Frontiers in Surgery最新文献

Introduction: The prognostic landscape of stage III Lung Adenosquamous Carcinoma (ASC) following primary tumor resection remains underexplored. A thoughtfully developed prognostic model has the potential to guide clinicians in patient counseling and the formulation of effective therapeutic strategies.

Methods: Utilizing data from the Surveillance, Epidemiology, and End Results database spanning 2000 to 2018, this study identified independent prognostic factors influencing Overall Survival (OS) in ASC using Boruta analysis. Employing Gradient Boosting, Random Forest, and Neural Network algorithms, predictive models were constructed. Model performance was assessed through key metrics, including Area Under the Receiver Operating Characteristic Curve (AUC), calibration plot, Brier score, and Decision Curve Analysis (DCA).

Results: Among 241 eligible patients, seven clinical parameters-age, sex, primary tumor size, N stage, primary tumor site, chemotherapy, and systemic therapy-were identified as significant predictors of OS. Advanced age, male gender, larger tumor size, absence of chemotherapy, and lack of systemic therapy were associated with poorer survival. The Random Forest model outperformed others, achieving 3- and 5-year AUCs of 0.80/0.79 (training) and 0.74/0.65 (validation). It also demonstrated better calibration, lower Brier scores (training: 0.189/0.171; validation: 0.207/0.199), and more favorable DCA. SHAP values enhanced model interpretability by highlighting the impact of each parameter on survival predictions. To facilitate clinical application, the Random Forest model was deployed on a web-based server for accessible prognostic assessments.

Conclusions: This study presents a robust machine learning model and a web-based tool that assist healthcare practitioners in personalized clinical decision-making and treatment optimization for ASC patients following primary tumor resection.

Objective: This study aims to evaluate the effects of pleural reconstruction during rib compartment tumor resection surgery on postoperative outcomes, including drainage volume, drainage duration, hospital stay, complications, and pain control.

Methods: A retrospective analysis was conducted on 142 patients who underwent rib compartment tumor resection surgery at Beijing Jishuitan Hospital from January 2013 to October 2023. The patients were divided into two groups: those who received pleural reconstruction and those who did not. Data were collected from hospital medical records and outpatient care records, focusing on postoperative drainage volume, total drainage time, length of hospital stay, complications, and pain scores. Continuous variables were compared using t-tests or nonparametric tests, while categorical variables were analyzed using chi-square tests or Fisher's exact tests.

Results: The analysis showed no significant differences between the two groups in terms of postoperative complications and pain thresholds. However, patients who underwent pleural reconstruction had significantly lower postoperative drainage volume (937.74 ± 855.97 vs. 1,595.26 ± 1,054.50 ml, p < 0.05), shorter drainage duration (5.5 ± 2.39 vs. 8.43 ± 2.87 days, p < 0.05), and reduced length of hospital stay (7.32 ± 3.30 vs. 10.99 ± 6.83 days, p < 0.05).

Conclusion: Pleural reconstruction during rib compartment tumor resection surgery reduces postoperative drainage volume, drainage duration, and hospital stay without increasing complications or short-term pain. Further large-scale studies are recommended to validate these findings.

This case report describes a rare instance of extrarenal clear cell renal cell carcinoma (ccRCC) in a 48-year-old woman who presented with a loss of consciousness. Abdominal CT revealed a 24 × 31 mm mass in the left adrenal region, with no kidney involvement. The mass was surgically excised, and histopathological examination confirmed the diagnosis of ccRCC. Immunohistochemical analysis revealed positive markers, including CA9, CD10, PAX-8, and vimentin. The patient did not undergo adjuvant therapy, and a 6-month follow-up showed no signs of recurrence or metastasis. This case emphasizes the importance of considering extrarenal ccRCC in differential diagnoses of adrenal masses.

Background and importance: Arteriovenous malformations (AVMs) are complex vascular anomalies that pose significant risks, including intracranial hemorrhage and neurological deficits. Surgical resection is the preferred treatment, requiring precise intraoperative imaging to ensure complete removal while preserving critical structures. This case report presents the first combined use of hyperspectral imaging (HSI) and indocyanine green video angiography (ICG VA) to visualize perfusion during brain AVM surgery, highlighting the potential benefits of these advanced imaging techniques.

Case description: A 66-year-old male presented with chronic headaches but no neurological deficits. MRI revealed a superficial AVM in the left frontal lobe within the superior frontal sulcus, measuring approximately 2.4 cm. The AVM was fed by feeders from the pericallosal artery, callosomarginal artery, and middle cerebral artery (MCA) branches, with drainage through a dilated cortical vein into the superior sagittal sinus. Preoperative embolization of two MCA feeding branches was performed, followed by microsurgical resection with ICG VA and HSI.

Conclusions: This case report demonstrates the successful application of HSI and ICG VA in brain AVM surgery. The combined use of these technologies provided comprehensive intraoperative assessment, enhancing surgical precision and safety. The integration of HSI offers non-invasive, contrast-agent-free imaging, potentially improving outcomes by enabling detailed perfusion mapping. Future studies should explore the broader applications of these imaging modalities in neurovascular practice.

Background: Mechanical failure following total spondylectomy is a surgical challenge. The cervicothoracic junction region is a special anatomical site with complex biomechanics, and few studies have reported a detailed surgical management strategy for cases where the mesh cage subsides and compresses the spinal cord in the cervicothoracic junction region after total spondylectomy.

Case presentation: A 56-year-old male patient experienced screw and rod fracture and mesh cage retropulsion into the spinal canal 5 years after total spondylectomy for osteochondroma in the first to third thoracic vertebrae. The patient complained of numbness and discomfort in both lower extremities, accompanied by unstable walking for 8 months prior to admission at our hospital. We concluded that uncorrected local kyphosis in the cervicothoracic junction after the first surgery resulted in current mesh cage subsidence and rod/screw fracture. Considering the difficulty and risks of removing the mesh cage from the anterior approach, we initially freed the superior end of the mesh cage without removing the mesh from the anterior approach by resecting the C6/7 intervertebral disc and the destroyed C7 vertebral body. We then removed the original screws and rods and performed long segment fixation from C4 to T6 via a posterior approach after recovering sagittal alignment by skull traction. Finally, the iliac bone was harvested and transplanted between the superior end of the mesh cage and the inferior end plate of C6 to fill the defect caused by kyphosis correction and C7 vertebral resection. After surgery, the patient experienced sagittal alignment reconstruction and symptom relief, and he was asked to wear a cast for at least 6 months until bone fusion was achieved. At the 3-year follow-up, there was fusion between the mesh cage and the C6 vertebra with successful instrument reconstruction and no mesh cage subsidence were observed.

Conclusions: When a subsided and migrated titanium mesh cage is difficult to remove after mechanical failure following total spondylectomy, recovering sagittal alignment to achieve indirect decompression based on unique anterior and middle column reconstruction, solid instrument construction, and bone fusion is an alternative solution.

Introduction: Achilles tendon rupture is a common and debilitating injury that significantly impacts mobility and quality of life. Effective treatment options that promote faster and more complete healing are needed. Fibroblast growth factor-2 (FGF-2) has shown potential in enhancing tendon repair. This study aims to investigate the efficacy of FGF-2 in promoting tendon healing in a rat model of Achilles tendon rupture, providing insights into its potential as a therapeutic option.

Materials and methods: Forty-eight rat hind legs with complete Achilles tendon ruptures were divided into four equal groups: the Sham (S) group (tendon repair only), the Polymer (P) group (tendon repair with scaffold wrapping), the Produced FGF-2 (PF) group (scaffold coated with lab-produced FGF-2), and the Commercial FGF-2 (CF) group (scaffold coated with commercially sourced FGF-2). Histological analyses at two and four weeks post-surgery evaluated healing based on nuclear morphology, vascularity, fibril organization, inflammation, and adipogenesis.

Results: At the end of the second week, no macroscopic healing was observed in one rat each from the S and P groups. By the end of the fourth week, macroscopic healing was observed in all groups. The S and P groups exhibited similarly severe fibril disorganization, pathological adipogenesis, and sustained inflammation, particularly at the fourth week. In contrast, the CF group demonstrated improved tendon healing with increased vascularity and extracellular matrix, lower inflammatory cell infiltration, and better fibril organization. Pathological adipogenesis was absent in the CF group, especially at the fourth week. The PF group showed comparable improvements at the second week but experienced a relapse by the 4th week, with increased inflammation and adipogenesis.

Conclusion: FGF-2 coated scaffolds significantly enhanced tendon healing in a rat Achilles tendon rupture model by improving fibril organization, increasing vascularity, and reducing inflammation and pathological adipogenesis. These findings suggest that FGF-2 could be a promising therapeutic option for accelerating tendon repair. Future perspectives on tendon repair will focus on enhancing FGF-2 delivery using innovative scaffolds, paving the way for more effective therapies and improved patient outcomes.

Background and objectives: Isolated bone tumors of the glenoid are exceedingly rare occurrence and pose a substantial surgical challenge. 3D printing technology has been proved to be a reliable tool to reconstruct complex anatomical part of the skeleton. We initially used this technology to reconstruct the glenoid component of the shoulder in a hemiarthroplasty configuration. We subsequently changed to a reverse shoulder arthroplasty.

Methods: Two patients were reconstructed with a hemiarthroplasty and 2 with a reverse configuration. Patients files were reviewed for radiographic analysis, pain and function scores.

Results: Mean follow-up was 36.44 ± 16.27 months. All patients are alive and disease free. The two patients who benefitted from a hemiarthroplasty demonstrated a rapid deterioration of the proximal humeral articular surface. Given their pain and function scores, they subsequently required revision towards a total shoulder arthroplasty. Following this conversion, one patient presented a shoulder dislocation requiring surgical reintervention. We did not observe any loosening or infection in this short series.

Conclusions: Custom made glenoid reconstruction should be designed as a reverse shoulder arthroplasty given the mechanical constrains on the proximal humerus and the extent of the surgery invariably damaging the suprascapular neurovascular bundle.

Introduction: This study evaluated the efficacy and learning curve of a maxillofacial surgical robotic system (MSRS) guided by electromagnetic navigation for mandibular angle ostectomy (MAO), compared to traditional surgical methods.

Methods: The study utilized a controlled experiment involving thirty rabbits, paired divided into experimental and control groups. The experimental group underwent MAO using the MSRS, while the control group was treated with conventional surgical techniques. The surgeons performing the procedures were inexperienced in robotic surgery and MAO to assess the learning curve and the impact of robotic assistance. Key parameters measured included the accuracy of ostectomy, setup time, and ostectomy efficiency, with data analyzed through a paired-t test to compare the performance between the two groups.

Results: The study indicated a significant reduction in ostectomy time for the experimental group, with improved accuracy and efficiency in ostectomy. The study found that robotic assistance could decrease the risk of complications and enhance surgical outcomes. It also highlighted the presence of an initial learning curve when adopting new robotic technologies, which could be mitigated through adequate training and simulation practices.

Discussion: Using MSRS for MAO could lead to faster early learning curves and increased ostectomy efficiency compared to traditional surgical methods. It demonstrated the potential benefits of integrating robotic systems into craniofacial surgery, suggesting a promising direction for future surgical practices.

Congenital nephrogenic diabetes insipidus (NDI) primarily arises from an X-linked recessive inheritance caused by mutations in the AVPR2 gene, which is responsible for approximately 90% of cases. This condition has an incidence rate of 4-8 per million male live births, with females being much less frequently affected. Symptoms typically manifest shortly after birth, predominantly in males. The key clinical features of NDI include excessive urination (polyuria), compensatory excessive thirst (polydipsia), cognitive impairment, consistently low urine specific gravity, dehydration, and imbalances in electrolyte levels. This case study highlights an unusual occurrence of NDI in a 50-year-old Chinese woman attributed to a mutation in the AVPR2 gene. For more than a year, she had been suffering from excessive urination and severe thirst. The patient, who had undergone surgery for cervical cancer, developed polyuria and hypernatremia postoperatively. Initial laboratory analyses revealed normal blood sodium and chloride levels but reduced urine osmolality and specific gravity. Imaging assessments revealed no irregularities. To validate the diagnosis of NDI, she participated in a water deprivation and vasopressin test. Subsequent genetic tests revealed a thymine (T) to adenine (A) mutation, leading to a missense mutation in the AVPR2 gene. As part of her treatment, she was placed on a low-sodium diet and prescribed oral hydrochlorothiazide and indomethacin for 1 month, resulting in a marked improvement in her symptoms. To the best of our knowledge, this is the first documented case of NDI diagnosed postoperatively in an older female patient with AVPR2 heterozygosity. This case highlights an unusual instance of an X-linked recessive clinical presentation of NDI in an elderly female patient. This study also underscores the importance of conducting water deprivation, vasopressin tests, and genetic testing in establishing the underlying cause for individuals diagnosed with NDI.

Objective: Acute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drainage (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.

Methods: We reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pre-treatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.

Results: Among the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (p = 0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (p = 0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (p = 0.458).

Conclusion: In patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.