Frontiers in Surgery最新文献

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.

Objective: To investigate whether medium-frequency pulse electrical therapy can effectively shorten the duration of postoperative ileus in gynecological patients.

Methods: Clinical data from 126 eligible gynecological surgery patients from January 2024 to June 2024 were analyzed. Patients were grouped based on whether they received medium-frequency pulse electrical therapy and the initiation time of the therapy. Postoperative time to first flatus was compared between groups.

Results: There was no statistically significant difference in the time to first anal exhaust between patients who received medium-frequency pulsed electrotherapy and those who did not (P = 0.36). Similarly, no significant difference was observed based on the timing of initiation of medium-frequency pulsed electrotherapy (P = 0.70).

Conclusion: Medium-frequency pulse electrical therapy shows no significant effect in shortening the duration of postoperative ileus in gynecological patients.

Background: Total hip arthroplasty (THA) reliably restores function and quality of life in patients with end-stage hip disease. Individuals with end-stage renal disease (ESRD) requiring dialysis are vulnerable to perioperative complications due to immune dysfunction, hemodynamic instability, and impaired wound healing. Evidence on risk-adjusted outcomes remains limited.

Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2022). Dialysis dependence was identified using ICD-10-CM Z99.2. Primary outcomes included in-hospital mortality, length of stay (LOS), and hospital charges; secondary outcomes were major complications. Propensity score matching (10:1 nearest neighbour) balanced baseline demographics and comorbidities. Survey weights were used for national estimates. Post-matching outcomes were compared using risk ratios (RR) with 95% CIs.

Results: Among 1,957,284 THA patients, 2,730 (0.1%) were dialysis dependent. In unmatched analysis, dialysis dependence was associated with substantially increased in-hospital mortality (1.3% vs. 0.03%; crude RR: 31.9, 95% CI: 22.7-44.9). After 10:1 propensity-score matching, dialysis-dependent patients had 62.5% longer LOS (3.9 vs. 2.4 days, p < 0.01), 95.8% higher hospital charges ($98,454 vs. $60,741, p < 0.01), and persistently elevated in-hospital mortality (matched RR: 10.1, 95% CI: 6.3-16.2). Major complications were significantly more frequent.

Conclusion: Dialysis dependence is a strong independent predictor of higher perioperative morbidity, mortality, and cost following THA. Targeted multidisciplinary optimization and enhanced perioperative care pathways are warranted.

Background: Laparoscopic cholecystectomy (LC) is the gold-standard minimally invasive gallbladder removal procedure. Optimal ventilation during LC requires positive end-expiratory pressure (PEEP) and low tidal volumes (TV) to prevent gastric insufflation (GI), which may cause regurgitation and cardiopulmonary complications.

Method: This strictly retrospective observational study analyzed routine collected data from 60 patients undergoing laparoscopic cholecystectomy between January 2022 and December 2023. Patients were categorized into three groups based on anesthesia records of delivered tidal volumes (6, 8, or 10 mL/kg) during facemask ventilation. While group assignment was performed retrospectively, ventilation parameters were standardized per institutional protocol, ensuring consistent clinical delivery. Patients were divided into Group 1 (6 mL/kg), Group 2 (8 mL/kg), and Group 3 (10 mL/kg). Gastric insufflation was assessed via ultrasonography, and respiratory parameters end-tidal carbon dioxide (PetCO₂), end-tidal oxygen (ETO₂), and peak inspiratory pressure (PIP) were recorded.

Result: GI incidence was significantly higher in Group 3 (60%) vs. Group 1 (15%, p = 0.0079) and Group 2 (20%, p = 0.0225). Group 3 showed greater antral area expansion post-ventilation (504.1 ± 109.8 mm² vs. 420.1 ± 47.1 mm², p = 0.001). PetCO₂ and ETO₂ levels differed significantly across groups (p < 0.001).

Conclusion: The study reveals that Group 2's facemask ventilation may improve preoxygenation and minimize gastric insufflation during laparoscopic cholecystectomy anesthesia induction. Further research is needed due to the small sample size, ultrasonography accuracy issues, and a single-center scenario.

Background: Split liver transplantation (SLT) expands the donor pool, but optimal arterial configuration remains debated. We report outcomes of right-sided in situ SLT with systematic celiac trunk preservation with the right graft.

Methods: Retrospective Multicentre analysis of 36 consecutive adult recipients of right-sided split grafts (2015-2025) with celiac trunk preservation. Primary outcomes included vascular complications, patient/graft survival, and comparison with published benchmarks.

Results: Recipients (mean age 54.0 ± 12.6 years, 53% male) underwent SLT for HCV (30.6%), NASH (19.4%), and other etiologies. Major vascular complications occurred in 12/36 (33%) of cases, though life-threatening events remained uncommon: HAT 2.8%, postoperative PVT 5.6%, arterial stenosis 5.6%. Biliary complications occurred in 25% (ischemic 8.3%, technical 17%). Patient survival was 86% at 1 year and 81% at 3 years. Reoperation rate was 47%, primarily for biliary complications (17%) and intra-abdominal abscess (14%). Retransplantation rate was 11%.

Conclusion: Right-sided SLT with celiac trunk preservation achieves excellent vascular outcomes, with both HAT (2.8%) and PVT (5.6%) rates meeting international benchmarks. These results strongly support this configuration as the preferred technical approach for in situ split liver transplantation.

Introduction: Secondary lymphedema is a chronic swelling of the extremities caused by physical disruption of the lymphatic system, leading to impaired lymph drainage. It frequently develops in cancer patients after surgical removal of lymph nodes and vessels during tumor resection, when reconnection of lymphatic pathways fails. Current clinical therapies are mainly palliative or conservative, with limited therapeutic effects. Therefore, an animal model that closely mimics the chronic and severe characteristics of secondary lymphedema in patients is required to enable mechanistic and therapeutic research.

Methods: To establish a long-term secondary lymphedema model in the mouse hindlimb, a combination of surgical, radiological, and mechanical interventions was designed. A novel surgical procedure termed the folding suture technique was developed to disrupt both the superficial and deep lymphatic networks. Controlled radiation exposure was applied postoperatively to inhibit early-stage lymphangiogenesis, while hindlimb immobilization was introduced to suppress lymphatic pumping and enhance edema formation.

Results: The newly developed model showed a significant and persistent increase in hindlimb paw thickness, with edema sustained for over six weeks. Immunofluorescence analysis demonstrated a markedly reduced number and diameter of regenerated lymphatic vessels compared to previously established models. Functional lymphography using fluorescein isothiocyanate (FITC)-dextran and live indocyanine green (ICG) imaging confirmed diminished lymphangiogenesis and impaired lymphatic flow. Further evaluation using the leg dermal backflow (LDB) staging system-commonly applied in clinical assessment-showed consistently higher severity scores, indicating a robust and irreversible secondary lymphedema phenotype.

Discussion: This study demonstrates that the newly established mouse hindlimb lymphedema model successfully replicates the chronic, severe, and irreversible nature of clinical secondary lymphedema. The combination of the folding suture technique, radiation-induced inhibition of lymphangiogenesis, and immobilization effectively induces and maintains the pathology. This model provides a reliable preclinical platform for in-depth investigation of secondary lymphedema pathophysiology and for the development and validation of novel therapeutic strategies.