Annali italiani di chirurgia最新文献

{"title":"Short-Term Outcomes and Pathological Features of Laparoscopic Versus Open Radical Total Gastrectomy for pT4a Gastric Cancer.","authors":"Bo Ding, Ke Liu, Ruyi Li, Zijian Liu, Shensi Chen","doi":"10.62713/aic.4867","DOIUrl":"https://doi.org/10.62713/aic.4867","url":null,"abstract":"<p><strong>Aim: </strong>The oncologic safety of laparoscopic radical total gastrectomy for pT4a gastric cancer remains debated, and the potential modifying role of Lauren histotype is unclear. This study aimed to develop an individualized prediction model for prolonged postoperative hospital stay to support risk-stratified rehabilitation. Secondary analyses compared perioperative outcomes between laparoscopic and open surgery, while exploratory subgroup analyses assessed potential effects of Lauren subtype.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included consecutive patients with pT4a gastric adenocarcinoma undergoing radical total gastrectomy at General Hospital of Ningxia Medical University from January 2021 to December 2025. Among 302 patients, 153 underwent laparoscopic surgery and 149 underwent open surgery. One-to-one propensity score matching (PSM) generated a balanced cohort of 248 patients. Univariable and multivariable logistic regression identified independent predictors of prolonged postoperative hospital stay. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration analysis, decision curve analysis (DCA), and SHapley Additive exPlanations (SHAP). A nomogram was constructed for individualized risk estimation. Perioperative and oncological outcomes were compared, and interaction analyses were performed to explore potential effect modification by Lauren subtype.</p><p><strong>Results: </strong>After PSM, baseline characteristics were well balanced (all standardized mean differences <0.1). Multivariable analysis identified laparoscopic surgery (odds ratio [OR] = 0.47, 95% confidence interval [CI] 0.27-0.82, <i>p</i> = 0.008), specific N-stage categories and histological differentiation categories were associated with a lower risk of prolonged hospitalization, whereas increased intraoperative blood loss was associated with prolonged hospitalization. The prediction model achieved an area under the curve (AUC) of 0.73 (95% CI 0.67-0.79), with good calibration and clinical utility across threshold probabilities of 0.1-0.7. SHAP analysis indicated Node (N) stage and surgical approach as the two most influential predictors. Compared with open surgery, laparoscopic gastrectomy resulted in shorter incision length, reduced blood loss, earlier drain removal, and shorter postoperative and overall hospital stays (all <i>p</i> < 0.05), despite longer operative time. No significant differences were observed in lymph node retrieval, positive lymph node counts, or N stage distribution. Exploratory analyses demonstrated consistent favorable trends of laparoscopic surgery across Lauren subtypes, but no significant interaction was detected between surgical approach and Lauren classification (all <i>p</i><sub>interaction</sub> > 0.05).</p><p><strong>Conclusions: </strong>Laparoscopic surgery, histological differentiation, N stage, and intraoperative blood loss independently pr","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1624-1643"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987795","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":"Monopolar Cautery Ablation as a Minimally Invasive Treatment Option for Grade II-III Hemorrhoidal Disease.","authors":"Suat Benek, Kasım Caglayan, Fatin Rustu Polat","doi":"10.62713/aic.4511","DOIUrl":"https://doi.org/10.62713/aic.4511","url":null,"abstract":"<p><strong>Aim: </strong>Hemorrhoidal disease (HD) is a common condition worldwide that significantly impairs quality of life. This study aims to compare the effectiveness of excisional hemorrhoidectomy (EH) and monopolar cautery ablation (MPCA).</p><p><strong>Methods: </strong>This retrospective study included 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease between January 2022 and December 2023. Patients were divided into two groups according to the surgical technique: the EH group and the MPCA group. All patients were followed for at least one year. The groups were compared in terms of operative time, postoperative pain scores (at the 12th hour, postoperative days 1, 7, and 14), duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates.</p><p><strong>Results: </strong>Thirty-two patients underwent EH, and 29 underwent MPCA. Baseline characteristics, including age, sex, and hemorrhoidal stage, were comparable between the groups. Operative time and postoperative analgesic requirements were significantly lower in the MPCA group (both <i>p</i> < 0.001). The time to return to daily activities was significantly shorter in the MPCA group, while patient satisfaction was significantly higher (both <i>p</i> < 0.001). No significant differences were observed between the groups regarding hospital stay or postoperative bleeding and edema (<i>p</i> = 0.086, <i>p</i> = 1.000 and <i>p</i> = 0.600, respectively). No recurrences were detected in the EH group, whereas three recurrences were observed in the MPCA group (<i>p</i> = 0.102).</p><p><strong>Conclusions: </strong>Monopolar cautery ablation appears to be a suitable minimally invasive option for selected patients with grade II-III hemorrhoidal disease, offering advantages in terms of operative time, postoperative pain, and recovery. However, a higher short-term recurrence rate compared to excisional hemorrhoidectomy was observed. These findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period. Further prospective studies with longer follow-up are required to confirm long-term efficacy and safety.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1665-1672"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987802","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":"Three-Year Single-Center Retrospective Comparison of Total Extraperitoneal Versus Transabdominal Preperitoneal Approach Laparoscopic Groin Hernia Repair: Postoperative Complications and Operative Performance.","authors":"Nedim Akgul, Burak Sakar, Ali Celik, Batuhan Ogut, Mehmet Ilker Turan, Kemal Eyvaz","doi":"10.62713/aic.4717","DOIUrl":"https://doi.org/10.62713/aic.4717","url":null,"abstract":"<p><strong>Aim: </strong>This single-center study aimed to evaluate the postoperative complications and operative performance of the total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques used in laparoscopic groin hernia repair.</p><p><strong>Methods: </strong>A total of 511 patients who underwent laparoscopic groin hernia repair between January 2022 and January 2025 were screened for eligibility, and 116 patients who did not meet the eligibility criteria were excluded. Patients were divided into the TEP (n = 291) and TAPP (n = 104) groups. The primary endpoint was the comparison of postoperative complication rates between the TEP and TAPP groups according to the Clavien-Dindo classification. The secondary endpoint was defined as a comparison of the operative time between the groups.</p><p><strong>Results: </strong>Significant differences in terms of age and American Society of Anesthesiologists (ASA) score were observed between the groups (<i>p</i> < 0.001 and <i>p</i> = 0.003, respectively), whereas no significant differences were found regarding sex, prior open hernia repair (recurrent hernia), preoperative symptom type, or hernia localization (<i>p</i> = 0.172, <i>p</i> = 0.059, <i>p</i> = 0.726, and <i>p</i> = 0.062, respectively). The distribution of hernia types was comparable between the groups (<i>p</i> = 0.957), whereas the operative time was significantly shorter in the TEP group (<i>p</i> < 0.001). The Clavien-Dindo classification indicated no significant differences in postoperative complication rates between the groups (<i>p</i> = 0.545). Grade ≥ IIIA complications were observed at low rates for both groups, and all grade IIIB events corresponded to recurrence cases. All recurrences were reoperated using open surgical repair.</p><p><strong>Conclusions: </strong>In our single-center experience, TEP and TAPP techniques demonstrated similar safety profiles in terms of postoperative complications. Operative time was shorter with the TEP technique, whereas complication rates were low in both approaches. Multicenter prospective studies are required to validate these findings and enhance generalizability.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1644-1652"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987876","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":"Effects of Animated Video Instruction Combined With Practical Demonstration Video on Postoperative Functional Exercise Compliance and Rehabilitation Outcomes in Patients Undergoing Arthroscopic Shoulder Surgery.","authors":"Shuang Zhang, Yuchen Li, Shiyao Yi, Xiaohua Liu, Meng Zhou","doi":"10.62713/aic.4560","DOIUrl":"10.62713/aic.4560","url":null,"abstract":"<p><strong>Aim: </strong>Patients undergoing shoulder arthroscopy often exhibit poor rehabilitation compliance due to kinesiophobia and inadequate understanding of postoperative rehabilitation. This study aimed to investigate the impact of animated video instruction combined with practical demonstration videos on postoperative compliance with functional exercises, correct brace use, and recovery of shoulder function in patients undergoing arthroscopic shoulder surgery, thereby providing evidence to optimize rehabilitation protocols.</p><p><strong>Methods: </strong>This prospective randomized controlled trial enrolled 140 patients between January 2024 and January 2025, who were randomly assigned to an experimental group (n = 70, combined video-based intervention with weekly application (APP)-based remote rehabilitation guidance) or a control group (n = 70, conventional care). Outcome measures included exercise compliance (6 weeks, 3 months, and 6 months), brace usage accuracy (1 week, 6 weeks, and 3 months), Constant-Murley Score (CMS), complication rate, and nursing satisfaction.</p><p><strong>Results: </strong>The experimental group demonstrated significantly higher exercise compliance rates at 6 weeks, 3 months, and 6 months (90.00%, 78.57%, 71.43%, respectively) than the control group (71.43%, 57.14%, 41.43%, respectively; all <i>p</i> < 0.05). Correct brace usage rates at 1 week and 6 weeks were also significantly higher in the experimental group (75.71% and 88.57%, respectively) compared with the control group (41.43% and 58.57%, respectively; both <i>p</i> < 0.001). At 1 week, 6 weeks, and 3 months postoperatively, the experimental group achieved significantly higher total CMS scores and subscores, including pain, range of motion, muscle strength, and activities of daily living, than the control group (all <i>p</i> < 0.05). Additionally, the experimental group showed a lower overall complication rate (8.57% vs. 24.29%, <i>p</i> = 0.012) and a higher proportion of \"very satisfied\" nursing evaluations (85.71% vs. 54.29%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The combined video-based rehabilitation intervention significantly improves postoperative exercise compliance, correct brace use, and early recovery of shoulder function. This approach may serve as a standardized rehabilitation nursing strategy for broader clinical application.</p><p><strong>Clinical trial registration: </strong>ISRCTN registry (ISRCTN13541497).</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1575-1585"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987753","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":"Comparative Efficacy and Safety of Coil Versus Onyx Embolization in Middle Meningeal Artery Embolization as an Adjunct to Burr Hole Drainage for Chronic Subdural Hematoma.","authors":"Chenhan Liu, Fubiao Chen, Peng Lu, Yunhui Wang","doi":"10.62713/aic.4654","DOIUrl":"https://doi.org/10.62713/aic.4654","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the differences in efficacy, safety, and health economic outcomes between coils and the Onyx liquid embolic agent in middle meningeal artery embolization (MMAE) as an adjunct to burr hole drainage for chronic subdural hematoma (cSDH).</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients with cSDH who underwent burr hole drainage combined with MMAE between April 2024 and October 2025. Patients were divided into a coil group and an Onyx group based on the embolic material used. Propensity score matching (PSM) was used to balance baseline characteristics across groups. The primary outcome was hematoma volume absorption at 90 days postoperatively. Secondary outcomes included imaging parameters, clinical outcomes, recurrence and reoperation rates, safety events, and health economic indicators.</p><p><strong>Results: </strong>A total of 184 patients were enrolled, with 66 patients in each group after PSM. Post-matching analyses demonstrated no statistically significant differences between the two groups in hematoma absorption volume at 90 days postoperatively or in other imaging parameters. Regarding clinical outcomes, the proportions of patients with modified Rankin Scale (mRS) scores of 0-2, as well as the recurrence and reoperation rates, were comparable between the groups. In terms of safety, the overall incidence of serious adverse events (SAEs) was comparable; however, cases of facial nerve palsy occurred in the Onyx group, whereas no such complications were observed in the coil group. Perioperative assessments showed that the coil group had a shorter operative time and lower hospitalization costs (all <i>p</i> < 0.05), whereas the length of hospital stay did not differ significantly between the groups.</p><p><strong>Conclusions: </strong>In the adjunctive treatment of cSDH with burr hole drainage, coils and Onyx liquid embolic agent demonstrate comparable short-term efficacy and overall safety.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1673-1680"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987636","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":"Clinical Correlates and Nonlinear Effects Associated With Short-Term Surgical Outcomes After Breast-Conserving Surgery for Breast Cancer: A Single-Center Retrospective Study.","authors":"Chengyao Cao, Sicong Yu","doi":"10.62713/aic.4744","DOIUrl":"https://doi.org/10.62713/aic.4744","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To explore clinical correlates of short-term surgical outcomes after breast-conserving surgery for breast cancer, and to examine whether the association between preoperative ultrasound tumor size and these outcomes is nonlinear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included 150 patients with breast cancer who underwent first breast-conserving surgery with curative intent between January 2021 and December 2025. Preoperative clinical, imaging, core needle biopsy, and laboratory data were collected. The primary outcome was a short-term adverse surgical outcome, defined as reoperation for margin-related reasons within 90 days, a strict positive margin, or a clinically meaningful close/indeterminate margin or suspected residual disease identified on postoperative pathology or imaging-pathology review when available, according to documented postoperative margin-related assessment. All association analyses were performed using Firth penalized logistic regression. A prespecified multivariable model was constructed with preoperative ultrasound tumor size as the main exposure, and restricted cubic spline (RCS) analysis was used as an exploratory analysis to examine potential nonlinearity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 150 patients, 15 (10.0%) experienced a short-term adverse surgical outcome. Compared with the no-adverse-outcome group, patients with the adverse outcome had larger preoperative ultrasound tumor size and a higher frequency of multifocal/multicentric disease on imaging. Univariable Firth regression showed that each 5 mm increase in preoperative ultrasound tumor size was associated with the adverse outcome (odds ratio (OR) = 2.32, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Multifocal/multicentric disease on imaging was also associated with the outcome (OR = 4.68, &lt;i&gt;p&lt;/i&gt; = 0.026), whereas a ductal carcinoma &lt;i&gt;in situ&lt;/i&gt; (DCIS) component on core biopsy showed borderline statistical significance (OR = 2.87, &lt;i&gt;p&lt;/i&gt; = 0.050). In the prespecified primary model adjusted for mammographic microcalcifications and a DCIS component on core biopsy, preoperative ultrasound tumor size remained associated with the outcome (OR = 2.16, &lt;i&gt;p&lt;/i&gt; = 0.001). RCS analysis showed an overall association and suggested potential nonlinearity, but the spline findings were exploratory. Exploratory subgroup analyses suggested a stronger association among patients without mammographic microcalcifications and a similar exploratory pattern among those without a DCIS component on core biopsy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative ultrasound tumor size may be associated with poorer short-term surgical outcomes, and this association may not be fully explained by a linear relationship. Multifocal/multicentric disease on imaging and a DCIS component on core biopsy may also be relevant risk-related features. For lesions characterized by microcalcifications or accompanied by a DCIS component, preoperative evaluation b","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1653-1664"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987647","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":"An Uncommon Cause of Obscure Gastrointestinal Bleeding: Inverted Meckel's Diverticulum With Combined Ectopic Gastric Mucosa and Pancreatic Ectopia in an Adult.","authors":"Giuseppe Di Donna, Matteo Capuzzo, Pietro Angelo Gaetano Bisagni","doi":"10.62713/aic.4834","DOIUrl":"https://doi.org/10.62713/aic.4834","url":null,"abstract":"","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1533-1535"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987591","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":"Dynamic Changes and Influencing Factors of Acute Pain After Elastic Band Ligation of Internal Hemorrhoids in Patients With Mixed Hemorrhoids.","authors":"Jie Pei, Guomin Xue, Chundong Jin, Xinping Wang","doi":"10.62713/aic.4649","DOIUrl":"https://doi.org/10.62713/aic.4649","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids in patients with mixed hemorrhoids and to analyze the independent factors influencing the pain trajectory.</p><p><strong>Methods: </strong>This single-center retrospective study included 173 patients with mixed hemorrhoids (grade III or IV) who underwent elastic band ligation of internal hemorrhoids at the Department of Proctology, The People's Hospital of Tinghu District, between April 2022 and April 2025. Baseline data, preoperative Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Social Support Rating Scale (SSRS) scores, and visual analog scale (VAS) pain scores on postoperative days 1, 3, 7, and 14 were collected. A growing mixture model (GMM) was used to identify pain progression trajectories. Univariate and multivariate logistic regression analyses were used to identify independent factors influencing trajectory categories, and receiver operating characteristic (ROC) curves were used to assess the discriminative power of risk factors.</p><p><strong>Results: </strong>GMM analysis identified two pain progression trajectories: a rapid relief group (82 cases, 47.4%) and a poor relief group (91 cases, 52.6%). There were statistically significant differences in VAS scores at each postoperative time point and in intra-group time changes between the two groups (<i>p</i> < 0.001). Multivariate logistic regression analysis showed that age (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.85-0.96, <i>p</i> = 0.002), SAS score (OR = 1.05, 95% CI: 1.01-1.10, <i>p</i> = 0.018), SDS score (OR = 1.05, 95% CI: 1.01-1.09, <i>p</i> = 0.009), SSRS total score (OR = 0.72, 95% CI: 0.65-0.81, <i>p</i> < 0.001), and number of ligations (OR = 4.96, 95% CI: 1.25-19.77, <i>p</i> = 0.023) were independent factors influencing the pain trajectory. ROC curve analysis showed that the area under the curve for the combination of these factors was 0.94 (95% CI: 0.91-0.97), the optimal cutoff value was 0.635, the sensitivity was 0.82, and the specificity was 0.96.</p><p><strong>Conclusions: </strong>Postoperative pain following elastic band ligation for mixed hemorrhoids exhibits heterogeneous trajectories. Younger age, higher preoperative anxiety and depression levels, lower levels of social support, and a greater number of ligations increase the risk of patients falling into an unfavorable relief trajectory. These factors may help identify patients at risk of unfavorable postoperative pain trajectories and inform individualized postoperative pain management.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1586-1596"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987696","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":"Pulmonary Sequestration Masquerading as Bronchiectasis in an Adult: A Case of Diagnostic Dilemma and Literature Review.","authors":"Jianguo Tuo, Xiuli Xia, Yu Qiu, Lifeng Xu","doi":"10.62713/aic.4815","DOIUrl":"https://doi.org/10.62713/aic.4815","url":null,"abstract":"<p><strong>Aim: </strong>Pulmonary sequestration is a rare congenital anomaly of the lung characterized by nonfunctioning pulmonary tissue that lacks normal communication with the tracheobronchial tree and receives blood supply from the systemic rather than the pulmonary circulation. Many patients remain asymptomatic for years, resulting in delayed diagnosis until adulthood. We report a case of adult intralobar sequestration (ILS) in which early diagnosis was obscured by bronchiectasis. This case aims to increase clinical awareness and provide insights into clinical strategies to reduce missed diagnoses.</p><p><strong>Case presentation: </strong>A 45-year-old woman initially presented with fever, cough, and right-sided chest pain. Chest computed tomography (CT) showed bronchiectatic changes with infection in the right lower lobe, and her symptoms improved after anti-infective treatment. However, recurrent hemoptysis developed 10 days later. Thoracic aortic computed tomography angiography (CTA) with three-dimensional reconstruction identified an aberrant systemic artery supplying the right lower lobe, confirming the diagnosis of intralobar pulmonary sequestration.</p><p><strong>Results: </strong>The patient subsequently underwent a right lower lobectomy via video-assisted thoracoscopic surgery (VATS). During the operation, an aberrant artery originating from the aorta was successfully identified and secured with double ligation. Postoperative pathological examination confirmed pulmonary sequestration, revealing marked thickening of the alveolar walls and chronic inflammation. At the 3-month follow-up, the patient had recovered well, with no recurrence of symptoms.</p><p><strong>Conclusions: </strong>Pulmonary sequestration should be considered in patients with recurrent localized bronchiectatic lesions, particularly when hemoptysis occurs or response to treatment is incomplete. CTA with vascular reconstruction is useful for diagnosis and preoperative evaluation.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1536-1543"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987772","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":"Rectal Tumor Height and Neoadjuvant Therapy Inform Interpretation of the Conventional Twelve-Node Benchmark: A Single-Center Colorectal Surgery Cohort.","authors":"Fei Wang, Sijie Yin, Yiming Lv, Sheng Dai","doi":"10.62713/aic.4838","DOIUrl":"https://doi.org/10.62713/aic.4838","url":null,"abstract":"<p><strong>Aim: </strong>The twelve-node benchmark is widely used as a minimum reference for staging adequacy and quality assessment after colorectal cancer resection. This study evaluated whether rectal tumor height and neoadjuvant therapy (NAT) status should be considered when interpreting this benchmark in rectal cancer.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients with non-metastatic colorectal adenocarcinoma who underwent minimally invasive radical resection with evaluable lymph node counts between 1 June 2019 and 30 June 2024. Rectal cancer constituted the primary analytic cohort; a contemporaneous colon cancer cohort was included as an institutional reference. The primary outcome was low lymph node yield (LNY), defined as fewer than twelve retrieved lymph nodes; lymph node yield (LNY) as a count outcome was analyzed as a complementary outcome. We first performed descriptive comparisons across tumor-height and NAT strata. We then fitted multivariable-adjusted negative binomial and logistic regression models in the rectal cancer cohort, including tumor height, NAT status, and their interaction to estimate adjusted height- and NAT-associated contrasts and test interaction.</p><p><strong>Results: </strong>The cohort included 4282 patients: 2317 with colon cancer and 1965 with rectal cancer, including 1024 without NAT and 941 with NAT. The colon cancer cohort had a median LNY of 19; the interquartile range (IQR) was 14-26, and the low-yield rate was 8.9%. Rectal cancer without and with NAT each had a median LNY of 15.0 (IQR, 12.0-19.0) and low-yield rates of 17.4% and 21.6%, respectively. Within rectal cancer, low-yield classification increased from high to mid to low rectal tumors (13.5%, 20.4%, and 26.8%). In adjusted rectal interaction models, comparisons with high rectal tumors were estimated at the no-NAT reference level. Low rectal tumors were associated with lower LNY (incidence rate ratio (IRR), 0.83; 95% CI, 0.77-0.89; <i>p</i> < 0.001). They also had higher odds of low LNY (odds ratio (OR), 2.20; 95% CI, 1.44-3.35; <i>p</i> < 0.001). In the mid-rectal stratum, NAT was associated with higher odds of low LNY (OR, 1.82; 95% CI, 1.24-2.66; <i>p</i> = 0.002); however, the overall interaction for low LNY was not statistically significant (<i>p</i> for interaction = 0.331).</p><p><strong>Conclusions: </strong>The twelve-node benchmark remains a useful reference for pathological staging and quality review. In the studied minimally invasive, sphincter-preserving rectal cancer cohort, a lymph node count below twelve should be interpreted together with tumor height, NAT exposure, and treatment composition rather than being used as an isolated indicator of inadequate surgical or pathological quality.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"97 9","pages":"1718-1726"},"PeriodicalIF":0.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987818","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}