Scandinavian Journal of Surgery最新文献

{"title":"Surgical resection of adrenal metastases: Single-center experience and narrative literature review with emphasis on colorectal metastases.","authors":"Bård I Røsok, Somaya H Ahmad, Åsmund A Fretland, Daniel Østergaard, Bjørn Edwin, Kristoffer W Brudvik, Sheraz Yaqub","doi":"10.1177/14574969251331341","DOIUrl":"https://doi.org/10.1177/14574969251331341","url":null,"abstract":"<p><p>Adrenal glands can host metastases from various malignancies. While surgical resection offers potential benefits in solitary- or oligometastatic cases, many patients have systemic disease unsuitable for surgery when adrenal metastases are diagnosed. Most adrenal metastases originate from malignancies in the lungs, kidneys, or liver. This review explores diagnostic and treatment strategies for adrenal metastases including data from a single center. In particular, it is shown that surgical resection of metastases from colorectal cancer to the adrenals may offer a potential survival benefit. Personalized treatment plans and further research are critical for improving outcomes for patients with adrenal metastases.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251331341"},"PeriodicalIF":2.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789319","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":"Surgery in patients with metastatic melanoma treated with immune checkpoint inhibitors.","authors":"Joséphine C Janssen, Anne E Huibers, Dirk J Grünhagen, Roger Olofsson Bagge","doi":"10.1177/14574969251331663","DOIUrl":"https://doi.org/10.1177/14574969251331663","url":null,"abstract":"<p><p>Surgery has historically played a pivotal role in the management of metastatic melanoma, evolving significantly with the advances of systemic therapies. The advent of immune checkpoint inhibitors initially diminished the role of surgery in treatment paradigms; however, there has been a resurgence of interest in its application within this setting. Several retrospective studies show a survival benefit for patients treated with immune checkpoint inhibitors who are resected to no evidence of disease, especially in case of an objective response to modern therapies. This narrative review explores the role of surgery as a treatment modality in metastatic melanoma before and in the era of immune checkpoint inhibitors, highlighting indications, outcomes, and integration with systemic treatment approaches.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251331663"},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755521","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":"Subtle Lisfranc: When is minimal displacement equal to stability, and does it matter?","authors":"Tim Schepers, Esmee W M Engelmann, Jens A Halm","doi":"10.1177/14574969251326386","DOIUrl":"https://doi.org/10.1177/14574969251326386","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251326386"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659593","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":"Visceral artery aneurysms: A shred of light on rare entities.","authors":"Nicola Leone, Mattia Migliari, Giovanni F Baresi, Stefano Gennai","doi":"10.1177/14574969251321936","DOIUrl":"https://doi.org/10.1177/14574969251321936","url":null,"abstract":"<p><p>Visceral artery aneurysms (VAAs) and pseudoaneurysms are rare but clinically significant vascular pathologies with potentially fatal complications including rupture. VAAs are often asymptomatic and frequently discovered incidentally during imaging performed for unrelated reasons. Their pathophysiology, clinical presentation, and management vary based on the etiology, anatomical location, and patient-specific factors. The prognosis for conservatively managed VAAs is generally favorable, with slow growth rates and low rupture risks. However, pseudoaneurysms, often associated with trauma or pancreatitis, carry a much higher rupture risk and typically require early intervention, regardless of size. Endovascular techniques have progressively replaced open surgery as the preferred treatment approach due to lower complication rates and comparable long-term outcomes. However, current knowledge is biased by the scarcity of high-quality evidence regarding the natural history, rupture risk, and optimal management of VAAs and pseudoaneurysms, largely due to the rarity of these conditions. Consequently, different international societies have provided recommendations with low strength and, in some cases, conflicting indications.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251321936"},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651520","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":"Risk of malignancy in indeterminate biliary tract strictures: Retrospective cohort study.","authors":"Joonas Sirén, Leena Kylänpää, Mia Rainio, Outi Lindström, Fredrik Åberg, Johanna Savikko, Arto Kokkola, Arno Nordin, Ville Sallinen","doi":"10.1177/14574969251321966","DOIUrl":"https://doi.org/10.1177/14574969251321966","url":null,"abstract":"<p><strong>Background: </strong>Indeterminate biliary strictures, that is, a stricture with benign brush cytology but without clear etiology in clinical or radiological assessment, pose a challenge for clinicians. This study aimed to assess the incidence and risk factors for malignant disease in patients with indeterminate biliary strictures.</p><p><strong>Methods: </strong>This is a single-center retrospective study of patients with indeterminate biliary stricture undergoing first endoscopic retrograde cholangiopancreatography (ERCP) and biliary brushing between March 2011 and March 2020. The study included patients with atypical cytology in the first ERCP biliary brushing samples. Main exclusion criteria were primary sclerosing cholangitis, apparent malignancy or tumor in imaging studies, postoperative strictures, chronic pancreatitis, biliary tract stone, and no ≥12-month follow-up or a final pathological diagnosis.</p><p><strong>Results: </strong>A total of 2279 patients underwent first ERCP procedure because of a biliary tract stricture during the study period, of which 51 patients (2.2%) had an indeterminate biliary stricture and were included. A total of 30 patients (58.8%) had final diagnosis of malignant disease. The patients with final diagnosis of malignant disease were mostly men (n = 19, 63.3%), had jaundice (n = 25, 86.2%), and had significantly higher bilirubin and CA19-9 values than those with benign disease. A total of 25 patients were operated on, of which 21 patients (84%) had malignant disease. Twenty-six patients were followed up only, of whom nine patients (34.6%) had a malignant disease.</p><p><strong>Conclusion: </strong>Indeterminate biliary strictures are uncommon, but two-thirds of the initially indeterminate biliary strictures are malignant. The presence of clinical jaundice and elevated bilirubin and CA19-9 values are associated with increased risk of malignancy.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251321966"},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651296","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":"Incidence, treatment, and survival of isolated patients with colorectal cancer lung metastases: A registry-based retrospective cohort study.","authors":"Sofia Dahlberg, Fredrik Jörgren, Pamela Buchwald, Halla Vidarsdottir","doi":"10.1177/14574969251319849","DOIUrl":"https://doi.org/10.1177/14574969251319849","url":null,"abstract":"<p><strong>Background: </strong>The benefit of surgical resection for colorectal cancer (CRC) lung metastases is unclear. The aim was to investigate the incidence, treatment strategy, and 5-year overall survival (OS) in CRC patients with isolated lung metastases.</p><p><strong>Methods: </strong>This registry-based retrospective cohort study included patients treated with curative resection of CRC within the county of Skåne during the period 2010-2016, who had synchrone or metachrone isolated lung metastases. Exclusion criteria were previous or concurrent metastases at other organ sites. Patients were identified in the Swedish Colorectal Cancer Registry (SCRCR) and data were retrieved from SCRCR and medical charts. Patients were divided into groups based on whether they had synchronous or metachronous lung metastases and curative or palliative treatment intent. The primary endpoint was 5-year OS. Multivariable Cox-regression and Kaplan-Meier survival analysis were performed.</p><p><strong>Results: </strong>Of 8457 curatively resected CRC patients, 93 (1.1%) had isolated lung metastases (53 synchronous/40 metachronous). Of these, 53 were treated with curative intent, 51 (96%) of whom were managed surgically. The remaining 40 patients were treated palliatively and either with chemotherapy or with best supportive care. Five-year OS was 42% (39/93), median 50 months (IQR: 24-60) for the entire cohort, and 68% (36/53), median 60 months (IQR 55-60) and 7.5% (3/40), median 22 months (IQR: 12-33) for curative and palliative patients, respectively. In multivariable analysis, age (hazard ratio (HR): 1.04, confidence interval (CI): 1.01-1.07), multiple lung metastases (HR: 1.64, CI: 1.08-2.47), and unilateral distribution (HR: 0.41, CI: 0.20-0.84) were predictors of OS.</p><p><strong>Conclusions: </strong>Isolated CRC lung metastases are rare. Curative treatment was associated with considerably better 5-year OS than palliative treatment (68% vs 8%). Age, solitary metastases, and unilateral distribution were predictors of survival.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251319849"},"PeriodicalIF":2.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634807","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":"Outcomes of biosynthetic collagen prostheses with comparison to cryopreserved arterial homografts for bypass reconstruction in infrainguinal vascular graft infections.","authors":"Matthaeus Zerdzitzki, Karin Pfister, Wilma Schierling, Florian Zeman, Ingolf Toepel, Markus Steinbauer, Thomas Betz","doi":"10.1177/14574969251320721","DOIUrl":"https://doi.org/10.1177/14574969251320721","url":null,"abstract":"<p><strong>Background and aims: </strong>Managing infrainguinal vascular graft infections (VGI) in bypass reconstruction is complex. Although an autologous vein is the preferred graft material, alternative conduits are required when autologous veins are unavailable. This study aimed to compare the efficacy of cryopreserved arterial homografts and biosynthetic glutaraldehydemodifiedovine collagen grafts (Omniflow II) for the treatment of infrainguinal VGI.</p><p><strong>Methods: </strong>The study was retrospective across two centers and included patients with infrainguinal VGI treated with cryopreserved arterial homografts or Omniflow II grafts between 2009 and 2019. Freedom from reinfection, primary patency rates, amputation-free survival, and overall survival were analyzed using 5-year Kaplan-Meier estimates.</p><p><strong>Results: </strong>Overall, 63 patients with infrainguinal VGI were treated with either Omniflow II grafts (n = 34) or cryopreserved arterial homografts (n = 29). At 5 years, freedom from reinfection was 97.1% for Omniflow II grafts and 93.1% for cryopreserved arterial homografts (p = .4). Primary patency was 50% for Omniflow II grafts and 55.2% for the cryopreserved arterial homografts (p = .5). Amputation-free survival was 52.9% for Omniflow II grafts and 55.2% for cryopreserved arterial homografts (p = .7). No graft degeneration or graft ruptures were observed during the follow-up.</p><p><strong>Conclusions: </strong>This study suggests that biosynthetic grafts are viable and accessible alternatives for traditional graft materials, offering similar efficacy and ease of use. Although autologous vein grafts remain the gold standard for VGI management, biosynthetic grafts may serve as a viable alternatives to cryopreserved arterial homografts in the treatment of infrainguinal VGIs.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251320721"},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617823","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":"Secondary aortic intervention may not impair survival in patients treated with TEVAR for type B aortic dissection: A Finnish national registry study.","authors":"Toimela Juhana, Hedman Marja, Selander Tuomas, Husso Annastiina","doi":"10.1177/14574969251321967","DOIUrl":"https://doi.org/10.1177/14574969251321967","url":null,"abstract":"<p><strong>Background and aims: </strong>This study investigated patients with type B aortic dissection (TBAD) who were treated with thoracic endovascular aortic repair (TEVAR). The aim was to study whether patients who needed secondary aortic intervention (SAI) had worse survival than patients who did not require SAI after the initial TEVAR.</p><p><strong>Methods: </strong>Data were collected from the National Care Register for Health Care (CRHC) at the Finnish National Institute for Health and Welfare. All Patients over 15 years of age with TBAD (ICD-10; I71.01) treated with TEVAR during the years 2000-2019 were included in the study. Data were collected retrospectively. A data search of the Official Statistics of Finland Cause of Death registry was carried out to identify the date and cause of death in patients with TBAD.</p><p><strong>Results: </strong>236 patients with TBAD received TEVAR as primary operative treatment from year 2000 to 2019. SAI after initial TEVAR was performed in 45 (17%) patients during median follow-up time of 5.1 years. There was no significant difference in survival between the patients who underwent primary TEVAR alone and those who required additional SAI (<i>p</i> = 0.063). Age-adjusted survival did not differ between the groups either. Median follow-up time was significantly longer in the SAI group compared to patients with no SAI (5.9 vs 4.9 years, <i>p</i> = 0.047). The most common cause of death in both groups was an aortic-related event (47%).</p><p><strong>Conclusions: </strong>Based on this study, SAIs may not impair the overall survival of patients previously treated with TEVAR for TBAD. Systematic follow-up after the initial TEVAR may be beneficial in identifying patients with TBAD who may require secondary operation.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251321967"},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626417","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":"Long-term glycemic control after sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus.","authors":"Randi S Gamlestøl, John R Andersen, Villy Våge","doi":"10.1177/14574969251321965","DOIUrl":"https://doi.org/10.1177/14574969251321965","url":null,"abstract":"<p><strong>Background and objectives: </strong>Long-term studies exploring factors associated with glycemic control of type 2 diabetes mellitus (T2DM) after bariatric surgery are being requested. This prospective cohort study aimed to evaluate potential predictors of long-term glycemic control 5 years after surgery.</p><p><strong>Methods: </strong>Patients were operated between 2002 and 2014. Data were collected prospectively in a database after obtaining written informed consent from the patients. Surgical methods were sleeve gastrectomy (SG) or biliopancreatic diversion with duodenal switch (BPDDS). Possible predictors of postoperative long-term glycemic control (HbA1c) were investigated using multiple path regression analysis, which handles missing data.</p><p><strong>Results: </strong>A total of 181 patients were included consecutively, 87 after SG and 94 after BPDDS. The follow-up rate was 124/181 (69%), 57 (66%) after SG and 67 (71%) after BPDDS. We found that 39/57 (68%) of the patients who underwent SG and 54/67 (81%) of the patients who underwent BPDDS had remission of T2DM at 5 years. Lower preoperative HbA1c (P < 0.010), higher preoperative C-peptide (P = 0.004), greater percent total weight loss (P < 0.005), and the BPDDS procedure (P < 0.001) were associated with better postoperative long-term glycemic control (explained variance = 39.4%).</p><p><strong>Conclusions: </strong>Both procedures, especially BPDDS, were effective in achieving long-term glycemic control. Lower preoperative HbA1c, higher C-peptide levels, greater weight loss, and the BPDDS procedure were key predictors of better long-term glycemic control.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251321965"},"PeriodicalIF":2.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol.","authors":"Heidi Lund, Jussi Haijanen, Saku Suominen, Saija Hurme, Suvi Sippola, Tuomo Rantanen, Tero Rautio, Anne Mattila, Tarja Pinta, Pia Nordström, Jyrki Kössi, Imre Ilves, Paulina Salminen","doi":"10.1177/14574969241293018","DOIUrl":"10.1177/14574969241293018","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic therapy is currently considered a safe and effective treatment alternative for computed tomography (CT)-confirmed uncomplicated acute appendicitis with recent studies reporting good results on both oral antibiotics only and outpatient management. Furthermore, there are promising pilot results on uncomplicated acute appendicitis management with symptomatic treatment (placebo). This trial aims to assess whether both antibiotics and hospitalization can be safely omitted from the treatment of uncomplicated acute appendicitis.</p><p><strong>Methods: </strong>The APPAC IV (APPendicitis Acuta IV) trial is a randomized, double-blind, multicenter noninferiority clinical trial comparing oral moxifloxacin with oral placebo in an outpatient setting with a discharge directly from the emergency room (ER). Adult patients (18-60 years) with CT-confirmed uncomplicated acute appendicitis (absence of appendicolith, abscess, perforation, tumor, appendiceal diameter ⩾15 mm on CT, or body temperature >38 °C) will be enrolled in nine Finnish hospitals. Primary outcome is treatment success at 30 days, that is, the resolution of acute appendicitis resulting in discharge from the hospital without appendectomy during the 30-day follow-up evaluated using a noninferiority design with a noninferiority margin of 6 percentage points. Noninferiority will be evaluated using one-sided 95% confidence interval of proportion difference between groups. Secondary endpoints include postintervention complications, recurrent appendicitis after the 30-day follow-up, duration of hospital stay, admission to hospital and reason for admission, readmissions to emergency department or hospitalization, VAS pain scores, quality of life, sick leave, and treatment costs. The follow-up after discharge from the ER includes a phone call at day 1, and at 3-4 days, 30 days, and 1, 3, 5, 10, and 20 years. Those eligible patients, who decline to undergo randomization, will be invited to participate in a concurrent observational cohort study with follow-up at 30 days, and 1 and 5 years.</p><p><strong>Discussion: </strong>To our knowledge, APPAC IV trial is the first large randomized, double-blind, noninferiority multicenter clinical trial aiming to compare oral antibiotics and placebo for CT-diagnosed uncomplicated acute appendicitis in an outpatient setting. The study aims to bridge the major knowledge gap on whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated acute appendicitis.</p><p><strong>Trial registration: </strong>The study protocol has been approved by the Clinical Trials Information System (CTIS) of the European Medicines Agency (EMA), study number: 2023-506213-21-00 and the trial has been registered in ClinicalTrials.gov, NCT06210269.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"3-12"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786564","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}