Pub Date : 2025-08-11DOI: 10.1016/j.cson.2025.100089
Maria Angela D. Magpantay , Corine Astroth , Alfred Garcia , Dong Ren , Oliver Eng , Michael P. O'Leary
Introduction
Lymphangioleiomyomatosis (LAM) is a rare disease mainly affecting women of child-bearing age that primarily involves lung parenchyma smooth muscles with resulting cystic changes. This disease can present symptomatically as shortness of breath or as a recurrent pneumothorax. Rare instances of extrapulmonary manifestations involving the kidneys and other visceral organs have been reported. Herein, we describe an unusual case of LAM in a patient with a retroperitoneal mass showing pure perivascular growth pattern.
Case presentation
We report a case of a 41-year-old female who presented with abdominal pain and was found to have a left para-aortic mass. This was at the aortic bifurcation and concerning for a paraganglioma; however, laboratory analysis excluded a functional mass. The patient was lost to follow-up due to complications from the COVID-19 pandemic and established care 4 years later, at which time biopsy revealed the diagnosis of LAM. She ultimately underwent surgical resection.
Conclusion
This is a unique presentation of non-pulmonary, para-aortic LAM. This case reviews the relevant literature and presents a methodical histologic work up of this unusual mass.
{"title":"Unusual lymphangioleiomyomatosis presenting as a pure perivascular growth pattern","authors":"Maria Angela D. Magpantay , Corine Astroth , Alfred Garcia , Dong Ren , Oliver Eng , Michael P. O'Leary","doi":"10.1016/j.cson.2025.100089","DOIUrl":"10.1016/j.cson.2025.100089","url":null,"abstract":"<div><h3>Introduction</h3><div>Lymphangioleiomyomatosis (LAM) is a rare disease mainly affecting women of child-bearing age that primarily involves lung parenchyma smooth muscles with resulting cystic changes. This disease can present symptomatically as shortness of breath or as a recurrent pneumothorax. Rare instances of extrapulmonary manifestations involving the kidneys and other visceral organs have been reported. Herein, we describe an unusual case of LAM in a patient with a retroperitoneal mass showing pure perivascular growth pattern.</div></div><div><h3>Case presentation</h3><div>We report a case of a 41-year-old female who presented with abdominal pain and was found to have a left para-aortic mass. This was at the aortic bifurcation and concerning for a paraganglioma; however, laboratory analysis excluded a functional mass. The patient was lost to follow-up due to complications from the COVID-19 pandemic and established care 4 years later, at which time biopsy revealed the diagnosis of LAM. She ultimately underwent surgical resection.</div></div><div><h3>Conclusion</h3><div>This is a unique presentation of non-pulmonary, para-aortic LAM. This case reviews the relevant literature and presents a methodical histologic work up of this unusual mass.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867218","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}
Pub Date : 2025-06-27DOI: 10.1016/j.cson.2025.100085
Zhanghuan Li , Wenqi Du , Yufei Qin , Yinghui Yang , Yuxia Gao , Jing Yang , Xiaojie Feng , Wenqiang Fan , Wenxiang Wang
Objective
Fertility preservation in patients with gynecological malignancies (FP-GM) has gained increasing attention. This study conducts a bibliometric analysis of FP-GM research, aiming to identify key themes, influential publications, major contributors, and emerging trends that have shaped the field over the last decade.
Methods
Data were sourced from the Web of Science Core Collection (WOSCC). Tools such as CiteSpace and VOSviewer were utilized to conduct a detailed bibliometric analysis, focusing on keyword co-occurrence, citation bursts, collaboration networks, and clusters of influential references.
Results
A total of 2029 original articles were identified, involving 11446 authors from 342 countries and 8693 institutions, and published across 417 academic journals. Annual Publication generally shows an increasing trend. The USA is leading much of the advancement in this field. The International Journal of Gynecological Cancer published the most articles, and the journal with the most citations was Fertility and Sterility. Grynberg, Michael was the author with the most publications, and Donnez, J was the author with the most citations. The most frequently occurring keywords were “fertility preservation”, “cancer”, “women” and “chemotherapy”. Clusters of references including “cryopreservation techniques”, “ovarian cancer”, “cervical cancer”, “endometrial cancer” and so on. Citation bursts underscored the impact of guidelines and experimental research on the evolution of FP-GM.
Conclusion
Research on FP-GM is dominated by cryopreservation techniques and the reproductive consequences of cancer treatments. Influential guidelines and experimental research have shaped the field, with emerging interest in fertility-sparing treatments and hormonal preservation strategies, indicating a continuous evolution in clinical practices.
目的保存妇科恶性肿瘤患者的生育能力已受到越来越多的关注。本研究对FP-GM研究进行了文献计量分析，旨在确定在过去十年中塑造该领域的关键主题、有影响力的出版物、主要贡献者和新兴趋势。方法数据来源于Web of Science Core Collection （WOSCC）。利用CiteSpace和VOSviewer等工具进行详细的文献计量分析，重点关注关键词共现、引文爆发、协作网络和有影响力的参考文献集群。结果共发现原创文章2029篇，作者11446人，来自342个国家8693个机构，发表于417种学术期刊。年度出版物总体呈增长趋势。美国在这一领域处于领先地位。发表文章最多的是《国际妇科癌症杂志》，被引用次数最多的是《生育与不育》。格林伯格，迈克尔是发表文章最多的作者，Donnez， J是被引用最多的作者。出现频率最高的关键词是“保留生育能力”、“癌症”、“女性”和“化疗”。参考文献簇包括“冷冻保存技术”、“卵巢癌”、“宫颈癌”、“子宫内膜癌”等。大量引用强调了指南和实验研究对FP-GM进化的影响。结论FP-GM的研究主要集中在冷冻保存技术和肿瘤治疗对生殖的影响。有影响力的指导方针和实验研究塑造了这一领域，对保留生育能力的治疗和激素保存策略的兴趣日益浓厚，表明临床实践在不断发展。
{"title":"Bibliometric and visualized analysis of fertility preservation in patients with gynecological malignancies from 2014 to 2023","authors":"Zhanghuan Li , Wenqi Du , Yufei Qin , Yinghui Yang , Yuxia Gao , Jing Yang , Xiaojie Feng , Wenqiang Fan , Wenxiang Wang","doi":"10.1016/j.cson.2025.100085","DOIUrl":"10.1016/j.cson.2025.100085","url":null,"abstract":"<div><h3>Objective</h3><div>Fertility preservation in patients with gynecological malignancies (FP-GM) has gained increasing attention. This study conducts a bibliometric analysis of FP-GM research, aiming to identify key themes, influential publications, major contributors, and emerging trends that have shaped the field over the last decade.</div></div><div><h3>Methods</h3><div>Data were sourced from the Web of Science Core Collection (WOSCC). Tools such as CiteSpace and VOSviewer were utilized to conduct a detailed bibliometric analysis, focusing on keyword co-occurrence, citation bursts, collaboration networks, and clusters of influential references.</div></div><div><h3>Results</h3><div>A total of 2029 original articles were identified, involving 11446 authors from 342 countries and 8693 institutions, and published across 417 academic journals. Annual Publication generally shows an increasing trend. The USA is leading much of the advancement in this field. <em>The International Journal of Gynecological Cancer</em> published the most articles, and the journal with the most citations was <em>Fertility and Sterility</em>. Grynberg, Michael was the author with the most publications, and Donnez, J was the author with the most citations. The most frequently occurring keywords were “fertility preservation”, “cancer”, “women” and “chemotherapy”. Clusters of references including “cryopreservation techniques”, “ovarian cancer”, “cervical cancer”, “endometrial cancer” and so on. Citation bursts underscored the impact of guidelines and experimental research on the evolution of FP-GM.</div></div><div><h3>Conclusion</h3><div>Research on FP-GM is dominated by cryopreservation techniques and the reproductive consequences of cancer treatments. Influential guidelines and experimental research have shaped the field, with emerging interest in fertility-sparing treatments and hormonal preservation strategies, indicating a continuous evolution in clinical practices.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867119","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}
Pub Date : 2025-06-24DOI: 10.1016/j.cson.2025.100086
K. Kutywayo , K. Chandarana , I. Das , S. Rathinam
Artificial intelligence (AI) and machine learning (ML) are rapidly transforming thoracic surgery, offering innovative solutions to enhance patient care, improve surgical outcomes, improve surgical training, and increase efficiency. This scoping review provides a comprehensive overview of the current applications, challenges, and future directions of AI and ML in thoracic surgery.
Key applications of AI in thoracic imaging include lung nodule detection and characterisation, with deep learning algorithms demonstrating performance comparable to or exceeding that of human radiologists. Radiomics combined with ML techniques show promise in tumour characterisation and classification of non-small cell lung cancer subtypes. In preoperative planning, AI-powered 3D reconstruction and virtual reality systems enable detailed surgical simulation and risk assessment.
Augmented reality and computer-assisted navigation systems are being developed to enhance surgical precision intraoperatively. While fully autonomous robotic surgery remains a distant goal, AI-enhanced robotic platforms are advancing rapidly. Postoperatively, AI algorithms show potential for predicting outcomes, interpreting pulmonary function tests, and guiding rehabilitation strategies.
Despite these advancements, several challenges persist, including data quality and quantity issues, algorithm interpretability, and the need for rigorous clinical validation. Ethical considerations surrounding AI implementation in healthcare also require careful attention.
Future directions include integrating multimodal data, developing real-time intraoperative guidance systems, and creating adaptive AI models capable of continuous learning. As these technologies mature, they have the potential to revolutionise thoracic surgical practice, ultimately improving patient outcomes.
{"title":"Artificial intelligence and machine learning in thoracic surgery- A scoping review","authors":"K. Kutywayo , K. Chandarana , I. Das , S. Rathinam","doi":"10.1016/j.cson.2025.100086","DOIUrl":"10.1016/j.cson.2025.100086","url":null,"abstract":"<div><div>Artificial intelligence (AI) and machine learning (ML) are rapidly transforming thoracic surgery, offering innovative solutions to enhance patient care, improve surgical outcomes, improve surgical training, and increase efficiency. This scoping review provides a comprehensive overview of the current applications, challenges, and future directions of AI and ML in thoracic surgery.</div><div>Key applications of AI in thoracic imaging include lung nodule detection and characterisation, with deep learning algorithms demonstrating performance comparable to or exceeding that of human radiologists. Radiomics combined with ML techniques show promise in tumour characterisation and classification of non-small cell lung cancer subtypes. In preoperative planning, AI-powered 3D reconstruction and virtual reality systems enable detailed surgical simulation and risk assessment.</div><div>Augmented reality and computer-assisted navigation systems are being developed to enhance surgical precision intraoperatively. While fully autonomous robotic surgery remains a distant goal, AI-enhanced robotic platforms are advancing rapidly. Postoperatively, AI algorithms show potential for predicting outcomes, interpreting pulmonary function tests, and guiding rehabilitation strategies.</div><div>Despite these advancements, several challenges persist, including data quality and quantity issues, algorithm interpretability, and the need for rigorous clinical validation. Ethical considerations surrounding AI implementation in healthcare also require careful attention.</div><div>Future directions include integrating multimodal data, developing real-time intraoperative guidance systems, and creating adaptive AI models capable of continuous learning. As these technologies mature, they have the potential to revolutionise thoracic surgical practice, ultimately improving patient outcomes.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703728","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}
Pub Date : 2025-06-23DOI: 10.1016/j.cson.2025.100087
Michelle P. Sosa , Deirdre G. McNicholas , Arbelina B. Bebla , Seth Emont , Zhun Cao , Manu Tyagi , Craig Lipkin , Sommer Gunia
Introduction
This study evaluates whether near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is associated with a lower outpatient (OP) revisit rate compared to isosulfan blue (IB) or methylene blue (MB) when combined with technetium-99m (Tc99m) for sentinel lymph node (SLN) mapping of breast cancer.
Materials and methods
This retrospective observational study included adult female patients with a breast cancer diagnosis who underwent SLN mapping and had an index OP discharge between July 1, 2017 and August 31, 2022 at a U.S. hospital contributing to the Premier Healthcare Database. Patients were grouped by SLN mapping method: IB + Tc99m, MB + Tc99m, and ICG + Tc99m. The primary outcome was OP revisit rates at 30, 60, and 90 days post-discharge. Propensity score weighting adjusted for differences in baseline characteristics.
Results
5.6 % (n = 60,068) of the 1,067,677 adult female patients with a breast cancer diagnosis underwent SLN mapping, and 54.9 % (n = 32,970) met the inclusion criteria. In the propensity-weighted sample (n = 2002), the ICG + Tc99m cohort had the lowest OP revisit rates at all time points compared to IB + Tc99m and MB + Tc99m: at 30 days, 36.4 % vs. 43.1 % vs. 43.2 %; at 60 days, 50.9 % vs. 55.8 % vs. 56.2 %; and at 90 days, 55.9 % vs. 59.7 % vs. 60.0 % (all p < .05). Adjusted odds ratios (aORs) confirmed the ICG + Tc99m cohort's reduced OP revisits: 30-day aOR, 0.74 (0.63–0.88); 60-day aOR, 0.80 (0.68–0.94); and 90-day aOR, 0.84 (0.71–0.99) (all p < .05).
Conclusion
NIRF with ICG + Tc99m was associated with significantly fewer OP revisits, suggesting that this method may improve patient outcomes and the continuum of care for breast cancer patients.
{"title":"Outpatient revisits associated with three sentinel lymph node detection techniques for breast cancer: A propensity score weighted analysis","authors":"Michelle P. Sosa , Deirdre G. McNicholas , Arbelina B. Bebla , Seth Emont , Zhun Cao , Manu Tyagi , Craig Lipkin , Sommer Gunia","doi":"10.1016/j.cson.2025.100087","DOIUrl":"10.1016/j.cson.2025.100087","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluates whether near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is associated with a lower outpatient (OP) revisit rate compared to isosulfan blue (IB) or methylene blue (MB) when combined with technetium-99m (Tc99m) for sentinel lymph node (SLN) mapping of breast cancer.</div></div><div><h3>Materials and methods</h3><div>This retrospective observational study included adult female patients with a breast cancer diagnosis who underwent SLN mapping and had an index OP discharge between July 1, 2017 and August 31, 2022 at a U.S. hospital contributing to the Premier Healthcare Database. Patients were grouped by SLN mapping method: IB + Tc99m, MB + Tc99m, and ICG + Tc99m. The primary outcome was OP revisit rates at 30, 60, and 90 days post-discharge. Propensity score weighting adjusted for differences in baseline characteristics.</div></div><div><h3>Results</h3><div>5.6 % (n = 60,068) of the 1,067,677 adult female patients with a breast cancer diagnosis underwent SLN mapping, and 54.9 % (n = 32,970) met the inclusion criteria. In the propensity-weighted sample (n = 2002), the ICG + Tc99m cohort had the lowest OP revisit rates at all time points compared to IB + Tc99m and MB + Tc99m: at 30 days, 36.4 % vs. 43.1 % vs. 43.2 %; at 60 days, 50.9 % vs. 55.8 % vs. 56.2 %; and at 90 days, 55.9 % vs. 59.7 % vs. 60.0 % (all p < .05). Adjusted odds ratios (aORs) confirmed the ICG + Tc99m cohort's reduced OP revisits: 30-day aOR, 0.74 (0.63–0.88); 60-day aOR, 0.80 (0.68–0.94); and 90-day aOR, 0.84 (0.71–0.99) (all p < .05).</div></div><div><h3>Conclusion</h3><div>NIRF with ICG + Tc99m was associated with significantly fewer OP revisits, suggesting that this method may improve patient outcomes and the continuum of care for breast cancer patients.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502766","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}
Pub Date : 2025-06-01DOI: 10.1016/j.cson.2025.100083
Jiapei Lin , Yilin Li , Dongrui Li , Liyong Zhuo , Jian Wei , Jingwei Wei
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with high incidence and death rates. Despite significant progress in conventional diagnostic methods such as imaging studies and biomarkers, inherent limitations hinder their effectiveness. The rapid development of large model techniques has unveiled considerable potential for improving imaging-based diagnosis and prognostic evaluation of HCC. This review highlights recent advances in applying large models to HCC, emphasizing developments in deep neural network architecture and multimodal data integration. It examines how these models enhance early diagnosis accuracy through automated feature extraction and explores their role in integrating clinical variables, radiomics, genomics, and pathology data, offering novel perspectives for prognosis assessment. Despite their promise, challenges such as data quality, model interpretability, and generalization capacity remain. The review concludes by discussing the future potential of large models in HCC diagnosis and prognosis, addressing key challenges and ethical considerations for clinical adoption.
{"title":"Application of large models in imaging diagnosis and prognostic analysis in hepatocellular carcinoma","authors":"Jiapei Lin , Yilin Li , Dongrui Li , Liyong Zhuo , Jian Wei , Jingwei Wei","doi":"10.1016/j.cson.2025.100083","DOIUrl":"10.1016/j.cson.2025.100083","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with high incidence and death rates. Despite significant progress in conventional diagnostic methods such as imaging studies and biomarkers, inherent limitations hinder their effectiveness. The rapid development of large model techniques has unveiled considerable potential for improving imaging-based diagnosis and prognostic evaluation of HCC. This review highlights recent advances in applying large models to HCC, emphasizing developments in deep neural network architecture and multimodal data integration. It examines how these models enhance early diagnosis accuracy through automated feature extraction and explores their role in integrating clinical variables, radiomics, genomics, and pathology data, offering novel perspectives for prognosis assessment. Despite their promise, challenges such as data quality, model interpretability, and generalization capacity remain. The review concludes by discussing the future potential of large models in HCC diagnosis and prognosis, addressing key challenges and ethical considerations for clinical adoption.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313363","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}
Pub Date : 2025-06-01DOI: 10.1016/j.cson.2025.100084
Laura Aguilera Saiz , Harald C. Groen , Wouter J. Heerink , Theo J.M. Ruers
The lower abdominopelvic region is characterized by complex anatomy harbouring many vital structures in a constrained area. Advanced guidance can enhance the precision and efficiency of lower abdominopelvic surgical procedures. This can be achieved with image-guided surgical navigation systems, which use preoperative data to display real-time updates of intraoperative data. The current literature review explores the current state and prospective approaches for developing clinical navigation systems tailored for the lower abdominopelvic region. We aim to identify current knowledge gaps and technological challenges in navigation and explore potential solutions proposed in the literature. A comprehensive literature review of the current state of the art of navigation systems was performed. Relevant clinical and technical information from the publications was extracted and added value of navigation systems was analysed. According to the reviewed literature, existing commercial navigation systems focus mainly on rigid structure navigation. Despite being certified for spine, hip, knee and neurosurgery, commercial systems were used in 16 out of 29 studies for non-rigid pelvic surgery, which was outside their intended use. Comparative studies showed that navigation was of added value for surgical efficiency and clinical outcomes. Navigation in lower abdominopelvic surgeries contributed to more precise resection margins and reduction of local recurrences, resulting in more precise and safe surgeries. Various promising navigation systems show high performance in lower abdominopelvic surgery. However, their implementation is mainly examined in feasibility studies. Consequently, the use of navigation systems in clinical standard routine still remains limited.
{"title":"Tracking systems in navigated lower abdominopelvic surgery, a review","authors":"Laura Aguilera Saiz , Harald C. Groen , Wouter J. Heerink , Theo J.M. Ruers","doi":"10.1016/j.cson.2025.100084","DOIUrl":"10.1016/j.cson.2025.100084","url":null,"abstract":"<div><div>The lower abdominopelvic region is characterized by complex anatomy harbouring many vital structures in a constrained area. Advanced guidance can enhance the precision and efficiency of lower abdominopelvic surgical procedures. This can be achieved with image-guided surgical navigation systems, which use preoperative data to display real-time updates of intraoperative data. The current literature review explores the current state and prospective approaches for developing clinical navigation systems tailored for the lower abdominopelvic region. We aim to identify current knowledge gaps and technological challenges in navigation and explore potential solutions proposed in the literature. A comprehensive literature review of the current state of the art of navigation systems was performed. Relevant clinical and technical information from the publications was extracted and added value of navigation systems was analysed. According to the reviewed literature, existing commercial navigation systems focus mainly on rigid structure navigation. Despite being certified for spine, hip, knee and neurosurgery, commercial systems were used in 16 out of 29 studies for non-rigid pelvic surgery, which was outside their intended use. Comparative studies showed that navigation was of added value for surgical efficiency and clinical outcomes. Navigation in lower abdominopelvic surgeries contributed to more precise resection margins and reduction of local recurrences, resulting in more precise and safe surgeries. Various promising navigation systems show high performance in lower abdominopelvic surgery. However, their implementation is mainly examined in feasibility studies. Consequently, the use of navigation systems in clinical standard routine still remains limited.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322200","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}
Pub Date : 2025-06-01DOI: 10.1016/j.cson.2025.100081
Anas A. Preukschas , Amila Cizmic , Philip C. Müller , Christoph Kümmerli , Faik Güntac Uzunoglu , Thilo Hackert , Felix Nickel
Robotic pancreatic surgery is complex, and its establishment in an institution require a structured approach to secure optimal short- and long-term outcomes. This article provides a structured training proposition for robotic pancreatic surgery and gives an overview of the learning curves and examines the key takeaways.
The preclinical training in robotic pancreatic surgery can be divided into a basic and advanced phase. The basic phase includes virtual reality training, biotissue drills, and specialized training courses. The advanced phase consists of reaching benchmarks for the biotissue drills and completing video-based training. After establishing a dedicated interprofessional surgical team index procedures and first robotic pancreatic cases can be performed under the supervision of a proctor.
Three phases of clinical training are proposed: competency, proficiency, and mastery. Competency referring to be able to perform the procedure without supervision in patients without risk factors and with average technical difficulty. Proficiency signifying consistently reaching benchmark- and textbook outcome in patients with risk factors and extended indications. Mastery is achieving benchmark values for morbidity rates even in complex cases requiring vessel or multi-visceral resections and with patients having multiple risk factors.
The number of cases to overcome the initial phase of the learning curve vary between 7 and 46 for robotic distal pancreatectomy and 8–100 for robotic partial pancreaticoduodenectomy. Significantly longer learning phases of 60–200 cases are reported to complete all three learning phases.
In conclusion the hallmarks for safe and efficient implementation of robotic pancreatic surgery are a dedicated team, structured training program and stepwise patient selection.
{"title":"Training and learning curves in robotic pancreatic surgery","authors":"Anas A. Preukschas , Amila Cizmic , Philip C. Müller , Christoph Kümmerli , Faik Güntac Uzunoglu , Thilo Hackert , Felix Nickel","doi":"10.1016/j.cson.2025.100081","DOIUrl":"10.1016/j.cson.2025.100081","url":null,"abstract":"<div><div>Robotic pancreatic surgery is complex, and its establishment in an institution require a structured approach to secure optimal short- and long-term outcomes. This article provides a structured training proposition for robotic pancreatic surgery and gives an overview of the learning curves and examines the key takeaways.</div><div>The preclinical training in robotic pancreatic surgery can be divided into a basic and advanced phase. The basic phase includes virtual reality training, biotissue drills, and specialized training courses. The advanced phase consists of reaching benchmarks for the biotissue drills and completing video-based training. After establishing a dedicated interprofessional surgical team index procedures and first robotic pancreatic cases can be performed under the supervision of a proctor.</div><div>Three phases of clinical training are proposed: competency, proficiency, and mastery. Competency referring to be able to perform the procedure without supervision in patients without risk factors and with average technical difficulty. Proficiency signifying consistently reaching benchmark- and textbook outcome in patients with risk factors and extended indications. Mastery is achieving benchmark values for morbidity rates even in complex cases requiring vessel or multi-visceral resections and with patients having multiple risk factors.</div><div>The number of cases to overcome the initial phase of the learning curve vary between 7 and 46 for robotic distal pancreatectomy and 8–100 for robotic partial pancreaticoduodenectomy. Significantly longer learning phases of 60–200 cases are reported to complete all three learning phases.</div><div>In conclusion the hallmarks for safe and efficient implementation of robotic pancreatic surgery are a dedicated team, structured training program and stepwise patient selection.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322282","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}
Pub Date : 2025-06-01DOI: 10.1016/j.cson.2025.100082
Rhea M Iyer
<div><h3>Objectives</h3><div>The purpose of this research is to demonstrate the benefit of SIEV inclusion and to identify the factors that deem a patient a suitable for SIEV grafting in a large patient cohort. By doing so we aim to facilitate more efficient preoperative planning and decrease the return to theatre (RTT) rates resulting from venous congestion or inappropriate SIEV use.</div></div><div><h3>Methods</h3><div>This was a retrospective study conducted at the St. Andrew's Centre for Burns and Plastic Surgery in Broomfield Hospital, United Kingdom. 60 patients who underwent a DIEP flap reconstruction between January 1st, 2020, and December 31, 2021, were selected based on having undergone a unilateral DIEP reconstruction either with or without additional SIEV use with no other adjunct flap technique used. The patients were stratified into two cohort groups: DIEP + SIEV use patient group (<em>n</em> = 30) and DIEP only patients (<em>n</em> = 30). For these patients a range of biographical data was obtained including: the presence of co – morbidities (BMI, BP, co – existing conditions such as diabetes mellitus) as well as flap characteristics (flap weight, time taken to raise the flap and the ischaemia time) from the free – flap audit forms and this was compared to anatomical data that was obtained from the pre – operative CT angiography reports detailing vascular characteristics: the Size/calibre of the SIEV (large = >3.0 mm, medium = 2.0–3.0 mm and small = <2.0mm), the presence of venous anastomosis and midline crossover. The data was recorded on a spreadsheet and compared with the DIEP only group to ascertain, p – values using Chi<sup>2</sup>/Fisher's Exact Test (for non – parametric/binary data) and the Two – Tailed P – values (parametric data) where appropriate, Microsoft Excel's correlation toolkit was also used to determine the extent of correlation between the cohort groups.</div></div><div><h3>Results</h3><div>For non-parametric values (binary) statistical significance was present for: High BMI defined as BMI >26 kg/m2 (p = 0.01), High BP-defined as BP > 140/90 mmHg (P < 0.01), Vein 2-IMVP (anastomosis between the second vein used whether this be a SIEV or not and the IMVP within the chest wall (p < 0.00001), Large SIEV calibre – defined as >3 mm (p = 0.015) and small SIEV calibre – defined as <2.00 mm (p = 0.0251). The average flap weight in the DIEP + SIEV cohort was 857.80g and in the DIEP only cohort was 641.92g (p = 0.024) therefore a larger flap weight was associated with SIEV usage in our cohort. Patients presenting with these characteristics conferred a superficial venous drainage system dominance and were therefore more numerous in the DIEP + SIEV cohort group compared to the DIEP only group. The RTT was defined to be 3-times higher in the DIEP only group and the overall cost benefit of primary SIEV use, extrapolated for the defined year period was determined to be £26
{"title":"Assessing the prophylactic use of superficial inferior epigastric vessels (SIEV) for the super-drainage of deep inferior epigastric perforator flaps (DIEPs), correlated to patient demographic, anatomical and operative risk factors","authors":"Rhea M Iyer","doi":"10.1016/j.cson.2025.100082","DOIUrl":"10.1016/j.cson.2025.100082","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this research is to demonstrate the benefit of SIEV inclusion and to identify the factors that deem a patient a suitable for SIEV grafting in a large patient cohort. By doing so we aim to facilitate more efficient preoperative planning and decrease the return to theatre (RTT) rates resulting from venous congestion or inappropriate SIEV use.</div></div><div><h3>Methods</h3><div>This was a retrospective study conducted at the St. Andrew's Centre for Burns and Plastic Surgery in Broomfield Hospital, United Kingdom. 60 patients who underwent a DIEP flap reconstruction between January 1st, 2020, and December 31, 2021, were selected based on having undergone a unilateral DIEP reconstruction either with or without additional SIEV use with no other adjunct flap technique used. The patients were stratified into two cohort groups: DIEP + SIEV use patient group (<em>n</em> = 30) and DIEP only patients (<em>n</em> = 30). For these patients a range of biographical data was obtained including: the presence of co – morbidities (BMI, BP, co – existing conditions such as diabetes mellitus) as well as flap characteristics (flap weight, time taken to raise the flap and the ischaemia time) from the free – flap audit forms and this was compared to anatomical data that was obtained from the pre – operative CT angiography reports detailing vascular characteristics: the Size/calibre of the SIEV (large = >3.0 mm, medium = 2.0–3.0 mm and small = <2.0mm), the presence of venous anastomosis and midline crossover. The data was recorded on a spreadsheet and compared with the DIEP only group to ascertain, p – values using Chi<sup>2</sup>/Fisher's Exact Test (for non – parametric/binary data) and the Two – Tailed P – values (parametric data) where appropriate, Microsoft Excel's correlation toolkit was also used to determine the extent of correlation between the cohort groups.</div></div><div><h3>Results</h3><div>For non-parametric values (binary) statistical significance was present for: High BMI defined as BMI >26 kg/m2 (p = 0.01), High BP-defined as BP > 140/90 mmHg (P < 0.01), Vein 2-IMVP (anastomosis between the second vein used whether this be a SIEV or not and the IMVP within the chest wall (p < 0.00001), Large SIEV calibre – defined as >3 mm (p = 0.015) and small SIEV calibre – defined as <2.00 mm (p = 0.0251). The average flap weight in the DIEP + SIEV cohort was 857.80g and in the DIEP only cohort was 641.92g (p = 0.024) therefore a larger flap weight was associated with SIEV usage in our cohort. Patients presenting with these characteristics conferred a superficial venous drainage system dominance and were therefore more numerous in the DIEP + SIEV cohort group compared to the DIEP only group. The RTT was defined to be 3-times higher in the DIEP only group and the overall cost benefit of primary SIEV use, extrapolated for the defined year period was determined to be £26","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470007","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}
Pub Date : 2025-03-25DOI: 10.1016/j.cson.2025.100079
Wenlong Qiu , Yu Liu , Wei Zhao , Shiwen Mei , Yuegang Li , Qian Liu
Objective
This study aims to assess the necessity and outcomes of bilateral lateral lymph node dissection (LLND) in rectal cancer, while exploring the role of Indocyanine Green (ICG) in enhancing surgical precision.
Methods
A retrospective analysis was conducted on 157 patients who underwent LLND between January 1, 2010, and December 31, 2022. The study focused on the incidence of bilateral lymph node metastasis, the predictors of metastasis, and the role of ICG-guided dissection in improving surgical outcomes. Propensity score matching (PSM) was used to compare the outcomes between the control and fluorescence-guided lymph node dissection (FLND) groups.
Results
Bilateral lateral lymph node metastasis was found in 6.4 % of patients. Positive D2 lymph nodes were the only significant predictor of bilateral metastasis. ICG, used via submucosal injection, significantly improved lymph node identification and dissection accuracy. Patients in the FLND group had a higher median number of harvested lymph nodes (32 vs. 19, P = 0.042) and better postoperative outcomes, including shorter hospital stay (6 vs. 9 days, P = 0.038) and less blood loss (30 ml vs. 180 ml, P < 0.001). Kaplan-Meier analysis showed no significant differences in disease-free survival (P = 0.658) or overall survival (P = 0.331) between groups.
Conclusion
While ICG-enhanced bilateral LLND improves short-term surgical outcomes, its impact on long-term survival remains unclear. The findings suggest selective use of bilateral LLND based on specific risk factors, particularly in patients with positive D2 lymph nodes. Further studies are required to refine guidelines and establish the procedure's long-term benefits.
目的探讨直肠癌行双侧淋巴结清扫术（LLND）的必要性及预后，同时探讨吲哚菁绿（ICG）在提高手术精度中的作用。方法回顾性分析2010年1月1日至2022年12月31日期间接受LLND治疗的157例患者。本研究的重点是双侧淋巴结转移的发生率，转移的预测因素，以及icg引导下的清扫在改善手术效果中的作用。倾向评分匹配（PSM）用于比较对照组和荧光引导淋巴结清扫（FLND）组之间的结果。结果6.4%的患者出现双侧淋巴结转移。D2阳性淋巴结是双侧转移的唯一显著预测因子。ICG通过粘膜下注射使用，显著提高了淋巴结识别和清扫的准确性。FLND组患者淋巴结清扫中位数较高（32 vs 19, P = 0.042），术后预后较好，包括住院时间较短（6 vs 9天，P = 0.038），出血量较少(30 ml vs 180 ml, P <；0.001)。Kaplan-Meier分析显示，两组无病生存期（P = 0.658）和总生存期（P = 0.331）无显著差异。结论：虽然icg增强的双侧LLND改善了短期手术结果，但其对长期生存的影响尚不清楚。研究结果建议根据特定的危险因素选择性地使用双侧LLND，特别是在D2淋巴结阳性的患者中。需要进一步的研究来完善指导方针，并确定该手术的长期效益。
{"title":"Efficacy of ICG-guided bilateral lateral lymph node dissection in rectal cancer","authors":"Wenlong Qiu , Yu Liu , Wei Zhao , Shiwen Mei , Yuegang Li , Qian Liu","doi":"10.1016/j.cson.2025.100079","DOIUrl":"10.1016/j.cson.2025.100079","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to assess the necessity and outcomes of bilateral lateral lymph node dissection (LLND) in rectal cancer, while exploring the role of Indocyanine Green (ICG) in enhancing surgical precision.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 157 patients who underwent LLND between January 1, 2010, and December 31, 2022. The study focused on the incidence of bilateral lymph node metastasis, the predictors of metastasis, and the role of ICG-guided dissection in improving surgical outcomes. Propensity score matching (PSM) was used to compare the outcomes between the control and fluorescence-guided lymph node dissection (FLND) groups.</div></div><div><h3>Results</h3><div>Bilateral lateral lymph node metastasis was found in 6.4 % of patients. Positive D2 lymph nodes were the only significant predictor of bilateral metastasis. ICG, used via submucosal injection, significantly improved lymph node identification and dissection accuracy. Patients in the FLND group had a higher median number of harvested lymph nodes (32 vs. 19, P = 0.042) and better postoperative outcomes, including shorter hospital stay (6 vs. 9 days, P = 0.038) and less blood loss (30 ml vs. 180 ml, P < 0.001). Kaplan-Meier analysis showed no significant differences in disease-free survival (P = 0.658) or overall survival (P = 0.331) between groups.</div></div><div><h3>Conclusion</h3><div>While ICG-enhanced bilateral LLND improves short-term surgical outcomes, its impact on long-term survival remains unclear. The findings suggest selective use of bilateral LLND based on specific risk factors, particularly in patients with positive D2 lymph nodes. Further studies are required to refine guidelines and establish the procedure's long-term benefits.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759224","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号