Frontiers in Surgery最新文献

Background: Laparoscopic operation holds multiple advantages as a minimal invasive method of surgical treatment. Vascular-related manipulations, including identification and dissection of vascular structures and control of bleeding, are highly experience-based and demand a tortuous learning curve. With the rapid development of artificial intelligence (AI) in the entire diagnosis and treatment process of diseases, data-driven AI models have shown promising potentials in both education and real-time aiding in surgery. However, there is no dedicated dataset existing for developing vascular identification models in laparoscopic settings.

Methods: Videos from 23 laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD) performed at Peking Union Medical College Hospital (PUMCH) between January 2021 and June 2022 were collected. Senior surgeons systematically reviewed surgical videos to visually identify critical venous vasculature, precisely annotating frame-accurate start and end timestamps on the video timeline. Frames were extracted from these video segments at a fixed temporal interval of one frame per second, then stored to compile the source image dataset. The contours of superior mesenteric vein (SMV), portal vein (PV), splenic vein (SV) were labelled and reviewed according to standard procedure. A High-Resolution Network (HRNet) was combined with a fully convolutional network (FCN) output head to construct a preliminary segmentation model for initial validation and comparison.

Results: A dataset comprises 19,003 annotated frames and is publicly available. The baseline model achieved a recall of 79.6%, precision of 95.8%, and Dice coefficient of 0.69 on the testing set.

Conclusion: This study constructed and released the first large-scale, expert-annotated dataset of key venous structures from pancreatic surgery (PS) videos and established benchmark performance for intraoperative vein segmentation using open-source models. This resource provides a foundation for advancing AI-assisted vascular identification in laparoscopic surgery.

Objective: This study aims to investigate the clinicopathological characteristics, imaging features, diagnostic approaches, and treatment strategies of spindle cell tumors of the thigh.

Methods: We performed a retrospective analysis of the clinical data of a patient admitted to the Department of Orthopedics at Yantai Yuhuangding Hospital in 2025. The study period encompassed the preoperative assessment, surgical intervention, and a 10-month postoperative follow-up.

Results: A 61-year-old male patient was admitted to our hospital with a 1 year history of right thigh pain without an obvious cause, accompanied by restricted mobility. Physical examination revealed a mass in the mid-posterior region of the right thigh with indistinct borders and skin numbness. Tenderness and percussion pain were noted in the right thigh, with pain limiting flexion and extension. Internal rotation was preserved, whereas external rotation was restricted. The Lasegue sign was positive. MRI examination showed a soft tissue mass located posteromedial to the proximal-to-mid segment of the right femur, raising suspicion for a tumor. The mass was irregular and lobulated with indistinct borders, presenting irregular, slightly prolonged signals on T1-weighted images and mixed high-/low-intensity signals on T2-weighted images. Intraoperatively, the tumor was located in the semimembranosus and semitendinosus muscles, spreading medially toward the anterior thigh. The tumor exhibited indistinct borders, lacked a capsule, and compressed the sciatic nerve. The tumor measured approximately 10 cm×5.6 cm×23 cm. Postoperative histopathological examination confirmed the diagnosis of a spindle cell tumor (occupying lesion of the root of the right thigh). The patient's postoperative pain and numbness were significantly alleviated.

Conclusion: Solitary spindle cell tumors arising in the deep soft tissues of the thigh are clinically uncommon and often lack features related to neurofibromatosis type I (NF1). MRI is an important preoperative diagnostic modality. Complete surgical excision remains the treatment of choice and offers a good prognosis.

Objectives: One-lung ventilation (OLV) is a standard technique during thoracic surgery, yet its impact on postoperative complications and ventilator settings remains under investigation. The objective of this study was to evaluate the impact of intraoperative ventilation parameters on postoperative outcomes in patients undergoing thoracic surgery with OLV.

Design and setting: A retrospective multicenter cohort analysis was conducted using data from the German Thoracic Registry.

Participants: The study encompassed 2,922 patients treated between 2017 and 2021 across eight German centers.

Interventions: Intraoperative variables analyzed included driving pressure (DP), positive end-expiratory pressure (PEEP), maximum airway pressure (pMax), tidal volume (TV) per predicted body weight (PBW), and ventilation mode. The primary outcomes of interest were postoperative complications, respiratory complications, and in-hospital mortality.

Measurements and main results: Postoperative complications occurred in 28.7% of cases. Elevated DP (>20 mbar), pMax (>25 mbar), and PEEP (>8 mbar) were significantly associated with increased complication and mortality rates. Patients receiving a TV > 5 mL/kg PBW also showed higher complication rates (p = .003). Respiratory complications occurred in 15.7% of patients and were strongly associated with higher DP, pMax, and OLV duration. Multivariate logistic regression identified OLV > 60 min and pMax >25 mbar as independent predictors of respiratory complications and overall complications.

Conclusion: Intraoperative ventilation parameters, particularly elevated DP, pMax and PEEP, have been demonstrated to be associated with an increased risk of complications and mortality in patients undergoing thoracic surgery with OLV. These findings lend support to the hypothesis that lung-protective ventilation strategies may improve perioperative outcomes.

Objective: To quantify the impact of hypertension and its grading on occult blood loss (HBL) during total hip arthroplasty (THA) and to offer clinical guidance for minimizing HBL.

Methods: Baseline data from femoral neck fracture patients treated with THA between January 2018 and December 2022 were included. SPSS 26.0 statistical software was used for correlation analysis employing statistical methods, including independent samples t-test, Pearson correlation, and multiple linear regression, to identify risk factors for elevated postoperative HBL in THA patients. Hypertension severity was categorized according to international guidelines to investigate the effect of hypertension grading on HBL.

Results: The mean perioperative bleeding (TBL) among all patients was 1,123.39 ± 518.89 mL, and the mean HBL was 923.93 ± 489.04 mL, which accounted for 78.76% ± 16.09% of the TBL. HBL was significantly higher in hypertensive patients (957.98 ± 509.72 mL vs. 895.94 ± 469.97 mL, P = 0.042). Multiple linear regression analysis revealed that hypertension was an independent predictor of HBL (P = 0.030). Grade 2 hypertension increased HBL by 11.2% (996.46 ± 573.80 mL, P = 0.046), while grade 3 hypertension further increased HBL by 18.7% (1,063.76 ± 584.11 mL, P = 0.044). Hypoalbuminemia had a clinically relevant, but not statistically significant, synergistic effect with hypertension (ΔHBL = 119.60 mL, P = 0.297).

Conclusion: Hypertension ≥ grade 2 (systolic blood pressure ≥ 160 mmHg) independently exacerbates HBL in THA patients through a dose-response relationship. It is recommended that preoperative systolic blood pressure be maintained below 160 mmHg, and metabolic status be optimized to reduce the risk of blood transfusion.

Objectives: Pseudomyxoma peritonei (PMP), generally spread of low grade appendiceal mucinous neoplasm (mucinous appendix neoplasms) into the abdominal cavity, is conventionally treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Prognostic factors of small cohort sizes remain incomplete and conflicting. This large-scale study aimed to characterize long-term survival outcomes and identify prognostic factors in PMP patients following CRS-HIPEC.

Materials and methods: We conducted a retrospective cohort study of 432 consecutive PMP patients treated with CRS-HIPEC at Aerospace Center Hospital (Beijing, China) from June 2014 to December 2020. Overall survival (OS) served as the primary endpoint, with event-free survival (EFS) as the secondary endpoint. Multivariable Cox proportional hazards models were employed to identify independent prognostic factors.

Results: With median survival durations of 56 months (OS) and 45 months (EFS), cumulative mortality and event incidence reached 21.4% and 32.4%, respectively. Independent predictors for poorer OS included: preoperative raised tumor markers (hazard ratio [HR] = 4.90-10.20; 95% confidence interval [95% CI]: 1.11-46.67; P < 0.05), completeness of cytoreduction (CC) score (HR = 3.37-9.41; 95% CI: 1.05-16.37; P < 0.05), and high-grade PMP (HR = 1.80; 95% CI: 1.10, 2.93; P = 0.019). EFS was significantly associated with preoperative Barthel index (HR = 0.86; 95% CI: 0.74, 0.98; P = 0.019) in addition to the aforementioned factors. Intraoperative hypotension and hyperthermia were not associated with both OS and EFS.

Conclusions: Key factors impacting outcomes of patients with PMP of mucinous appendix neoplasms included preoperative elevated tumor markers, Barthel index, CC-score, and the PMP histology, without intraoperative hypotension and hyperthermia.

Background: Facial vascularized composite allotransplantation (FVCA) provides transformative restoration for patients with severe craniofacial defects, but successful outcomes depend heavily on facial nerve (FN) reconstruction and reinnervation. Unlike standard nerve repair, FN coaptation in FVCA must address donor-recipient mismatch and immunologic variability. This systematic review synthesizes clinical and preclinical evidence on FN reconstruction strategies in FVCA and their functional outcomes.

Methods: This review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (ID: CRD420251029430). A comprehensive search of PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) and SYRCLE tool for preclinical studies.

Results: Overall, n = 45 (11%) studies [n = 41 (91%) human, n = 4 (9%) preclinical] published between 2006 and 2025 were included. Human studies were predominantly case reports n = 18 (44%), case series n = 11 (27%), and cadaveric investigations n = 9 (22%). Across n = 139 (100%) documented nerve repair interventions (NRIs), direct coaptation was performed in n = 20 (14%), most commonly at the FN trunk or its buccal, zygomatic, marginal mandibular, and frontal branches n = 28 (20%). Nerve grafting was more frequent, in n = 62 (45%), typically using great auricular or thoracodorsal donor nerves; only n = 2 (1.4%) NRIs employed dual-level trunk and branch coaptation. Synkinesis was reported in n = 11 (7.9%) NRIs, and patient-reported outcomes, though inconsistently collected, indicated improvements in oral continence, speech, social integration, and psychosocial well-being. Secondary revisions occurred in n = 27 (19%) and infectious complications in n = 12 (8.6%) NRIs. Preclinical rodent and porcine models corroborated clinical evidence that combined motor and sensory nerve repair enhances functional recovery.

Conclusion: FN reconstruction in FVCA is feasible and often results in partial functional recovery. However, outcomes remain heterogeneous and are influenced by surgical approach, immunologic status, and rehabilitative support. Standardized assessment tools should be more widely adopted to improve comparability and guide individualized treatment planning. Translational research and multicenter data collection are needed. FN reconstruction represents both a clinical challenge and an opportunity to improve long-term quality of life in FVCA recipients. Systematic Review Registration: identifier CRD420251029430.

Aim: This study aimed to compare the impacts of laparoscopic surgery (LS) and open surgery (OS) on the short-term efficacy and long-term survival in patients diagnosed with colorectal cancer (CRC).

Methods: Sixty CRC patients who underwent LS at our hospital between January 2021 and January 2022 were enrolled as the LS group. Another 60 CRC patients who received OS during the same period at the same hospital were selected as the OS group. The study compared surgical parameters, postoperative recovery metrics, stress response indicators, inflammatory markers, immune function markers, the incidence of postoperative complications, quality of life assessments, and 3-year survival rates between the two cohorts.

Results: The LS group exhibited a longer surgical duration but had shorter surgical incisions and less intraoperative blood loss compared to the OS group (P < 0.01). The number of lymph nodes dissected was similar in both groups (P > 0.05). The LS group also demonstrated quicker recovery, with shorter times to anal gas expulsion, defecation, oral intake, and activity, as well as a reduced hospital stay (P < 0.01). On the third day post-surgery, the study group showed lower levels of cortisol, epinephrine, and norepinephrine (P < 0.05), along with decreased levels of IL-6, TNF-α, and CRP (P < 0.05). Conversely, the study group had higher levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ on the third day after surgery (P < 0.05). The overall incidence of postoperative complications was lower in the study group (P < 0.05). Twelve months post-surgery, both groups showed significant improvements in the Gastrointestinal Quality of Life Index (GIQLI) scores, with the study group outperforming the OS group (P < 0.05). Kaplan-Meier analysis revealed a 3-year survival rate of 81.67% in the study group vs. 80.00% in the OS group, with no statistically significant difference (P = 0.833).

Conclusion: LS for CRC patients is highly effective, alleviating inflammatory and immune stress responses in patients, lowering the incidence of postoperative complications, improving the quality of life of patients, and having a long-term efficacy comparable to OS.

Marfan syndrome (MFS) is a systemic connective tissue disease severely affecting the cardiovascular system. We present the case of a MFS 55-year-old woman who arrived at the emergency department with increasing chest pain. Over the past 25 years, this patient had undergone mitral valve annuloplasty, subsequent open surgical repair of a ruptured infrarenal abdominal aortic aneurysm followed by open surgery for a type I thoracoabdominal aortic aneurysm. She was also operated for fenestrated endovascular repair of a visceral aortic aneurysm using a 'graft-to-graft' approach. Upon the urgent admission, a multislice computed tomography angiography demonstrated an aortic aneurysm sac with a maximum diameter of 11.8 cm that was fed by a type IIIB endoleak, due to complete branch stent disconnection of the right renal artery (RRA) and by type IIIB/IIIC endoleaks secondary to stent fracture and disconnection in the superior mesenteric artery (SMA) and celiac trunk (CT), respectively. A common hepatic artery aneurysm (diameter of 2.29 cm) was detected, too. Under general anaesthesia a relining of both RAA and SMA was performed with Ballon-expandable Gore Viabahn and VBX stent-grafts. Subsequently, a CT stenting was successfully carried out. The bridging stents were intentionally positioned to protrude into the fenestrations to get enough overlap with the previously placed stent at the target vessel level. There were no postoperative systemic complications and the patient was discharged after 3 days under dual anti-platelet therapy. At 12 months of follow-up, complete exclusion and shrinkage of the aneurysmal sac and the patency of the stented visceral vessels are demonstrated. This complex case serves as the starting point for a literature review on current trends and perspectives in the treatment of aortic pathology related to MFS. Since MFS patients often present with aortopathy at a young age, different surgical treatments could be combined over the years to provide durable results in in protection against aortic rupture, until more effective drugs can be implemented.

Background: Hereditary Diffuse Gastric Cancer (HDGC) is a rare but highly penetrant autosomal dominant cancer predisposition syndrome, most commonly associated with germline pathogenic variants in the CDH1 gene. Early diagnosis remains challenging due to the absence of specific clinical or endoscopic features in early disease stages.

Methods: We present a case series describing a cluster of advanced diffuse gastric cancer (DGC) cases in a single Italian family. Clinical, genetic, and surgical data were collected and analyzed, including pedigree reconstruction, genetic testing, and risk-reducing interventions.

Results: Two male siblings developed advanced signet ring cell gastric carcinoma at ages 41 and 44, both with rapid disease progression and fatal outcomes. Their family history revealed two sisters who had died from gastric cancer at a young age. Genetic counseling identified a CDH1 c.1792C>T pathogenic variant in affected family members. Two young, asymptomatic female carriers (aged 18 and 22) underwent prophylactic total gastrectomy in accordance with international guidelines. Subsequently, another male sibling died at the age of 30 due to gastric cancer. This familial cluster demonstrated high phenotypic penetrance and highlighted the impact of genetic testing on clinical management. In addition, we discuss the evolving landscape of risk stratification and the balance between prophylactic total gastrectomy and structured endoscopic surveillance.

Conclusion: This case series underscores the clinical heterogeneity of HDGC and the critical role of timely genetic testing, family history assessment, and early prophylactic gastrectomy in high-risk carriers. A multidisciplinary approach integrating clinical genetics, surgery, and endoscopic expertise is essential to optimize risk-reducing strategies and outcomes in HDGC.