Frontiers in Surgery最新文献

Objective: This study aims to evaluate the efficacy of palliative surgery in patients with spinal metastases from lung cancer and to identify prognostic factors affecting postoperative 1-year survival, providing clinical treatment references for these patients.

Methods: Clinical data of 55 patients with spinal metastases from lung cancer who underwent surgery at Shenzhen People's Hospital from January 2017 to December 2022 were analyzed. Improvements in preoperative and postoperative visual pain scores, ODI scores, and Frankel grades were assessed. Kaplan-Meier method was used to plot survival curves, and the Cox proportional hazards model was employed to analyze various factors influencing postoperative 1-year survival.

Results: Surgical treatment helped alleviate pain, maintain or improve neurological function, and enhance the quality of life. Among the 55 patients, 23 (41.82%) died, and 32 (58.18%) survived, with a median survival time of 16.83 months (95% CI: 9.88, 23.78) and a one-year survival rate of 58.18%.Factors influencing postoperative 1-year survival included ODI score one-month post-surgery, presence of visceral metastases, and postoperative bone modifying agents (BMA). Multivariate Cox proportional hazards model survival analysis indicated that the presence of visceral metastases and postoperative BMA were independent factors affecting one-year survival in these patients.

Conclusion: Surgical treatment effectively alleviates pain, maintains or improves neurological function, and enhances the quality of life in patients with spinal metastases from lung cancer. The presence of visceral metastases and postoperative BMA are independent factors influencing postoperative 1-year survival.

Background: Infected pancreatic necrosis (IPN) remains a life-threatening complication of acute pancreatitis. While minimally invasive "step-up" strategies are now standard, their implementation in resource-limited settings is often constrained by availability of interventional radiology, advanced endoscopy, and intensive care support. This study describes management pathways, morbidity, and outcomes of surgically treated IPN in a tertiary hepatopancreatobiliary (HPB) unit operating under such limitations.

Methods: A retrospective analysis of prospectively maintained data was performed on patients who underwent surgical necrosectomy for IPN between 2015 and 2021. Management followed a step-up philosophy where feasible, incorporating antibiotics, image-guided or endoscopic drainage, and delayed surgery. Clinical characteristics, interventions, complications, and outcomes were analysed descriptively.

Results: Six patients underwent surgery for IPN. Initial interventions included ultrasound-guided percutaneous drainage (n = 3), endoscopic ultrasound-guided drainage (n = 1), and primary surgery (n = 2). All patients ultimately required open necrosectomy due to persistent sepsis or failure of less invasive measures. Early morbidity was substantial, with organ failure occurring in 83.3%, including acute respiratory distress syndrome in 66.6%. Clinically relevant postoperative pancreatic fistula occurred in 50%, and incisional hernia developed in all patients during follow-up. Median ICU and hospital stays were 17.3 and 58.5 days respectively. There was one mortality (16.6%).

Conclusion: In resource-limited environments, the step-up approach to IPN is frequently constrained by service availability rather than intent. Open necrosectomy remains an essential salvage strategy when minimally invasive interventions are unavailable or unsuccessful, but is associated with significant morbidity. Careful patient selection, delayed intervention, and multidisciplinary management are critical to achieving acceptable outcomes.

Background: Immersive and interactive technologies such as Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) are reshaping surgical planning by enhancing anatomical visualization, enabling personalized procedures, and improving intraoperative navigation and decision-making across diverse surgical specialties.

Methods: This systematic review was conducted in accordance with the PRISMA guidelines, and was registered in PROSPERO (CRD420251066149), analyzing 30 studies (1,270 participants) from PubMed, Google Scholar Web of Science and Ovid MEDLINE up to February 2025. Included studies evaluated VR, AR, or MR in preoperative or intraoperativesurgical planning, reporting outcomes on accuracy, time efficiency, or plan modifications. Risk of bias was assessed using RoB 2.0 for RCTs and ROBINS-I for non-randomized studies.

Results: VR was the most utilized technology (17 studies), improving spatial understanding and prompting plan modifications in 32%-52% of cases (e.g., lung segmentectomies, TAVR). AR (8 studies) enhanced intraoperative accuracy, reducing pedicle screw placement errors (98% vs. 91.7% control) and procedure times (e.g., 50% faster spinal screw placement). MR (2 studies) demonstrated potential in reducing thoracic epidural needle adjustments (7.2 vs. 14.4 movements) and sentinel node biopsy durations (3.6 vs. 7.9 min). Heterogeneity in study designs and outcomes limited meta-analysis.

Conclusion: VR enhanced anatomical understanding and preoperative planning, while AR, and MR were better for procedural accuracy and intraoperative workflow. Future multicenter trials with standardized protocols are needed to establish long-term clinical efficacy and cost-effectiveness in diverse surgical settings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251066149, PROSPERO CRD420251066149.

Introduction: Carotid endarterectomy (CEA) is considered the surgical intervention of choice for symptomatic and asymptomatic carotid artery stenosis. Restenosis following CEA is not a rare condition. However, cases of restenosis resulting from short-term massive intimal hyperplasia of the carotid artery are relatively rare.

Case description: We present a case of a 69-year-old male patient who successively underwent carotid artery stenting (CAS), CEA and stent removal due to recurrent ischemic symptoms. Subsequently, the patient received redo carotid endarterectomy (reCEA) combined with patch angioplasty to address a third episode of carotid artery stenosis caused by extensive intimal hyperplasia. Based on a review of the relevant literature, the underlying pathological conditions and corresponding surgical strategies were analyzed and discussed.

Conclusion: Symptomatic restenosis caused by simple intimal hyperplasia shortly following CEA is relatively uncommon. In contrast to atherosclerotic plaques, this dense and fibrous tissue is more resistant to dissection and may lead to a reduction in vessel diameter. Neither standard CEA nor CAS alone can adequately prevent long-term restenosis. However, CEA combined with patch angioplasty has been shown to be an effective therapeutic option for this specific type of stenosis.

Background: Femoral neck fractures carry a substantial risk of complications such as varus malalignment, avascular necrosis and the need for reoperation. While traditional prognostic factors have been extensively studied, the relevance of postoperative spinopelvic characteristics after internal fixation remains unclear. This study evaluated whether spinopelvic parameters measured on standardized postoperative radiographs are associated with adverse outcomes.

Methods: Ninety-six patients aged 18-60 years who underwent internal fixation for femoral neck fractures were analysed. Demographic variables, fracture characteristics, fixation type and postoperative complications were recorded retrospectively. Sacral slope, pelvic tilt, pelvic incidence and sacral slope difference were measured on lateral lumbosacral radiographs obtained at the 6 month follow-up. Associations with varus deformity, avascular necrosis and reoperation were assessed using univariable and multivariable logistic regression.

Results: Sacral slope difference demonstrated consistent associations with all major complications. Patients with higher sacral slope difference had significantly greater rates of varus deformity, avascular necrosis and reoperation. Higher pelvic tilt was associated with avascular necrosis, and higher pelvic incidence was associated with reoperation. Several multivariable analyses met exploratory criteria due to limited events per variable, and these results should be interpreted with caution. Interobserver reliability for all spinopelvic measurements was excellent.

Conclusion: Spinopelvic parameters, particularly sacral slope difference, were associated with key complications after internal fixation of femoral neck fractures. These postoperative measurements may help identify patients who could benefit from closer follow-up, although they should not be interpreted as predictive factors. Prospective studies are required to validate these associations and clarify their clinical relevance.

Introduction: Spondyloptosis, the most severe form of spondylolisthesis, involves complete (>100%) anterior or posterior displacement of one vertebra over the subjacent segment, resulting in total anatomical dislocation. Typically caused by high-energy trauma, it leads to severe spinal instability, bony fragment intrusion into the canal, and significant neurological deficits. This report presents a representative case of T8-T9 spondyloptosis with complete spinal cord injury [American Spinal Injury Association (ASIA) Impairment Scale Grade A]to analyze its injury features, surgical approach, and clinical outcomes.

Patient concerns: A 61-year-old female was admitted to the hospital presenting with severe thoracodorsal pain and complete paralysis of both lower extremities for 8 h following a crushing injury by a heavy object. The patient exhibited intense back pain and a pronounced thoracic kyphotic deformity. Complete loss of motor and sensory function was observed below the xiphoid process level. Imaging studies revealed complete dissociation between the T8 and T9 vertebral bodies. The distal fracture segment (T9) was displaced posteriorly and superiorly, resulting in impaction of the anterior margin of the T9 vertebral body against the spinous process of T8. Complete fractures with rotational displacement were noted in the posterior elements, including the pedicles and facet joints at the T8-T9 level.

Primary diagnosis: T8-T9 spondyloptosis with complete spinal cord injury (ASIA A).

Interventions: On the ninth day post-injury, the patient underwent posterior open reduction, laminectomy for decompression, inter-laminar bone grafting, and segmental instrumentation with internal fixation of the thoracic fracture.

Outcomes: The patient's postoperative vital signs remained stable. Imaging revealed satisfactory correction of the thoracolumbar deformity, adequate positioning of the internal fixation hardware, near-complete restoration of the spinal physiological curvature, satisfactory fracture reduction, reconstitution of the spinal canal morphology, and appropriate alignment of the implants, all of which met preoperative expectations.

Conclusion: This case represents the first reported instance of T8-T9 spondyloptosis with complete spinal cord injury resulting from high-energy trauma. The management of high-energy thoracolumbar fractures necessitates an in-depth understanding of the injury mechanism to formulate an individualized surgical strategy.

Background: Acute pancreatitis (AP) is a heterogeneous inflammatory disease, with ∼20% of patients progressing to moderate-to-severe (MSAP) or severe AP (SAP), conditions associated with high mortality. Early risk stratification is therefore critical. This study systematically evaluated and compared 12 inflammatory biomarkers for predicting AP severity.

Methods: This retrospective cohort included 1,981 hospitalized AP patients (January 2018-December 2023). According to the revised Atlanta criteria, patients were classified into mild AP (MAP, n = 1,058) and MSAP/SAP (n = 923) groups. Twelve inflammatory indices-monocyte-to-lymphocyte ratio (MLR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein-to-albumin ratio (CAR), C-reactive protein-albumin-lymphocyte index (CALLY), C-reactive protein-to-calcium ratio (CCR), C-reactive protein-to-lymphocyte ratio (CLR), red cell distribution width-to-albumin ratio (RDW/Alb), neutrophil-to-albumin ratio (NAR), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)-were calculated. A multivariate logistic regression model adjusted for 28 covariates. ROC curves assessed predictive performance; restricted cubic splines (RCS) explored nonlinear relationships; and threshold effect analysis was conducted for the highest-performing biomarker.

Results: In the fully adjusted model, nine biomarkers were significantly associated with MSAP/SAP risk: MLR (OR = 1.29, 95%CI: 1.15-1.45), LMR (OR = 0.75, 95%CI: 0.66-0.85), CAR (OR = 3.82, 95%CI: 3.18-4.64), CALLY (OR = 0.56, 95%CI: 0.49-0.64), CCR (OR = 4.84, 95%CI: 3.98-5.96), CLR (OR = 2.12, 95%CI: 1.84-2.46), RDW/Alb (OR = 1.74, 95%CI: 1.54-1.99), NAR (OR = 1.44, 95%CI: 1.27-1.64), and SIRI (OR = 1.29, 95%CI: 1.15-1.46). CCR demonstrated the highest observed accuracy (AUC = 0.768, 95%CI: 0.737-0.799). Threshold effect analysis revealed a nonlinear association, with an inflection point at 15: no significant association was observed below this threshold (OR = 1.015, P = 0.558), whereas risk significantly increased above it (OR = 1.212, P < 0.001).

Conclusion: Among 12 inflammatory biomarkers, CCR showed the strongest predictive value for MSAP/SAP, with a critical threshold of 15. As an easily obtainable marker, CCR may serve as a practical early warning tool to guide clinical management and risk stratification in AP.

Background: Colorectal cancer is a major global health concern that requires successful surgical treatments. While robotic-assisted surgery (RAS) provides prospective improvements, laparoscopic surgery has proven to yield better results than open surgeries.

Methods: From 2018 to December 2024, PubMed, Scopus, and Web of Science were used to perform a systematic review and meta-analysis of cohort studies and randomized controlled trials (RCTs). Studies comparing RAS and conventional laparoscopic surgery were included. The primary outcomes assessed were length of hospital stay, conversion to open surgery, postoperative complications, and operating time. Using Comprehensive Meta-Analysis software, statistical analysis was performed, including subgroup analyses by anatomical site (colon, rectum, colorectal). Sensitivity analyses and heterogeneity were conducted.

Results: 21 studies involving over 70,000 patients were included. The meta-analysis demonstrated significantly longer operative times with RAS (MD = 0.161-1.049, p < 0.001). RAS was linked to a significantly lower chance of re-operative rates (RR = 0.549, p = 0.023) and a significantly lower risk of conversion to open surgery (RR = 0.412-0.592, p < 0.001). RAS decreased problems in the colorectal group (RR = 0.867, p = 0.023), but overall rectum group complication rates were comparable. Hospital stays were shorter after robotic-assisted surgery (MD = -0.284 to -0.755, p = 0.001).

Conclusion: When compared to CLS, RAS has the advantage of lowering conversion and re-operation rates, albeit at the expense of higher operating time. CLS led to shorter hospital stays, but in some circumstances, the complication rates were on level with or lower than those of RAS. According to these results, RAS might be useful in some surgical situations and patient demographics.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/614084, PROSPERO CRD42024614084.

Background: Intramedullary spinal cord metastases (ISCM) from non-small cell lung cancer (NSCLC) are rare and carry a grave prognosis. Cervical segment involvement is exceptionally uncommon, and its distinct clinicopathological profile is not well characterized.

Methods: We present the case of a 72-year-old male with a history of NSCLC who developed acute quadriparesis and sphincter dysfunction. Cervical magnetic resonance imaging (MRI) revealed a C7 intramedullary mass. The patient underwent C6-T1 laminectomy with microsurgical gross-total resection. Histopathology confirmed metastatic lung adenocarcinoma. We supplemented this case with a systematic literature review of NSCLC-derived ISCM cases to summarize demographic, clinical, and therapeutic outcomes.

Results: Histopathology confirmed metastatic lung adenocarcinoma. Postoperatively, the patient's neurological function improved. Although local recurrence was detected at 11 months and treated with salvage radiotherapy, the patient nevertheless maintained ambulatory function and was alive at the 18-month follow-up. Our literature review of 68 cases with complete data identified a male predominance (4.2:1 ratio) and a mean age of 58.1 years. The cervical spine was the most commonly involved segment (47.1%). Analysis of treatment modalities revealed that multimodal therapy, particularly the combination of surgery and chemotherapy (potentially incorporating modern agents such as immune checkpoint inhibitors), was associated with improved survival, with a mean overall survival of 15.0 months in this subgroup. This paradigm, centered around maximal safe resection, successfully achieved long-term functional preservation and survival.

Conclusion: Cervical ISCM from NSCLC represents one of the most challenging complications in spinal oncology. This case, supported by our literature review, provides a surgical-led, multimodal management template for spine surgeons, demonstrating that aggressive yet strategic intervention can achieve favorable long-term neurological and survival outcomes.

Aim: To evaluate the safety, feasibility, and long-term efficacy of natural orifice specimen extraction surgery (NOSES) compared with totally laparoscopic right hemicolectomy (TLRH) for right-sided colon cancer.

Methods: This single-center retrospective study included 349 patients who underwent laparoscopic curative resection for stage I-III right-sided colon cancer between January 2018 and January 2023. After 1:1 propensity score matching (PSM) for age, tumor size, BMI, neoadjuvant therapy, and T stage, 115 NOSES patients were compared with 115 TLRH patients. Outcomes included postoperative recovery, perioperative fatigue, complications, pelvic floor function, disease-free survival (DFS), and overall survival (OS).

Results: After PSM, baseline characteristics were balanced. Operative time and blood loss did not differ between groups. NOSES was associated with significantly less postoperative pain (P < 0.001) and lower analgesic use (25.2% vs. 47.0%, P < 0.001). Learning curves indicated proficiency after 57 transvaginal and 32 transrectal procedures. Recovery indicators, including time to first flatus, defecation, and hospital stay, were comparable. Incision-related complications occurred more frequently in TLRH (P = 0.024). NOSES patients reported lower fatigue levels on postoperative days 1 and 3 (P < 0.001), with fewer cases of postoperative fatigue syndrome. Pelvic floor and continence outcomes were similar. No local recurrences were observed, and DFS and OS did not differ significantly.

Conclusions: NOSES is a safe and effective alternative for selected patients with right-sided colon cancer. It reduces postoperative pain, fatigue, and incision-related complications without compromising oncological outcomes or pelvic floor function, and demonstrates a clear learning curve supporting its broader application.