Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Intraoperative frozen section diagnostics for low rectal cancer-Primary surgery vs. neoadjuvant pretreatment].","authors":"Franziska Eckert, Daniela Aust, Johanna Kirchberg, Jürgen Weitz, Johannes Fritzmann","doi":"10.1007/s00104-025-02272-5","DOIUrl":"10.1007/s00104-025-02272-5","url":null,"abstract":"<p><p>Depending on the extent of the tumor, the treatment strategies for rectal cancer include primary surgical resection or, in the case of locally advanced carcinoma, neoadjuvant chemo(radio)therapy (C[R]Tx) or total neoadjuvant therapy (TNT), usually followed by surgical treatment. During resection, it is important to find a balance between radicality and preservation of function. Current data show that shorter safety margins are possible for patients who received neoadjuvant treatment without compromising the oncological outcome. This enables continence-preserving surgery in many patients with low rectal cancer. In these cases in particular, intraoperative frozen section diagnostics play a central role in confirming tumor-free margins. However, frozen section diagnostics also play an important role in the transanal resection of early carcinomas or in the therapy of recurrent rectal cancer. It should not be performed routinely, but rather in a targeted maner for specific questions and the corresponding therapeutic consequences. The informative value of frozen section diagnostics in neoadjuvant treated rectal cancer may be limited, so that the final assessment of the resection status and thus the determination of further therapy must be based on paraffin-embedded sections.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"365-370"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evidence of intraoperative frozen section examinations].","authors":"Christiane J Bruns","doi":"10.1007/s00104-025-02283-2","DOIUrl":"https://doi.org/10.1007/s00104-025-02283-2","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":"96 5","pages":"363-364"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Frozen section in oncologic endocrine surgery].","authors":"Costanza Chiapponi, Atsuko Kasajima","doi":"10.1007/s00104-025-02266-3","DOIUrl":"10.1007/s00104-025-02266-3","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study is to discuss the benefits of intraoperative frozen sections (FS) for the surgical management of endocrine tumors.</p><p><strong>Methods: </strong>A systematic search of the literature of the last ten years on FS in the field of oncologic endocrine surgery was carried out and a discussion based on the available evidence and experience of the authors is provided.</p><p><strong>Results: </strong>A group of publications focused on the role of intraoperative FS in thyroid surgery in identifying the malignant potential of thyroid nodules. The detection of lymph node metastasis and extrathyroidal growth in differentiated thyroid cancer (DTC) were also two other topical groups as well as the diagnosis of lymph node involvement based on stromal desmoplasia in medullary thyroid cancer (MTC). A further group investigated the possibilities of deep learning to overcome technical problems and another investigated the cost-benefit analyses. There is no relevant literature on the role of FS in the surgical treatment of parathyroid and adrenal cancers.</p><p><strong>Discussion: </strong>The synthesis of the available evidence suggests that FS investigations of the thyroid glands should be restricted to Bethesda V nodules. The technical limitations in the exclusion of vascular and capsular invasion make the FS unsuitable for follicular neoplasms and oncocytic lesions. The Delphi lymph node seems to be suitable for investigation using FS and when positive represents an indication for lymphadenectomy in cN0 patients. Larger studies are necessary in the future to confirm if the absence of desmoplasia with an intact tumor capsule can reliably justify omitting lymph node resection in MTC, independent of the calcitonin level. The costs and benefits depend on the individual context so that generalization is difficult. Deep learning models could generally improve the performance of FS analysis in the future.</p><p><strong>Conclusion: </strong>In thyroid surgery awareness of the technical limitations of FS is crucial for correct implementation and thus to optimize its performance. A preoperative fine needle biopsy and surgical experience help in selecting the nodules that can benefit from FS. Deep image learning could help to overcome current problems in the future. In adrenal and parathyroid oncologic surgery FS do not play a relevant role.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"385-393"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Plastic surgical treatment of neurofibromatosis type 1].","authors":"Gregor Längle, Andreas Gohritz, Clemens Gstöttner, Leopold Harnoncourt, Hannes Platzgummer, Amedeo A Azizi, Oskar Aszmann","doi":"10.1007/s00104-024-02232-5","DOIUrl":"10.1007/s00104-024-02232-5","url":null,"abstract":"<p><p>Neurofibromatosis type 1 (NF1, formerly Recklinghausen's disease) is a genetic tumor predisposition syndrome in which the mutation of a tumor suppressor gene (neurofibromin) leads to the development of mostly benign neurofibromas of the skin and the central and peripheral nervous systems and malformations or tumors of other organ systems. Patients with NF1 should receive lifelong interdisciplinary care in specialized centers and important treatment decisions should be made by a regularly meeting interdisciplinary panel of experts. Plastic surgery plays an important role in the multidisciplinary management of all clinical forms of NF1-associated peripheral nerve sheath tumors, from cutaneous and subcutaneous to deep nodular and diffuse plexiform neurofibromas. Each patient requires individualized surgical planning, whereby the timing and extent of surgery are determined by the accompanying symptoms, functional and esthetic limitations, disease progression and potential malignant transformation. As any region of the body can be affected, the esthetic and reconstructive procedures required include a wide range of interventions, such as eyelid surgery and facial restoration to breast shaping and nerve reconstruction or motor replacement surgery. A timely surgical intervention can have a profoundly positive effect on the course of the disease and the quality of life of those affected and, in the case of transformation into a malignant peripheral nerve sheath tumor (MPNST), can even be lifesaving.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"394-404"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cure probabilities after resection of ductal adenocarcinoma of the pancreas: a multi-institutional analysis of 2554 patients].","authors":"Laura Schwenk, Michael Ardelt, Utz Settmacher","doi":"10.1007/s00104-025-02280-5","DOIUrl":"10.1007/s00104-025-02280-5","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"421-422"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Randomized comparison of oncologic robotic vs. laparoscopic distal gastrectomy: results of a prospective phase 2 study].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-025-02299-8","DOIUrl":"https://doi.org/10.1007/s00104-025-02299-8","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Is the procedure or the patient decisive for prehabilitation?]","authors":"Lara Braun, Lucrezia De Santis, Alexander Semaan, Jörg C Kalff, Tim O Vilz","doi":"10.1007/s00104-025-02293-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02293-0","url":null,"abstract":"<p><p>Various studies on structured prehabilitation programs indicate positive effects on performance status, postoperative complication rates and possibly overall survival in patients with gastrointestinal carcinomas. Older and multimorbid patients in particular could benefit from a trimodal approach that addresses physical fitness, nutritional status and mental health. Challenges exist in the possibly limited ability to participate due to pre-existing physical or mental limitations. Previous studies have shown reduced complication rates and shorter hospital stays for this patient group but the data remain heterogeneous and limited. Future research should further investigate the benefits for specific patient groups and different procedures as well as the long-term oncological outcome.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The stress level of surgeons influences surgical complications].","authors":"Katharina Vedder, Christoph Reissfelder","doi":"10.1007/s00104-025-02302-2","DOIUrl":"https://doi.org/10.1007/s00104-025-02302-2","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Specialty-specific knowledge as prerequisite for effective treatment of critically ill patients].","authors":"Sonja Vonderhagen, Uwe Hamsen, Andreas Markewitz, Ingo Marzi, Gerrit Matthes, Andreas Seekamp, Georg Trummer, Felix Walcher, Christian Waydhas, René Wildenauer, Jens Werner, Wolfgang H Hartl, Thomas Schmitz-Rixen","doi":"10.1007/s00104-025-02286-z","DOIUrl":"https://doi.org/10.1007/s00104-025-02286-z","url":null,"abstract":"<p><p>Since the last meeting of the German Medical Association in May 2024, there has been a discussion in Germany about the shortening of primary specialty training and a transfer of the contents of additional supra-specialty training to the existing primary specialty training. This also affects intensive care medicine, with the prospect of creating a subspecialty for subspecialties in intensive care medicine (e.g., a specialty in surgical intensive care medicine). We consider the associated reduction of general specialty-specific contents to be inappropriate for several reasons. Knowledge of the specialty-specific trigger factors (foci) of a critical illness (organ dysfunction) as well as knowledge of the respective trigger factor-specific symptoms, diagnostics and pathways for initiating a causal treatment, are decisive for the prognosis. Recent evidence suggests that in the case of septic foci a time span between making the diagnosis and treatment of the focus should not exceed ca. 6h in order to avoid a worsening of the prognosis. To ensure that the time between symptom onset and effective treatment of the causal factors is not too long, an in-depth expertise in the primary specialty is required throughout the process. This expertise is independent of training in intensive care medicine and can only be acquired through adequate training in the specialty, followed by additional training in intensive care medicine. Expertise in the primary specialty is a prerequisite for the effective treatment of critically ill patients. Maintaining the training specific to the primary specialty and the associated acquisition of specific knowledge in the respective specialty also enables a wider deployment of specialists in clinical practice and a more economical use of diagnostic and therapeutic resources. The additional training in intensive care medicine (supraspecialty) should not be at the expense of content specific to the primary specialty and must remain accessible to all surgical specialties in the field of surgery in the next revision of the training regulations. Due to the unavoidable extent, the additional training in intensive care medicine can itself only be provided on a full-time basis.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Osteitis pubis and spinal diseases : Differential diagnosis of groin pain].","authors":"Martin C Jordan, Stefan Zwingenberger, Martin Burchardt, Willi L Wagner, Mark O Wielpütz, Georgi Wassilew","doi":"10.1007/s00104-025-02284-1","DOIUrl":"https://doi.org/10.1007/s00104-025-02284-1","url":null,"abstract":"<p><p>Aseptic osteitis pubis can be a possible cause of groin pain in young physically active patients. As a correlation with femoroacetabular impingement has been demonstrated, this pathological condition should also be considered as a possible cause. In older patients aseptic osteitis pubis is usually a degenerative alteration of the symphysis, which can also lead to groin pain. It is important to distinguish this from septic osteitis pubis, which is often associated with infections in the region of the true pelvis or previous surgery in this area. Vertebrogenic causes of groin pain are attributable to irritation of the nerve roots L1-L3, which can result from inflammatory, traumatic or degenerative alterations of the spine. This article provides an overview of these differential diagnoses based on case examples.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}