Annali italiani di chirurgia最新文献

{"title":"A Novel Ensemble Approach for Rib Fracture Detection and Visualization using CNNs and Grad-CAM.","authors":"Ling Wu, Hongyu Chen, Puxu Li, Kai Yang","doi":"10.62713/aic.3666","DOIUrl":"https://doi.org/10.62713/aic.3666","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to develop a reliable and efficient system for predicting and locating rib fractures in medical images using an ensemble of convolutional neural networks (CNNs).</p><p><strong>Methods: </strong>We employed five CNN architectures-Visual Geometry Group Network 16 (VGG16), Densely Connected Convolutional Network 169 (DenseNet169), Inception Version 4 (Inception V4), Efficient Network B7 (EfficientNet-B7), and Residual Network Next 50 layers (ResNeXt-50)-trained on a dataset of 840 grayscale computed tomography (CT) scan images in .jpg format collected from 42 patients at a local hospital. The images were categorized into two groups representing healed and fresh fractures. The ensemble model was designed to improve predictive accuracy and robustness, utilizing techniques like gradient-weighted class activation mapping (Grad-CAM) for visualization of fracture locations.</p><p><strong>Results: </strong>The ensemble model achieved an accuracy of 0.96, area under the curve (AUC) of 0.97, recall of 0.97, and F1 score of 0.96. Grad-CAM visualizations could effectively locate rib fractures, providing crucial assistance in diagnostics.</p><p><strong>Conclusions: </strong>The ensemble model demonstrates high accuracy and robustness in fracture detection, underscoring its potential for enhancing diagnostic processes in clinical settings. Despite limitations such as the small dataset size and lack of diverse demographic representation, the results are promising for future clinical application.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"86-97"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Outcomes of Low Anterior Resection Syndrome in Patients Undergoing Preventive Ostomy for Laparoscopic Rectal Cancer Surgery.","authors":"Guizhi Luo, Jinhong Lu, Youzhuan Yang, Hongchao Ma","doi":"10.62713/aic.3773","DOIUrl":"https://doi.org/10.62713/aic.3773","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing preventive colostomy following laparoscopic rectal cancer surgery. Additionally, the outcomes of LARS were analyzed to provide evidence for effective prevention and treatment strategies.</p><p><strong>Methods: </strong>The medical records of 143 patients with laparoscopic rectal cancer who underwent preventive ostomy at the Zhujiang Hospital of Southern Medical University between January 2020 and October 2022 were retrospectively reviewed. All patients underwent ostomy reversal within 2 to 6 months post-surgery. The LARS score scale was used to evaluate the occurrence of LARS at 3, 6, and 12months post-surgery. Based on LARS scores, patients were divided into LARS and non-LARS groups. Clinical characteristics, including gender, TNM stage, and other related data, were compared between the two groups. Multivariate logistic regression analysis was conducted to identify risk factors for LARS, and the predictive performance of the regression model was evaluated using the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>The LARS score demonstrated a significant decrease over time after surgery (p < 0.05). LARS was identified in 80 patients (55.94%) at 3 months post-surgery, with no new cases reported after this period. Statistically significant differences between the LARS and non-LARS groups were observed in body mass index (BMI), tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal (p < 0.05). The ROC curve analysis revealed that the logistic regression model predicting LARS had an area under the curve (AUC) of 0.809 (95% CI: 0.735-0.870), with a sensitivity of 76.25% and a specificity of 79.37%. Among the LARS patients 3 months post-surgery, 73.75% (59/80) showed improvement by 12 months. The improvement rate in patients with mild LARS (87.93%) was significantly higher than in those with severe LARS (36.36%) (p < 0.05).</p><p><strong>Conclusions: </strong>The incidence of LARS is relatively high in patients undergoing preventive ostomy after laparoscopic rectal cancer surgery. Key factors associated with LARS include BMI, tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal. Over time, the incidence of LARS decreases, and outcomes improve, especially in patients with mild LARS.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"152-159"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Specific Rods vs Traditional Rods in Surgical Correction of Adult Spinal Deformities: A Case-Matched Study.","authors":"Luigi Aurelio Nasto, Chiara Paolicelli, Angelo Sieczak, Paolo Ulisse, Alessandro Cattolico, Enrico Pola","doi":"10.62713/aic.3367","DOIUrl":"https://doi.org/10.62713/aic.3367","url":null,"abstract":"<p><strong>Aim: </strong>Patient specific pre-contoured rods (PSRs) represent a relatively new technological development aimed at improving surgical outcomes and reducing complications in adult spinal deformity surgery. To date, only a limited number of studies have been published comparing PSRs with traditional spinal rods. In this paper, we compare the surgical, imaging, and clinical outcomes of PSRs and traditional spinal rods in a single-center case-matched study.</p><p><strong>Methods: </strong>Thirty cases of adult spinal deformities (ASD) were retrospectively analysed. These included 10 patients who were operated on using UNiD™ (Adaptive Spine Intelligence, MedTronic, Minneapolis, MN, USA) PSRs and 20 operated on using traditional rods from January 2023 to August 2023. Minimum post-surgical follow-up was 6 months. General demographics and standard radiographic parameters, as well as Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI) and Short Form Health Survey (SF-12) Scores, were measured at pre-operative examination and at 6-month follow-up. Follow-up imaging data were compared with software-planned correction goals. Intra-operative data and complications were also recorded.</p><p><strong>Results: </strong>Patients in the two groups were matched in terms of age, body mass index (BMI), sex, type and severity of spinal deformity. The magnitude of the coronal deformity (p = 0.812) and preoperative sagittal imbalance (p = 0.845) were similar between the two groups. The number of fused levels (p = 0.439), osteotomies (p = 0.188), implant density (p = 0.880), and surgery duration (p = 0.299) were similar between the two groups. Sagittal correction goals set during preoperative planning were achieved in the PSRs group, with the exception of pelvic tilt (PT) (p = 0.042). In contrast, PT (p = 0.040), L1-S1 lordosis (p = 0.032) and global tilt (GT) (p = 0.001) remained significantly undercorrected in the control group at 6-month follow-up. Clinical outcomes (ODI and SF-12 Scores) and complication rates were similar between the two groups.</p><p><strong>Conclusions: </strong>The use of PSRs improves the achievement of better post-operative spinopelvic alignment in adult spinal deformity surgery. Moreover, no significant differences were noted in terms of complications, operative times, and clinical outcomes compared to traditional spinal rods at 6-month follow-up.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"116-123"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Hypothermia during Laparoscopic or Open Surgery of Colorectal Cancer under General Anesthesia.","authors":"Yi-Hui Tu, Di Zhang","doi":"10.62713/aic.3548","DOIUrl":"https://doi.org/10.62713/aic.3548","url":null,"abstract":"<p><strong>Aim: </strong>Colorectal cancer (CRC) is one of the most prevalent malignancies, which is commonly treated with curative surgical resection, often leading to intraoperative hypothermia. Therefore, this study aimed to compare and analyze the risk factors for intraoperative hypothermia associated with laparoscopic and open CRC resections under general anesthesia.</p><p><strong>Methods: </strong>This study included 120 CRC patients admitted between January 2023 and January 2024. Data from these patients were analyzed using logistic regression analysis to investigate the risk factors for hypothermia during CRC surgery. Additionally, surgical indicators such as, intraoperative bleeding volume, number of lymph nodes dissected, and operation time, and serum inflammatory markers like Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were assessed and compared between the two surgical groups.</p><p><strong>Results: </strong>The study group comprised 41 men and 79 women, with a mean age of 52.53 ± 8.90 years and an average body mass index (BMI) of 23.13 ± 3.32 kg/m2. The American Society of Anesthesiologists (ASA) score was measured as 1 for 62 (51.67%) patients and 2 for 58 (48.33%). Among them, 50 patients underwent open surgery, whereas 70 patients were treated with laparoscopic surgery. Gender, laparoscopic surgery, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion were determined as the independent risk factors for intraoperative hypothermia during CRC surgery under general anesthesia (p < 0.05). The intraoperative bleeding volume was significantly reduced (p < 0.01), with significantly longer operation time (p < 0.05) in patients treated with laparoscopic surgery compared to those with open surgery. However, the two groups had a similar number of lymph nodes dissected. Additionally, the levels of IL-6 and IL-8 in both laparoscopic and open surgery of patients increased significantly after surgery, but the extent of increase in the patients of laparoscopic surgery was significantly lower than that in the patients of open surgery (p < 0.05).</p><p><strong>Conclusions: </strong>In conclusion, gender, surgical approach, intraoperative fluid infusion volume, prolonged anesthesia, and intraoperative blood transfusion are the potential risk factors for hypothermia during laparoscopic radical CRC surgery under general anesthesia.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"108-115"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Current Practice in Chest Tube Management Following Lung Resection-A Canadian National Survey.","authors":"Fabrizio Minervini, Esther Lau, Housne Begum, Yaron Shargall","doi":"10.62713/aic.3535","DOIUrl":"https://doi.org/10.62713/aic.3535","url":null,"abstract":"<p><strong>Aim: </strong>Timing of chest tube removal post lung resection is variable in practice and often based on personal experience rather than evidence. The current practice in chest tube management among thoracic surgeons across Canada is so far unknown. Our primary aim was to assess the current status of chest tube removal in Canada in order to uncover potential shortcomings.</p><p><strong>Methods: </strong>An online anonymous survey was emailed to members of Canadian Association of Thoracic Surgeons in order to better understand the status quo of the chest tubes' removal policy in the different departments preparing the grounds for suggesting a future uniformity. Data were collected and analysed with descriptive statistics. A linear regression analysis was performed in order to understand the factors related to chest tube removal.</p><p><strong>Results: </strong>Sixty responses were received (44.4% response rate). Most surgeons place a single chest tube in both open (75%, 45/60) and minimally invasive lobectomies (93.3%, 56/60). Digital drainage systems are used by half of the surgeons surveyed. A quarter of the respondents report removing chest tubes regardless of drainage output. This practice was independent of the surgeons' number of years in practice (p = 0.127), number of lobectomies performed annually (p = 0.877), proportion of lobectomies performed minimally invasively (p = 0.259), whether digital drainage system is used (p = 0.141) and whether the surgeon is aware of the Enhanced Recovery after Surgery (ERAS) guideline (p = 0.374). Of those who remove chest tubes based on fluid output, thresholds vary widely; a significant proportion (86%, 37/43) uses a volume lower than the 450 mL/24 h threshold set out ERAS. Most respondents (77%) were interested in a clinical trial studying chest tube removal independent of drainage volume.</p><p><strong>Conclusions: </strong>This study demonstrated ongoing diverse practice amongst thoracic surgeons in Canada with regards to post-operative chest tube management, indicating a much-needed area of research.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"69-77"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Performance of an Innovative Model for the Organisation of Specialised Hospital Activities throughout Italy: The \"Diffuse Hospital\".","authors":"Mattia Morri, Cristiana Forni, Anselmo Campagna, Annella Mingazzini, Viola Damen, Manuela De Clerico, Elisa Carretta, Guglielmo Celli, Matteo Buccioli, Marika Tomasello, Gerardina Protupapa, Erik Boetto","doi":"10.62713/aic.3565","DOIUrl":"https://doi.org/10.62713/aic.3565","url":null,"abstract":"<p><strong>Aim: </strong>The objective of the study is to evaluate the performance of an innovative model of hospital activity known \"Diffuse Hospital\" (DH) that involved 3 hospital wards/departments (A, B and C) located throughout Italy and the Reference Hospital (RH) that organised the construction of this model.</p><p><strong>Methods: </strong>An organisational retrospective observational study was conducted on the orthopaedic ward of each hospital from March 2022 to March 2023. Hospitals A, B and C had organisational differences in relation to the working relationship of healthcare professionals, the care pathways implemented, the presence or absence of an emergency department and the management of operating theatres. The primary indicator was the number of Diagnosis-Related Groups (DRGs) provided by the individual facilities. Additionally, a series of indicators were collected, and to enable comparison, these indicators were calculated in relation to the available resources.</p><p><strong>Results: </strong>The total number of DRGs provided by the DH was 3904, broken down into 1187 at Hospital A, 1851 at Hospital B and 866 at Hospital C. The RH comparison standard recorded 1603 DRGs. Hospital B showed higher DRG indicators of 39.7, 2.5 and 30.9 percentage points, respectively, than the RH. In relation to theatre activities and healthcare staff, Hospitals A and C revealed lower scores than the standard.</p><p><strong>Conclusions: </strong>The DH model may become a useful tool in healthcare policy strategies to enable national RHs to deliver treatments with high standards of care at a territorial level. The facilities involved in the DH organisational model produced different outcomes in terms of both efficiency and clinical outcomes. Where there is no direct management by the RH of healthcare staff, care pathways and operating theatres, replication of the standard is more difficult and outcomes are poorer. In the hospital where there is no need for emergency surgical activity and scheduling is concentrated within the week, better efficiency levels can be achieved.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"221-227"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Timing of Percutaneous Coronary Intervention on the Prognosis of Non-ST Segment Elevation Myocardial Infarction Patients.","authors":"Tianzhu Li, Nimin Lu, Yingxue Dong","doi":"10.62713/aic.3339","DOIUrl":"https://doi.org/10.62713/aic.3339","url":null,"abstract":"<p><strong>Aim: </strong>To study the effect of timing of percutaneous coronary intervention (PCI) to prognosis of Non-ST segment elevation myocardial infarction (NSTEMI) patients.</p><p><strong>Methods: </strong>295 Patients were derived from our hospital who were diagnosed as NSTEMI and accepted PCI therapy in 24 hours from admission during March 2017 to May 2020. According to results of coronary angiography, patients with NSTEMI were divided into culprit artery occlusion (CO, n = 117) and non-culprit artery occlusion (N-CO, n = 178) two groups and then according to timing of PCI into three categories: <6 h, 6-12 h and 12-24 h from admission. We defined major adverse cardiovascular events (MACE) in 1 year follow.</p><p><strong>Results: </strong>In this study, with earlier time to PCI, the incidence of MACE was lower in NSTEMI patients with CO. The incidence of MACE was higher in the CO group than in the N-CO group (25.8% vs. 36.8%, p = 0.046). The incidence of MACE was 11.8% in T1 (<6 h) group (n = 50), less than 29.4% in T2 (6-12 h) group (n = 30) and 43.4% in T3 (12-24 h) group (n = 215), with a statistically significant difference (p = 0.044). However, this phenomenon does not occur in N-CO group. As the duration of PCI increased, patient survival decreased progressively over the course of follow-up in NSTEMI with CO (p = 0.048).</p><p><strong>Conclusions: </strong>Our study found that early PCI improves the prognosis of NSTEMI patients with culprit artery occlusion.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"339-344"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desmoid-type Fibromatosis of the Breast: A Case Report.","authors":"Wen-Yong Ren, Hao Su, Wei Guo, Xiao-Min Fu, Yanhong Dou, Jian-Ling Jia, Ai-Ping Shi, Di Wu","doi":"10.62713/aic.3581","DOIUrl":"https://doi.org/10.62713/aic.3581","url":null,"abstract":"<p><p>Desmoid-type fibromatosis (DTF) is a rare and locally aggressive benign tumor affecting the breasts. It is characterized by infiltrative growth and local recurrence, though it cannot metastasize. We present the case of a woman in her early 20s diagnosed with a palpable mass within her right breast. Imaging evidence was classified as Breast Imaging Reporting and Data System (BI-RADS) category 4 and above. We performed ultrasound-guided core needle biopsy, and pathological examination revealed hyperplasia of ductal epithelium and lobular tissue. Imaging results suggested a greater likelihood of the mass being malignant; however, pathological outcomes indicated that it was benign, resulting in the decision to perform an extended mastectomy. Postoperative pathological results suggested DTF. However, no further treatment was performed after surgery, and the patient's breast color Doppler ultrasound evaluation 12 months after surgery showed no recurrence or metastasis.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"315-321"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact and Safety of Ketorolac Tromethamine in Tibial Plateau Fracture Patients Undergoing Open Reduction and Internal Fixation.","authors":"Kai Lin, Weiping Zheng, Jinyi Zhu, Xiaoyong Zhang, Xinxiang Jiang, Zhenzhong Ding, Zongyao Duan","doi":"10.62713/aic.3895","DOIUrl":"https://doi.org/10.62713/aic.3895","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the postoperative analgesic efficacy and safety of ketorolac tromethamine in tibial plateau fracture (TPF) patients undergoing open reduction and internal fixation (ORIF) surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 194 TPF patients treated at Dongtai People's Hospital between October 2022 and March 2024. Patients meeting the inclusion criteria were divided into two groups: the ketorolac tromethamine group (n = 104), who received ketorolac tromethamine combined with imrecoxib, and the control group (n = 90), who received imrecoxib alone after ORIF. Baseline characteristics, postoperative analgesia (measured using the visual analogue scale (VAS) and Ramsay sedation scores), fracture healing parameters (healing time, alkaline phosphatase (ALP), bone gamma-carboxyglutamate protein (BGP), and collagen type I carboxy-terminal propeptide (PICP), and adverse events were evaluated preoperatively and at hospital discharge.</p><p><strong>Results: </strong>The ketorolac tromethamine group demonstrated significantly lower VAS scores (1 h, p = 0.017; 6 h, p = 0.022) and Ramsay sedation scores (1 h, p = 0.017; 6 h, p = 0.034) after anesthesia recovery compared to the control group. No significant differences between the two groups were observed in fracture healing time, ALP, BGP, or PICP levels (p > 0.05). The incidence of adverse events was comparable between the groups (p > 0.05). Laboratory results, including routine blood tests (neutrophil-to-lymphocyte ratio, p = 0.080; hemoglobin, p = 0.830), liver function tests (alanine aminotransferase (ALT), p = 0.773; aspartate aminotransferase (AST), p = 0.629), and renal function markers (creatinine, p = 0.596; uric acid (UA), p = 0.466; β2-microglobulin, p = 0.605), exhibited no significant differences between the two groups.</p><p><strong>Conclusions: </strong>The combination of ketorolac tromethamine and imrecoxib was more effective than imrecoxib alone in alleviating postoperative pain in TPF patients undergoing ORIF. Ketorolac tromethamine had no significant impact on bone healing, indicating its potential as bone-safe analgesia when combined with imrecoxib.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"329-338"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery of the Primary Tumor in de novo Metastatic Breast Cancer: A Palliative Approach or a Potential Survival Game-Changer?","authors":"Gianluca Franceschini","doi":"10.62713/aic.3928","DOIUrl":"https://doi.org/10.62713/aic.3928","url":null,"abstract":"<p><p>Approximately 5-10% of primary breast cancer cases present as de novo stage IV disease, characterized by distant metastases at diagnosis. Traditionally, systemic therapies such as chemotherapy, endocrine therapy and targeted treatments have formed the cornerstone of treatment for metastatic breast cancer (MBC), focusing on disease control, symptom palliation and quality of life improvement. While systemic therapies remain crucial, the role of local treatments, particularly surgery for the primary tumor, is increasingly debated. Historically viewed as a palliative intervention, surgery for the primary tumor aimed to address symptoms such as bleeding, ulceration and pain. However, emerging evidence suggests that surgical resection could offer survival benefits in specific patient subgroups, such as those with limited metastatic burden or bone-only metastases. Retrospective studies and meta-analyses indicate potential survival advantages but randomized trials have produced mixed results. These discrepancies highlight the complexity of surgery's role in MBC management influenced by factors such as cancer subtype, metastatic pattern and systemic treatment response. Personalized treatment strategies are mandatory for optimizing outcomes in de novo MBC. Surgery of the primary tumor should not be universally applied but considered for select patients based on clinical and molecular factors. Collaboration within multidisciplinary teams is essential to integrating surgery into comprehensive care plans. Future research, including nuanced and appropriate clinical trials, is needed to define the role of surgery in prolonging survival and enhancing quality of life for patients with de novo MBC.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"277-281"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}