Frontiers in Surgery最新文献

Purpose: To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.

Methods: A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.

Results: Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267).

Conclusions: Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.

Introduction: The optimal surgical strategy for synchronous bilateral pulmonary nodules remains unclear. One-stage bilateral resections may offer logistical and clinical advantages, but safety concerns persist regarding bilateral complications.

Methods: We conducted a systematic review and meta-analysis of studies comparing one-stage vs. two-stage pulmonary resections in adult patients with synchronous bilateral nodules. Ten observational studies were included, encompassing 1,015 patients. Continuous outcomes were assessed using mean differences (MDs) and binary outcomes with odds ratios (ORs), applying DerSimonian and Laird random-effects models. Subgroup and meta-regression analyses were performed. Statistical analyses were conducted using R software (v4.4.1).

Results: One-stage resection was associated with significantly reduced operative time (MD -24.36 min; 95% CI -40.59 to -8.13), shorter hospital stay (MD -2.79 days; 95% CI -4.25 to -1.33), and lower direct surgical costs (MD -5,543.73 USD; 95% CI -6,601.05 to -4,486.40). No significant differences were observed in intraoperative blood loss, persistent air leak, or arrhythmia. Subgroup analysis revealed that the type of pulmonary lesion influenced hospital stay, while meta-regression showed no effect of lobectomy rate.

Conclusions: One-stage bilateral resection demonstrates greater efficiency without increased morbidity, supporting its use in experienced centers. These findings suggest that a single-anesthetic approach may facilitate earlier recovery and timely systemic therapy in selected patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804, identifier: CRD420251048804.

Introduction: Anterior ankle impingement syndrome (AAIS) is a degenerative condition that causes anterior ankle pain and limited dorsiflexion, especially in athletes. It results from either osseous (osteophytes) or soft tissue (synovial hypertrophy, fibrosis) pathology.

Methods: Although conservative treatments offer temporary relief, arthroscopic surgery has become the preferred approach due to its minimally invasive technique and surgical precision.

Results: Current evidence shows 80%-90% success rates, with significant improvements in visual analog scale scores (mean reduction of 4.1 points) and American orthopedic foot & ankle society scores (mean increase of 28 points), along with low complication rates (2%-7%). However, outcomes are closely linked to the severity of pre-existing osteoarthritis, with 93% success in non-arthritic joints compared to 53% in cases with moderate osteoarthritis. Key research limitations include heterogeneous study designs, small sample sizes, and a lack of long-term data (only 18.6% of studies report ≥5-year follow-up).

Discussion: Future research should focus on standardizing outcome measures, assessing the cost-effectiveness of advanced techniques, and establishing evidence-based protocols for patient selection and rehabilitation. These efforts will help optimize surgical decision-making and enhance long-term outcomes for patients with AAIS.

Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.

Objective: To evaluate the feasibility, technical nuances, and clinical outcomes of using the LVIS stent as a bridging device for the salvage treatment of a malapposed Lattice flow diverter (FD) in a giant posterior circulation aneurysm.

Methods: We present a detailed case report of a patient with a giant aneurysm in the V4 segment of the vertebral artery. Following implantation of a Lattice blood flow diverter and coils, immediate post-procedural angiography revealed incomplete opening and malapposition at the proximal segment of the stent, accompanied by delayed distal flow. After unsuccessful attempts to improve wall apposition via microcatheter massage, a salvage strategy was employed by deploying an LVIS stent within the malapposed FD segment. This approach aimed to enhance overall wall apposition and metal coverage to achieve ultimate aneurysm occlusion.

Results: The salvage procedure was performed successfully. The LVIS stent was accurately deployed within the malapposed segment of the FD. Angiographic assessment after the procedure demonstrated complete wall apposition of the composite stent construct and total occlusion of the aneurysm sac. The patient experienced no new neurological deficits during the perioperative period. Short-term follow-up indicated an excellent clinical outcome, with a modified Rankin Scale score of 0.

Conclusion: Utilizing the LVIS stent as a bridging salvage strategy is a safe and effective technical option for managing malapposed FDs in complex giant posterior circulation aneurysms. This technique effectively enhances stent wall apposition and structural integrity, potentially promoting intra-aneurysmal thrombosis and eventual occlusion. It provides a valuable clinical approach for managing this challenging complication.

Purpose: To investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.

Methods: This single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.

Results: This study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (P < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.

Conclusions: BMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.

Background: Bone metastasis is the most common site of distant metastasis in breast cancer. Patients with bone metastasis have their quality of life and survival rate threatened. This study aims to develop a practical nomogram for predicting the risk of bone metastasis in breast cancer by integrating clinical data, assisting doctors in making more scientific clinical decisions.

Methods: We conducted a retrospective analysis of the data of newly diagnosed breast cancer patients from the database of the Affiliated Hospital of Qingdao University from January 2015 to December 2017. The cohort is divided into training set and validation set in a ratio of 7.5:2.5. Determine independent risk factors through Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis and logistic regression, and develop a nomogram prediction model. The model's performance and clinical utility were evaluated by Receiver Operating Characteristic (ROC) curve analysis, Area Under the Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).

Results: During the 5-year follow-up period, bone metastases developed in 48 of 421 patients (11.40%). Ultimately, six independent risk factors were identified: neoadjuvant chemotherapy, family history of cancer, distant metastasis in other locations, axillary lymph node metastasis, marital status, and primary tumor site. The nomogram demonstrated excellent predictive performance, with AUC values of 0.89 and 0.86 in the training and validation cohorts, respectively.

Conclusions: This pioneering nomogram, incorporating baseline, tumor characteristics, and therapeutic parameters, provides visual guidance for breast surgeons to assess bone metastasis risk in breast cancer patients. It enables clinicians to prioritize high-risk patients through early identification, thereby optimizing surveillance protocols and therapeutic strategies to safeguard patients' quality of life.

Purpose: This study aimed to evaluate the efficacy and safety of Controlled Venospasm-Assisted Foam Sclerotherapy (CVAFS) combined with high ligation (HL) for treating primary great saphenous vein (GSV) varicosities.

Materials and methods: A retrospective cohort of 127 patients with primary GSV varicosities underwent CVAFS with high ligation between 1 Jan 2023 and 1 October 2023. Venospasm was induced by rotational mechanical stimulation of the catheter combined with external compression, resulting in a transient reduction of vessel diameter by 50%-70%, followed by DSA (Digital subtraction angiography)-guided foam injection (1:4 liquid-to-gas ratio). Technical success was defined as complete procedural execution under imaging guidance. Primary endpoints included 1-year GSV occlusion rate (assessed by duplex ultrasound) and reduction in Venous Clinical Severity Score (VCSS). Complications were recorded and managed conservatively.

Results: Technical success was achieved in 100% of limbs (145/145). Among 127 enrolled patients, 109 patients (125 limbs) completed the 12-month follow-up, yielding a follow-up rate of 85.8% (109/127). At 12 months, 93.6% of great saphenous veins (117/125 limbs) maintained complete occlusion. The Venous Clinical Severity Score (VCSS) significantly decreased from 6.18 ± 3.90 preoperatively to 0.86 ± 0.90 postoperatively (V = 7,875, p < 0.001). Thrombophlebitis observed in 9.6% of limbs (12/125), all cases resolved spontaneously within 2 weeks with conservative management (warm compression and NSAIDs). Saphenous Junction Pain occurred in 32.8% of limbs (41/125), with complete resolution within 2 weeks without intervention. No deep venous thrombosis (DVT), pulmonary embolism, skin necrosis, or neurological injuries were documented.

Conclusion: CVAFS leverages controlled venospasm to enhance foam-endothelium contact, significantly improving occlusion rates and symptom relief with acceptable safety. This approach offers a promising minimally invasive alternative for GSV varicosities.