Gland surgery最新文献

In oncologic breast reconstruction, autologous techniques have been demonstrated to provide patients with improved long-term outcomes and fewer complications than implant-based techniques, especially in the setting of adjunct therapies. While the deep inferior epigastric perforator (DIEP) flap remains the gold standard, not all patients are suitable candidates due to insufficient abdominal tissue or prior abdominal surgeries. Recent advances in microsurgical and imaging techniques, such as computed tomography angiography (CTA) for perforator mapping, have provided reconstructive surgeons with the ability to reliably harvest perforator-based flaps from various areas of the body that minimize donor site morbidity while maximizing reconstructive success. The profunda artery perforator (PAP) flap has emerged as a useful tool in the reconstructive microsurgeon's armamentarium for breast reconstruction in patients where more traditional donor sites are inappropriate or unavailable. Harvested from the posteromedial thigh, this fasciocutaneous flap preserves underlying muscle function and offers distinct advantages, including a reliable vascular pedicle and a discreetly hidden scar. This review article outlines the development of the flap, recent modifications, and relevant surgical anatomy, ultimately synthesizing current clinical outcomes to validate the PAP flap as a robust and aesthetically superior alternative for restoring natural breast contour.

Background: Robot-assisted surgical techniques are increasingly adopted in breast reconstruction, yet the optimal implant placement approach remains debated. Robot-assisted nipple-sparing mastectomy (RANSM) with immediate prosthetic breast reconstruction using the Da Vinci system has shown improved cosmetic outcomes and patient satisfaction. While prepectoral reconstruction offers easier implant placement and fewer complications, subpectoral reconstruction provides better upper pole contours and reduced acellular dermal matrix (ADM) requirements. This study compared surgical and esthetic outcomes between prepectoral and subpectoral approaches in robot-assisted immediate prosthetic reconstruction.

Methods: This single-institute retrospective analysis included patients with breast cancer who underwent RANSM with immediate prosthetic breast reconstruction between October 2021 and May 2024. Seventeen breasts from 10 patients (five prepectoral and five subpectoral cases) were analyzed. Surgical metrics, including operation time, console time, blood loss, hospital stay, and complications, were assessed. Seven independent plastic surgeons graded 1-year postoperative esthetic outcomes using the Harvard/National Surgical Adjuvant Breast and Bowel Project scale.

Results: The prepectoral group demonstrated significantly better esthetic outcomes (mean score, 2.42) than those of the subpectoral group (mean score, 3.65; P=0.04). Complication rates were similar between groups, with animation deformities occurring exclusively in the subpectoral group. Subpectoral reconstruction required additional ADM in patients with curved thoracic contours due to muscle injuries.

Conclusions: In conclusion, prepectoral reconstruction provides superior esthetics outcomes and eliminates animation deformity, while subpectoral reconstruction may offer enhanced upper pole support. Both methods offer distinct benefits, with patient-specific factors being crucial for optimal approach selection. Larger studies are needed to refine patient selection and outcomes in robot-assisted reconstruction.

Background: Although myasthenia gravis (MG) commonly coexists with thymoma, its prognostic role in thymoma recurrence is controversial. Therefore, we aimed to identify clinical and pathological predictors of recurrence after thymectomy in a single-center cohort.

Methods: We retrospectively reviewed adult patients who underwent thymectomy for pathologically confirmed thymoma between January 2000 and December 2023 at a single tertiary center. Patients with at least 12 months of follow-up were included. Clinical, surgical, and pathological features were compared between patients with and without MG. Survival outcomes, including recurrence-free survival (RFS, R0 subgroup), progression-free survival (PFS, overall cohort), and overall survival (OS), were analyzed using Kaplan-Meier methods with log-rank tests. Independent predictors of recurrence were evaluated using Cox proportional hazards regression restricted to patients with R0 resection.

Results: Patients with MG were significantly younger and more likely to undergo transsternal extended thymectomy than those without MG. Although thymoma recurrence was more frequent in the MG group, MG status was not significantly associated with RFS or OS. Kaplan-Meier analysis showed that advanced-stage thymoma (stage III-IV) was associated with significantly shorter RFS, PFS, and OS compared with early-stage disease. In multivariate Cox regression restricted to R0 resections, advanced Masaoka stage remained an independent predictor of recurrence, while tumor size showed only a borderline association.

Conclusions: Advanced Masaoka stage is the strongest independent predictor of thymoma recurrence after complete resection. Tumor size demonstrated a borderline association, suggesting a potential contributory role that requires further validation. MG, although clinically important for peri- and post-operative management, was not independently associated with recurrence.

Background: Pancreatic anastomosis has been developed, and each anastomosis has its pros and cons. This study investigated the prevalence of postoperative complications, particularly pancreatic fistula (POPF), among five types of pancreatoenteric anastomoses to determine the optimal anastomosis for patients undergoing pancreatectomy.

Methods: This study retrospectively and consecutively analyzed the data of 365 patients who underwent pancreatectomy with pancreaticoenteral anastomosis at two academic institutions from 1994 to 2024. Pancreaticogastrostomy via invagination was performed in 24 patients (group PG). For pancreaticojejunal anastomosis, we performed an end-to-end invagination procedure on eight patients (group PJI), two-layer suturing procedure on 96 patients (group PJT), Kakita procedure on 55 patients (group K), and modified Blumgart procedure on 182 patients (group B).

Results: Group B had the shortest hospital stay and fastest resumption of oral intake. Groups PG and PJI exhibited higher grade B/C POPF rates and prolonged ascites. The potential benefits of group B included reduced hospitalization period and enhanced recovery owing to decreased POPF rates. Habitual alcohol consumption and high preoperative creatinine levels increased the risk of POPF, whereas external drainage issues and blood loss contributed to prolonged ascites. In particular, habitual alcohol consumption [relative risk (RR) =2.42], group K anastomosis (RR =2.79), soft pancreatic texture (RR =2.48), delayed oral intake (≥4 days; RR =2.78), and complete external drainage (RR =8.68) were independent predictors of POPF.

Conclusions: Modified Blumgart procedure is an optimal pancreaticoenteral anastomosis technique for avoiding POPF. Early oral intake has emerged as a protective factor, highlighting its role in improving postoperative outcomes. Surgeons should prioritize intraoperative blood conservation, perioperative nutritional support, and appropriate anastomotic selection to enhance surgical success.

Background: Adenoid cystic carcinoma (ACC) of the parotid gland is a rare malignant salivary tumor with aggressive biological behavior, including perineural invasion and delayed metastasis. Despite an 85% 5-year survival rate, long-term prognosis declines to approximately 30%. Preoperative imaging diagnosis remains challenging due to ACC's heterogeneous features on ultrasound, often mimicking benign tumors like pleomorphic adenoma, leading to misdiagnosis. The clinical value of multimodal imaging integration for ACC is underexplored.

Case description: A 46-year-old female presented with a painless left parotid mass persisting for >1 year. Initial ultrasound revealed a well-defined, hypoechoic solid nodule (measuring 2.5 cm × 2.0 cm × 2.0 cm on sonography) with homogeneous echogenicity, posterior acoustic enhancement, and sparse punctate/linear vascular signals, suggestive of pleomorphic adenoma. Enhanced computed tomography (CT) showed a heterogeneously enhancing mass (+45 HU arterial phase) without invasion. Postoperative pathology confirmed ACC (cribriform/trabecular patterns; SOX10/p63-positive; Ki-67 3%; MYB::NFIB fusion-negative). The patient underwent parotidectomy with facial nerve preservation and adjuvant radiotherapy, with no recurrence at 6-month magnetic resonance imaging (MRI) follow-up.

Conclusions: This case highlights ACC's propensity for "benign-mimicking" sonographic features (well-defined margins, posterior enhancement, hypovascularity), contributing to misdiagnosis. It underscores that integrating elastography (for assessing stiffness), contrast-enhanced ultrasound (for evaluating washout patterns), CT/MRI (for detecting suspicious perineural spread), and molecular biomarkers (e.g., low Ki-67) is crucial to improving diagnostic accuracy and optimizing follow-up management for ACC.

Background: Prognostic evaluation of metastatic breast cancer (MBC) currently confronts a two-fold challenge: suboptimal accuracy of conventional scoring systems and insufficient clinical interpretability of machine learning models. This study aimed to construct and validate an accurate prognostic model for predicting the overall survival (OS) of patients with MBC in the Surveillance, Epidemiology, and End Results (SEER) database using machine learning (ML) techniques.

Methods: A total of 1,385 MBC patients were enrolled from the SEER database and randomly assigned into the training cohort (1,035 cases) and the internal validation cohort (350 cases). An external validation cohort comprising 73 patients from Jiaxing Women and Children's Hospital was also set up. The key characteristics influencing the OS were identified through multivariate Cox regression analysis, and prognostic models were constructed using four ML algorithms.

Results: The random survival forest (RSF) model achieved the best performance both in the training and internal validation cohorts, with a concordance index (C-index) of 0.723 [95% confidence interval (CI): 0.704-0.740] and 0.727 (95% CI: 0.693-0.761), respectively. Notably, the area under the curve and Brier scores of the RSF model exceeded those of other models, confirming its superior survival prediction performance. The decision curve analysis (DCA) further indicated that the RSF model could effectively predict the 1-, 3-, and 5-year OS, making it ideal for clinical application. In the external validation cohort, the C-index of the RSF model was 0.685 (95% CI: 0.606-0.758), which, although slightly lower compared with that recorded in the training cohort, was more stable. The area under the curve and Brier scores further confirmed high accuracy and calibration power of the model. The SHapley Additive exPlanations (SHAP) analysis revealed that triple-negative breast cancer (TNBC) and brain metastasis were core variables that increased mortality risk.

Conclusions: The constructed RSF prognostic model demonstrated excellent predictive performance in MBC survival prediction and achieved good interpretability as confirmed by the SHAP analysis. These findings indicate that the developed model can facilitate prognostic assessment and promote the design of individualized treatments for MBC patients.

Background: Cytologically indeterminate thyroid nodules (CITNs) are heterogeneous, and their assessment remains controversial. In this study, we examined the prognostic utility of anti-thyroid antibodies for predicting thyroid cancer (TC) in CITNs.

Methods: This prospective multicenter analysis included all patients with CITNs who were surgically treated between August 2023 and August 2024 at two hospitals in Saudi Arabia; preoperative anti-thyroid antibodies [thyroid peroxidase and thyroglobulin antibodies (TgAbs)], thyroid stimulating hormone (TSH), and a definitive histological diagnosis were required for inclusion. Multivariate analysis was used to identify independent predictors of TC.

Results: This study included 76 individuals; 70/76 (92.1%) were women. Overall, 43/76 (56.6%) nodules had a cytological diagnosis of atypia of undetermined significance (AUS) (Bethesda III), whereas 33/76 (43.4%) were follicular neoplasms (FNs) (Bethesda IV). Pathological analysis revealed that 56/76 (73.7%) patients had benign nodules and 20/76 (26.3%) had malignant tumors. The coexistence of elevated levels of both antibodies and TSH demonstrated the highest odds ratio [3.10; 95% confidence interval (CI): 1.14-5.47], signifying a significant correlation with TC (P=0.003). Furthermore, high levels of one antibody along with elevated TSH levels resulted in an odds ratio of 2.25 (95% CI: 1.02-6.44), indicating a significant association with TC (P=0.04). The multivariate analysis identified Bethesda IV cytological diagnoses, the presence of Hashimoto's thyroiditis, and TSH levels >1 mIU/L as independent predictors of TC.

Conclusions: Elevated anti-thyroid antibody and TSH levels were effective predictors of TC in CITNs. These findings may help guide endocrine surgeons managing patients with these nodules.