Frontiers in Surgery最新文献

Background: Epithelial Ovarian Cancer is one of the most lethal cancers among gynecologic malignancies. The disease metastasizes mainly through the peritoneal spread in the abdomen and through the lymphatic system. Lymph node involvement is present in 48% up to 75% of cases of advanced-stage ovarian cancer (ASOC). In this context, the aim of our study is to analyze the current literature on the topic and to investigate survival outcomes in patients affected by advanced-stage ovarian cancer undergoing lymphadenectomy.

Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the Pubmed and Scopus databases in June 2022 since the first publication. We made no limitations on the country. We included the studies containing disease-free survival (DFS) and Overall Survival (OS) data. Only comparative studies with a direct comparison between Lymphadenectomy and its avoidance were included for meta-analysis.

Results: 18 studies fulfilled the inclusion criteria. The overall OS, DFS, and RR were comparable in the studies. 26965 patients were enrolled in the meta-analysis. Patients were analyzed concerning OS and DFS. Meta-analysis highlighted statistically significant higher OS than the lymphadenectomy group (RR 1.31 [95% CI 1.16-1.48] p < .00001), and no statistically different DFS RR 1.23 [95% CI 0.82-1.92] p = 0.25).

Conclusion: Our analysis showed a protective role of lymphadenectomy in advanced ovarian cancer, with a reduction in death risk.Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341646, Identifier CRD42022341646.

Purpose: To explore the clinical efficacy of perforated Kirschner wire tension band in the treatment of Mayo IIA olecranon fracture.

Method: A retrospective study was conducted to analyze the clinical data of 96 adult patients with olecranon fractures of the ulna. Thirty-four cases underwent perforated Kirschner wire tension band fixation(group A), which included 21 males and 13 females, with an average age of 49.1 ± 11.57 years. Thirty-two cases received fixation with an olecranon anatomical plate (group B), comprising 19 males and 13 females, with an average age of 48.9 ± 8.84 years. Additionally, 30 cases were treated with ordinary Kirschner wire tension band fixation (group C), consisting of 18 males and 12 females, with an average age of 46.6 ± 12.03 years. The study compared various outcomes among the three groups, including operation time, intraoperative blood loss, number of fluoroscopy exposures, postoperative visual analogue score (VAS), fracture healing time, internal fixation failure rates, skin irritation rates, and the Broberg-Morrey score for elbow joint function at the final follow-up.

Result: All patients were followed for a duration of 15 to 21 months, with an average follow-up period of 18 months. The operation time, intraoperative blood loss, number of fluoroscopy sessions, fracture healing time, and incidence of skin irritation for group A were recorded as (73.8 ± 11.72) min, (113.5 ± 20.73) milliliters, (7.5 ± 1.96) times, and (3.7 ± 1.46) months, respectively, with 1 case of skin irritation. In group B, the corresponding values were (98.4 ± 10.46) min, (154.7 ± 20.11) milliliters, (11.8 ± 2.78) times, and (4.3 ± 1.69) months, with 5 cases of skin irritation. For group C, the values were (81.7 ± 15.66) min, (115.5 ± 18.82) milliliters, (7.3 ± 1.99) times, and (4.3 ± 1.86) months, with 7 cases of skin irritation. Group A demonstrated superior outcomes compared to group B in terms of intraoperative blood loss and number of fluoroscopy sessions, and outperformed both group B and group C regarding operation time, fracture healing time, and skin irritation. These differences were statistically significant (P < 0.05).

Conclusion: Perforated Kirschner wire Tension band is an effective method for treating olecranon fractures. This technique is associated with a short operative time, minimal intraoperative blood loss, and a reduced need for fluoroscopy. Additionally, it promotes fracture healing and significantly reduces the risk of complications, such as postoperative skin irritation.

Objective: Although tumor size is an essential oncologic feature, it is often underutilized in diagnosing and treating bladder cancer (BC). This study investigates the relationship between tumor size and BC prognosis, aiming to enhance clinical applications.

Methods: BC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Cox proportional hazard models were conducted to identify prognostic factors, and restricted cubic splines (RCS) were used to assess the relationship between tumor size and survival outcomes. The Kaplan-Meier method and multivariate COX models were utilized to estimate the effect of the classification scheme.

Results: A total of 69,478 patients with BC were evaluated from the SEER database. Larger tumor size, recent diagnosis, older age, high pathologic grade, variant histology, advanced T stages, positive lymph node status, and receipt of radiotherapy and chemotherapy were associated with worse overall and cancer-specific survival. RCS curves of each stage showed that the relationship between tumor size and prognosis was non-linear. Optimal cut-off points were identified based on the shape of RCS curves, suggesting new classifications of tumor size: 2.5 cm and 5 cm for Ta, 3 cm and 5 cm for T1, and 4 cm and 6 cm for T2.

Conclusions: Incorporating tumor size into prognostic evaluations can enhance bladder cancer risk stratification. Further research is needed to validate these findings and improve personalized treatment strategies.

Background: As society ages, the incidence of osteoporotic vertebral compression fractures steadily rises. Procedures like percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) have proven effective in significantly relieving pain in patients with these fractures. While PKP and PVP are minimally invasive, complications can still occur. However, most complications are not clinically significant, with cement leakage being the most common.

Case presentation: We present the case of a patient with an osteoporotic vertebral compression fracture who underwent percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). On the night following the procedure, the patient experienced transient discomfort in the chest, which resolved on its own. A chest CT scan the next day revealed a 5 cm arc-shaped high-density shadow near the right atrium, along with multiple high-density lung spots. After consulting with cardiothoracic surgery, interventional vascular surgery, and radiology experts, and discussing options with the patient and their family, a thoracotomy was recommended to remove the bone cement from the heart. However, the attempt was unsuccessful. Despite this, the patient made a good recovery and was successfully discharged.

Conclusions: Vascular leakage of bone cement is a potentially life-threatening complication of PKP/PVP, and it warrants careful attention.

Background: A meta-analysis study was done to figure out how to predict the prognosis of people with resectable non-small-cell lung cancer (NSCLC) who had a significant pathological response following neoadjuvant immunotherapy.

Methods: Up until August 2024, a comprehensive literature study was completed, and 2,386 connected studies were revised. The 35 selected studies included 3,118 resectable non-small-cell lung tumor participants at the beginning of the study. Using dichotomous techniques and a fixed or random model, the odds ratio (OR) and 95% confidence intervals (CIs) were used to assess the prediction using significant pathological response following neoadjuvant immunotherapy in resectable NSCLC.

Results: Individuals with resectable NSCLC had significantly higher major pathological response when comparing neoadjuvant chemo-immunotherapy to neoadjuvant chemotherapy (OR, 5.07; 95% CI, 4.09-6.27, p < 0.001), objective response rate to non-objective response rate (OR, 7.02; 95% CI, 4.28-11.50, p < 0.001), and programmed death-ligand 1 ≥1% to programmed death-ligand ≤1% (OR, 2.49; 95% CI, 1.44-4.30, p = 0.001). However, no significant difference was found in major pathological response between stage III and stage I-II (OR, 1.43; 95% CI, 0.88-2.33, p = 0.15), and squamous cell cancer and non-squamous cell cancer (OR, 1.35; 95% CI, 0.95-1.92, p = 0.09) in individuals with resectable NSCLCs.

Conclusion: Individuals with resectable NSCLCs had significantly higher major pathological response when comparing neoadjuvant chemo-immunotherapy to neoadjuvant chemotherapy, objective response rate to non-objective response rate, and programmed death-ligand 1≥1% to programmed death-ligand 1 ≤1%, however, no significant difference was found between stage III and stage I-II, and squamous cell cancer and non-squamous cell cancer. To validate this discovery, more research is required since most of the selected studies had a low sample size, and caution must be implemented when interacting with its values.

Background: Laparoscopic appendectomy (LA) is an effective treatment for the surgical care of appendicitis, with this minimally invasive approach allowing patients to typically spend less time in hospital and promptly return to normal life activities. Residents can acquire the competence and confidence needed in a safe learning environment prior to real patient encounters through simulation-based learning of these techniques. We propose a low cost, sustainable, high fidelity simulation-based training model for LA to compliment regular resident practice of these skills.

Methods: A team dedicated to developing this surgical simulation training model was established, equipped with the clinical knowledge and model engineering expertise. We used concepts of design-based research (DBR) to iteratively develop this model at key intervals. Our LA training model underwent four stages of model development prior to unified stakeholder consensus that this model was deemed effective and suitable for integration into formative surgical simulation curricula.

Results: This model simulates most of the key anatomical structures associated with performing an LA. In order to provide high fidelity haptic feedback, attempts were made to mimic the tensile properties of real tissue using different concentrations of silicone. The model can be utilized with laparoscopic box trainers of various sizes due to its scalability. It cost €9.67 to create, and single use appendix components cost €1.22 to build thereafter.

Conclusions: Surgical residents can benefit from the platform that simulation-based education offers to develop the psychomotor skills necessary to perform LA in a safe learning environment. We describe a model for LA, which allows learners to develop their skill proficiency in this area under expert supervision.

Background: Acute Achilles tendon rupture (AATR) is common among young individuals. There are various management options available, including conservative treatment, open surgical repair, and minimally invasive treatments. However, the optimal treatment approach remains controversial.

Purpose: In this study, we conducted a thorough analysis of the existing literature to compare the clinical outcomes of surgical and nonoperative treatments for patients with AATR by conducting a meta-analysis of randomized controlled trials.

Study design: Meta analysis; Level of evidence, 1.

Methods: Eligible trials randomly assigned adults with AATR to surgical or conservative treatment and assessed by three independent reviewers. We searched in PubMed, Embase, and The Cochrane Library. The assessment of risk of bias was conducted by entering the data from each included study into the Revman computer program. Extracted data were meta-analyzed. Heterogeneity was evaluated using the I2 test. Pooled results were expressed as odds ratios, risk ratios (OR), and mean differences (MD).

Results: The meta-analysis included a total of 14 studies and 1,399 patients, with 696 patients receiving surgical intervention and 703 patients undergoing non-surgical treatment. The follow- up duration ranged from 12 to 30 months. The surgical group was found to have a significantly lower re-rupture rate (OR: 0.30, 95% CI: 0.18-0.54; P < 0.00001), but also had a higher risk of other complications (OR: 3.28, 95% CI: 1.56-6.93, P = 0.002). The surgical group also had significantly abnormal calf (OR: 0.45, 95% CI: 0.26-0.76, P = 0.03). There was no statistically significant difference between the two groups in terms of returning to sports, ATRS, abnormal motion of foot and ankle, unable heel-rise, and torque for plantar flexion.

Conclusion: The meta-analysis results indicate that surgical intervention for AATR is associated with a lower re-rupture rate, but a higher risk of other complications. Our assessment of life-quality and functional outcomes also suggests that surgery leads to significantly better outcomes in terms of sick leave, abnormal calf, and torque for plantar flexion. Based on these findings, we recommend that surgery is a preferable option for patients who have a higher risk of re-rupture and require a quick rehabilitation.

Introduction: The global increase in cardiovascular diseases has resulted in an augmented development of artificial small-caliber vascular grafts used in bypass graft surgeries, such as coronary and distal artery bypass graft surgeries. However, no consensus exists regarding the best method for creating vascular grafts. Poly-ε-caprolactone (PCL) is a biocompatible and biodegradable material that has been widely studied as a scaffold for tissue regeneration, inclusive of vascular grafts. In this study, a vascular graft was created from a PCL nanofiber sheet (PCL graft), and the performance thereof was examined using a rat abdominal aortic implantation model.

Methods: The PCL nanofiber sheets were created using an electrospinning machine. These nanofiber sheets were rolled up. Glue was applied between layers using a PCL solution to create a PCL nanofiber vascular graft, with an inner diameter of 1 mm. PCL grafts with 7 mm length were implanted into the abdominal aorta of rats. Thereafter, the patency was determined by pulsating blood flow from the hemiresection site of the distal aorta of the graft anastomosis, and endothelialization was examined using hematoxylin and eosin and immunofluorescent staining methods.

Results: The patency rate of the PCL graft at 2 weeks was 57.1% (12 of 21 cases), which is not satisfactory as a small-caliber vascular graft. Patent cases, however, revealed a CD31-positive endothelial cell layer in the inner lumen and autologous cell infiltration into the scaffold, indicating autologous vessel-like regeneration. By contrast, the occluded cases showed disassembly of the nanofiber layers; and the inner layers folded into the middle of the lumen. This observation suggested that the disassembled inner layer of the PCL graft disturbed the blood flow and triggered occlusion.

Conclusions: PCL grafts can exhibit autologous vessel-like regeneration; nonetheless, regarding patency, grafts made from rolled-up PCL nanofiber sheets have structural weaknesses. Further improvements are required to achieve a long-term and high patency rate for PCL grafts.

Recurrence of low-grade appendiceal pseudomyxoma peritonei (PMP) with splenic invasion and parastomal hernia is exceptionally rare. We present a 47-year-old female with recurrent PMP, four years post-cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). She presented with abdominal distension, splenic invasion, and parastomal hernia. Imaging revealed extensive peritoneal and pelvic metastases, splenic lesions, and parastomal hernia. Intraoperative findings confirmed widespread pseudomyxoma, involving the spleen and diaphragm. She underwent CRS, splenectomy, tumor resection, adhesiolysis, partial colectomy, hernia repair, and diaphragmatic reconstruction, followed by intraoperative HIPEC. Despite postoperative complications, the patient recovered well with no recurrence over 20 months. This case underscores the challenges of managing recurrent PMP with splenic metastases and parastomal hernias, highlighting the importance of multidisciplinary collaboration and personalized therapeutic strategies.

Objective: This retrospective study aimed to explore the relationship between intraoperative glucose (IG) and the length of hospital stay (LOS) in patients with femoral neck fractures via the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.

Methods: A generalized additive model was performed to explore the relationship between IG levels and LOS. Restricted cubic spline curves were used to analyze the dose-response relationship between IG levels and prolonged LOS (or 7-day LOS). Threshold effect analysis was conducted to assess the key points influencing their association. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were performed to evaluate the predictive performance of IG levels for LOS.

Results: A total of 743 patients with femoral neck fractures were enrolled from the MIMIC-IV database. We found that there was a non-linear relationship between IG and the LOS (or prolonged LOS/>7 days LOS). Moreover, their relationship was still significant even after adjusting for potential confounders. The threshold effect showed that IG was significantly related to a prolonged LOS when it was >137 mg/dl, and IG was significantly related to a 7-day LOS when it was >163 mg/dl. ROC showed that IG had a better function in predicting a 7-day LOS in participants with IG >163 mg/dl than in predicting a prolonged LOS among participants with IG >137 mg/dl. Moreover, the DCA results showed that IG can obtain a favorable net benefit in clinical settings in predicting a 7-day LOS among participants with IG >163 mg/dl.

Conclusions: In summary, there was a non-linear relationship between IG levels and LOS. In patients with IG levels >163 mg/dl, using IG content to predict an LOS >7 days had a good function.