Pub Date : 2024-09-12DOI: 10.3389/fsurg.2024.1417787
Marion Durand, Lee S. Nguyen, Frankie Mbadinga, Maksim Pryshchepau, Hadrien Portefaix, Nouha Chaabane, Stanislas Ropert, Naziha Khen-Dunlop
IntroductionThe aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.MethodsIn a single-center subset of the Epithor® database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann–Whitney–Wilcoxon test for continuous variables. Tests were considered significant for a p-value <0.05.ResultsRobotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9 ± 7 vs. 7 ± 5.6 days, p < 0.001), a shorter surgery time (99 ± 24 vs. 116 ± 38 min, p < 0.001) a lower conversion rate (n = 2 vs. n = 17, p = 0.004), and a lower complication rate (28% vs. 40%, p = 0.009, mainly Clavien–Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, p < 0.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%/20% to 30%/70% over the 9 years.DiscussionA robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.
方法在法国胸外科前瞻性队列数据库 Epithor® 数据库的单中心子集中，我们分析了 2014 年 2 月至 2023 年 4 月期间的手术特征和临床结果。肺部手术采用四臂胸腔闭合式手术技术，采用端口入路，血管缝合和打结优于缝合。对不连续变量采用Chi-2检验，对连续变量采用Mann-Whitney-Wilcoxon检验进行统计分析。P值为<0.05的检验被认为是有意义的。结果85%的病例在解剖肺切除术中使用了机器人胸腔镜手术。在研究期间，1,067 名患者接受了机器人手术，其中 509 人进行了肺叶切除术，391 人进行了肺段切除术。在分段切除术组与肺叶切除术组中，我们观察到住院时间更短（9±7天 vs. 7±5.6天，pamp &;lt;0.001），手术时间更短（99±24分钟 vs. 116±38分钟，pamp &;lt;0.001），转换率更低（n = 2 vs. n = 17，p = 0.004），并发症发生率更低（28% vs. 40%，p = 0.009，主要是Clavien-Dindo II，分别为18%和28%）。在癌症治疗手术方面，我们发现分段切除术组的既往癌症发生率更高（48% 对 26%，p < 0.001）。讨论机器人平台是进行肺部解剖切除术的合适工具，尤其适用于开发安全、系统的保肺肺叶下切除术。
{"title":"Robotic thoracic surgery: lessons learned from the first 1,000 procedures","authors":"Marion Durand, Lee S. Nguyen, Frankie Mbadinga, Maksim Pryshchepau, Hadrien Portefaix, Nouha Chaabane, Stanislas Ropert, Naziha Khen-Dunlop","doi":"10.3389/fsurg.2024.1417787","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1417787","url":null,"abstract":"IntroductionThe aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.MethodsIn a single-center subset of the Epithor® database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann–Whitney–Wilcoxon test for continuous variables. Tests were considered significant for a <jats:italic>p</jats:italic>-value &lt;0.05.ResultsRobotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9 ± 7 vs. 7 ± 5.6 days, <jats:italic>p</jats:italic> &lt; 0.001), a shorter surgery time (99 ± 24 vs. 116 ± 38 min, <jats:italic>p</jats:italic> &lt; 0.001) a lower conversion rate (<jats:italic>n</jats:italic> = 2 vs. <jats:italic>n</jats:italic> = 17, <jats:italic>p</jats:italic> = 0.004), and a lower complication rate (28% vs. 40%, <jats:italic>p</jats:italic> = 0.009, mainly Clavien–Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, <jats:italic>p</jats:italic> &lt; 0.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%/20% to 30%/70% over the 9 years.DiscussionA robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"40 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundManaging complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.MethodsWe conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19–73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores (HHS).ResultsThe patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d’Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another cas
{"title":"Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach","authors":"Wei Wang, Xianhua Cai, Ximing Liu, Guodong Wang, Hui Kang, Shenglong Qian","doi":"10.3389/fsurg.2024.1438036","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1438036","url":null,"abstract":"BackgroundManaging complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.MethodsWe conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19–73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores (HHS).ResultsThe patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d’Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another cas","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"15 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.3389/fsurg.2024.1434730
Stefano Restaino, Sofia Schierano, Martina Arcieri, Barbara Costantini, Alice Poli, Sara Pregnolato, Giovanni Terrosu, Sergio Calandra, Marco Petrillo, Giulia Pellecchia, Alessandro Lucidi, Marko Klarić, Lorenza Driul, Vito Chiantera, Alfredo Ercoli, Cristina Taliento, Francesco Fanfani, Anna Fagotti, Giovanni Scambia, Giuseppe Vizzielli
This narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve “optimal” cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy.
这篇叙述性综述介绍了卵巢癌吻合口漏的最新治疗技术。局部晚期卵巢癌患者通常需要进行包括肠道切除在内的多种手术，才能达到 "最佳 "的细胞减灭术。肠吻合术是目前恢复肠道连续性最常用的方法。然而，有些患者需要临时保护性造口，以防止吻合口渗漏。这是改善手术效果的一个重要问题，但直到最近，仍缺乏客观数据来明确吻合口漏的风险因素。本综述描述了与手术相关的 AL 风险因素，并比较了近期的研究结果。我们还回顾了目前放置保护性回肠造口术的适应症以及保守治疗 AL 的治疗方案。除了评估最多的 AL 风险因素外，我们还介绍了两种实用的临床 AL 风险计算器。迄今为止，导致外科医生实施保护性回肠造口术的决策过程是多种多样的，主要基于外科医生的个人经验和个人培训。本文介绍了 OC 结肠直肠吻合术后的三种不同处理方案：保守处理、转流回肠造口术和幽闭回肠造口术。
{"title":"Surgical management of anastomotic leakage related to ovarian cancer surgery: a narrative review","authors":"Stefano Restaino, Sofia Schierano, Martina Arcieri, Barbara Costantini, Alice Poli, Sara Pregnolato, Giovanni Terrosu, Sergio Calandra, Marco Petrillo, Giulia Pellecchia, Alessandro Lucidi, Marko Klarić, Lorenza Driul, Vito Chiantera, Alfredo Ercoli, Cristina Taliento, Francesco Fanfani, Anna Fagotti, Giovanni Scambia, Giuseppe Vizzielli","doi":"10.3389/fsurg.2024.1434730","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1434730","url":null,"abstract":"This narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve “optimal” cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.3389/fsurg.2024.1387351
Juntao Chen, Hui Xu, Hang Zhou, Zheng Wang, Wanyu Li, Juan Guo, Yunfeng Zhou
ObjectivesMagnetic resonance imaging (MRI) is increasingly used to detect knee osteoarthritis (KOA). In this study, we aimed to systematically examine the global research status on the application of medical knee MRI in the treatment of KOA, analyze research hotspots, explore future trends, and present results in the form of a knowledge graph.MethodsThe Web of Science core database was searched for studies on medical knee MRI scans in patients with KOA between 2004 and 2023. CiteSpace, SCImago Graphica, and VOSviewer were used for the country, institution, journal, author, reference, and keyword analyses.ResultsA total of 2,904 articles were included. The United States and Europe are leading countries. Boston University is the main institution. Osteoarthritis and cartilage is the main magazine. The most frequently cocited article was “Radiological assessment of osteoarthrosis”. Guermazi A was the author with the highest number of publications and total references. The keywords most closely linked to MRI and KOA were “cartilage”, “pain”, and “injury”.ConclusionsThe application of medical knee MRI in KOA can be divided into the following parts: (1). MRI was used to assess the relationship between the characteristics of local tissue damage and pathological changes and clinical symptoms. (2).The risk factors of KOA were analyzed by MRI to determine the early diagnosis of KOA. (3). MRI was used to evaluate the efficacy of multiple interventions for KOA tissue damage (e.g., cartilage defects, bone marrow edema, bone marrow microfracture, and subchondral bone remodeling). Artificial intelligence, particularly deep learning, has become the focus of research on MRI applications for KOA.
{"title":"Knowledge mapping and bibliometric analysis of medical knee magnetic resonance imaging for knee osteoarthritis (2004–2023)","authors":"Juntao Chen, Hui Xu, Hang Zhou, Zheng Wang, Wanyu Li, Juan Guo, Yunfeng Zhou","doi":"10.3389/fsurg.2024.1387351","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1387351","url":null,"abstract":"ObjectivesMagnetic resonance imaging (MRI) is increasingly used to detect knee osteoarthritis (KOA). In this study, we aimed to systematically examine the global research status on the application of medical knee MRI in the treatment of KOA, analyze research hotspots, explore future trends, and present results in the form of a knowledge graph.MethodsThe Web of Science core database was searched for studies on medical knee MRI scans in patients with KOA between 2004 and 2023. CiteSpace, SCImago Graphica, and VOSviewer were used for the country, institution, journal, author, reference, and keyword analyses.ResultsA total of 2,904 articles were included. The United States and Europe are leading countries. Boston University is the main institution. Osteoarthritis and cartilage is the main magazine. The most frequently cocited article was “Radiological assessment of osteoarthrosis”. Guermazi A was the author with the highest number of publications and total references. The keywords most closely linked to MRI and KOA were “cartilage”, “pain”, and “injury”.ConclusionsThe application of medical knee MRI in KOA can be divided into the following parts: (1). MRI was used to assess the relationship between the characteristics of local tissue damage and pathological changes and clinical symptoms. (2).The risk factors of KOA were analyzed by MRI to determine the early diagnosis of KOA. (3). MRI was used to evaluate the efficacy of multiple interventions for KOA tissue damage (e.g., cartilage defects, bone marrow edema, bone marrow microfracture, and subchondral bone remodeling). Artificial intelligence, particularly deep learning, has become the focus of research on MRI applications for KOA.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"59 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.3389/fsurg.2024.1457583
Sherif Sultan, Yogesh Acharya, Wael Tawfick, William Wijns, Osama Soliman
BackgroundPararenal abdominal aortic aneurysms (PR-AAA), constituting around 15%-20% of AAA patients, are defined as having no neck between the aneurysm and the renal arteries. Due to an insufficient sealing zone, open surgical repair (OSR) is the gold standard, while EVAR is reserved for those unfit for surgery. Renal outcomes disturb long-term survival, and they have massive socioeconomic and quality of life implications, especially if patients require dialysis.MethodsThis study aims to elucidate any difference between EVAR and OSR of PR-AAA, excluding suprarenal aneurysms, with specific emphasis on renal dysfunction over the short and long term. An existing database of PR-AAA between 2002 and 2023 was used to glean information regarding the therapeutic option used. Renal events were defined by the RIFLE criteria. Out of 1,563 aortic interventions, we identified 179 PR-AAA, of which 99 high-risk patients had an aortic neck of less than 10 mm with complete follow-up. We excluded patients with fenestrated EVAR (FEVAR), branched EVAR (BEVAR), or chimney EVAR (Ch-EVAR) and any patients requiring visceral artery reimplantation.ResultsIn total, 63 patients underwent EVAR, and 36 required OSR. 17.46% of patients who underwent EVAR experienced acute kidney injury (AKI) compared with 36.11% of the OSR group (P = 0.037). The mean post-op creatinine for OSR was 109.88 µmol/L, and for EVAR was 127.06 µmol/L (P = 0.192). The mean difference between long-term (9–12 years) creatinine values in OSR was 14.29 µmol/L (P = 0.191), and the mean difference for EVAR was 25.05 µmol/L (P = 0.024). Furthermore, 27.8% of OSR patients who underwent Left Renal Vein Division and Ligation (LRVDL) experienced an AKI, while 50% who did not undergo LRVDL experienced an AKI (P = 0.382). Thirty-day morbidity in the EVAR group (20.97%) was significantly lower than in the OSR group (42.62%) (P = 0.022). Moreover, 3.17% in EVAR group and 7.14% in OSR group had aneurysm-related mortality (P = 0.584).ConclusionThe rate of renal events for OSR is higher, while the rate of endovascular renal events was lower. Our study shows that PR-AAA undergoing OSR may benefit from endovascular repair.
{"title":"Comparative study of acute kidney injury in pararenal aortic aneurysm: open surgical versus endovascular repair","authors":"Sherif Sultan, Yogesh Acharya, Wael Tawfick, William Wijns, Osama Soliman","doi":"10.3389/fsurg.2024.1457583","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1457583","url":null,"abstract":"BackgroundPararenal abdominal aortic aneurysms (PR-AAA), constituting around 15%-20% of AAA patients, are defined as having no neck between the aneurysm and the renal arteries. Due to an insufficient sealing zone, open surgical repair (OSR) is the gold standard, while EVAR is reserved for those unfit for surgery. Renal outcomes disturb long-term survival, and they have massive socioeconomic and quality of life implications, especially if patients require dialysis.MethodsThis study aims to elucidate any difference between EVAR and OSR of PR-AAA, excluding suprarenal aneurysms, with specific emphasis on renal dysfunction over the short and long term. An existing database of PR-AAA between 2002 and 2023 was used to glean information regarding the therapeutic option used. Renal events were defined by the RIFLE criteria. Out of 1,563 aortic interventions, we identified 179 PR-AAA, of which 99 high-risk patients had an aortic neck of less than 10 mm with complete follow-up. We excluded patients with fenestrated EVAR (FEVAR), branched EVAR (BEVAR), or chimney EVAR (Ch-EVAR) and any patients requiring visceral artery reimplantation.ResultsIn total, 63 patients underwent EVAR, and 36 required OSR. 17.46% of patients who underwent EVAR experienced acute kidney injury (AKI) compared with 36.11% of the OSR group (<jats:italic>P</jats:italic> = 0.037). The mean post-op creatinine for OSR was 109.88 µmol/L, and for EVAR was 127.06 µmol/L (<jats:italic>P</jats:italic> = 0.192). The mean difference between long-term (9–12 years) creatinine values in OSR was 14.29 µmol/L (<jats:italic>P</jats:italic> = 0.191), and the mean difference for EVAR was 25.05 µmol/L (<jats:italic>P</jats:italic> = 0.024). Furthermore, 27.8% of OSR patients who underwent Left Renal Vein Division and Ligation (LRVDL) experienced an AKI, while 50% who did not undergo LRVDL experienced an AKI (<jats:italic>P</jats:italic> = 0.382). Thirty-day morbidity in the EVAR group (20.97%) was significantly lower than in the OSR group (42.62%) (<jats:italic>P</jats:italic> = 0.022). Moreover, 3.17% in EVAR group and 7.14% in OSR group had aneurysm-related mortality (<jats:italic>P</jats:italic> = 0.584).ConclusionThe rate of renal events for OSR is higher, while the rate of endovascular renal events was lower. Our study shows that PR-AAA undergoing OSR may benefit from endovascular repair.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"10 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundHypoganglionosis resembles Hirschsprung disease (HSCR) which is characterized by severe constipation. Enterocolitis due to hypoganglionosis or Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of both diseases. This study investigated the role of Paneth-like cells (PLCs) and gut microbiota in the development of enterocolitis in an iatrogenic rectosigmoid hypoganglionosis rat model.MethodsThe rectosigmoid serosa of male Sprague-Dawley rats were exposed to 0.1% benzalkonium chloride (BAC). The rats were then sacrificed after 1, 3, 5, 8, and 12 weeks. A sham group was sacrificed on Week 12. With hematoxylin-eosin staining, the ganglionic cells were quantified, the degree of enterocolitis was analyzed, and the PLCs was identified. Intestinal barrier function was assessed for the anti-peripherin, occludin, and acetylcholinesterase (AChE)/butyrylcholinesterase (BChE) ratio. qRT-PCR was used as reference for the evaluation of antimicrobial peptide (AMP) of PLCs using cryptdins, secretory Phospholipase A2, and lysozyme levels. 16S rRNA high-throughput sequencing on fecal samples was performed to analyze the changes in the intestinal microbiota diversity in each group.ResultsAfter 1 week of intervention, the ganglion cells were fewer in all sacrificial 0.1% BAC groups at varying times than those in the sham group. Occludin and peripherin were decreased, while the AChE/BChE ratio was increased. At Week 5 postintervention, the number of α-defensins-positive PLCs increased in the sigmoid colon tissues from BAC-treated rats. Conversely, PLCs-produced AMP decreased from Week 5 to Week 12. The sham group demonstrated increased Lactobacillus and decreased Bacteroides, while the 0.1% BAC group exhibited reciprocal changes, indicating dysbiosis. Enterocolitis occurred from Week 1 postintervention.ConclusionApplication with BAC influences the disruption of PLCs in Week 5 postintervention, and dysbiosis exacerbate the occurrence of enterocolitis. Further research on Paneth cells involvement in HAEC development is warranted.
{"title":"Paneth-like cells disruption and intestinal dysbiosis in the development of enterocolitis in an iatrogenic rectosigmoid hypoganglionosis rat model","authors":"Iskandar Rahardjo Budianto, Kusmardi Kusmardi, Andi Muh. Maulana, Somasundaram Arumugam, Rejina Afrin, Vivian Soetikno","doi":"10.3389/fsurg.2024.1407948","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1407948","url":null,"abstract":"BackgroundHypoganglionosis resembles Hirschsprung disease (HSCR) which is characterized by severe constipation. Enterocolitis due to hypoganglionosis or Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of both diseases. This study investigated the role of Paneth-like cells (PLCs) and gut microbiota in the development of enterocolitis in an iatrogenic rectosigmoid hypoganglionosis rat model.MethodsThe rectosigmoid serosa of male Sprague-Dawley rats were exposed to 0.1% benzalkonium chloride (BAC). The rats were then sacrificed after 1, 3, 5, 8, and 12 weeks. A sham group was sacrificed on Week 12. With hematoxylin-eosin staining, the ganglionic cells were quantified, the degree of enterocolitis was analyzed, and the PLCs was identified. Intestinal barrier function was assessed for the anti-peripherin, occludin, and acetylcholinesterase (AChE)/butyrylcholinesterase (BChE) ratio. qRT-PCR was used as reference for the evaluation of antimicrobial peptide (AMP) of PLCs using cryptdins, secretory Phospholipase A<jats:sub>2</jats:sub>, and lysozyme levels. 16S rRNA high-throughput sequencing on fecal samples was performed to analyze the changes in the intestinal microbiota diversity in each group.ResultsAfter 1 week of intervention, the ganglion cells were fewer in all sacrificial 0.1% BAC groups at varying times than those in the sham group. Occludin and peripherin were decreased, while the AChE/BChE ratio was increased. At Week 5 postintervention, the number of α-defensins-positive PLCs increased in the sigmoid colon tissues from BAC-treated rats. Conversely, PLCs-produced AMP decreased from Week 5 to Week 12. The sham group demonstrated increased <jats:italic>Lactobacillus</jats:italic> and decreased <jats:italic>Bacteroides</jats:italic>, while the 0.1% BAC group exhibited reciprocal changes, indicating dysbiosis. Enterocolitis occurred from Week 1 postintervention.ConclusionApplication with BAC influences the disruption of PLCs in Week 5 postintervention, and dysbiosis exacerbate the occurrence of enterocolitis. Further research on Paneth cells involvement in HAEC development is warranted.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"95 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142213853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.3389/fsurg.2024.1444942
Sergei Malev, Hao Zhang, Ziming Yuan, Qingchao Tang, Guiyu Wang, Giorgi Oganezov, Rui Huang, Wang Xishan
IntroductionThe aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer.Materials and methodsThis study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients’ information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up.ResultsBoth groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05).ConclusionThe results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.
{"title":"Frontiers | Retrospective analysis of immediate and long-term results of NOSES technique and conventional laparoscopic-assisted resection in patients with colorectal cancer","authors":"Sergei Malev, Hao Zhang, Ziming Yuan, Qingchao Tang, Guiyu Wang, Giorgi Oganezov, Rui Huang, Wang Xishan","doi":"10.3389/fsurg.2024.1444942","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1444942","url":null,"abstract":"IntroductionThe aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer.Materials and methodsThis study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients’ information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up.ResultsBoth groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05).ConclusionThe results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"53 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.3389/fsurg.2024.1410127
Ziyue Sun, Kexin Liu, Yanru Guo, Nanyuan Jiang, Meina Ye
Locally advanced breast cancer (LABC) remains a significant clinical challenge, particularly in developing countries. While neoadjuvant systemic therapy (NST) has improved the pathological complete response (pCR) rates, particularly in HER2-positive and triple-negative breast cancer patients, surgical management post-NST continues to evolve. The feasibility of omitting surgery and the increasing consideration of breast-conserving surgery, immediate reconstruction in LABC patients are important areas of exploration. Accurate assessment of tumor response to NST through advanced imaging and minimally invasive biopsies remains pivotal, though challenges persist in reliably predicting pCR. Additionally, axillary lymph node management continues to evolve, with emerging strategies aiming to minimize the extent of surgery in patients who achieve nodal downstaging post-NST. Minimizing axillary lymph node dissection in favor of less invasive approaches is gaining attention, though further evidence is needed to establish its oncological safety. The potential for personalized treatment approaches, reducing surgical morbidity, and improving quality of life are key goals in managing LABC, while maintaining the priority of achieving favorable long-term outcomes.
{"title":"Surgery paradigm for locally advanced breast cancer following neoadjuvant systemic therapy","authors":"Ziyue Sun, Kexin Liu, Yanru Guo, Nanyuan Jiang, Meina Ye","doi":"10.3389/fsurg.2024.1410127","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1410127","url":null,"abstract":"Locally advanced breast cancer (LABC) remains a significant clinical challenge, particularly in developing countries. While neoadjuvant systemic therapy (NST) has improved the pathological complete response (pCR) rates, particularly in HER2-positive and triple-negative breast cancer patients, surgical management post-NST continues to evolve. The feasibility of omitting surgery and the increasing consideration of breast-conserving surgery, immediate reconstruction in LABC patients are important areas of exploration. Accurate assessment of tumor response to NST through advanced imaging and minimally invasive biopsies remains pivotal, though challenges persist in reliably predicting pCR. Additionally, axillary lymph node management continues to evolve, with emerging strategies aiming to minimize the extent of surgery in patients who achieve nodal downstaging post-NST. Minimizing axillary lymph node dissection in favor of less invasive approaches is gaining attention, though further evidence is needed to establish its oncological safety. The potential for personalized treatment approaches, reducing surgical morbidity, and improving quality of life are key goals in managing LABC, while maintaining the priority of achieving favorable long-term outcomes.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"3 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundLaparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors.MethodsThis retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group.ResultsAmong 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups.ConclusionReduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.
{"title":"Early vs. interval approach to laparoscopic cholecystectomy for acute cholecystitis: a retrospective observational study from Pakistan","authors":"Sandesh Raja, Azzam Ali, Dileep Kumar, Adarsh Raja, Khursheed Ahmed Samo, Amjad Siraj Memon","doi":"10.3389/fsurg.2024.1462885","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1462885","url":null,"abstract":"BackgroundLaparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors.MethodsThis retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group.ResultsAmong 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups.ConclusionReduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.3389/fsurg.2024.1467154
Chao Sun, Bin Qin, Jingyu Zhang, Yidan Liang, Cui Min, Qiang Yang, Yanglingxi Wang, Jian Gong, Yi Xiang
ObjectiveTo investigate the correlation between the swelling rate of brain volume within the first 48 h after aneurysmal subarachnoid hemorrhage and the subsequent development of delayed cerebral ischemia.MethodsA retrospective analysis was conducted on patients with spontaneous aneurysmal subarachnoid hemorrhage admitted to the Neurosurgery Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University between January 2020 and January 2023. The clinical data, treatment outcomes, and imaging data were analyzed. Brain volume was evaluated using 3D-Slicer software at two time points post-hemorrhage: within the first 24 h and between 24 and 48 h. The swelling rate of brain volume was defined as the ratio of the absolute difference between two measurements to the smaller of values. Patients were categorized into two groups based on established diagnostic criteria of delayed cerebral ischemia. Univariate and multivariate logistic regression analyses were performed to identify factors influencing delayed cerebral ischemia.ResultsA total of 140 patients were enrolled in this study. 46 patients experienced delayed cerebral ischemia after bleeding. The swelling rate of brain volume was larger in the DCI group (10.66 ± 8.45) compared to the non-DCI group (3.59 ± 2.62), which showed a statistically significant difference. Additionally, advanced age, smoking history, history of hypertension, loss of consciousness, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH were also statistically different between the two groups. Multivariate logistic regression analysis revealed that the swelling rate of brain volume was an independent risk factor for DCI with adjusting the advanced age, smoking history, history of hypertension, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH.ConclusionBrain volume significantly increased in patients with aneurysmal subarachnoid hemorrhage during the early phase (within 48 h post-onset). The larger swelling rate of brain volume is an independent risk factor for the development of delayed cerebral ischemia, and it may hold significant predictive value for the incidence of delayed cerebral ischemia.
{"title":"Frontiers | Increased Brain Volume in the Early Phase of Aneurysmal Subarachnoid Hemorrhage leads to Delayed Cerebral Ischemia","authors":"Chao Sun, Bin Qin, Jingyu Zhang, Yidan Liang, Cui Min, Qiang Yang, Yanglingxi Wang, Jian Gong, Yi Xiang","doi":"10.3389/fsurg.2024.1467154","DOIUrl":"https://doi.org/10.3389/fsurg.2024.1467154","url":null,"abstract":"ObjectiveTo investigate the correlation between the swelling rate of brain volume within the first 48 h after aneurysmal subarachnoid hemorrhage and the subsequent development of delayed cerebral ischemia.MethodsA retrospective analysis was conducted on patients with spontaneous aneurysmal subarachnoid hemorrhage admitted to the Neurosurgery Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University between January 2020 and January 2023. The clinical data, treatment outcomes, and imaging data were analyzed. Brain volume was evaluated using 3D-Slicer software at two time points post-hemorrhage: within the first 24 h and between 24 and 48 h. The swelling rate of brain volume was defined as the ratio of the absolute difference between two measurements to the smaller of values. Patients were categorized into two groups based on established diagnostic criteria of delayed cerebral ischemia. Univariate and multivariate logistic regression analyses were performed to identify factors influencing delayed cerebral ischemia.ResultsA total of 140 patients were enrolled in this study. 46 patients experienced delayed cerebral ischemia after bleeding. The swelling rate of brain volume was larger in the DCI group (10.66 ± 8.45) compared to the non-DCI group (3.59 ± 2.62), which showed a statistically significant difference. Additionally, advanced age, smoking history, history of hypertension, loss of consciousness, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH were also statistically different between the two groups. Multivariate logistic regression analysis revealed that the swelling rate of brain volume was an independent risk factor for DCI with adjusting the advanced age, smoking history, history of hypertension, poor Hunt-Hess grade, high mFisher score, brain volume within 24 h, and IVH.ConclusionBrain volume significantly increased in patients with aneurysmal subarachnoid hemorrhage during the early phase (within 48 h post-onset). The larger swelling rate of brain volume is an independent risk factor for the development of delayed cerebral ischemia, and it may hold significant predictive value for the incidence of delayed cerebral ischemia.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"10 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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