disease.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"252-269"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of organ failure in perforation peritonitis and its impact: a prospective observational study.","authors":"Shreyasi P, Yashwant R Sakaray, Kanai Debnath, Santhosh Irrinki, Siddhant Khare, Satish Subbiah Nagaraj, Kailash C Kurdia, Ajay Savlania, Cherring Tandup, Divya Dahiya, Lileswar Kaman","doi":"10.23736/S2724-5691.26.11186-1","DOIUrl":"10.23736/S2724-5691.26.11186-1","url":null,"abstract":"<p><strong>Background: </strong>Perforation peritonitis remains one of the most common and severe surgical emergencies worldwide. Despite advances in perioperative care and intensive monitoring, organ failure associated with perforation peritonitis continues to contribute significantly to morbidity and mortality.</p><p><strong>Methods: </strong>A prospective study was conducted on 200 patients with perforation peritonitis undergoing emergency laparotomy. Patients were categorized based on the presence and progression of organ failure: no organ failure, single organ failure, multiple organ failure, treatment-resistant organ failure, and subsequently developed organ failure. These categories were correlated with 30-day perioperative outcomes. Student's t-test or Mann-Whitney were used to compare groups, Chi-square/Fisher's Exact Test for categorical variables and ANOVA or Wilcoxon Signed Rank test to analyze time-related data.</p><p><strong>Results: </strong>Among the 200 patients, only 12 (6%) had no organ failure, 22 (11%) had single organ failure, and 169 (84.5%) developed multiple organ failures. Overall, 52 patients (26%) died during hospitalization, while 148 (74%) survived. Mortality rates were significantly higher in patients with: multiple organ failure: 67/165 (40.6%) (P<0.001), treatment-resistant organ failure: 54/66 (81.85%) (P<0.001), subsequently developed organ failure: 60/81 (74%) (P<0.001). Preoperatively, respiratory and renal failures were the most common organ dysfunctions, while postoperatively, respiratory and hematological failures predominated. Postoperative complications according to the Clavien-Dindo classification were: grade II in 64 patients (43.2%), grade III in 11 (5.0%), grade IV in 77 (38.5%), and grade V in 48 (24%) (P<0.001).</p><p><strong>Conclusions: </strong>Perforation peritonitis continues to pose a major clinical challenge due to its high morbidity and mortality, primarily driven by associated organ failures. Patients with multiple or treatment-resistant organ failures have significantly poorer outcomes.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"219-227"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac xenotransplantation: from concept to clinical reality.","authors":"Ahmed A Abdelrehim, W Hampton Gray, Robert A Sorabella, Matthew G Broyles, Farshad Ghanbari, Charlie Hughes, Lindsay Johnson, Luz A Padilla","doi":"10.23736/S2724-5691.26.11212-X","DOIUrl":"https://doi.org/10.23736/S2724-5691.26.11212-X","url":null,"abstract":"<p><p>Advanced heart failure afflicts over 6 million adults in the United States alone, yet fewer than 4,000 donor hearts become available for transplantation each year. Mechanical circulatory support devices extend survival for many of these patients, but device-related complications, anatomic contraindications, and limited applicability to certain populations leave a substantial unmet need. For decades, xenotransplantation (XTx)-the transplantation of organs across species-has been proposed as a means of closing this gap. The discovery of CRISPR-Cas9 gene editing, improved immunosuppressive strategies, and refined preclinical models have accelerated the field at an unprecedented pace. Multi-gene-edited porcine donors now survive for more than 200 days in orthotopic non-human primate models, and two compassionate-use pig-to-human cardiac transplants at the University of Maryland (2022 and 2023) demonstrated the feasibility of clinical cardiac XTx for the first time. Parallel progress in kidney XTx has yielded the first FDA-cleared investigational new drug application and the initiation of a formal clinical trial in late 2025. In May 2026, the FDA granted clearance for the first-ever cardiac XTx clinical trial (EXPRESS), using a 10-gene-edited porcine heart. The 2026 International Society for Heart and Lung Transplantation Consensus Statement now provides a structured framework for recipient selection, immunologic assessment, and outcome benchmarking in cardiac XTx. Antibody-mediated rejection remains the dominant barrier, as both clinical cases ended in xenograft failure driven by antipig antibody responses despite aggressive immunosuppression. Porcine cytomegalovirus reactivation, coagulation dysregulation, and xenograft overgrowth represent additional obstacles that demand resolution before broader clinical application. The optimal immunosuppressive regimen for human recipients has yet to be defined, and long-term zoonotic surveillance protocols require further standardization. With the first cardiac XTx clinical trial now cleared by the FDA, the field continues to face not only the remaining immunologic and virologic hurdles but also the ethical, regulatory, and equity considerations that will shape how this therapy is introduced. This review synthesizes the historical, scientific, and clinical foundations of cardiac XTx, appraises the current evidence, and outlines the path toward responsible clinical translation.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 4","pages":"236-251"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid-energy-based devices in thyroid surgery: a comparative study on surgical timing and clinical outcomes.","authors":"Vittoria Perano, Matteo Uccellini, Sonia Kumar, Luigi Armiraglio, Walter Zuliani, Marta N Monari, Damiano Chiari","doi":"10.23736/S2724-5691.26.11147-2","DOIUrl":"https://doi.org/10.23736/S2724-5691.26.11147-2","url":null,"abstract":"<p><strong>Background: </strong>The development of technology has changed the approach to thyroid surgery. Energy-based devices (EBD) are now widely utilized. This study aims to evaluate whether the Thunderbeat Open Fine Jaw, a hybrid EBD (bipolar and ultrasonic energies), allows to reduce operative time compared to traditional surgery without increasing complications.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study based on prospectively collected data from patients who underwent total thyroidectomy in our Unit between January 2017 and June 2023. Patients were divided into two groups: Group A (Thunderbeat) and Group B (traditional surgery). The primary outcome was operating time. The secondary outcomes were short-term and long-term complications.</p><p><strong>Results: </strong>A total of 173 patients were included in the study: 57 in group A, 116 in group B. Demographic data and histopathological findings were comparable between two groups. In Group A, there was a reduction in operative times (79.00 [IQR: 70.00-85.00] vs. 88.50 [IQR: 75.00-100.00]) minutes, P=0.009). Short-term and long-term complications were similar between two groups.</p><p><strong>Conclusions: </strong>Hybrid EBD has proven to reduce operative times without increasing postoperative complications in thyroidectomy procedures, allowing for a greater number of surgeries to be performed in the same operating session. The use of this device did not result in an increase of complications compared to traditional surgery.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 3","pages":"153-162"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Tips and tricks\" for optimizing the role of gravity force during colonic endoscopic submucosal dissection: a single center experience.","authors":"Damiano Bisogni, Michele Rossi, Luca Talamucci, Fabio Staderini, Fabio Cianchi","doi":"10.23736/S2724-5691.26.11173-3","DOIUrl":"10.23736/S2724-5691.26.11173-3","url":null,"abstract":"","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":" ","pages":"203-206"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of the Operate-Now Score for early prediction of clinically significant intestinal ischemia in adhesive small bowel obstruction.","authors":"Alberto M Maruca, Luca Bonazza, Dario Andreotti, Filippo Aisoni, Maria G Sibilla, Francesco Marchetti, Rocco Stano, Savino Occhionorelli","doi":"10.23736/S2724-5691.26.11150-2","DOIUrl":"10.23736/S2724-5691.26.11150-2","url":null,"abstract":"<p><strong>Background: </strong>Adhesive small bowel obstruction (ASBO) is the leading cause of mechanical small bowel obstruction in developed countries and represents a major burden in emergency surgery. Early identification of clinically significant intestinal ischemia remains challenging. Delayed surgical intervention increases the risk of bowel resection and postoperative morbidity. This study aimed to develop and internally validate a simplified clinical-radiological score for early prediction of intestinal ischemia requiring resection.</p><p><strong>Methods: </strong>A retrospective single-center observational study was conducted including 236 consecutive adult patients admitted with mechanical small bowel obstruction between 2020 and 2024. The primary endpoint was intestinal resection, used as a proxy for clinically significant ischemia. Independent predictors were identified using multivariate logistic regression. Model discrimination was assessed using ROC curve analysis and area under the curve (AUC). Internal validation was performed using bootstrap resampling (1000 iterations).</p><p><strong>Results: </strong>Sixty-three patients (26.7%) required intestinal resection. Independent predictors of resection were serum lactate (OR 4.14 per 1 mmol/L increase; 95% CI 2.42-7.10; P<0.001), CT wall hypoenhancement (OR 3.39; 95% CI 1.47-7.78; P=0.004), and intraperitoneal free fluid (OR 4.07; 95% CI 1.56-10.66; P=0.004). The final model demonstrated good discrimination (AUC 0.839) with optimism-corrected AUC of 0.810.</p><p><strong>Conclusions: </strong>The Operate-Now Score integrates metabolic and radiological parameters to support early identification of ASBO patients at high risk of ischemia. External prospective validation is required before widespread implementation.</p>","PeriodicalId":29847,"journal":{"name":"Minerva Surgery","volume":"81 3","pages":"172-175"},"PeriodicalIF":1.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}