Gland surgery最新文献

Background: Whether ascites volume independently predicts survival in ovarian cancer remains unresolved due to conflicting evidence, binary classification approaches, and the absence of dose-response analysis. This prospective study aimed to characterize the dose-response relationship between ascites volume and survival outcomes and identify clinically meaningful volume thresholds.

Methods: We analyzed data from 293 high-grade serous ovarian cancer patients from Xiangya Hospital, Central South University [2017-2020]. Patients were stratified by intraoperative ascites volume: no ascites (0 mL), low-volume (<1,000 mL), and high-volume (≥1,000 mL). The primary outcomes were progression-free survival (PFS) and overall survival (OS). Restricted cubic spline (RCS) analysis examined dose-response relationships between ascites volume and survival outcomes. Cox proportional hazards models estimated survival associations.

Results: Among 293 patients, 15.4% had no ascites, 56.0% had low-volume, and 28.7% had high-volume ascites. RCS analysis revealed significant nonlinearity for PFS, with hazard ratio (HR) increasing steeply from 0 to 1,000 mL then plateauing (P for nonlinear =0.004), while OS demonstrated a predominantly linear relationship (P for nonlinear =0.83). Multivariable Cox analysis indicated that high-volume ascites independently predicted worse outcomes (adjusted HR 1.29 for PFS, 95% confidence interval (CI): 1.02-1.64, P<0.05; adjusted HR 1.54 for OS, 95% CI: 1.07-2.23, P<0.05), whereas low-volume ascites showed no independent prognostic significance. Adjusted 3-year PFS rates were 44.2%, 40.8%, and 36.5% for the three groups, respectively, while adjusted 3-year OS rates were 83.6%, 81.9%, and 76.5%.

Conclusions: Ascites volume represents a quantifiable, independent prognostic factor in ovarian cancer with distinct dose-response patterns: a nonlinear relationship with PFS characterized by a critical 1,000 mL threshold, and a continuous linear relationship with OS.

Background: Precise preoperative imaging localization of parathyroid tumors is critical in primary hyperparathyroidism (PHPT) for choosing proper surgical methods and ensuring successful surgery, but may be challenging due to the variable size, number, and location of parathyroid tumors. This study aimed to investigate the association between biochemical indices and intraoperative parathyroid tumor size, number, location, and imaging results in a cohort of PHPT patients, and to explore whether these indices can assist in preoperative localization of PHPT.

Methods: A total of 462 patients with surgically confirmed PHPT were enrolled in this study retrospectively. Preoperative biochemical indices, including serum parathyroid hormone (PTH), plasma ionized calcium (iCa), and serum calcium (Ca), as well as the intraoperative size, number, location, and imaging results of the parathyroid tumor, were reviewed and analyzed. The correlation between preoperative biochemical indices and intraoperative parathyroid tumor size was investigated using Spearman's rank correlation. The comparison of preoperative biochemical indices between single-gland disease (SGD) and multi-gland disease (MGD), orthotopic and ectopic hyperparathyroidism, as well as imaging true positive (TP) and false negative (FN) groups, was performed using the Mann-Whitney U test.

Results: The Spearman's rank correlation coefficient (r _s) of serum PTH, plasma iCa, and serum Ca with intraoperative parathyroid tumor maximum diameter were 0.352, 0.342, and 0.224, respectively. The r _s of serum PTH, plasma iCa, and serum Ca with intraoperative parathyroid tumor volume were 0.394, 0.355, and 0.256, respectively. Serum PTH and plasma iCa levels were weakly correlated with intraoperative parathyroid tumor size (P<0.001), while no correlation was found between serum Ca levels and intraoperative parathyroid tumor size (P<0.001). Serum PTH levels were significantly higher in ectopic hyperparathyroidism than in orthotopic hyperparathyroidism (204.8 vs. 139.7 pg/mL, P<0.001). However, plasma iCa (1.38 vs. 1.36 mmol/L, P=0.76) and serum Ca levels (2.74 vs. 2.71 mmol/L, P=0.82) were not significantly different between them. No significant differences were found in these indices between SGD and MGD (P=0.10-0.84), as well as imaging TP and FN groups (P=0.10-0.88).

Conclusions: Serum PTH and plasma iCa levels were weakly correlated with intraoperative parathyroid tumor size. Higher serum PTH levels tend to be associated with ectopic hyperparathyroidism. The ability of biochemical indices to reliably predict parathyroid tumor anatomical features (size, number, or location of glands) appears to be limited.

Background: The necessity of adjuvant radiotherapy following breast-conserving surgery (BCS) in elderly patients with early-stage breast cancer remains controversial. Existing studies focus predominantly on population-level benefits without identifying specific prognostic subgroups with different baseline survival probabilities. We aimed to develop interpretable machine learning models to predict survival and establish precise prognostic risk stratification that could inform individualised treatment discussions.

Methods: Using the Surveillance, Epidemiology, and End Results database (2016-2022), we included patients aged ≥70 years with T1-2N0M0, oestrogen receptor-positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer who underwent BCS. We developed six machine learning survival models incorporating age, tumour grade, T stage, progesterone receptor status, race, histology, and chemotherapy. Model performance was evaluated using time-dependent area under the curve (AUC) and concordance index. The optimal model was interpreted using SHapley Additive exPlanations (SHAP) framework. Patients were stratified into three risk groups, with survival differences assessed using Kaplan-Meier analysis.

Results: A total of 39,872 patients were included (training set: 31,897; test set: 7,975). The eXtreme Gradient Boosting (XGBoost) model demonstrated optimal performance with 1-, 3-, and 5-year AUCs of 0.714, 0.692, and 0.711, respectively. SHAP analysis identified age as the most important predictor, followed by tumour grade and T stage. Risk stratification successfully delineated three distinct prognostic groups: low-risk (37% of patients, 5-year overall survival 88-90%), intermediate-risk (33% of patients, 5-year overall survival 82-84%), and high-risk (30% of patients, 5-year overall survival 65-67%) (log-rank P<0.001). Notably, the low-risk group's survival rate was comparable to radiotherapy-treated patients in previous studies (88.6%).

Conclusions: We successfully established a prognostic risk stratification system identifying three distinct survival groups (low-risk, intermediate-risk, and high-risk). The low-risk group's 5-year survival matched radiotherapy-treated patients in a previous study (Yang et al., 88.6%). Our system provides prognostic information that, integrated with existing radiotherapy evidence, can inform individualised treatment discussions. Prospective studies comparing radiotherapy outcomes within risk strata are needed to validate clinical utility for treatment decision-making.

Background: Plasma cell mastitis (PCM), a rare form of chronic nonbacterial breast inflammation, is characterized pathologically by ductal dilatation and plasma cell infiltration. Despite its increasing global incidence, large-scale studies on PCM remain limited, and its etiology is poorly understood. This study provides extensive descriptive data on the spectrum of PCM's clinical features.

Methods: A retrospective cross-sectional analysis was conducted on 1,260 patients with pathologically confirmed PCM treated at the Breast Department of Chongqing Hospital of Traditional Chinese Medicine. Descriptive statistical methods were employed to analyze their demographic data, clinical characteristics, and laboratory indicators.

Results: A total of 1,260 patients with PCM were included. Among the patients, the median age was 31 years, the majority reported history of childbirth (92.8%) and breastfeeding for ≥6 months (67.6%), and 44.9% developed PCM within 3 years postpartum. Identifiable inducement factors were present in 656 (52.1%) of patients and were predominantly psychological factors (20.5%). Breast mass was the most common symptom (92.5%), with a median size of 6.8 cm. Lesions were primarily located in the central area including the areola (78.9%). The positive rate of bacterial culture was low at 17.2%.

Conclusions: PCM primarily affects women of childbearing age, especially those aged 30-39 years, and a history of delivery and lactation. Typical presentation includes a large inflammatory mass in the areolar region, but there is a low rate of positive bacterial culture.

Background: Pigmented lesions of the nipple-areola complex (NAC) are uncommon and may pose a diagnostic challenge because they can mimic malignant melanoma and other NAC conditions. Pigmented basal cell carcinoma (BCC) arising in this sun-protected site is particularly rare and may be overlooked, especially in Asian patients. This case highlights the diagnostic overlap between melanoma-like clinical features and pigmented BCC in the NAC, which can create uncertainty during initial evaluation.

Case description: A 61-year-old Thai woman presented with a 1-year history of a progressively enlarging, asymptomatic hyperpigmented lesion on the left NAC. There was no history of trauma or chronic sun exposure. On examination, the lesion was an irregularly shaped pigmented plaque 1 cm with asymmetry, heterogenous pigmentation localized to the left NAC, raising clinical concern for melanoma based on ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6 mm); no definite evolution was reported. Mammography and ultrasonography demonstrated focal skin thickening at the lesion site without an underlying breast mass or nodal involvement. Dermoscopic evaluation was not available in our clinical setting and therefore was not performed. A punch biopsy confirmed superficial pigmented BCC. Definitive excision was planned with approximately 4-mm clinical margins; final pathology demonstrated negative margins on all sides, with the closest histologic margin measuring 7 mm. The postoperative course was uneventful, and there was no evidence of recurrence at the 6-month follow-up.

Conclusions: Although rare, pigmented BCC of the NAC should be considered in the differential diagnosis of persistent pigmented NAC lesions that mimic malignant melanoma. Systematic clinical assessment, dermoscopic evaluation when available, and timely biopsy when indicated are important to establish the diagnosis and guide appropriate management. Given the short follow-up duration, longer surveillance is required to assess long-term disease control.

Background: Identifying parathyroid glands during surgery is challenging. Recent studies suggest that near-infrared autofluorescence (NIRAF) detection can improve their recognition. However, the correlation between positive NIRAF detection and clinical features in parathyroidectomy remains unclear. This study aimed to explore correlation between positive NIRAF detection and clinical features in parathyroid surgery, aiming to improve the application of this technology.

Methods: Prospective data were collected from patients undergoing parathyroidectomy using handheld NIRAF devices. Data included the ratio of parathyroid NIRAF to baseline, and clinical features such as age, gender, body mass index (BMI), parathyroid gland size, preoperative blood calcium, parathyroid hormone levels, and pathological properties. Factors influencing parathyroid autofluorescence intensity were evaluated.

Results: From June 2023 to June 2024, 20 primary and 19 secondary hyperparathyroidism patients with 98 parathyroid lesions were analyzed. NIRAF probe detection showed no significant correlation with age, gender, or preoperative serum calcium. However, it was significantly correlated with parathyroid volume, BMI, and pathological properties. Smaller glands, lower BMI, and diffuse parathyroid hyperplasia were more easily detected by near-infrared probes (P<0.01).

Conclusions: NIRAF probes improve the accuracy and safety of parathyroidectomy. Positive NIRAF detection is significantly correlated with parathyroid volume, BMI, and pathology, making it particularly useful for patients with smaller BMI, smaller gland volume, and diffuse hyperplasia.

Background and objective: Autologous breast reconstruction is a complex microsurgical procedure in which perioperative management critically influences surgical and patient-reported outcomes. Several physiological and perioperative strategies-including oxygenation enhancement, metabolic modulation, nutritional support and wound care-remain underexplored in this specific setting. This narrative review summarizes evidence on emerging approaches to perioperative optimization in autologous breast reconstruction and discusses their potential to improve recovery and long-term outcomes.

Methods: A narrative literature review was conducted using PubMed (MEDLINE, Bethesda, MD, USA) and Scopus (Elsevier, Amsterdam, The Netherlands) for studies published in English up to October 2025. Reference lists of key reviews and consensus statements were manually screened to identify additional relevant publications. The selected literature was analyzed thematically to highlight evolving concepts and their reported impact on reconstructive outcomes.

Key content and findings: Emerging strategies target perioperative physiology through systemic and local interventions. Hyperbaric oxygen therapy and closed-incision negative pressure wound therapy demonstrate potential benefits in improving perfusion, reducing edema, and lowering wound-related complications. Antioxidant and metabolic modulation, perioperative protein optimization, and preoperative carbohydrate loading may attenuate catabolic stress and support microvascular stability. Structured drain care and infection-prevention protocols further contribute to safer recovery. Evidence remains heterogeneous and limited in scope, but collectively these approaches point toward a more comprehensive and individualized perioperative management paradigm in reconstructive breast surgery.

Conclusions: Optimizing perioperative care in autologous breast reconstruction requires an integrated framework that aligns surgical precision with systemic support. Emerging biological and metabolic interventions may complement established recovery practices, potentially improving flap outcomes and overall patient well-being. Prospective multicenter studies are needed to standardize protocols and determine their clinical impact.