BMC Surgery最新文献

{"title":"Circumferential resection margin and early recurrence after neoadjuvant-treated hybrid ivor lewis esophagectomy: a single-center cohort study.","authors":"Muhammad Hammad Ur Rehman, Mariam Asad, Mehrub Munawar, Haider Abid, Zubair Shabbir Khanzada","doi":"10.1186/s12893-026-03809-z","DOIUrl":"10.1186/s12893-026-03809-z","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of circumferential resection margin (CRM) width after neoadjuvant-treated esophagectomy remains uncertain.</p><p><strong>Objective: </strong>To assess whether CRM distance predicts early (12-month) locoregional recurrence (LRR) following hybrid Ivor-Lewis esophagectomy.</p><p><strong>Design/setting: </strong>Retrospective observational cohort at a tertiary cancer center, April 2023-October 2024.</p><p><strong>Participants: </strong>Consecutive adults who underwent two-stage (hybrid) esophagectomy for malignancy; emergencies and abandoned resections excluded.</p><p><strong>Exposure: </strong>Pathologic CRM measured in millimeters, analyzed continuously and by RCPath thresholds (≤ 1 mm vs. > 1 mm).</p><p><strong>Main outcomes: </strong>Primary-12-month locoregional recurrence (LRR). Secondary-any recurrence and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Sixty-three resections were analyzed. CRM was measurable in 45 (71.4%). Median CRM was 2.0 mm (IQR 1.0-3.0). Six patients (9.5%) developed recurrence within 12 months-five locoregional and one distant. One of twenty-nine pathological complete responders (pCR, 3.4%) recurred. Univariable analysis did not demonstrate a significant association between CRM distance and early recurrence. Kaplan-Meier analysis showed no statistically significant difference in recurrence-free survival between CRM categories.</p><p><strong>Conclusions: </strong>Early recurrence occurred in 9.5% of patients, predominantly locoregional. CRM distance, whether analyzed continuously or using RCPath thresholds, was not associated with early recurrence. These findings suggest that, within this single-center cohort, early relapse may reflect underlying tumor biology rather than marginal radial clearance, although results should be interpreted with caution given limited event numbers.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative outcomes of reconstituting versus fenestrating subtotal cholecystectomy: a systematic review and meta-analysis of observational studies.","authors":"Behnam Reza Makhsosi, Pourya Ghobadi, Amir Tarighinia, Tara Mazaheri, Leila Solouki","doi":"10.1186/s12893-026-04039-z","DOIUrl":"10.1186/s12893-026-04039-z","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy remains the gold-standard treatment for symptomatic gallbladder disease; however, in situations where safe dissection is not achievable, subtotal cholecystectomy has emerged as a reliable alternative to minimize operative risk. Given the technical differences between the reconstituting and fenestrating approaches and the inconsistent evidence regarding their postoperative outcomes, this systematic review and meta-analysis was designed to provide a comprehensive comparison of these two surgical techniques. The present study incorporates more recently published studies and provides an updated synthesis of the available evidence.</p><p><strong>Materials and methods: </strong>This study was conducted as a systematic review and meta-analysis in accordance with PRISMA guidelines. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, Google Scholar, SID, Magiran, and IranMedex using relevant MeSH terms and keywords. The literature search was conducted up to December 2025. Eligible studies were systematically analyzed using random-effects meta-analysis; risk of bias was assessed using the Newcastle-Ottawa Scale, and results were visualized using the ROBVIS tool.</p><p><strong>Results: </strong>Thirteen studies involving 950 patients (reconstituting: n = 324; fenestrating: n = 626) were included. Reconstituting subtotal cholecystectomy was associated with a significantly lower incidence of postoperative bile leak compared with the fenestrating technique (OR = 0.29, 95% CI 0.16-0.55; P = 0.0002; I² =34%). No statistically significant differences were observed for postoperative ERCP (OR = 0.43, 95% CI 0.17-1.07; P = 0.071; I² = 64.7%) or reoperation rates (OR = 0.55, 95% CI 0.19-1.61; P = 0.276; I² = 0%).</p><p><strong>Conclusion: </strong>Based on low-certainty GRADE evidence, this meta-analysis indicates that reconstituting subtotal cholecystectomy is associated with a significantly lower risk of postoperative bile leak compared with the fenestrating technique, with low-to-moderate heterogeneity. Although the overall direction of effect for postoperative ERCP and reoperation also favored the reconstituting technique, these differences did not reach statistical significance, likely reflecting limited statistical power and heterogeneity; these results should be considered hypothesis-generating. Overall, the reconstituting technique appears to offer a safer postoperative profile, though confirmation by prospective studies is warranted.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for postoperative ecchymosis after medial open-wedge high tibial osteotomy: an exploratory analysis of thromboelastography parameters.","authors":"Yu Jiang, Jingyuan Li, Huan Liang, Liang Zhang, Wenlian Song, Tianrui Wang, Xia Zhao, Ning Yu, Yingze Zhang, Jinli Chen, Kuishuai Xu","doi":"10.1186/s12893-026-04040-6","DOIUrl":"10.1186/s12893-026-04040-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify risk factors for ecchymosis and its associated coagulation characteristics following medial open-wedge high tibial osteotomy (OWHTO) using thromboelastography (TEG).</p><p><strong>Methods: </strong>This single-center retrospective study included 220 consecutive patients undergoing unilateral medial OWHTO between January 2023 and September 2025. All patients received rivaroxaban 10 mg orally once daily for 14 days, commencing 12 h postoperatively. The primary endpoint was the incidence of peri-incisional ecchymosis, assessed daily during the hospital stay (postoperative days 1-4). Patients were categorized into ecchymosis (n = 74) and no-ecchymosis groups. Pre-operative and post-operative day-4 TEG parameters, blood loss volumes, and baseline characteristics were analyzed. Multivariable logistic regression (variables selected based on clinical relevance and univariate P < 0.10) determined independent factors, while group discrimination was assessed descriptively using AUC.</p><p><strong>Results: </strong>Ecchymosis occurred in 33.6% (74/220) of patients. The ecchymosis group demonstrated higher BMI (mean difference 1.57 kg/m², 95% CI 0.81-2.33, P < 0.001), prolonged tourniquet time, greater hidden blood loss, and impaired TEG-CI recovery (ΔTEG-CI: -1.04, 95% CI - 1.48 to - 0.60, P < 0.001). Multivariable analysis identified BMI (OR 1.26, 95% CI 1.11-1.43), tourniquet time (OR 1.03, 95% CI 1.01-1.05), and ΔTEG-CI (OR 0.71, 95% CI 0.56-0.91) as independently associated with ecchymosis (AUC = 0.81, 95% CI 0.75-0.87). Increased hidden blood loss correlated with ecchymosis in affected patients, suggesting a shared bleeding process rather than an independent pathogenic factor.</p><p><strong>Conclusions: </strong>This exploratory single-center retrospective analysis identified BMI, tourniquet time, and impaired perioperative recovery of the coagulation index as independently associated with ecchymosis following medial OWHTO. These findings detail a post-event coagulation status in patients developing ecchymosis under consistent perioperative anticoagulation; however, they do not support temporal or predictive inferences and remain hypothesis-generating. Prospective multicenter validation is necessary before any clinical utility can be inferred.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of circumferential surgery for multisegmental pyogenic cervical spine infection.","authors":"Shuang Xu, Shuai Zhang, ZiYao Ma, Qing Wang, Song Wang","doi":"10.1186/s12893-026-03931-y","DOIUrl":"10.1186/s12893-026-03931-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of circumferential surgery, involving combined anterior and posterior approaches, in the management of multisegmental cervical pyogenic spondylitis (CPS).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 12 patients with multisegmental CPS who underwent circumferential surgical intervention between January 2015 and November 2023. The study evaluated medical records, spinal alignment correction, postoperative complications, and neurological functional recovery.</p><p><strong>Results: </strong>In total, 12 patients (8 men and 4 women; mean age: 57.1 years) met the inclusion criteria. Identified risk factors included diabetes mellitus in four patients, a history of substance abuse in two patients, and long-term immunosuppressive therapy following organ transplantation in one patient. Preoperatively, nine patients presented with spinal cord or nerve root compression. All patients underwent circumferential surgery with anterior column reconstruction using autologous bone grafts; titanium alloy plates were additionally used in two cases. Posterior stabilization was achieved using pedicle screws or lateral mass screws. The mean number of corpectomies performed was 3.7 (range, 3-5); the mean number of fused levels was 4.8 (range, 4-7). The mean follow-up duration was 19.4 (range, 6-38) months. Cervical alignment improved significantly, with the mean C2-7 Cobb angle changing from - 5° preoperatively to 3° postoperatively. Neurological function significantly improved in all patients (P = 0.023), and successful bone fusion was achieved in 11 patients (91.7%) at the final follow-up. Pathogens were identified in seven cases, including Staphylococcus aureus Staphylococcus epidermidis (n = 2), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). All patients received intravenous antibiotic therapy for 4-6 weeks postoperatively, followed by oral antibiotic treatment for an additional 6-8 weeks. No intraoperative complications were reported. Postoperatively, one patient developed pneumonia with respiratory failure, and another experienced posterior cervical wound infection.</p><p><strong>Conclusions: </strong>Circumferential surgical intervention combined with appropriate antibiotic therapy appears to be an effective treatment strategy for achieving satisfactory outcomes in patients with multisegmental CPS.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and short-term outcomes of vNOTES versus conventional laparoscopic hysterectomy in obese patients.","authors":"Varol Gülseren, Bilgesu Çetinel Kaygun, Kemal Güngördük","doi":"10.1186/s12893-026-04035-3","DOIUrl":"10.1186/s12893-026-04035-3","url":null,"abstract":"<p><strong>Background and objective: </strong>We compared the short-term outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) versus conventional laparoscopic surgery (CLS) hysterectomy in women with body mass index (BMI) ≥ 30 kg/m², with explicit acknowledgement of the temporal and confounding limitations inherent to our non-randomised retrospective design.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study reviewed records of obese women who underwent hysterectomy at two tertiary university hospitals in Turkey between 2020 and 2024. CLS predominated during 2020-2021 and vNOTES from 2022 onwards, reflecting evolving institutional experience rather than formal allocation. The principal comparative endpoint was umbilical-region VAS at 24 h; feasibility (completion without conversion to laparotomy) is reported descriptively. A pre-specified hierarchical testing strategy was applied, and complications were graded by Clavien-Dindo classification.</p><p><strong>Results: </strong>Of 168 eligible women (CLS n = 126, vNOTES n = 42) from two centres, all procedures were completed minimally invasively with zero conversions to laparotomy in both arms. Umbilical pain at 24 h (VAS) was substantially lower with vNOTES (5.4 ± 1.2 vs. 2.1 ± 0.9; p < 0.001). Operative times were broadly comparable (mean difference 5.0 min; not significant under the hierarchical plan). Serious (Clavien-Dindo grade IIIb) complications were numerically more frequent in the vNOTES arm (4.8% vs. 0.8%); the study was not powered to interpret this difference, and no inference of safety equivalence should be drawn. OSAS/PSAS scar scores were applicable only to the CLS group and are reported descriptively.</p><p><strong>Conclusions: </strong>In this retrospective cohort of obese women undergoing hysterectomy, vNOTES was associated with substantially lower umbilical-region pain and comparable operative times relative to CLS. Given temporal confounding from sequential non-randomised allocation, these associations should not be interpreted causally, and the near-absence of Class III obesity limits generalisability to the population most likely to benefit. Adequately powered prospective randomised trials are required to confirm these preliminary findings.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of open partial preperitoneal tension-free repair for inguinal hernia following radical prostatectomy: a single-center retrospective study.","authors":"Ying Du, Yunshou Lin, Shisong Wang, Manli Huang, Wenguan Yu, Zhiyu Ye","doi":"10.1186/s12893-026-04036-2","DOIUrl":"10.1186/s12893-026-04036-2","url":null,"abstract":"<p><strong>Background: </strong>Radical prostatectomy (RP) is associated with an increased risk of subsequent inguinal hernia (IH). Because prior pelvic surgery may disrupt the preperitoneal plane and cause adhesions, hernia repair in this setting can be technically challenging. However, the clinical outcomes of open partial preperitoneal tension-free repair for IH after RP have not been well described in consecutive case series.</p><p><strong>Objective: </strong>To evaluate the clinical outcomes of open partial preperitoneal tension-free repair for inguinal hernia after radical prostatectomy.</p><p><strong>Method: </strong>We retrospectively reviewed 64 consecutive patients with IH after RP who underwent open partial preperitoneal tension-free repair at our institution between January 2013 and January 2024. Data collected included demographic and hernia characteristics, operative time, drain placement, postoperative length of stay, postoperative complications, chronic groin discomfort, and recurrence during follow-up.</p><p><strong>Results: </strong>The mean operative time was 67.6 ± 28.5 min. Nine patients (14.1%) underwent selective drain placement, with a mean drain duration of 3.44 ± 0.88 days. The median postoperative hospital stay was 4 days (IQR, 4-7 days). One patient (1.6%) developed postoperative hematoma/seroma, and two patients (3.1%) reported chronic postoperative groin discomfort or foreign body sensation during follow-up. No surgical site infection was observed. The mean follow-up duration was 34.7 ± 22.2 months. One patient reported a suspected recurrence during telephone follow-up, but this was not clinically confirmed because the patient declined further evaluation.</p><p><strong>Conclusion: </strong>Open partial preperitoneal tension-free repair may be a feasible option for selected patients with inguinal hernia after RP when performed by surgeons familiar with this technique. In this retrospective surgeon-specific, center-related series, the procedure was associated with acceptable perioperative outcomes and a low rate of unconfirmed recurrence, although the findings should be interpreted cautiously given the study design, limited sample size, and limited generalizability.</p><p><strong>Trial registration: </strong>This retrospective study was approved by the Institutional Ethics Committee of the First Affiliated Hospital of Ningbo University (Approval No. 098RS), which waived the requirement for informed consent because of the retrospective design and the use of anonymized data. The study was registered on Medicalresearch.org (Registration No. ChiCTR2500101225).</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study.","authors":"Iyad M Ballas, Husam N Abualwafa, Ibrahim H Al-Shaer, Ibrahim Aljamal, Ahmad Tabhoub, Saja Nazzal, Mahdi Aljamal","doi":"10.1186/s12893-026-04029-1","DOIUrl":"10.1186/s12893-026-04029-1","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide, accounting for approximately 75% of abdominal wall hernias, and predominantly occurring in males. Although it is a common procedure with generally favourable outcomes, the postoperative outcomes, such as chronic pain, recurrence, and surgical complications, remain important concerns. The aim of this study was to compare short-term postoperative outcomes and complications between open and laparoscopic inguinal hernia mesh repair.</p><p><strong>Method: </strong>A retrospective cohort study was conducted to compare the outcomes between open vs. laparoscopic inguinal hernia mesh repair. All patients who underwent inguinal hernia mesh repair in 3 hospitals from 2017 to 2025 were collected. Patients were divided into groups based on surgical technique (open repair vs. laparoscopic repair). Demographic data, operative time, length of hospital stay, postoperative outcomes including surgical complications (hematoma, seroma, surgical site infection, hydrocele, recurrence), and general postoperative complications (urinary retention and postoperative nausea/vomiting) were extracted and analysed. A P-value < 0.05 is considered statistically significant.</p><p><strong>Results: </strong>A total of 609 patients underwent inguinal hernia repair with mesh. Open repair was more prevalent (77.2%). Reducible and uncomplicated hernias were significantly associated with laparoscopic repair (p < 0.001, p = 0.006), while irreducible and strangulated hernias were predominantly managed with open surgery. Patients undergoing laparoscopic repair were younger (median 51.5 vs. 55 years, p = 0.001) and had shorter operative duration (median 101.5 vs. 113 min, p = 0.001). Urinary retention occurred more frequently after open repair (5.5% vs. 0.7%, p = 0.015), whereas postoperative nausea and vomiting were more common following laparoscopy (2.2% vs. 0.2%, p = 0.039). Overall postoperative complications were low and comparable between the two approaches (12.6% vs. 14.4%, p = 0.572), and early documented recurrence during short-term follow-up was uncommon and did not differ significantly between groups; however, the follow-up duration was insufficient to reliably assess true recurrence rates. (1.1% vs. 1.4%, p = 0.709).</p><p><strong>Conclusion: </strong>Both open and laparoscopic inguinal hernia repair demonstrated favourable safety profiles in this cohort and were associated with low rates of short-term postoperative complications. However, the short follow-up duration limits assessment of long-term outcomes such as recurrence, chronic postoperative pain, and mesh-related complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel nomogram based on preoperative inflammatory indicators and postoperative clinicopathological features for predicting metachronous liver metastasis of colorectal cancer.","authors":"Yufei Gu, Fengyu Zheng, Xin Feng, Jin Du, Yanxin Zhao, Zhongwen Sun, Haijian Yang, Libing Yang, Zhenzhen Cao, Xintao Wang","doi":"10.1186/s12893-026-04034-4","DOIUrl":"10.1186/s12893-026-04034-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The occurrence of metachronous liver metastasis (MLM) after primary resection of colorectal cancer (CRC) significantly worsens patient prognosis. Identification of patients at high risk of MLM would enable closer monitoring and more timely intervention. We therefore aimed to develop and validate a novel nomogram to predict MLM in patients with CRC, based on preoperative inflammatory indicators and postoperative clinicopathological features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 505 patients with CRC who underwent radical resection of the primary tumor at the First Affiliated Hospital of Zhengzhou University between August 2018 and August 2022 were retrospectively analyzed. The patients were divided into training (n = 289) and validation (n = 216) cohorts. Independent risk factors for MLM were identified using least absolute shrinkage and selection operator and multivariate logistic regression analyses of the training cohort and used to develop a novel nomogram. To quantify the incremental predictive value of inflammatory markers, three models were constructed using logistic regression: a pathological model (T stage, N stage, vascular invasion, mismatch repair status, and carcinoembryonic antigen), an inflammatory model (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio), and a combined nomogram including all eight predictors. The discriminative performance of the three models was compared using area under the receiver operating characteristic curve (AUC), the DeLong test, calibration curves, decision curve analysis, and reclassification metrics (net reclassification improvement and integrated discrimination improvement). Sensitivity analyses modeling inflammatory markers as continuous variables were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A preoperative carcinoembryonic antigen (CEA) level &gt; 5 ng/mL, neutrophil-to-lymphocyte ratio (NLR) &gt; 2.35, platelet-to-lymphocyte ratio (PLR) &gt; 127.29, and lymphocyte-to-monocyte ratio (LMR) &gt; 3.80, and the postoperative clinicopathological features T stage, N stage, vascular invasion, and mismatch repair (MMR) proficient were identified as independent risk factors for MLM of CRC and used to develop the nomogram. In the three-model comparison, the combined nomogram achieved the highest discriminative performance (training AUC 0.937, validation AUC 0.777), significantly outperforming the pathological model (training AUC 0.911, DeLong P = 0.012; validation AUC 0.735, DeLong P = 0.037) and the inflammatory model (training AUC 0.838, DeLong P &lt; 0.001; validation AUC 0.706, DeLong P = 0.021). Calibration curves and decision curve analysis demonstrated that the combined model had the best calibration and the highest net clinical benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The preoperative inflammatory indicators NLR, PLR, and LMR were identified as independent risk factors for MLM. The three-model comparison demonstrated that the com","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geometric simplification by ductal unification of dual pancreatic ducts during pancreaticojejunostomy.","authors":"Shinnosuke Harata, Yoichi Matsuo, Naoi Sato, Haruka Shigemori, Akitoshi Okuyama, Seiya Yamamoto, Ryo Nakajima, Masayuki Komura, Kaori Watanabe, Naruomi Jinno, Yushi Yamakawa, Kenta Saito, Tomoya Shamoto, Kazuyoshi Shiga, Hiroyuki Sagawa, Tatsuya Tanaka, Nobuo Ochi, Kazuki Hayashi, Shuji Takiguchi","doi":"10.1186/s12893-026-04030-8","DOIUrl":"10.1186/s12893-026-04030-8","url":null,"abstract":"<p><strong>Background: </strong>Anatomical variations of the pancreatic duct are common; however, two closely approximated ductal lumens at the margin of pancreatic transection present a distinct reconstructive challenge during pancreaticoduodenectomy (PD). When the inter-ductal distance is minimal, conventional assumptions underlying pancreaticojejunostomy may not apply.</p><p><strong>Case presentation: </strong>In this two-case report, two patients undergoing PD were preoperatively diagnosed with dual pancreatic ducts by contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography. Histopathological assessment demonstrated minimal inter-ductal distances (3.05 mm and 0.35 mm) at the transection margin in each patient. Separate duct-to-mucosa anastomoses were considered technically unfavorable because the pancreatic parenchymal cuffs were too small to allow secure suturing and because of the risk of ischemia in the narrow intervening pancreatic bridge. Therefore, a ductal unification strategy was adopted. The septum between the ducts was sealed using an ultrasonic device, divided under hemostatic control, and sutured to create a single ductal orifice. Standard duct-to-mucosa pancreaticojejunostomy was then performed within the Blumgart framework. Both patients had uneventful postoperative courses without clinically relevant postoperative pancreatic fistulae.</p><p><strong>Conclusion: </strong>Ductal unification may represent a feasible technical option in carefully selected cases of closely approximated dual pancreatic ducts, but further experience is required before any recommendation can be made.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous surgical treatment of multiple abdominal echinococcosis and benign pelvic organ tumours: a case report.","authors":"Anton Goncharov, Yury Zharikov, Cyrill Gorlenko, Yana Kiseleva, Yulia Stepanova, Ivan Gruzdev, Dmitry Kalinin, Beslan Gurmikov","doi":"10.1186/s12893-026-03718-1","DOIUrl":"10.1186/s12893-026-03718-1","url":null,"abstract":"<p><strong>Background: </strong>Echinococcosis of the liver is a parasitic infection that poses a significant healthcare challenge in endemic regions. The majority of cases present with either no clinical signs or non-specific ones, making differential diagnosis difficult until after the operation. Preoperative diagnostics rely mainly on computed tomography, magnetic resonance imaging, and ultrasound. The usual treatment for liver echinococcosis involves an operation, such as percutaneous intervention, surgical resection of the cyst as well as surrounding liver tissue, or major liver resection, followed by prolonged conservative treatment with Albendazole. Even though cases of simultaneous treatment of the echinococcosis and neoplastic lesions are present in the literature, they are scarce and the new data on the subject is of importance. A 61-year-old female patient presented to our clinic with chief complaint of abdominal pain. Upon physical examination, a palpable mass was discovered in the right ileac region along with hepatomegaly. Laboratory studies indicated the presence of an unspecified infection. An MRI of the abdomen revealed masses in both ovaries and cystic lesions in the liver and pelvis. The patient underwent surgical resection of cysts located both in the abdominal cavity and liver, as well as resection of surrounding liver parenchyma in S2 through S7 for echinococcosis and both-sided ovariectomy, hysterectomy, and omentum resection for lesions of the ovaries. The hepatic and abdominal cystic lesions were found to be of echinococcal origin, and the right ovary lesion was a mature teratoma even though preoperatively it was considered to be cancer. The patient is currently alive and well with no signs of recurrence after seven years.</p><p><strong>Conclusion: </strong>As such cases are rare, the medical documentation should be well described and analyzed for future reference. It is now considered to be possible to treat multiple cystic echinococcosis of the liver and free abdominal cavity along with potentially malignant lesions of the abdomen and pelvis - in our opinion survival rates should be similar to the rates of malignancy alone as radical surgical treatment of cystic echinococcosis remains effective and well accepted route of treatment. This rare case demonstrates and emphasizes an importance of simultaneous surgical interventions as well as correct preoperative suggestion of diagnosis.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}