Scandinavian Journal of Surgery最新文献

{"title":"Comparison of oncological outcomes of T1-3 N1 rectal cancer patients treated with neoadjuvant radiotherapy versus no radiotherapy: A retrospective cohort study.","authors":"Suvi Marjasuo, Laura Koskenvuo, Anna Lepistö","doi":"10.1177/14574969251319201","DOIUrl":"10.1177/14574969251319201","url":null,"abstract":"<p><strong>Background and aims: </strong>Neoadjuvant short-course radiotherapy (SCRT) prior to surgery has been used to reduce local recurrences in moderately advanced rectal cancer (RC). Total mesorectal excision (TME) surgery by itself can reduce the local recurrence rate in these patients. The objective was to assess whether discontinuing neoadjuvant SCRT had a negative impact on survival and local recurrence rates of moderately advanced RC.</p><p><strong>Methods: </strong>This retrospective study examined 137 consecutive patients (67 neoadjuvant SCRT, 70 TME without neoadjuvant therapy) treated for rT1-3N1M0 RC without extramural venous invasion (EMVI) or a threatened surgical margin between January 2016 and March 2020 in a tertiary rectal surgery referral center. The primary objective was the impact of neoadjuvant therapy on overall, cancer-specific, and disease-free survival, and local recurrence rate. Secondary outcomes were risk factors affecting survival. The analyses were conducted on the total study cohort as well as a propensity score matched cohort of the same patient group, with the matching predicated upon age, gender, and histological T score.</p><p><strong>Results: </strong>The oncological outcomes were similar between the two different treatment groups. The 5-year cumulative overall survival rate, calculated using the Kaplan-Meier method, was 89.6% in the neoadjuvant SCRT group and 83.5% in the surgery-only group (<i>p</i> = 0.570), with the corresponding cancer-specific survival rates at 97.0% and 98.4% (<i>p</i> = 0.219) and disease-free survival rates at 97.0% and 91.9% (<i>p</i> = 0.438). No local recurrencies were detected in either group during the 5-year follow-up period.</p><p><strong>Conclusion: </strong>The omission of neoadjuvant SCRT in rT1-3N1M0 RC with no EMVI and no threatened resection margin caused no adverse effects on the survival of the patients. Based on this series, it appears that avoiding SCRT does not compromise the oncological outcome in these patients.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"202-209"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416018","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":"Clinical prediction model for gangrenous appendicitis: A retrospective single-center study.","authors":"Toshiyuki Suzuki, Akiyo Matsumoto, Daisuke Sugiki, Takahiko Akao, Hiroshi Matsumoto","doi":"10.1177/14574969251319853","DOIUrl":"10.1177/14574969251319853","url":null,"abstract":"<p><strong>Background and aims: </strong>Gangrenous appendicitis, a type of complicated appendicitis, is an indication of emergency surgery due to a high risk of perforation. However, it can be challenging to diagnose preoperatively. This study aimed to validate the predictive factors of patients with gangrenous appendicitis and develop a novel scoring model based on objective parameters.</p><p><strong>Methods: </strong>This retrospective single-center study included 171 of 302 consecutive patients undergoing appendectomy between April 2014 and December 2023. Patients with perforation, chronic appendicitis, and appendicitis presenting with an abscess were excluded from the analysis. In other words, the study targeted Grades 1 and 2 on the American Association for the Surgery of Trauma (AAST) severity assessment scale. Computed tomography (CT) scan value was defined as the average value of fluid in the appendix lumen on plain CT scan. Univariate and multivariate analyses were performed to identify the independent objective predictors of gangrenous appendicitis. A new scoring model was developed based on the logistic regression coefficients of the independent predictors. The scores were then classified into three categories, and the probability of gangrenous appendicitis for each category was evaluated.</p><p><strong>Results: </strong>Overall, 46 (27%) and 125 (73%) patients presented with gangrenous appendicitis (=AAST Grade 2) and non-gangrenous (uncomplicated) appendicitis (=AAST Grade 1), respectively. The independent predictive factors of gangrenous appendicitis included a CT value of ≥24 HU, an appendiceal diameter of ≥12 mm, the presence of cecal mucosal edema, and a C-reactive protein level of ≥5.4 mg/dL. The scoring model, based on these four independent predictors, ranged from 0 to 4. The probability values of gangrenous appendicitis were 0%, 15%, and 97% in the low (0)-, moderate (1, 2)-, and high (3, 4)-risk categories, respectively.</p><p><strong>Conclusion: </strong>Our scoring model may assist in decision-making concerning emergency surgery and appendicitis management.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"210-217"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469782","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":"Corrigendum to \"Swedish female and male general surgeons differ in personality traits\".","authors":"","doi":"10.1177/14574969251359780","DOIUrl":"https://doi.org/10.1177/14574969251359780","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":"114 2","pages":"299"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745812","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":"Swedish female and male general surgeons differ in personality traits.","authors":"My Blohm, Aleksandra McGrath, Sebastian Mukka, Per Jolbäck","doi":"10.1177/14574969241299472","DOIUrl":"10.1177/14574969241299472","url":null,"abstract":"<p><strong>Background and aims: </strong>Evidence suggests that female surgeons achieve comparable or even more favorable outcomes than male surgeons. It is currently unclear what factors contribute to these potential differences. Possible explanations might be differences in personality traits, communication style, attitude, and risk-taking behavior. This cross-sectional study aimed to examine disparities in personality traits between male and female general surgeons in Sweden.</p><p><strong>Methods: </strong>The research was conducted as a cross-sectional study of personality traits. Between August 29, 2022, and December 15, 2023, Swedish specialists in general surgery were invited to participate in an online survey. The survey, assessed with the Big Five Inventory, collected information on self-reported surgeon gender, years in practice, employment data, and differences in personality traits.</p><p><strong>Results: </strong>The analysis encompassed responses from 223 Swedish general surgeons: 121 (54%) males and 102 (46%) females. In contrast to female surgeons, male surgeons were older and had longer surgical experience. A higher proportion of male surgeons were employed in rural hospitals. Higher mean scores were observed in all personality traits among female surgeons. The adjusted analysis showed significantly higher scores for conscientiousness (p < 0.001), extraversion (p < 0.001), agreeableness (p = 0.006), and neuroticism (p < 0.001); however, no such change was observed for openness.</p><p><strong>Conclusion: </strong>This cross-sectional study demonstrates that Swedish female and male surgeons differ in personality traits. The implications of these results could lead to a deeper understanding of the variations in surgical outcomes based on the gender of the surgeon.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"164-171"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677885","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":"Rib-sparing scalenotomy in thoracic outlet syndrome treatment: A systematic review and meta-analysis.","authors":"Niina Ruopsa, Heidi Vastamäki, Tero Vahlberg, Martti Vastamäki, Leena Ristolainen","doi":"10.1177/14574969251332910","DOIUrl":"10.1177/14574969251332910","url":null,"abstract":"<p><strong>Background and aims: </strong>The majority of neurogenic thoracic outlet syndrome (NTOS) surgery still involves removal of the first rib. A rib-sparing procedure has also been found to give a good result, but no meta-analysis has been published about this procedure. Also, from a financial point of view, it is important to know what kind of results have been obtained in the treatment of NTOS with rib-sparing surgery. Our opinion is that first-rib resection (FRR) surgeries, which contain more complications and require a longer recovery time, are performed too often these days, if the same result is achieved with rib-sparing surgery.</p><p><strong>Methods: </strong>We accomplished a systematic review and meta-analysis to find out the outcome of rib-sparing NTOS surgery, collecting studies on rib-sparing supraclavicular scalenotomy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using appropriate databases.</p><p><strong>Results: </strong>Of 1354 studies, 18 studies met our inclusion criteria. The mean study sample size was 58, and the mean patient age at surgery was 35.8 years. All studies reported long-term outcomes, with the mean follow-up time of 49 months. All reported fewer patient complaints after surgical TOS treatment. In our meta-analysis, improvement to Derkash's excellent/good classifications was achieved in 71% (95% confidence interval (CI) = 64.4% to 76.4%, I² = 73.0%). The heterogeneity noted in the systematic review showed no significant moderation by gender, age, or follow-up time. The studies included had a low risk of publication bias, with most failing to use validated evaluation methods.</p><p><strong>Conclusion: </strong>According to this analysis, the rib-sparing surgical treatment of NTOS is beneficial to most patients and relatively safe. Still, future studies should accommodate validated thoracic outlet scales.Type of study / level of evidence:Therapeutic IV.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"266-275"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019613","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 for breast cancer liver and lung metastases: A review.","authors":"Ellen Hansson, Charlotta Wadsten, Oskar Hemmingsson","doi":"10.1177/14574969251333526","DOIUrl":"10.1177/14574969251333526","url":null,"abstract":"<p><strong>Background and objective: </strong>Breast cancer liver and lung metastases are common and associated with poor prognosis. Personalized medical treatment of advanced breast cancer, based on established predictive factors, has improved survival during the last decades. In contrast, there is no consensus regarding indications for surgery. The aim of this narrative review is to summarize the current knowledge on the outcome of surgical treatments for breast cancer liver and lung metastases.</p><p><strong>Method: </strong>A narrative review of existing evidence for diagnosis and treatment of breast cancer liver and lung metastases.</p><p><strong>Results: </strong>There are no randomized trials to evaluate surgery as an adjunct to medical treatment. In this review, data are reported from case-control studies and meta-analyses on surgery for liver and lung metastases. Selected patients have an improved survival after surgery compared to those who only received medical treatment. The survival benefit is, however, uncertain when adjusting for prognostic factors, and prospective trials are warranted. Anecdotal cases have long-term survival and surgery is safe.</p><p><strong>Conclusion: </strong>Surgery for breast cancer liver and lung metastases may be considered in selected cases within prospective studies.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"135-141"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051887","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":"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":"248-257"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","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":"Comparison of reconstruction techniques after pancreatoduodenectomy: A single-center retrospective cohort study.","authors":"Iago Justo Alonso, Paola Peralta Fernández-Revuelta, Alberto Marcacuzco Quinto, Oscar Caso Maestro, Laura Alonso Murillo, Carlos Jiménez-Romero","doi":"10.1177/14574969241312287","DOIUrl":"10.1177/14574969241312287","url":null,"abstract":"<p><strong>Background: </strong>There is controversy regarding which is the best reconstruction technique after the pancreatoduodenectomy. Currently, there are no studies comparing the three most frequent reconstruction techniques: Whipple + Roux-en-Y gastrojejunostomy (WRYGJ), pyloric-preserving + Billroth II (PPBII), and Whipple + BII (WBII).</p><p><strong>Methods: </strong>Between 2012 and March 2023, 246 patients underwent pancreaticoduodenectomy with the following type of reconstruction techniques: (1) WRYGJ: 40 patients; (2) PPBII: 118 patients; and (3) WBII: 88 patients. A retrospective comparative study among these groups was performed.</p><p><strong>Results: </strong>No significant differences were found among the groups regarding duration of the surgery, the blood volume transfused, or caliber of the Wirsung duct. The size and types of tumors, the degree of differentiation and tumor invasion of the peripancreatic tissue, vascular and neural structures, and lymph nodes were similar among the groups. The rate of R0 resection was lower in WBII (62.5% [55/88]) than in WRYGJ (75% [30/40]) and PPBII (72% [85/118]), but statistically insignificant among the groups (p = 0.232). The incidences of relevant B/C postoperative pancreatic fistula (POPF) were similar among the groups: 7.5% (7/40) in WRYGJ, 17% (20/118) in PPBI, and 26.2% (23/88) in WBII (p = 0.292). In addition, the incidence of B/C delayed gastric emptying (DGE) was higher in WBII (27.3% [24/88]) than in WRYGJ (20% [8/40]) and PPBII (19.5% [23/118]) but statistically insignificance among the groups (p = 0.381). The incidence of medical and surgical complications, intensive care unit and hospital stays, morbimortality at 90 days, and 5-year survival were similar among the groups. Multivariate analysis revealed that POPF grade B/C was a risk factor for DGE grade B/C (odds ratio (OR) = 9.903, 95% confidence interval (CI) = 4.829-20.310; p < 0.001), and a <3-mm Wirsung duct was a risk factor for POPF (OR = 3.604, 95% CI = 1.791-7.254; p < 0.001).</p><p><strong>Conclusion: </strong>No technique was superior to the others. Only relevant POPF B/C was a risk factor for DGE B/C, and <3 mm Wirsung for a POPF.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"183-193"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957823","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":"Review of frailty in geriatric surgical oncology.","authors":"Joanna Abi Chebl, Ponnandai Somasundar, Lidia Vognar, Steve Kwon","doi":"10.1177/14574969241298872","DOIUrl":"10.1177/14574969241298872","url":null,"abstract":"<p><p>Frailty is a common phenomenon in older adult population and associated with an elevated risk of adverse health outcomes. Recent studies have demonstrated that patients with frailty undergoing surgery had a significantly higher morbidity and mortality compared to those without frailty. This is particularly important in patients with cancer because the prevalence of frailty is persistently high across a spectrum of primary cancers. Identifying frailty in oncological patients undergoing surgery may provide an important preoperative intervention opportunity to mitigate operative risks. In this review, we provide an overview of frailty and its association with other geriatric syndromes. We will also review the impact of frailty on postoperative outcomes focusing on the field of surgical oncology. We then describe currently available tools to objectively measure frailty to provide clinicians with various practical tools that may be adopted in their clinical practice. Finally, we will describe potential interventional programs, including the recently introduced Geriatric Surgery Verification program by the American College of Surgeons, that may be institutionally adopted to mitigate postoperative complications and improve meeting patient-centered goals in the frail patient population.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"276-285"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683261","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":"Modern surgical treatments for lymphedema.","authors":"Marie Kearns, Susanna Kauhanen, Maria Mani","doi":"10.1177/14574969241300101","DOIUrl":"10.1177/14574969241300101","url":null,"abstract":"<p><p>Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"286-296"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774085","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}